Monday, November 26, 2007

Gerald's Last Days

I woke Daddy at 3:30 a.m. this morning as usual for my first breakfast, and the moon was completely full in the sky, and I woke him again just before sunrise for my second breakfast and for my drink out of the sink, and I still have the same kibble dish that Gerald and I always shared, and it has two sides on it, but ever since Gerald passed away a few days ago I haven’t been eating out of the one side but I’ve left the food there because that’s Gerald’s side, and maybe Daddy will give me a new dish now, I don’t know.

I’ve been thinking a lot about how Gerald died, and even though it’s very distressing to write about such things on a blog, it might be good for me to talk about it since I think about it a lot every day, and even though I want to remember all the happy times Gerald and I spent together, it’s also good to remember the bad times too because that shows what kind of special cat Gerald was. Just about three weeks ago Uncle Kevin noticed that Gerald wasn’t eating as much kibble and looked thin, so he bought Gerald some canned kitty food and Gerald ate it, but he was more interested in the jelly/sauce stuff than in the meat chunks, and on top of that Daddy was overseas in a place called Italy where he had been travelling for two weeks, so at first I thought Gerald had lost his appetite just because he missed Daddy a lot like I did, but I could tell something was wrong when Gerald didn’t want to sit on the Kevin Pillow as much, and then he started sneezing, and Kevin thought Gerald was beginning to look weak, so on November 9, which was a Friday, he took Gerald to the kitty doctor and they gave Gerald a blood test but Gerald acted very strange at the doctor’s office because he usually hisses and screams and tries to bite whoever pokes and prods him, but this time he was all compliant because he was so weak and the only fuss he made was when they drew some of his urine, and this made Uncle Kevin and the doctor very worried. Gerald’s blood pressure was normal for a change, given that he was so docile, and that showed that the Norvasc was working, and his urine concentration was a little worrying but not serious, and his temperature was normal, so they sent him home to wait for the blood test results. And on Saturday the results came in and the kitty doctor told Uncle Kevin that Gerald had stage 2 kidney failure which showed up in the blood test, and this meant that Gerald’s body wasn’t able to process proteins as well as it used to, which is very common in older cats, so Gerald would have to eat special low-protein food called a “renal diet” but it wasn’t clear what this meant for Gerald’s overall health since many cats live long lives with kidney failure as long as they stick to their diet, but others don’t live as long, but at this point things looked hopeful because Gerald’s blood pressure wasn’t high, but what was worrying was that he had a cold and was sneezing, and his red cell blood count was low but acceptable (24), but it was a sign that he was ill, since kitty blood (like people blood) is made of two colors of cells, and red blood cells carry oxygen throughout our body and keep us energetic, and white blood cells fight off disease and infection, so when the red blood cell count is low, we feel very tired. So that weekend Gerald was tired but he ate his canned renal diet food and Uncle Kevin called Daddy in Italy to say he was glad Gerald had regained a little appetite even though he was still sneezing, and he told him that the kitty doctor said that when cats gets colds they lose their sense of smell, and that they won’t eat their food if they can’t smell it first, and the doctor was right because I’m a cat and I should know and of course I never eat anything unless I sniff it first, but I don’t think that was the only reason why Gerald wasn’t eating his food. And when Gerald was on the renal diet, I was very interested in the food that he had, and I was very annoyed that Uncle Kevin would feed Gerald in the bedroom but feed me in the kitchen, and I was beside myself because Gerald was getting special food and of course I wanted to sample it! So sometimes Uncle Kevin would let me lick Gerald’s dish after he had finished since the kitty doctor said that a tiny bit of the renal diet wouldn’t hurt me, and I loved it of course because it was different, but finally Uncle Kevin had to buy me some kitty treats because it was driving me crazy that Gerald was in the bedroom all the time getting special food.

