the chuck essay is easily the scariest part of my book-to-be. telling stories about how i try to do right by other creatures is fine, i do that all the time, but in talking about him i'm just pan without his shadow. or am i his shadow? as a little scrap of night in a shelter in san francisco he had a himness i couldn't stop watching. i spent the thirteenish years of our lives together trying to learn what he'd always known, what he extended to me so gracefully and guilelessly.
every day, my heart, and more than ever.
Showing posts with label fuck cancer. Show all posts
Showing posts with label fuck cancer. Show all posts
03.23.16
three years ago, matty was born; three years ago today, chuck died in my arms. happy birthday, my coconut cat. every day and more than ever, my shadow.
07.06.13
it's taken me some time to come around to writing about how chuck died. when we first started dealing with his cancer, it fortified me to think that talking about my research and how we used what we learned might benefit someone in a similar situation; i wanted so badly for his suffering to mean something. after failing so utterly to protect him - after losing him so quickly and so suddenly that i feel like a great hand came together out of nothingness and simply took him, he was taken - i don't know that i have the right to talk about guardianship at all.
back when our week-long trip to california and arizona to visit family still seemed like a possibility, i cancelled our plans with our customary petsitter and arranged for a vet tech from our oncologist's office to come take care of chuck and steve. though she seemed wonderful and had much more experience with veterinary chemo patients than we did, it didn't feel anything like right to leave chuck, and i dropped out of our plans. i spent a morning on what felt like grief burlesque, calling hotels, rental car companies, and airlines to explain that i needed the indulgence of a refund because my cat was dying. you don't know me, but i'm about to fall apart on the phone to you because my cat is dying. i should be the one to call everyone, joe said, because it's harder to refuse a crying woman. he was right, i suppose, as everyone but jetblue agreed to let me out of my portion of our commitments. they had lost animals too, those representatives in phoenix and los angeles, and they were so sorry. my voice was gone by the time i took down the last cancellation number. it was such a relief to know i wouldn't be leaving him, that my vacation could be a week with him in our apartment.
march in my desk calendar is full of mysterious initials; i haven't referred to it in months. i continued giving chuck mirtazapine, his appetite stimulant, for a few more days, and started him on zofran, an anti-nausea medication, which did little to keep him from throwing up prednisone, his oral steroid. on our oncologist's orders, we stopped giving him leukeran, the oral chemo that works on 80 percent of cats with lymphoma (but not ours). on thursday, march 14, i begged a livery cab driver not to kick me out of his sedan for having a cat in my bag - he was so sick, i just needed to get him to his vet for a follow-up ultrasound and a flow cytometry test (a last-ditch non-biopsy attempt to diagnose small-cell lymphoma), he wouldn't leave any kind of residue in the car - but we returned to the cold and the curb anyway. you've got to go, mami. on friday, march 15, joe flew to arizona and i brought chuck back to the vet to take a chance on elspar, the $500 one-time subcutaneous chemo that, if effective, would confirm for us that he had large-cell lymphoma. more prednisone and zofran that weekend, and no change from the elspar. posters on the lymphoma message board told me i needed to educate myself about "assisted feeding," so i watched a bunch of youtube videos of a woman who assured me her cat wasn't traumatized in the slightest. on st. patrick's day, without joe's knowledge or consent, i bought high-calorie food and three impossibly huge syringes from the little pet shop near our old apartment in hell's kitchen. i stayed in bed all of the next day, curled around the limp C of chuck like the border of a copyright symbol.
our oncologist called on tuesday to tell me that the flow cytometry had confirmed once and for all that we were dealing with small-cell lymphoma. i took the train back up to her office for cytoxan, a different oral chemo, and more zofran. joe came back from arizona on wednesday, the first day of spring, and we steeled ourselves for new, more serious treatment. there are notations for C, C3, and CER smattered across that week in my calendar - i think CER was a different kind of appetite stimulant? - and little Vs for each day chuck vomited. there was no vomiting by thursday or friday of that week, as i think he'd stopped drinking water at that point. he was holed up at the back of my underwear shelf in the closet, back where i used to accidentally poke him in the nose because i couldn't see him when i reached for a bra in the dark.
on saturday morning i pulled him from that cubby as gently as possible, and he staggered when i set him down. i unwrapped one of those horrible syringes and the food i tried to coax into chuck's mouth didn't even make it; he couldn't close his mouth. we took one last black car up the west side highway to one of our oncologist's colleagues, who made it clear that leaving chuck to be stabilized at the clinic overnight would be a long shot at best. my chuck, the thought of you dying alone in a cage in that place crumpled me like a tissue.
