Fig Camp

Last week I had the opportunity for a brief escape to the Sierras, and a friend kindly agreed to take Fig for a few days. Fig is a very mellow traveler - he climbs into his crate without much fuss and sleeps in the car, so it was no trouble to get him over there. Since there are other cats in the house where he was staying, he remained in my friend's bedroom. Windows on two sides with low sills provided him with hours of entertainment, and his appetite didn't suffer one bit. Neither, it seems, have his territorial tendencies. When I called in for a Fig report, I was told that he had awakened the household quite early in the morning when the two other cats began pawing at the bedroom door. Fig became agitated and ready to defend his turf. When my friend opened the door to shoo the cats away, one of them bumped into the other and the two of them indulged their fight instinct with each other while rolling down the hallway. Unfortunately, they had riled up the dogs that share the house, so the cats beat a hasty retreat down the stairs, followed by the dogs. The barking, cat shrieks, and sounds of frantic scrambling served as an instant alarm clock for the entire household. I heard that Fig was beside himself with laughter and pleased as punch at being the catalyst.

As much as I love Fig, it was good to take a short break from worrying about and tending to him. And I was that much happier to pick him up, laugh about his exploits, and bring him home.

He is looking good these days, and acting normally. I don't know if this is the last hurrah before the cancer worsens, or if the medicine is working, but I am grateful for it. Perhaps it will last well into fall and winter. One can always hope.

Feline discrimination

I've heard that felines are discriminating animals - as a species, they have a reputation for being finicky eaters, for example, and they don't blindly offer their affection with the eagerness of many of their canine brethren. However, I feel compelled to share an example of discrimination against cats, namely in housing. Recently I have been searching craigslist for a new place to live, always checking the box for "cats allowed" in my search. One place looked promising but the rental agent wasn't sure about the owner's pet policy. Turns out the owner will accept dogs but not cats. I don't understand why, when pet owners are often charged exhorbitant pet deposits and sometimes even pay extra "pet" rent for the privilege of keeping their extended family intact. To be sure, there are irresponsible pet owners, but there are all kinds of irresponsible people in the world, and in my experience, people who open up their hearts and lives to pets can be just as stable and responsible as non pet-owners. To me, a house is truly a home when a four-legged shares the space with me.

Fig is old, neutered, and certainly not about to tear up the walls, engage in endless caterwauling, or otherwise commit mayhem. He just wants a quiet, peaceful place to be with me and live out what is remaining of his life. Is that too much to ask?

Today, the world feels just a little bit colder to me.

To know or not to know

I know that Fig is going to die, almost certainly within the next 12 months, probably within the next few months. In a way that knowledge is a gift - it gives me time to prepare for his death, to make the most of the time I have left with him, to come to terms emotionally with losing him. I remember when my mother died, and it was very different. She had surgery for lung cancer and seemed to be recovering when she took a sudden turn for the worse and never made it out of ICU. She died within 2 months of her surgery, and I never saw it coming. Much of that time she was on a respirator, so she wasn't able to talk. And there were so many things I wanted to ask her, so many unfinished conversations between us.


To lose my mother was an awful, defining moment - the severing of a spiritual umbilical cord that left me alone, baptized in the realization that life is precious and too fleeting to not honor the gift of each moment, each connection with another. Just as light and dark together give visual form and texture to the world around us, life and death are bound in their own symbiotic dance of meaning. Knowledge of Fig's mortality forces me to wring as much as I can from each moment we have left together; priorities are clarified dramatically when impending death casts its shadow across the face of life. Fig's incontinence is relegated to the position of mere inconvenience, while the sight of him bounding up the stairs in the morning to greet me is an occasion for great joy and gratitude for another precious day.

And while I still catch myself getting caught up in petty grievances more often than I would like, I took from my mother's death the lesson that to spend time harboring grudges or indulging in unwarranted anger at perceived slights is to dishonor life, a foolish expense with no lasting reward. What lessons, I wonder, will I take from Fig's death?

The Power of Communication

Now and again I stop to marvel at how effectively animals and people can communicate, especially considering that we don't share a spoken language. Fig is no slouch in the communciation department, and he doesn't even use feline verbal language, except on very rare occasions. His primary voice is the silent meow, a breathless "hah" to signal that he wants attention - usually food or to be let out onto the porch. He uses his plumed tail to beckon - if he wants to be fed, he will find the nearest available human, walk up to them, and combine his silent meow with a soulful look. Then he will turn around and head for the kitchen, slightly twitching his tail and stopping at the doorway to be sure he is being followed. When he engaged in this behavior with a houseguest, she told me that Fig was trying to "take her out." Not knowing the context of her remark, at first I thought she worried that he was going to attack and kill her. Too many gangster movies, I guess. When I understood what she meant, I was impressed yet again by Fig's cross-species communication savvy.