On November 14, which was a Wednesday, Gerald had another blood test in the morning to see if the renal diet was working, and the results that came back were bad since Gerald was very anemic, which meant his red blood cell count had dropped from 24 to 14 over five days, and he had lost more weight and was only about 10 ½ pounds, but he had weighed almost twelve pounds in August when he had his vaccine shots. The kitty doctor said there were a few things that can cause sudden anemia but the most likely was an auto-immune condition of some kind, which means that the kitty body destroys its own red blood cells, and the doctor thought this because the plasma in Gerald's blood was very yellow-orange instead of nearly clear, and that meant the red blood cells might have broken down in his blood. And the kitty doctor said it was very important to stop Gerald’s anemia from getting any worse, since without treatment, Gerald would only have about 2 more days to live, it was that bad! So if it was an auto-immune condition, there were two possible treatments, and one was to take a medicine called cortisone which is good for the auto-immune thing, but is very bad for the kidneys and can speed up kidney failure; the other treatment was a blood transfusion, which meant they would take some blood from another kitty and put it inside Gerald, but this wouldn’t fix the problem forever because whatever was making Gerald sick would make the new blood sick, and another transfusion would be needed after about five days, and besides that, there’s no blood bank for kitty cats like there is for dogs so the doctors would have to find a suitable blood donor, and they’d try me out first, and of course I’d give my blood for Gerald, but it would mean we would both be in hospital for days. So Uncle Kevin called Daddy in Italy and they decided to give Gerald the cortisone medicine first to see if it had any effect, and then Daddy changed his plans to come home from Italy about five days early, which was a really good idea because it was clear that Gerald might not have much time left.

So Gerald had cortisone tablets and antibiotics for a couple nights and spent most of his time in the bedroom in his carrier cage and he didn’t want to sit on the Kevin Pillow any more or play with me, and that really worried me. Then Uncle Kevin gave Gerald his own litter box and put it on the bed along with his carrier cage and they shared the bed at night while I got shut out in the living room, but I didn’t mind since I had the sofa and the kitty tree all to myself, but I was worried about Gerald, since he would spend most of his time in his cage, looking like this:

Then on November 16, which was a Friday, Gerald had another blood test which showed his red cell blood count had gone up a point (from 14 to 15) and the anemia wasn’t getting any worse, but he had lost more weight and had stopped eating his renal cat food, so Uncle Kevin bought him some regular canned food, but Gerald refused to eat very much of it. And on Friday night Daddy finally arrived home from Italy and when I saw him I was so happy to see him, but Gerald was so weak and so thin that he didn’t jump up when he saw Daddy, but he tried to purr a little bit, but it sounded very raspy and gruff because it was a sick purr. And Daddy tried to get Gerald to eat a little something but Gerald refused, although he did drink a little water. Here's a picture of him on that day, looking thin:

Early on Saturday morning Gerald decided to leave the bedroom and walk into the kitchen and the living room, and he went into the other carrier cage that was in the living room and he made himself comfortable there. Around lunch time Daddy and Uncle Kevin went to the kitty doctor again and were told to force feed Gerald if they had to, since it was vital that he eat something, so they got a can of some high calorie and high energy diet food and a sticky paste full of vitamins and mixed it together with water into a slurry and put it into a syringe and fed Gerald about 10ml every three hours on Saturday and Sunday, and even though he hated it and made a mess, after a while he seemed to start liking the taste of it, even though he still refused to eat solid food. And after each feeding, or whenever he was being fussed over too much, Gerald would try to run away or hide in the corner or in his carrier cage because he was a proud cat and he hated being watched and gawked at when he was sick, so Uncle Kevin and Daddy would make Gerald comfortable in his cage and leave him alone in the bedroom and shut the door. And I would peek in on Gerald every once in a while when they opened the door, and I could see that he was still feeling weak and looking thin and once I pressed my paw into his side to see if he wanted to play, but he didn’t, so I left him alone. And he was still sneezing a lot, and he wouldn't lick himself the way healthy kitties should, which was another sign that he wasn't feeling well, and whenever Gerald walked, he was very wobbly on his legs and a couple times he tripped and fell over; and when he went poo box, there were three times when he was too weak to turn around, so his pee went on the floor just outside the box, and Daddy cleaned it up without complaining at all. And when Gerald would sit on the floor in the bedroom, he wouldn’t curl up like healthy kitties do, but he would lie on his side and rest his chin on the edge of his water dish, and I think it was so he wouldn’t need to move very far if he wanted a drink of water, or maybe there was a little cool air rising up from the water. And at night time Gerald was kept in the bedroom and the door would be closed so I would have to sleep in the living room, but I had gotten used to that so I didn't complain.

