Monday, November 19, 2012

The All Too Short Life of Blanche the Cat

Blanche the Cat


I have just watched one of the most vibrant, intelligent, good-natured cats I’ve ever known rapidly succumb to her cancer right before my eyes.  

As a veterinarian, I fully understand that death is a big part of this job.  Naturally, it behooves us veterinarians not to get too attached to our patients.    There’s a proper balance between being a cold heartless stone and a total emotional wreck that all veterinarians navigate soon after becoming practitioners.  I thought I had negotiated that balance pretty deftly.  But here I sit, at home in front of my laptop, barely able to keep myself together as I type.

In fairness, Blanche wasn’t simply a patient.  Most patients visit Manhattan Cat Specialists once or twice a year for their regular exams. We enjoy seeing these cats, the way we enjoy all of our feline patients.  

However, it’s hard to truly bond with a cat that only pops by once or twice a year.   It tends to be the chronically ill ones that we form stronger bonds with, since they spend more time in our hospital. We get to really know these cats, and our love for them grows deeper as we witness them bravely battle their illness.  Blanche, though, wasn’t sick (at least not until the very end.)  Blanche’s owner , however, was chronically ill, which explains why Blanche spent so much time at our hospital.  When the owner’s condition would relapse, Blanche would board with us while her owner recuperated.  Sometimes, she would board for a month.  Sometimes longer.  This last stint unexpectedly lasted over a year!

Our boarding area is on the lower level of our hospital.  Normally, cats reside in their cages while they board with us.  In the morning, while their cage is being cleaned, we let the cat roam around the boarding ward to stretch its legs.  In the evening, it’s the same routine.   When it became apparent that Blanche was going to be with us for a while, we gave Blanche her own special “cage”.  It was, in fact, a room.  More specifically, my office. 

I do a lot of work in my office when I’m not upstairs seeing appointments.  I wasn’t particularly thrilled with the prospect of my cramped little office being further cluttered by food bowls, water bowls, cat beds, and a litter box.  I had occasionally allowed other long-term boarders to commandeer my office, and Blanche, being small in stature and independent in nature, would likely be less obtrusive than most other cats.  Truthfully, I kinda like having a pet in my office.   Years ago, while working at The ASPCA, I agreed to foster one of the cruelty cases, a young female pit bull that was intentionally starved,  in my office while waiting for the case to work its way through the court.  “It should take no more than two weeks”, I was told.  Nine months later, Flower and I were still together, and were inseparable.  


So it didn’t take much arm-twisting by my staff for me to green-light Blanche.

Initially, Blanche didn’t spend too much time in my office.  Instead, she roamed the rest of our little basement, hunting.  Occasionally she’d snatch an unsuspecting fly out of thin air, but the prey she prized the most were waterbugs.  Our water heater in the basement was located in a small closet.  Now and then, a waterbug would dart out from under the door, foolishly straying from the safety of that closet.  Blanche was ready.  She would be sitting there for hours, totally content, her eyes focused like a laser on that closet door. She wouldn’t just catch them.  She would tease them.  Torment them.  Let them think they were free to go, and then pounce again.  It was death by humiliation.  If she was really in a diabolical mood, she would transport them by mouth to the Tent of Death.  [See video]  Waterbugs condemned to the T.o.D. were never to be heard from again.


Our basement is separated by a door from the much larger basement of the apartment building that houses our practice.  I think it’s a safe bet to say that nearly all apartment buildings in NYC have hosted an occasional mouse now and then.  We’ve never had a problem with mice in our basement.  After all, a mouse would have to be either crazy or kamikaze to wander into a cat hospital.  One day, however, while working at my desk, I saw from the corner of my eye Blanche trotting down the hall toward my office.  She was carrying one of her toys in her mouth, and was preparing to play with it in my office.  We provided Blanche with many toys, to satisfy her strong predatory instinct.  I didn’t quite recognize the toy she was carrying.  Then I saw that the toy had a tail.  The tail was moving. 


I have absolutely no qualms whatsoever admitting that I am a major mouse-o-phobe. I quickly jumped out of my seat and shut the door right in Blanche’s face.  The last thing that I wanted to risk was Blanche releasing the mouse in my office for one of her torment/humiliation sessions, only to have it disappear behind a file cabinet.  I’d never enter my office again.  Knowing how much Blanche’s antics delight my staff, I quickly alerted my staff that Blanche had caught a mouse.  (I didn’t stop to consider the consequences of using the hospital intercom to broadcast Blanche’s freshly caught victim, i.e. a client or two might be within earshot.  As it happens, the client who was in earshot found it completely amusing.)  Our staff whisked themselves downstairs and gathered around Blanche, beaming with pride for her as she paraded around with her trophy.  As expected, she placed it on the floor, and it quickly tried darting away, only to have her pounce and grab it in her mouth again.  

