Many people assume that the hardest part of my job as a veterinarian must be putting pets to sleep. Surprisingly, it isn’t. Putting a beloved pet to sleep is certainly the saddest part of my job, but by the time we’ve reached the point of euthanasia, we’ve run out of options for maintaining a good quality of life for the cat, and humanely ending the cat’s life is the proper and kind thing to do.
In actuality, the hardest part of my job is giving people bad news. Very worried people have been bringing their sick cats to me for years — hoping to hear that whatever is ailing their beloved cat is something that can be easily treated or cured. Telling a client that the X-ray reveals an inoperable tumor or that the bloodwork confirms end-stage kidney failure is undoubtedly the most difficult part of my job.
Although I’ve been amazingly fortunate that my own cats — both current and past — have been remarkably healthy and have never had any serious medical scares, witnessing my clients fret over bloodwork and agonize over impending biopsy results has made me acutely aware of the tight bonds that we form between ourselves and our cats. I certainly like to think that I’ve never taken my own cats’ good health for granted.
Little did I know that in March of this year, in very dramatic fashion, I would indeed discover what it was like to be on the other side of the examination table.
How Crispy came into my life
In 2001, while I was working at The American Society for the Prevention of Cruelty to Animals, a kitten arrived in their hospital’s ICU. Although the details were sketchy, I was told that she had been put in scalding water and had second and third degree burns on her body. I poked my head into the ICU and saw, in the corner cage, a frail eight-week old kitten on intravenous fluids, her skin slathered with burn cream, tenaciously clinging to life.
I vowed that if this kitten survived this ordeal, I would take her home and dote on her forever, making certain that the rest of her life was totally stress free. Over the next few days, she lost the tips of her ears and the end of her tail, but she pulled through. I took her home as promised, and the little diva (whom I dubbed “Crispy”) and I became inseparable. She is definitely the smartest cat I’ve ever owned. I can read her every thought and mood, and I’m certain she can read mine. For 14 years, she’s lived the life of a queen, in amazingly good health.
Maintenance for an aging cat
As Crispy aged, she became a little less fastidious about grooming, so I began to bring her to my office once a year for a bath. I also did annual bloodwork at that time. Cobblers’ children may go barefoot, but this veterinarian’s kitty wasn’t escaping her blood tests! Crispy’s displeasure at being bathed is hilarious, and I have numerous videos confirming this. Before filming this year’s epic battle, I whisked her into the exam room to get blood and urine samples.
While feeling her abdomen to locate her bladder for the urine sample, I detected something unusual. I felt the blood drain from my face as I palpated her abdomen again. It was a mass, and it was unmistakable. I asked my associate to have a feel, and though she tried to maintain a poker face, I could see that she felt it too.
No signs of illness
Crispy had zero signs of illness — normal appetite, normal thirst, no vomiting, no diarrhea, no weight loss. I scheduled her for ultrasound. (She did not get excused from that bath, though, much to her chagrin.)
On ultrasound, we discovered a 5 cm long mass involving her small intestine. With Crispy sedated, we inserted a syringe and needle several times into the mass and aspirated some cells into the hub of the needle. We sprayed the cells onto microscope slides and sent them to the lab for analysis. I expected this to be high-grade lymphoma. Although this is a chemotherapy responsive cancer, the prognosis is guarded.
Frustratingly, the aspirates were non-diagnostic — there weren’t enough cells on the slide for the pathologist to make a diagnosis. Crispy would need surgery so that a proper biopsy specimen could be obtained. Although I hated the thought of her undergoing surgery, I held out hope that the tumor might not be lymphoma after all.
Lymphoma typically exfoliates its cells into the needle when the tumor is aspirated — and because this mass didn’t exfoliate its cells, perhaps it was something benign, and removing it would be curative.
The day of the surgery
Some veterinarians can perform surgery on their own cat. However, I’m not one of them. Rather than send her to another hospital, I had a board-certified surgeon come to our hospital to perform the operation. At surgery, a firm, hemorrhagic tumor was located in the intestinal tract. The mass was removed as cleanly and completely as possible. The surgeon closed the abdomen, and we began waking her up.
During the surgery, we had some difficulty maintaining Crispy’s blood pressure. Despite aggressive fluids and appropriate drugs, her pressure remained low. Now, with the anesthesia turned off and Crispy just on oxygen, she still wasn’t waking up. Her gums were very pale and her breathing became shallow.