we were ushered down to an underground room with a leather couch. chuck came back to us in a little plush donut of fabric, arranged to look as if he could stand up whenever he felt like it. i thanked him for taking care of jude for so many years, and for teaching steve how to be a cat. i told him i knew we were for each other at the shelter in san francisco when i turned back to see his little black ears crest the bottom of the window, when he stood watch for me for the first time. i told him i was so lucky to have a shadow, and i told him i was so sorry. we pressed the little buzzerless button to summon the vet back.
a thin young guy with a beat-up acoustic guitar boarded the train home with us at bryant park and sang.
wouldn't that save you?
wouldn't that save you?
wouldn't that save you?
a few weeks later i got a call about picking up chuck's ashes. the bag with the box and our vets' notes of condolence included a little plaster piece with the impression of chuck's paw, something i consented to before they left us and that they made after he died. CHARLIE BRONSON stamped around the edge. they'd gotten his name wrong at intake a month earlier and i never corrected it; i'd told myself he was at the doctor's with an alias, and that nothing could happen to him if they couldn't call him by his name. i want to throw it in the river.
03.13.13
greetings from barfland, a bilious place in which i haven't spent much time in recent years; chuck has always been the sort of cat who pukes after eating too quickly, but in general he paces himself and our floors and bedding go unscathed. the scene changed dramatically on monday night after we decided to take the leap and start him on prednisone (which would rule out biopsy as a diagnostic option but would hopefully stimulate his appetite and support the effect of leukeran, his oral chemo); a few hours later he threw up all the food his appetite stimulant (mirtazapine, prescribed on friday) had coaxed into his stomach and more water than i'd have thought he was capable of holding. okay, we thought, starting a steroid regimen is rough. maybe it'll be better in the morning. we gave him his second dose, and another dose of mirtazapine, before leaving for work yesterday; he'd thrown all of that up by the time we got home. we spoke to our oncologist yesterday evening and she said it was alright to discontinue the prednisone, since he'd only had two doses. i felt good about that, at least until he was spectacularly sick again at two this morning. my sweet, stoic cat, the one who seemed slinkier than he'd been but otherwise my shadow as he always is, was absent from his customary spot on the bathroom sink (where he perches while i take my morning shower) today. now we all feel like throwing up, and joe and i are due to be out of town for a week as of this friday.
i called the specialist again this morning, full of questions from a feline lymphoma message board, and she agreed to prescribe zofran, an anti-nausea medication. she worries that his vomiting is a result of disease progression rather than a lousy response to prednisone - he might, for example, have switched up to large-cell lymphoma - and she thinks we should have his "official" one-month-or-so-on-chemo ultrasound before we go away rather than after we get back. i agree; though a technician from her office will be petsitting for us and seeing chuck every day, i hate the idea of leaving questions unanswered when his condition is changing so rapidly. i hate the idea of leaving at all, actually, but you don't need to hear about the place in my head where i fantasize about eating uncancellable travel arrangements and spending a week begging chuck to come out of the bedroom closet.
and what if he does have large-cell lymphoma? joe and i assumed that it was something we didn't need to know, since we were almost sure we wouldn't want to compromise his quality of life by bringing him across town for weekly IV therapy. there are other options, our specialist says. we could give him a $500 one-time, subcutaneous shot of elspar, a chemo drug which has minimal side effects and is apparently quite effective for large-cell; if it works (and it works quickly, she says; we'd see changes in a few days), we'd have "backed into" a diagnosis. we could then consider other oral agents, too - CCNU (lomustine), for example, or cytoxan - agents she doesn't want to put on the table unless we know what we're facing for sure. IV chemo is not the only path, prednisone is not a dead end, the decisions do not stop and grieving for the living is a waste of time.
as i waited for the train on the lower east side this morning i thought about how chuck seemed like a changeling, as if fairies had come in the night and swapped him out for their black cat. maybe he's making it easier for me, i thought, being someone else so i won't remember who i'm losing. but i am not losing. grieving for the living is a waste of time.
03.11.13
i should have savored the feeling that i was doing the best i could for our cat while it lasted. the PARR test which was to tell us if he had lymphoma or not came back, as the veterinary oncologist warned us it might, inconclusive, so she suggested i bring chuck in again so that we could check out his blood, she could put him on the scale (we need a scale, and i'm starting to realize how stupid it is that we don't have one), and she could do a quick, informal ultrasound to see if his spleen and lymph nodes looked any better after two weeks of chemo at home with us. a tech carried him down to the treatment floor and i settled in up at reception, where a pile of custom photo books told the stories of dogs and cats who received care through frankie's friends, a nonprofit which funds treatment for animals with cancer. fridays are a big chemo day for our specialist, so i also watched e-collared dogs and cats stream out of the office and into the night, a little squadron of cosmonauts returning to their families on earth.