On November 19, which was a Monday (and only a week ago today), Gerald went to the kitty doctor again and the news was not good. Gerald looked very yellow all over, even more yellow than a ginger cat usually looks, and the doctor said he was “jaundiced,” which is usually a sign that something is wrong with the liver, which is a different part of the body from the kidneys. And the kitty doctor said that it’s very unusual for cats to have kidney and liver problems at the same time unless there’s a disease called cancer, but in order to find out, Gerald should go to a specialist hospital, otherwise without any treatment he could die in the next few days, and when Daddy heard all of this from the doctor, he started seeing spots and began to feel faint and had to sit down on the floor with his head between his knees to keep him from passing out. And the kitty doctor said that Gerald was very dehydrated, which meant his body had lost a lot of water, and the blood test said that his red cell blood count was up to 16 or 17, but dehydrated kitties can give a false high reading in their blood count, which meant Gerald’s anemia was probably unchanged. So Daddy and Uncle Kevin took Gerald home to see me for a few minutes, and then they called a taxi and took Gerald to an “Emergency Vet Clinic” at Essendon Airport where they met a kitty specialist who examined Gerald, took another blood test, and recommended keeping him in the intensive care unit overnight where an IV tube (which is a plastic tube attached to a machine) could be connected to Gerald’s leg so that they could pump fluids into his body and keep him “hydrated.” And when Daddy and Uncle Kevin came back I wondered why Gerald wasn’t with them this time, but I decided not to worry about it too much until after I had finished my kibble, but this was the first night I got to sleep all night next to Daddy, and I liked it since I hadn't seen him for all those weeks, and I got to climb up into the bedroom window and watch the moon which was getting fuller and fuller every night.

It wasn’t until the next day, November 20, which was a Tuesday, that the kitty specialist called in the morning with the results of the blood test, and I was sitting next to Daddy when the kitty specialist said that Gerald’s anemia was not his primary disease, meaning that there was not much evidence of an auto-immune disease like the first kitty doctor had thought. Instead, Gerald’s kidney failure was one of the main diseases, and the kitty specialist called the kidney failure still “moderate” at this stage, even though it was a 75% failure of Gerald’s kidneys; but Gerald’s yellowness seemed to be caused by a liver disease, which was either caused by a blockage (a “plumbing” problem with bile, which can be fixed by surgery) or a “medical” condition (which has different kinds of treatment), so the kitty specialist suggested an ultrasound, which is a machine that reads the inside of a kitty’s body without actually having to cut it open, and that an ultrasound of both the liver and kidneys would show if there was any blockage, so Daddy agreed to this. And in the afternoon the kitty specialist called again to say the ultrasound showed that the liver was inflamed (what they call “hepatitis”), but there was no blockage; and Gerald’s kidneys were perfectly normal in size; so he suggested a “needle biopsy,” which is where the doctor sticks a very fine needle into the body to take a tiny sample of an organ, and it doesn’t hurt hardly at all, but this would tell what might be causing the liver disease, whether it was as simple as a bacterial infection, or as serious as cancer, so Daddy agreed to a biopsy of both the liver and kidneys, even though it meant Gerald would spend another night in hospital. And later that afternoon after my catnap, another person called to say that the biopsy had taken place, and Gerald did fine and didn’t need any drugs to make him sleep, and thankfully he had got some of his spirit back and resisted a little when the doctors tried to handle him; but Gerald did need to stay in the hospital another night for more hydration and a “wide-spectrum antibiotic” in his IV. That afternoon Uncle Kevin and Daddy did something they thought was “practical” and rearranged the furniture in the living room, making the place cleaner and brighter, and putting my kitty tree in a different spot so I could see more of the garden. But it was very hot all day and they got all sweaty and I just felt like sleeping all day, and I thought to myself that Gerald was lucky to be in an air-conditioned hospital on a hot day like this, but the weather finally started cooling down in the evening.