Although Blanche was having the time of her life, my staff felt bad for the poor little rodent.  My technician Hiromi grabbed a small plastic bag, opened it, and held it under Blanche’s chin.  As if on cue, Blanche dropped the mouse into the bag.  That mouse remains the only critter known to survive an encounter with Blanche.

Although Blanche enjoyed everyone’s company, she was particularly fond of Brad, our Director of Marketing.

     

Brad has a quirky type of animal magnetism.  Cats just naturally seem to gravitate in his direction.  Our notoriously aloof hospital cat, Missy, is inexplicably drawn to him.  No matter where she was, Blanche dropped whatever she was doing at the sound of Brad’s voice.  But it was more than just Brad’s voice.  Members of my staff constantly went up and down the stairs leading to our basement.  The stairs are at the opposite end of the basement from my office. Blanche, usually resting quietly on my desk or a nearby chair, never stirred.  The instant Brad set foot on those stairs, though, her head popped up, her ears rotated forward, her eyes widened, and then… zoom!  She would bound out of my office to greet him in the middle of the hallway. From about 50 feet away, she could discern his particular footfall on the stairs! Hearing him cry “Blanchie!!” and getting a nice little squeeze from him was the reward she sought, and Brad didn’t disappoint.


One day, a member of my staff was tending to Blanche when she discovered that Blanche’s neck was noticeably swollen.  Of course, we couldn’t say for sure when the swelling might have begun, since she was acting completely normal.  Considering the amount of attention that we steadily lavished on her, we thought the swelling had to be fairly acute.

Fortunately, financial issues weren’t much of a concern for Blanche’s owner, and we were given carte blanche (admit it, that’s a really cute pun) to perform whatever diagnostics were necessary.  The swelling in her neck was due to the enlargement of the submandibular lymph nodes – the lymph nodes directly below her jaw.  We called in Dr. Jane Kosovsky, a surgeon that travels to different veterinary hospitals as needed, to perform the surgery.  Dr. Kosovsky removed the swollen nodes, and we sent them to the pathology lab.  We expected a diagnosis of lymphosarcoma, the most common type of lymph node cancer.  The biopsy report confirmed our suspicions.  Distressingly, the pathologist described this particular form of lymphosarcoma as aggressive. 

Lymphosarcoma is the most treatable form of cancer, and as soon as the diagnosis was made, we started planning her treatment.  I consulted with Dr. Joshua Lachowicz, a smart young oncologist at Blue Pearl Veterinary Partners.  The protocol we elected to use consisted of a combination of oral and injectable medications.  Not surprisingly, Blanche, being as strong as an ox, immediately went into remission.  

By this point, Blanche had been living in my office for several months, and we had a nice routine in place.  When I went home at the end of the day, I would turn off the fluorescent light in my office and leave a small desk lamp on for Blanche.  The next morning, I’d open my office, and she was waiting at the foot of the door.  She would dart out the door and check out what might be happening in the hallway (scanning for waterbugs, I suspect), while I turned on my office light and fired up my computer.  As my e-mail began to download, Blanche would jump on my desk and rub her head all over my face, making her cute little trilling noises.  She wanted her “mornin’ lovin’” (as I called it), and I was happy to oblige.

     

It’s funny how these little rituals become ingrained in our lives.  I started to feel like I was two-timing my own housecats, Crispy and Mittens.  All cat owners have their morning routines with their own pets, but little did Crispy and Mittens know that every morning after I said goodbye to them, I was having a scandalous affair with another woman. 

One morning, while Blanche was getting all up in my face as usual, I heard some congestion in her breathing.  I felt her neck.  It felt normal, however, her left prescapular lymph node (the lymph node in front of her shoulder) was enlarged.  Behaviorally, she seemed fine, however, her appetite had decreased a little, and she had lost a little weight.  Chemotherapy drugs suppress the immune system, and it is pretty common for cats on chemo to develop an upper respiratory infection.  This is what I assumed was going on with Blanche, and I prescribed antibiotics.  After a week, however, she was no better.  In fact, she was breathing as noisily as a bulldog.  Worried that something might be going on in her nasal cavity, I scheduled rhinoscopy.  This is a procedure where we look inside her nasal cavity using a rhinoscope – a thin flexible tube with a fiber optic camera on the end.  We scheduled the procedure for that Friday.

On Friday morning, we induced anesthesia.  As we opened her mouth to intubate her, my technician noticed a pink mass protruding from above her soft palate, toward the left side of her throat.  Clearly, this was the cause of her congested breathing.  There was no need for rhinoscopy now.  I grabbed the biopsy forceps and obtained several good tissue samples for the pathologist to evaluate.  Blanche recovered from anesthesia and biopsy as if nothing had ever happened. 

Our fears were confirmed as the sample was read as lymphosarcoma, high grade.  Sadly, the cancer from her submandibular lymph nodes had spread to the left side her nasal cavity.   After consulting with Dr. Lachowicz again, we elected to add a different, more potent chemotherapy drug to our regimen.  This involved taking Blanche to Blue Pearl every three weeks for treatment.  Blanche’s owner wasn’t capable of doing this, so Brad transported her. Blanche of course never raised a fuss, since she was hopelessly smitten with Brad. 

It didn’t take long for Blanche to go right into remission again.  On this new chemotherapy protocol, the noisy breathing resolved, and the prescapular lymph node shrunk down to normal size.  Blanche’s interest in her surroundings had waned in the previous two weeks, but now, she was darting around like a little nut.  Our old Blanche was back.  

Six weeks later, during our usual mornin’ lovin’ session, I again detected enlargement of the left prescapular lymph node. The congestion never recurred, but the lymphosarcoma cells in that lymph node refused to submit to the chemotherapy drugs.  We were running out of options.  This time, we decided to use a drug called CCNU.  It’s a drug that has shown promise in treating lymphosarcoma that is resistant to a lot of chemotherapy drugs.  It is easy to administer – one pill every three weeks.  It can really wallop the immune system, though, so conscientious monitoring of the white blood cell count is necessary.  We gave Blanche her first dose of CCNU.  Four days later, the lymph node was a little smaller.  Three days after that, it was big again.  Although she was eating normally and acting like her usual self (perhaps a bit subdued), the writing was on the wall.  Blanche was clearly going to lose this battle.  I wasn’t certain when, though. Perhaps her next dose of CCNU, in six days, might stave things off a little longer. 

When I left the office last Tuesday night, she was sleeping quietly on her chair.  Wednesday was my day off, so I didn’t see her.  Thursday, when I went into my office, she didn’t dart out the door into the hallway.  Instead, she came right up onto my desk.  But there was no head butting and trilling.  She just sat there in front of me, quietly.  I felt her lymph node.  It was bigger than it was on Tuesday.  I watched her breathe.  It looked a bit labored.  I scheduled her for an x-ray.  I was worried.

Surprisingly, her chest x-ray was normal, but Blanche definitely wasn’t.  The act of taking the x-ray really wiped her out.  She was totally winded. She laid on the floor quietly while we tended to her.  She then suddenly got up and wobbled over to the stairs, to head back down to my office.  My office is where she spent her last few months, and it had become her sanctuary.  The sight of our gallant little hunter stumbling weakly down the stairs was almost too much for me to bear. But once she reached the landing, she slowly strode to my office on her own, her pride still very much intact.  

I followed Blanche down to my office. I lifted Blanche onto her favorite chair, pulled the chair next to my own, and we kept each other company.  I lowered myself so that we were eye to eye, and in my own personal way, I said my goodbyes.  I won’t share those details; that’s between me and her.  She made a motion to get down, so I placed her on the floor.  She laid there, limp.  I could see the end was near.  I went upstairs and let my staff know.  My appointments for the day had already ended.  As my staff filed down to my office to spend some last moments with her, I left the office.   

The text message from Brad came about 40 minutes later...

I haven’t calculated it out, but I’d venture that of her seven short years on this Earth, Blanche spent, cumulatively, about three of them in our hospital.  She was more than a patient, and more than a boarder.  I suppose after so many months in our hospital, you could elevate her to the level of “staff”, but to me she was family.  Those 20 minutes of quiet time that she and I spent together before the workday began will forever remain priceless.  It’s bittersweet moments like this, when I reflect on the life of such a wonderful cat,  that make me appreciate so much the career I’ve chosen.   Tomorrow morning when I open my office door and find the room empty, it’s going to be rough.  I’m dreading it.  But there’s no way around it.  Life goes on, and I have many patients to see.

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