chuck lost two thirds of a pound between his weigh-in three weeks ago and his weigh-in after two weeks of leukeran every other day. if the treatment had been working, our vet explained when she came up to join me, he should have been gaining weight; at the very least he shouldn't have lost any more. his spleen wasn't looking too mottled, but his lymph nodes looked the same. it could be that he's one of the 20% of cats who don't respond to leukeran, or that he needs the steroid we'd be using if we knew for sure that we're dealing with lymphoma (starting a steroid regimen, she says, is "the path of no return" for diagnosis - the cells change too much to be useful). she described another test which had a slim chance of getting us closer to an answer, something about a hollow needle which would shoot another needle and grab some of his tissue, but it sounded no more promising than the PARR test. it was time to start talking about a biopsy again.
fact: the biopsy would be laparoscopic if at all possible - one of the surgeons was downstairs measuring her tools even as we spoke, she could operate on monday after a consult - and incisions would be minimal. "we wouldn't be splitting him open from chin to belly," our vet said.
fact: oral chemo administered for large-cell lymphoma misdiagnosed as small-cell lymphoma would be useless at best and possibly harmful (because of potential side effects). i am probably the only member of the family who might be in favor of IV chemo for large-cell lymphoma.
fact: some conditions which mimic but aren't lymphoma (inflammatory conditions, infectious diseases) are exacerbated by the steroids we've been holding off on giving chuck to treat the cancer we've been assuming he has.
fact: we could pay for a biopsy by emptying our savings account and getting a loan to cover the balance. that it would be extremely difficult but not impossible for us to pay for said biopsy makes me suspect that it is a test for us, not chuck, and that if we agree to do it everything will be alright.
when i worked at an spca animal hospital just after college, i once processed a client who'd booked a PTS, put to sleep, appointment for her dog. he was a massive old rottweiler, and he hopped through our waiting room like a hobby horse, like our three-legged cat, jude - he had a shaved stump where a hind leg had been and squares of grey skin all over his back, as if he'd been parked in a rough neighborhood. cancer, maybe several cancers. his person, a short, sour-faced woman, could barely look at him. we were to give PTS families as much space and privacy as we could, but we also had to keep an eye on them; we had all seen animals abandoned and terrified, their people overwhelmed and unable to stay with them in their last moments. i thought that woman was one of those when i approached her treatment room fifteen minutes later and saw nothing in the window - i sped up - and then i saw her lying on the floor, her little arms across her dog's back. and to think i thought i knew anything about anything.
02.20.13
the veterinary oncologist called back to discuss chuck's results with joe and me at six o' clock last night. the slides weren't entirely conclusive: it's possible, ironically, that the oral steroid our vet prescribed on thursday (and which we gave him at home for the first and only time that night) changed the look of his cells prior to the collection on friday afternoon. she told us we could try to strengthen the diagnosis - which one wants to do because cancers' responses to various treatment options can vary so widely by cell type - by sending what they've already collected out to colorado for a PARR test, an assay which identifies lymphoma in dogs and cats via DNA. a negative PARR test, she explained, isn't very useful, as false negatives are possible; a positive, on the other hand, could be treated as a certainty. with that certainty, the big remaining question is whether we're dealing with small cell lymphoma (which tends to progress more slowly and for which she would likely prescribe oral chemo) or large cell lymphoma (which moves faster and would in turn potentially mean intravenous chemo to be administered at the hospital; i was thinking about that scenario as i weighed the facility we chose against the one our vet recommended, as the latter is across town and not easily accessible by train). she strongly suspects it's small cell, given that chuck's weight loss was significant (he's just under 10 pounds now and was at about 13 last february) but not sudden (it's been happening over the fall/winter; we thought for most of that time that he was simply eating less because he has old-man teeth) and he seems to be in high spirits (he chirrups and follows me around the apartment at shoulder level just as he always has). i asked if we could be more diagnostically aggressive - of course, i want to give him the best possible treatment at the earliest possible date, not to move through clue-style eliminations of rooms, weapons, and suspects - but the other immediate option would be a comparatively invasive biopsy. chuck would need to recover for a week or two before beginning chemo based on the results, and we would traumatizing him with a potentially-unnecessary major procedure.
so we are starting him on leukeran, also known as chlorambucil, chemotherapy which we'll administer via two-milligram pills every other day (we're going to talk about adding the steroid, prednisone, back in after we get the results of the PARR test). after about a month, we'll bring him back in for more ultrasounds; if his cancer seems to be responding well, we'll keep that up for a year and re-image again. veterinary chemo prioritizes the minimization of side effects, since companion animals don't know (as human patients do) that they're suffering in order to feel better. the bad news is that with that in mind, dosages are much lower and recurrence is therefore more frequent; the good news is that chuck might have some gastrointestinal distress, but it's also possible that the leukeran and prednisone could stimulate his appetite. if we're lucky, he could feel better than he does now.
if we're lucky. i folded up on the phone at my desk as the oncologist began using the words "year" and "years" when she spoke of what could happen next. as i said a few days ago, the panicked googling i was doing last week made me feel like chuck was dying in our arms. our vet, in turn, was so unenthusiastic about the idea of aggressive treatment that i was convinced chemo would be joyless time purchased at our poor little cat's expense, and the caretaker narratives i found online were feel-good rainbow bridge stuff that contributed nothing to my understanding about what i should do for my family. friends and friends' friends have been incredibly generous with their experience and support, i'm building the lexicon i need to find real talk and hard data about what we'll face, and i'm finally starting to feel like i am doing the best i can.
i made some shockingly good bagels this weekend - like, i-think-i-might-formally-be-a-real-new-yorker bagels - and i'm one movie away from the end of ye olde death-by-academy-award-nominee marathon. i have been meaning to tell you about antarctica (the researchers down there really love tom jones, among other things). my blog is not eat pray chuck, and i won't be journaling his bowel movements. i will, however, continue with my customary, random tales of my excellent black cat, and i'll share everything i learn about how to take care of him. if you find us in the course of panicked googling, i hope we help you do the best you can.
02.18.13
i want to post photos of chuck all day, but i feel like taking pictures when he's just home from the doctor is unfair (this one is from our old apartment in hell's kitchen). you should know, however, that he is as handsome as he has always been. he has a little priest's collar of lighter shaved skin on his neck where our vet drew blood last week, and a panel on his belly that was shaved for his x-rays and ultrasounds on tuesday and thursday. the skin there is stone grey, so he looks a bit like a statue that has come to life. this is reasonable, for he is a magical cat.
joe and i decided on thursday night that we needed to find out what sort of chemotherapy might be available for chuck, so i called our vet as soon as i got to the office on friday morning. he told me that he would try to refer us to a specialist at a large, venerable veterinary research hospital here in the city, but when he called back he said that it would be two weeks before we could get in to see one of their oncologists. that was unacceptable - according to my nauseating, interminable internet research, an aggressive, untreated cancer could take chuck from us in a matter of weeks - so i kept going. i tried the specialist who interpreted chuck's original ultrasound: she could see us, but her practice is an hour away on long island. i tried calling the hospital myself and mentioning their conversation with my vet; they sounded harried and didn't recognize his name. at last i found another group of veterinary specialists a few blocks from my office. one of them had been named one of the city's best doctors a few years ago, a friend of a friend responded to the call for help in my last post and told me that same vet and his colleagues had taken wonderful care of the cat she and her husband lost to cancer last year, and that i needed to call him and drop their names immediately, and our friend lesley's excellent dog hayley underwent emergency surgery (and has since recovered beautifully) in their care. they had appointments that afternoon and could begin staging chuck's cancer (that is, aspirating his growths and determining how far they had progressed and what course of treatment would stand the best chance of arresting them or perhaps even, oh, my dear cat, putting him into remission) immediately. i arranged for his records to be transferred, took the train home and bundled chuck into his fifth car of the week, and spent two hours pacing a glass-walled exam room and speaking with his new doctor. we're now waiting to discuss his cytology results with her.
a cab driver carried chuck and me downtown in silence on thursday afternoon as i called joe to break our original vet's cancer news, as i called my office to ask if i could spend the rest of the afternoon at home, and as i cried raggedly in the backseat. he then apologized for his broken english and told me that i was a strong person, and that he believed in god, and that he knew god was going to take care of me. he refused the money i offered him when he pulled to the curb in front of our building, and he blessed me and said that he would pray for us. god bless you, too, i said.
02.14.13
after joe and i adopted him, chuck lived with my college roommate jen for six weeks. we had no apartment and i had no job, but i knew that i needed a black cat in my life as soon as possible.
chuck is now nearly thirteen. he had an ultrasound this morning (at his yearly checkup this week, we learned that he'd lost three pounds over the course of this past year, and his doctor felt a mass when he palpated his chest) and the specialist found that his spleen is enlarged, his intestines are moderately thickened, and he has multiple severely enlarged mesenteric lymph nodes; the assessment is that he has lymphosarcoma, a diagnosis we can confirm with a guided aspiration. we're giving him steroids as of this evening, and we're going to get in touch with an oncologist tomorrow to talk about the possibility of veterinary chemo, something we know almost nothing about. if any of you know someone who's pursued that kind of treatment for a cat in their family, i would be grateful to know how they felt about it; they can reach me at cuttlefish [at] gmail [dot] com.
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