The next day was November 21, a Wednesday, and I was a pest all morning because it was raining and that makes me hungry, so I woke up Daddy twice in the early hours as usual. But Daddy had to go to work in the late morning and still hadn’t heard anything from the hospital before he left. It wasn’t until the late afternoon that the kitty specialist was able to say that Gerald’s biopsy showed no cancer in either organs, which was good, but it was still unclear what was causing the liver inflammation, so he wanted to keep Gerald a third night in hospital to continue giving him antibiotics and appetite stimulants, since he said a lot depended on whether we could get Gerald to eat anything, since he hadn’t eaten for two days. So that night Daddy and Uncle Kevin went to the hospital to visit Gerald, which they hadn’t done before since they don’t own a car, but they got Uncle Andrew (one of Daddy’s friends who’s looked after us before) to drive them there, and they brought two of Gerald’s favorite kitty toys, and one is a toy in the shape of a boxing glove stuffed with catnip, and the other is a red piece of fuzzy felt that used to have eight legs when it was a spider-toy but Gerald licked off all the legs years ago. And they had a private consulting room that looked like this:

where they chatted with Gerald, who had an IV tube in his front leg, and his abdomen had been shaved for the ultrasound, and he was very thin and weighed only 9 ¾ pounds. Gerald wanted off the table so he could walk around the floor, or maybe he wanted to escape from Daddy and Uncle Kevin because Gerald hated being fussed over when he was sick, but he was still very wobbly on his feet and kept tripping. Daddy held Gerald for a while, though Gerald could only stand it for so long, and he was very limp in Daddy’s arms, and then Gerald lay on the table and purred a little bit, but it was a sick purr again, and Daddy spent a lot of time whispering into Gerald’s ear, telling him all the private things he had wanted him to know for some time, things Daddy won’t even tell me.

Then came November 22, which was a Thursday, and it was very cloudy. There was no news of Gerald’s condition until the afternoon, when the kitty specialist asked Daddy and Uncle Kevin to come to the Emergency Clinic in person, so Uncle Andrew drove them again, and some blue sky was emerging and driving the black rain clouds away, and there was even some sunshine. Daddy and Uncle Kevin saw Gerald in his special cage in the hospital in this room:

where he was hooked up to the IV, but he was still very weak and just lying around with his chin on the edge of his water dish like he did at home, and after they had been there a while, Gerald started making some noises which were very rough and husky, but no one could tell if it was a purr or not. The kitty specialist said that Gerald had still refused to eat anything despite the appetite stimulants they gave him, and they had added some cortisone to Gerald’s IV drip in mid-morning, but there was no real change in Gerald’s condition, and there was little they could do for him any more in hospital except for desperate things like blood transfusions or a feeding-tube into Gerald’s stomach, but Daddy said no, he wanted to take Gerald home where they could give him his medicine in pill form and feed him with a syringe again if necessary, so the kitty specialist gave him another special high-calorie diet and some new medicines and some new syringes.