Before surgery, her PCV was 27, meaning that 27 percent of her blood was comprised of red blood cells. This number is fine. After surgery, however, her PCV was 12! This is dangerously low. But exactly why her red count dropped so low was a mystery. The surgeon was meticulous and there was minimal blood loss during surgery. Regardless, Crispy needed a blood transfusion if she was going to survive.
A need for donor’s blood
Cats have blood types, similar to humans. Purebred cats will sometimes have blood type B, but the vast majority of domestic shorthaired cats are blood type A. I naturally assumed Crispy was type A, but almost as a formality, I quickly blood typed her using our in-house kit. To my utter shock, she was type B! Topeka, our hospital donor cat, is type A. Yikes!
First, I called the nearby emergency clinic and they had no type B blood on hand. Neither did the world-renowned referral center across town. I began to panic until I called the emergency center further downtown — and to my great relief, they had three units of type B blood in their fridge.
My staff packed Crispy up in her carrier. I grabbed my coat, hailed a cab and implored the driver to get me to my destination as fast as possible. Crispy was still intubated, and I watched her carefully, confirming that her breaths — though shallow — were still occurring. At one point I thought that she might actually expire on the cab ride. After what seemed like an eternity, we arrived at the ER, and I whisked her in.
The staff was expecting her, and before you could blink, a unit of type B blood was flowing into her. I hovered around the treatment table like a mother hen. After 30 minutes, her blood pressure began to register, and 15 minutes later, she began chewing on her endotracheal tube. We removed her tube, and she sat up in a daze and looked right at me before lying back down. I managed to remain composed, but I almost collapsed with relief.
Crispy quickly stabilized and improved over the next 24 hours. However, her incision began to leak fluid. A bandage was placed on it, but after a few hours, it was soaked and needed changing. I received a call from the team caring for her. They suspected that a few vessels were continuing to ooze after the surgery.
They theorized that because her blood pressure was so low during the surgery, the surgeon didn’t see the vessels and didn’t cauterize them — but now that her blood pressure was normal, these vessels were well perfused and were now leaking. I had to face the reality of a second anesthesia and surgery for her.
Putting trust in your vet
It was at this moment that I felt the most kinship with my clientele. Though I was reluctant to put her through another surgery, I had to simply trust that the professionals who were evaluating her every respiration and every heartbeat were making their recommendations objectively and with her best interests, in much the same way my clients put their trust in me.
It wasn’t easy for a control-freak like myself to surrender control to others, but I knew that my emotional attachment was preventing me from being objective, and I wisely stepped back. As surmised, during the second surgery three small oozing vessels were identified and tied off. Individually, each leaking vessel was minor. Taken together, however, the fluid loss was substantial and was threatening Crispy’s recovery. This time, luckily, she recovered uneventfully.
I then felt even greater empathy with my clients as I anxiously awaited the biopsy results. I always put “stat” on the biopsy form, so that my clients get the results in two days, rather than a week. Although my clients often comment how impressed they are that we get results so fast, I quickly discovered how even two days can feel like a month when you’re waiting for results that can determine your cat’s future.
The prognosis for Crispy
Sadly, Crispy’s report was not good. Her tumor was a hemangiosarcoma, a very malignant tumor that arises from the cells that line the blood vessels. It is a very rare tumor in cats. By the time you detect a hemangiosarcoma, malignant cells have likely already spread somewhere else. In one report, the median survival time was 77 days; one cat managed to make it to 295 days.
As I plan my upcoming vacation to Paris, I am reminded of that city’s motto, ‘Fluctuat nec Mergitur.’ It means “tossed by the waves, but unsinkable.” I feel that this describes Crispy perfectly. She survived her kittenhood trauma, and she endured two recent surgeries. If any cat is going to break the record for survival time after hemangiosarcoma surgery, it’ll be her. As I watch her sleeping next to her favorite catnip toy, I’m grateful that she’s back home and doing well.
Having now been on the other side of the examination table, I feel I understand even better the emotional rollercoaster my clients experience when they entrust their ailing cat to my care. I can only hope that this experience with Crispy, in which I was both doctor and client, serves to make me a better veterinarian. — Arnold Plotnick, DVM, DACVIM