Fig also knows how to galvanize people (namely me) into action. As his kidney disease has progressed, he has the occasional "accident," sending me scurrying for the cleaning solution and an armload of paper towels. Now, if I am a few hours behind on the litterbox cleaning schedule, he will saunter over to a bookcase or other spot and begin sniffing intently, with one ear cocked back, all the better to hear when I've gotten his message, grabbed the scoop, and headed for the litter box.

The School of Fig

What is it about bonding with animals that makes us more human? Do they teach us by example? I've lived with pets all of my life, and save for one german shepherd who used to slink off the sofa with averted eyes and guilty posture every morning, I have been struck by their authenticity and capacity for returning love without game playing. Fig is an exceptional companion in that regard. Even during periods when I had extensive business travel, he never gave me the cold shoulder when I returned home, but was always genuinely glad to see me. He enjoys meeting new people and is not one to hide under the bed when company comes calling. His early experience of being abandoned by his first owner didn't make him bitter and mistrustful of people; he is always ready to forgive and forget. He asks for what he wants, as best he can with his body language and silent meows, with perfect trust that I will provide it. There is something immensely calming about living with a being who takes each day as it comes, with no worries about the future, no need to prove himself, just an unapologetic ability to enjoy the simple pleasures of life - sleeping in a sunny spot, eating favorite foods, watching the world from his perch, and having his cheeks rubbed. Obviously life is more complicated for humans, but still we have much to learn from our four-legged companions.

Back to the vet

A week has gone by without a word - a humbling testament to how quickly time marches on when we are busy living it. Last Tuesday Fig went to the vet for the blood panel needed before he could receive his next chemotherapy medication. I hate to stress him by taking him there, but this seemed necessary. They drew his blood and we waited...and waited...and waited for the results. In that instance, time crawled as I worried about Fig's stress level, about what the results would be, and what our options would be. At last the doctor came out with a dizzying array of colorful charts that essentially told me:
1) Fig's kidney function is continuing to deteriorate due to the cancer (it is still growing)
2) His liver function and white blood cell count are still good (he can have more chemo)

I caught myself feeling disappointed that the chemo wasn't stopping the cancer. He looked and acted so much better than before we started it - he has an appetite, his coat is still glossy, his eyes still clear, he is still alert and even plays after having some catnip. How could he not be getting better? Ah, the human proclivity for hope and denial!

Then we discussed options. I asked about the more aggressive chemo approach. Sadly, I learned that it would require weekly hospitalization for hours while an IV dripped the chemicals into him. This is where the quality of life issue comes in, since Fig would be miserable spending one whole day of each week he has left on earth being at the vet with a tube stuck in him. He might even have another seizure or stroke, and become debilitated or even dead as a result. Clearly, this approach does not seem an option for Fig. So we opted to take another capsule home. The pharmacy technician gave me a pair of blue latex gloves with the capsule - just to drive home how toxic is the substance I am putting in his body. I feel like a poisoner, but shove the capsule down his throat and wait until he swallows. I continue to hope that he will outlast the vet's prediction of 1-4 months left.

I have been wondering if, on some level, Fig knows that he is going to die. He wants to spend nearly all of his time on our front porch, watching the birds, cats, and neighbors; it's as if he wants to soak up every bit of experience and stimulation possible, making up for years spent indoors. And even in food, he wants constant variety. I have to mix wet food of different flavors and dry food with the bonito flakes to tempt him. These days I have 3 or more tins of different cat food flavors open in the refrigerator at once to accommodate his need for diversity in meals. One night my friend and I took him for a short walk - it was a mild evening and the night sky was sparkling with stars. After a block he ensconced himself on the warm asphalt and regally watched the bats flying overhead, listened to the crickets, and quietly enjoyed our company. I am glad that we are able to spend these moments together. Glad, too, for the miracle of technology that allows us to capture his moments and antics on video - memories of Fig that will outlast his all-too-brief passage on this mortal coil.

Hard Truth

I took Fig to the vet today. They wanted to do a blood panel before dispensing his monthly chemo capsule. It's not hard to get him into his crate these days - he seems to think of it as his sanctuary - but at the other end, it can be difficult to get him out of it. Especially after he's been spooked by hearing a myriad of dogs barking and trotting by us. This time I had to upend the crate and pour him onto the stainless steel table. One woman held him while I rubbed his head in a vain attempt to distract him from the needle being inserted in his neck to draw blood. We all got through it, though, and he was happy to scramble back into his crate afterwards.



Then we sat in the lobby to wait for the results. Isn't it odd how anxiety distorts time? It felt like days passed before the vet came out with a sheet of colorful graphs comparing his baseline tests to the ones done today. His kidney function is somewhat worse, due to the cancer, the vet said. The good news is that his white cell count, his liver - all are fine, which means that he can continue with the chemo. I asked how long she thought he had, acknowledging that there are no guarantees. She said that renal lymphoma moves quickly, and that he probably doesn't have more than 2-4 months, although it's possible he might live another 6 months.



Now I wonder if I asked the right question, for what do I make of the answer? He will die of this disease well before the 5-8 year window I thought we had before he got sick. So does the amount of time he has left matters? Or is it the quality of time he has left that is important? How does a cat value its life? For Fig, perhaps, the answer lies in the number of birds and other creatures he observes from his post on our front porch, or the amount of bacon we give him from our plates in the morning, or how long we gently rub his cheek in just the right spot. Yet I truly don't know.



I was disheartened by the vet's report, though. Since Fig has seemed better since we started treatment (more of an appetite, more normal activity levels, etc.), I was thinking that he might be a candidate for the more aggressive chemo treatment than the one we are using. I've been told that treatment hits the cancer harder than the capsules do, so he might have more time with that treatment protocol. But the vet explained that it would require Fig to spend whole days at the hospital on an IV drip. Given how stressed he gets by just a short visit to the vet, it doesn't seem that given a choice, Fig would choose that treatment for himself; it doesn't feel right to make that choice for him, just for the possibility of extending his existence.

Bath Day

Generally Fig gets a bath about once a week - it keeps the dander at a mostly manageable level, and ensures that the spots he doesn't get around to cleaning too often remain sweet smelling. I partly fill up the kitchen sink with warm, soapy water and line up several towels on the counter, then bring Fig over and lower him into the water. We've experimented with a variety of cat shampoos - for shaggy cats, scratchy cats, cats longing to exude an organic aura, for cat owners with allergies - each one costing 3 to 5 times the price of any shampoo I've ever used on my own head. He usually suffers in silence while I soap him up and rinse him with the spray, then use a washcloth on his face and ears. Sometimes he seems to enjoy the finish, when I wrap him up in a couple of bath sheets and gently rub him dry while holding him on my lap, although he rarely allows me to dry him completely, preferring to jump off my lap halfway through and go through an elaborate ritual of shaking each leg in a comical dance before settling down to lick himself dry.

Fig has never been a very difficult cat to bathe, especially not compared with the Maine Coon cat I had to bathe regularly for her dermatitis - she exhibited superhuman strength when it came to wriggling out of my grasp at bathtime. He showed a little more spunk than normal today, though, even growling at me while I rinsed him. I'll take that as a sign that he is feeling more himself, even if it makes bathtime a bit more challenging.

At last Fig emerged from the towels, did his dryoff dance, and happily made his escape to the warm sunshine on the front porch, where he continued his surveillance of the neighborhood.

The Baconator

Fig is a bacon slut. No matter where he is or what he is doing, you can count on him to charge into the kitchen when he smells bacon cooking and park himself at your feet, willing you with his eyes to drop a piece. He'll turn up the most delectable pieces of salmon in favor of bacon, he'll walk away from a meal in progress to follow the bacon to the dining table, and he is your instant friend when you have a piece of bacon in your hand.

Does he think about bacon in the afternoon or evening? Does he dream of chasing down bacon-filled mice? Or is it just a morning phenomenon? Ah, the deeper mysteries of Figness.

Alert Fig

Decisions, decisions

Fig seems to be responding well to his second steroid injection, which I gave him last Saturday. His appetite is normal, and he has put some weight back on. He is active and alert, and doesn't seem to be in any pain. I can look at him and momentarily forget his diagnosis.

So, the time is at hand to decide about his second chemo treatment. The vet wants me to bring him in for another blood panel to see how the first treatment, nearly a month ago, has impacted his white blood cell count before giving him another dose. He warns that going ahead without the test could be risky, should his count be too low. I see the sense in that, but remember the experience of his first panel - he got so stressed out that he became nonresponsive and was drooling; the vet thought he might have had a seizure. Is that risk more acceptable than the risks inherent in not testing him? To compound the equation, there is the cost of the test - not insignificant. I am fortunate to have a friend who is willing to share the cost with me, but it is still a consideration. It shouldn't be (guilt is telling me that a responsible pet owner will have the resources needed to provide whatever treatment her pet needs), but it is (reason is asking me if I can afford expensive lab tests for a cat with an incurable disease when I have postponed some routine, but expensive tests for myself this year out of financial considerations).

The other question casting a shadow over this decision is the impact it will have on Fig. Will the chemo weaken him, will it make him feel sick? After the first treatment we had to contend with bouts of constipation and diarrhea, alongside his unpredictable incontinence. It wasn't fun forcing pumpkin down his throat; he and I both ended up with as much pumpkin on our outsides as went into his insides, and I know he didn't understand that I was doing it for his own good. Thank goodness the pumpkin worked, though, in conjunction with a stool softener. Better a more gentle approach than a harsher one, I think, given his health.

So, given his seemingly improved health, should I try the more aggressive chemo or stay with the moderate one? Will the more aggressive chemo give him more time? What will the quality of that time be? What matters to Fig? What is the impact of all this on us?

The fact that euthanasia is an option with pets, unlike people, both simplifies and complicates the basis for making health care decisions. When our beloved companions seem to be suffering and treatment is either not efficacious or affordable, or when the burden of caring for a sick animal overwhelms us emotionally, physically, or financially, we can "put them out of their misery." And perhaps, even feel noble for having made such a difficult decision. I'm not kidding myself about the difficulty of that decision, either - it is no small thing to decide to end a life, even if it is the life of an animal. Hopefully that decision is a long way off.

For now, I will probably opt for the blood test, and based on the results and the vet's recommendation, decide to continue with the moderate chemo or try the more aggressive chemo. But this time I will insist that the vet allow me to remain with Fig while they draw his blood, rather than allow them to take him to a back room where he is cut off from me. I know my presence calms him, so I owe him that much.

Fig

About Fig

I met Fig at a pet adoption fair a decade ago. I was actually looking for a kitten, a companion to help Missy, our other cat, shake off the depression she developed following the death of her companion. Although losing Tintalle, a friend for 17 years, was too open a wound to yet think about adding another to our household, I couldn't bear to see our remaining cat languish in depression - she had stopped eating and was pulling her fur out - so there I was. There was one kitten available that day, but it had already been adopted. One other cat interested me. He was grown, a large black and white domestic longhair with a sign posted on his cage: "Keep your fingers out! I bite!" He looked more miserable at being in such a noisy public place than dangerous, so I reached my fingers inside and rubbed his soft cheek. I felt the rumblings of a purr as he rubbed back against my hand, and I knew I had found a new friend. An application, interview, and some preliminary visits later Fig was home.

The cat rescue group told us that he had been found half-starved under some pipes beneath an apartment building in town. Apparently he had been abandoned by his previous owner when he left the building. His early experience didn't seem to dampen his ability to give and receive love, however, as Fig and I bonded quickly and deeply. To this day, he loves people, and happily greets visitors to our home with a swish of his stately plumed tail and a keen eye for potential treats.

Apart from some dental work and regular vaccinations, he has not needed much veterinary care, and always took to new situations with great equanimity. In November the only thing that came up during his exam was a borderline heart murmur. So at age 12, I assumed that he would be with us for another 5 at least. When I observed weight loss and a total loss of appetite, though, I knew something was seriously wrong. After an ultrasound, blood panel, and biopsy we learned that it was renal lymphoma.

There are days when I rage against the unfairness of the cancer, striking such a sweet, innocent creature. And there are days when I weep at the realization that he is going to leave us, probably much sooner than I had expected. I listen to the vet, with his warning that even with treatment, Fig may only have a few months left to live. I read about other cats with renal lymphona, and cling to stories such as that of the woman whose cat with a similar diagnosis lived for 2 full years beyond her projected demise. And then I agonize over what is the right thing to do for him: let the disease progress naturally? Fight it with steriods and chemotherapy? Moderate chemo or the more aggressive version? How will it impact the quality of his life? And how will I decide when, or if, euthanasia is the right option?

But while these questions hang over my head, there is still the business of daily living. Fig still expects to be fed, let out on the porch, cuddled. Last night he actually ate some catnip and played with my partner - something he hasn't done in weeks. Clearly the steroids are making him feel better, at least for the moment.

It starts

My friend is dying. Not without a fight, though - he has already lived a week beyond the 2-week window the vet gave him on that black afternoon he calmly informed me and my best friend that my cat has renal lymphoma, inoperable and incurable. To let him die without a fight was unthinkable, so we opted for the recommended treatment of steroid injections and chemotherapy capsules, not knowing if he would be around for a second round of treatment. But he is with us still, his voracious appetite for observing life from our front porch and devouring plates of cat food garnished with bonito flakes belying the cancer that is growing inside him. And so, to honor his spirit, and to chronicle this last phase of our life together, I am writing this blog. Perhaps I will learn a bit more about loss, death - and life - along the way.