Gerald got home about 6:30 p.m. that night after being away for three nights and he didn’t look at all well, and I knew he was by no means the same kitty he had once been. Daddy and Uncle Kevin settled Gerald in the bedroom in his carrier cage with the lid off, but his breathing was rapid and he sounded uncomfortable, and he kept trying to get up and walk away from them and kept tripping, so they left him alone and shut the bedroom door. They went and got fish and chips for dinner, which is my favorite kind of dinner for them to get because Daddy always gives me a treat of his leftover fish and Uncle Kevin gives me some of his leftover roast chicken, and usually Gerald likes to snack on the fish too, but this time he wasn’t interested in eating any. At 7:30 p.m. Daddy and Uncle Kevin tried to feed Gerald with the syringe, but it did not go well, since Gerald was forcing his mouth closed against Daddy’s efforts, and the whole exercise really exhausted Gerald, and his breathing became more rapid and his grunting more labored, and he would also lie outstretched and pant with his mouth slightly open. So they left him alone for a little while longer, and Uncle Kevin began to cry since it seemed to him that Gerald was suffering, and he wondered if maybe they shouldn’t have tried to feed him. Then Daddy called the Emergency Vet Clinic and spoke to a nurse who had looked after Gerald, and she said that Gerald’s behaviour at home was exactly the same as at the hospital, namely, he was refusing to eat, so the nurse told Daddy to “keep Gerald’s fluids up” without much indication of how to do that. When Daddy looked in on Gerald again, he was relaxing again on his side, but he was resting his head on his water dish again, but that didn’t look safe, so Uncle Kevin took Gerald’s boxing glove toy and put it under Gerald’s head like a pillow.

At 9:00 p.m. it was time to give Gerald his pills, and there were three of them—one cortisone and two antibiotics, and one of the antibiotic pills was so big that it had to be cut again in half. I came in with Daddy this time and Gerald was relaxing on the floor, stretched out but breathing rapidly and staring into space, and he looked very dazed and probably didn’t know who Daddy was, and once again his mouth was difficult to open, but Daddy managed to place a cortisone pill at the back of his mouth like he always used to, then he stroked Gerald’s chin so he would swallow, but this time Gerald refused to swallow, and even after two minutes of coaxing, this proud cat was refusing to allow anything down his throat, so Daddy just kept stroking Gerald’s chin hoping the pill would just dissolve in Gerald’s mouth. After a few minutes Gerald became very perturbed and crawled into his hooded litter box, presumably to get away from all of us, even me, so Daddy put him back in his carrier cage to rest. Then Gerald began making very labored breathing noises, again with his mouth open, so Daddy phoned the kitty specialist but got his paging service and left a message, then received a call from a different doctor, one unfamiliar with Gerald’s case, who essentially said that if Gerald was showing breathing problems, we should take him back to the emergency clinic. Uncle Kevin was crying again and they adjusted Gerald’s position since it seemed he was struggling for breath, so Daddy lifted Gerald from the carrier cage while Kevin folded a green blanket and put it on the floor, then they gingerly placed Gerald on it so he could stretch out. But once again Gerald seemed to want to get away from everyone and he tried to walk away again, so they let him lie down quietly and left him alone and shut the bedroom door again. Daddy decided he would have to take Gerald back to the Emergency Clinic again, so he grabbed the phone but remembered he left the phone number in the bedroom; and when he opened the bedroom door, he found that Gerald had vomited and was lying on his side and his breathing was extremely slow.

Daddy came back into the living room and told Kevin to be strong and to attend to Gerald while Daddy called the Emergency Clinic, and as Daddy was speaking to the nurse (a different nurse this time), Kevin said he didn’t think Gerald was breathing, and the nurse told them to look at Gerald’s gums and describe their color, and get to the hospital as fast as possible, so Daddy called for a cab and was put on hold, and as he waited, Kevin told him that he thought Gerald was gone, and after Daddy managed to book the cab, he inspected Gerald and had to agree that, yes, Gerald had passed. It was about 9:30 p.m. Then they let me come into the bedroom and look at Gerald, and I sniffed him, and I understood what was going on, but I wasn’t sure what to do with myself, so I started pacing, and Daddy picked up Gerald’s little body and wrapped it in a blanket, and Gerald’s head fell back all limp, and he put Gerald in his carrier cage and they fixed the lid on top and carried it into the living room, and Kevin put me in front of Gerald’s cage, but I looked inside and ran away. When the taxi arrived, Daddy cried, “What am I doing, taking a dead cat to the hospital? I don’t know what to do,” but after that moment of indecision, Daddy decided to go to the Emergency Clinic anyway, so he called them again to tell the nurse that Gerald had passed away, but could they bring him to the clinic to be kept there? Daddy couldn’t bear having Gerald’s corpse in the house overnight, especially with me here, and Daddy was probably right, because I would have sniffed and poked at Gerald all evening if he had been here, or I would have pawed at the door of whatever room they would have kept him in, and that would have been very distressing for Daddy.

Daddy and Uncle Kevin were gone for about two hours, and it started raining again and rained the whole time they were gone, and when they came back, Daddy picked me up and kissed me and told me that when they got to the Emergency Clinic, the nurse took them to what was called the Triage Room:

and there they opened up Gerald’s carrier cage and Gerald lay there as if he were sleeping and his fur was very silky, and Daddy sat down and held Gerald’s body in his arms, all wrapped up in the blanket, and he held it for a long time, and he kissed and stroked Gerald and said all the sweet things he could think of to say to him, and Daddy’s tears kept falling on Gerald’s fur, and then they put Gerald back in his carrier cage, and they both stroked Gerald’s chin and tickled his jowls like they used to, and they cried some more and spent nearly an hour with Gerald, but finally Daddy knew it was time to go home so they called a taxi, and Daddy talked to the nurse about getting a lock of Gerald’s fur, and about leaving the cage and blanket with the clinic until they were ready to retrieve them, then Daddy held Gerald’s body in his arms one last time, and the body was so limp and so cold, then he put him back in his cage so that he looked like he was sleeping, and when the taxi came Daddy gave Gerald many goodbye kisses and strokes, but finally he knew he would have to walk away.

That night I spent the whole night sleeping next to Daddy, and I knew he’d feel better if I stuck to my routine, so I woke him at 3:30 a.m. for first breakfast and just before sunrise for second breakfast and a drink from the bathroom sink. But Daddy himself was wide awake at 6:00 a.m., and after a while he called Popo and Uncle Joel (who now live in Hawaii) to tell them about Gerald, and he was crying a lot.

That was only a few days ago, and now there’s a big empty space in our flat where my brother Gerald used to be. If you ask me (since I’m a kitty, and I should know), I think Gerald was waiting to come home in order to die, because I know Gerald, and the fact that he refused to eat for so long tells me he was stubborn and determined on a course of action, because Gerald was a very proud cat, and even though Daddy did his best to find out what was wrong with Gerald by taking him to the hospital, and even though the kitty specialist tried his best to cure Gerald's liver problem, I think Gerald knew he was too sick to save, and he wanted to die alone, without anyone looking at him or coddling him, which is why he was so agitated by the presence of other people, even Daddy and Uncle Kevin, even me. Proud cats go away by themselves whenever they’re sick, and when they know that they’re so sick that they won’t survive, they go off where no one can see them and they die alone, and that’s exactly what Gerald did. He died very quickly, and the vomiting that started his passing happened while everyone was outside the bedroom, but Gerald had waited to die until he was at home instead of in the hospital, and even though he was suffering a bit that evening, that suffering was minimal since he lasted only three hours after being brought back home, so it wasn’t the kind of prolonged suffering which would have required Daddy to make a difficult decision about putting him down. We kitty cats know instinctively when our time is up because our bodies get older and begin to shut down, and we always have a better sense of our own state of health than people do, and Gerald in true stubborn form died the way he planned for himself, because he was always a very proud cat and I loved him for that.


No comments: