I would have liked to call this post Pressure Cooker Learning Experience, but I’m not sure that I have achieved full understanding yet. On Super Bowl Sunday, henceforth to be known in my apartment as Green Split Pea Souper Sunday, I set out to cook a pot of green split peas, more or less as I had done the previous week, except with more water and except that I had cooked yellow split peas the week before.
On that occasion, I covered two cups of yellow split peas, plus two tablespoons of olive oil, with about half an inch of water, cooked for 12 minutes, and then did a quick release of pressure by turning the pressure cooker’s operating valve to the steam setting. Releasing pressure this way takes just a minute or so. The result was bricklike, and very tasty once separately boiled water, garlic, a couple of bouillon cubes, and tamari were added.
On Green Split Pea Souper Sunday, I covered two cups of green split peas, plus two tablespoons of olive oil, with more like two inches of water, cooked for 11 minutes, and did the same quick release of pressure—resulting in a geyser of oily beans that shot upward and also ran down the sides of the pot, coating the stovetop, the front of the stove, the side of the stove, the side of the refrigerator, the floor in between the two, the floor in front of the stove, and the little oven on top of the refrigerator. There were beans on the photographs on the front of the refrigerator, on the ceiling above the stove, and even some specks inside the freezer.
I called Tom for assistance, and when he didn’t answer his phone, which is the case 99 times out of a hundred, I yelled his name toward my ceiling until he appeared, which took about 15 seconds. From now on, that’s how I’m going to do it. I asked for his help pulling the stove away from the wall so I could clean the sides of the stove and the refrigerator, and the floor next to and behind the stove.
I learned from the Internet later that it can appear that pressure has been fully released and that it is safe to remove the lid of one’s pressure cooker, but if a bubble of steam is trapped underneath the surface of the stuff being cooked—this could easily happen with beans, especially ones prone to forming a brick, like split peas—there can be an explosion and even injuries when the steam bubble is disturbed. This isn’t what happened to me. The eruption was right through the valve. But I can take some guidance from the advice offered to those seeking to avoid the former scenario: not to do quick pressure release, and to tilt the pot from side to side to free any trapped steam bubbles before opening the lid.
Now, it is possible that my pot’s safety valve was warning me that the pressure was dangerously high by emitting steam horizontally. I hope that it was, and that I just failed to notice it, because that would mean my pot’s safety features are working correctly. But if it wasn’t, then I am left to wonder: Is my pot defective? Is there some inherent difference between green split peas and yellow split peas? Did it make a difference to cover by two inches of water instead of half an inch of water? Was I just lucky with the yellow split peas?
I would call up T-Fal and complain—the best defense being a good, swift offense—except that the manual for this pot explicitly says not to cook split peas in it. Also, it may be that the safety valve did perform just as it was supposed to.
However, the Internet says you can safely cook split peas in a pressure cooker if you proceed with caution. I don’t think Lorna Sass says not to do it. In the interest of science, I’m tempted to cook green split peas again next week covered by just half an inch of water and do the quick release, but have a small pot handy to clap over the valve in case the same thing happens. Also, it might be prudent to wear my safety goggles. Or I could cook green split peas covered with two inches of water and keep a closer eye on the safety valve.
It took forever to clean up the mess. Mysteries remain. The good news is that, once I added all the other stuff, the green split peas were delicious. Serving suggestion: Reheat with finely chopped leafy greens and a handful of frozen shiitake.
Monday, February 03, 2020
Friday, January 31, 2020
The Winner Is Kahnfections, 3321 20th St.
I completed my thesis toward the end of 2019 and sent it in. In due time, I got feedback on needed revisions, and sent those in earlier this week. The next day, I got an email from our thesis mentor saying that my paper had been accepted, and so I am done with all of the requirements for my two-year chaplaincy program in Santa Fe except for a 15-minute presentation, which will be the telling of a couple of stories from my thesis, and the graduation ceremony. Flatteringly, our mentor asked if she could share my paper with the palliative care fellow at her hospital; she said it did a “really good job” of explaining the theological foundations of my chaplaincy.
The next task is to put together my actual application for board certification, which, like everything else pertaining to professional chaplaincy, is not a trivial matter. I had the vague idea that it was due in July, which meant that after July, I can sit around on my butt reading when I’m not at work—finally! This whole process began in January of 2016. I checked on that due date yesterday evening and discovered that the due date is July 8, but applicants are strongly encouraged to send everything in as far in advance as possible, to have time to remedy anything that is amiss. I have assigned myself a due date of April 23, which is even better. After April 23, I can sit around on my butt reading when I’m not at work.
Yesterday, I took my thesis and portfolio—a collection of every paper I wrote during the program—to a nearby copy shop and had them spiral bound, and today I mailed them off to school, to be handed back to me at graduation.
At County Hospital, I found there had been a cataclysm in the area of personnel and I was suddenly at loose ends. I went back to the chaplain office to brush my teeth—I had celebrated mailing in my thesis by conducting a croissant taste test while en route to the hospital—and while I was sitting there talking with another chaplain, our priest came in and told me that the person who was the priest at my paying job for six or seven years died unexpectedly yesterday.
He was there when I did my summer unit of Clinical Pastoral Education, and still there when I was hired as a staff chaplain a year later. Several months into 2019, the church leadership called him home to Uganda, where he became the dean of a seminary. Perhaps in the past few weeks, he came here to fill in at a church in South San Francisco; this might also have been a vacation for him. (I’m a little miffed that he didn’t get in touch.) He went to visit the hospital—we have three—where his office was and where he was revered by the staff. Yesterday he was supposed to fly home to Uganda—but he never woke up. He was only 52. He had an emphatic personality. He made me smile.
I left County Hospital this morning after I found this out and went over to the hospital where our priest had spent the most time. I found my co-workers busily putting together a prayer service, which we conducted at noon, giving staff members a chance to start to grieve. I offered the closing prayer, and could hear people crying.
The next task is to put together my actual application for board certification, which, like everything else pertaining to professional chaplaincy, is not a trivial matter. I had the vague idea that it was due in July, which meant that after July, I can sit around on my butt reading when I’m not at work—finally! This whole process began in January of 2016. I checked on that due date yesterday evening and discovered that the due date is July 8, but applicants are strongly encouraged to send everything in as far in advance as possible, to have time to remedy anything that is amiss. I have assigned myself a due date of April 23, which is even better. After April 23, I can sit around on my butt reading when I’m not at work.
Yesterday, I took my thesis and portfolio—a collection of every paper I wrote during the program—to a nearby copy shop and had them spiral bound, and today I mailed them off to school, to be handed back to me at graduation.
At County Hospital, I found there had been a cataclysm in the area of personnel and I was suddenly at loose ends. I went back to the chaplain office to brush my teeth—I had celebrated mailing in my thesis by conducting a croissant taste test while en route to the hospital—and while I was sitting there talking with another chaplain, our priest came in and told me that the person who was the priest at my paying job for six or seven years died unexpectedly yesterday.
He was there when I did my summer unit of Clinical Pastoral Education, and still there when I was hired as a staff chaplain a year later. Several months into 2019, the church leadership called him home to Uganda, where he became the dean of a seminary. Perhaps in the past few weeks, he came here to fill in at a church in South San Francisco; this might also have been a vacation for him. (I’m a little miffed that he didn’t get in touch.) He went to visit the hospital—we have three—where his office was and where he was revered by the staff. Yesterday he was supposed to fly home to Uganda—but he never woke up. He was only 52. He had an emphatic personality. He made me smile.
I left County Hospital this morning after I found this out and went over to the hospital where our priest had spent the most time. I found my co-workers busily putting together a prayer service, which we conducted at noon, giving staff members a chance to start to grieve. I offered the closing prayer, and could hear people crying.
Medical Mano a Mano
I continued agonizing about what to do, which greatly increased my sympathy for those trying to make decisions for their human loved ones. It’s hard! I felt that whatever I did would be wrong: Making Hammett undergo an unpleasant course of treatment would be wrong, but wouldn’t giving up too soon also be wrong?
But if both sides of something are wrong, then both must also be right: To choose not to do chemo would be to prioritize his happiness and comfort. To choose to do chemo would be to give him a chance of having a longer life.
The next day at County Hospital, I saw a man in the ICU whose elderly mother had been in an accident. He said, “I didn’t want her end to be like this.” I took him for a walk in the rooftop garden to discuss the surgery the patient’s doctors were planning to do. (Tsk!) The man said, “Would it be wrong to let her go?” I told him that he should feel empowered to decline any treatment for his mother he didn’t think made sense, and then I wondered if I was being too blunt. I couldn’t recall ever hearing any palliative care physician use those words.
I discussed it with Robert, and he said sometimes the chaplain’s role is to be blunt, so I guess that was OK. I asked him if it angers non-palliative care doctors when the palliative care team meets with a patient or family, and then the patient or family declines treatment the primary team was all set to go ahead with, or does that rarely happen because a doctor who believes in aggressive treatment simply won’t engage the palliative care team? Robert agreed that the latter is how it usually goes.
The patient cannot directly request a palliative care consultation. It has to come from a doctor. Usually, a doctor will relay a patient’s request to the palliative care team, but not always. If the patient of a doctor who believes in aggressive treatment requests a palliative care consultation and the doctor does pass on that request, then it can happen that a palliative care attending physician dukes it out with a non-palliative care attending physician. “Clash of egos” is the phrase I believe Robert used.
He said that in such a dispute, the primary team physician will typically point out that he is the one with the longer relationship with the patient and that not two days ago, the patient said she really wanted a fourth round of chemotherapy.
As for Hammett, trying to predict the future didn’t seem to be helping me to make a decision, so I thought about what values might apply, and concluded that any choice I made would be made out of love. Hammett himself was bulking up rather astonishingly, thanks to the prednisone. In two days, he went from 6.75 pounds to 7.5 pounds! He seems happy enough, but not quite like himself. Certain routines he has had for a long time have suddenly been abandoned, though he still does a lot of things he has always done. One new thing is that he has taken to clambering onto my lap, underneath the table, when I’m eating breakfast. It’s nice to have his warm little body there for a time.
Dr. Press had said that if we were going to try chemo, we should start ASAP, because once cancer starts to be resistant to prednisone, as it will soon enough, it also becomes more resistant to chemotherapy. Being urged to hurry up was a red flag. Katy Butler, in her wonderful book Knocking on Heaven’s Door: The Path to a Better Way of Death writes about the perils of Fast Medicine, where people feel hurried into decisions that turn out to have catastrophic consequences.
The following day, I told my co-worker Nevada about my dilemma. She said, “I don’t know about chemo for an old cat. If he were young … .” In the end, something my mother said helped me make the decision, which was not to do chemotherapy. She pointed out that Hammett’s quality of life was not the only consideration—that mine also would be affected. She said that if Hammett were to undergo chemotherapy, I would be worried about it every single day. This is correct. I’d be worried about whether it was working and if he was unhappy. I’d be worried about this symptom and that symptom. I’d be worried about spending so much money. If the chemo didn’t work, I’d be worried about that (and I’d also feel guilty that I had made the end of his life miserable). If it did work, I’d be worried about it ceasing to work—which it is guaranteed to do, sooner or later. (My mother also pointed out that once upon a time, we didn’t have to make these kinds of decisions: If a cat got cancer, it died of cancer, and that was all there was to it.)
So Hammett continues on his prednisone and is still eating like a horse. His cat sitter said he might live years on prednisone. The internet says more like a couple of months, maybe six at the most.
But if both sides of something are wrong, then both must also be right: To choose not to do chemo would be to prioritize his happiness and comfort. To choose to do chemo would be to give him a chance of having a longer life.
The next day at County Hospital, I saw a man in the ICU whose elderly mother had been in an accident. He said, “I didn’t want her end to be like this.” I took him for a walk in the rooftop garden to discuss the surgery the patient’s doctors were planning to do. (Tsk!) The man said, “Would it be wrong to let her go?” I told him that he should feel empowered to decline any treatment for his mother he didn’t think made sense, and then I wondered if I was being too blunt. I couldn’t recall ever hearing any palliative care physician use those words.
I discussed it with Robert, and he said sometimes the chaplain’s role is to be blunt, so I guess that was OK. I asked him if it angers non-palliative care doctors when the palliative care team meets with a patient or family, and then the patient or family declines treatment the primary team was all set to go ahead with, or does that rarely happen because a doctor who believes in aggressive treatment simply won’t engage the palliative care team? Robert agreed that the latter is how it usually goes.
The patient cannot directly request a palliative care consultation. It has to come from a doctor. Usually, a doctor will relay a patient’s request to the palliative care team, but not always. If the patient of a doctor who believes in aggressive treatment requests a palliative care consultation and the doctor does pass on that request, then it can happen that a palliative care attending physician dukes it out with a non-palliative care attending physician. “Clash of egos” is the phrase I believe Robert used.
He said that in such a dispute, the primary team physician will typically point out that he is the one with the longer relationship with the patient and that not two days ago, the patient said she really wanted a fourth round of chemotherapy.
As for Hammett, trying to predict the future didn’t seem to be helping me to make a decision, so I thought about what values might apply, and concluded that any choice I made would be made out of love. Hammett himself was bulking up rather astonishingly, thanks to the prednisone. In two days, he went from 6.75 pounds to 7.5 pounds! He seems happy enough, but not quite like himself. Certain routines he has had for a long time have suddenly been abandoned, though he still does a lot of things he has always done. One new thing is that he has taken to clambering onto my lap, underneath the table, when I’m eating breakfast. It’s nice to have his warm little body there for a time.
Dr. Press had said that if we were going to try chemo, we should start ASAP, because once cancer starts to be resistant to prednisone, as it will soon enough, it also becomes more resistant to chemotherapy. Being urged to hurry up was a red flag. Katy Butler, in her wonderful book Knocking on Heaven’s Door: The Path to a Better Way of Death writes about the perils of Fast Medicine, where people feel hurried into decisions that turn out to have catastrophic consequences.
The following day, I told my co-worker Nevada about my dilemma. She said, “I don’t know about chemo for an old cat. If he were young … .” In the end, something my mother said helped me make the decision, which was not to do chemotherapy. She pointed out that Hammett’s quality of life was not the only consideration—that mine also would be affected. She said that if Hammett were to undergo chemotherapy, I would be worried about it every single day. This is correct. I’d be worried about whether it was working and if he was unhappy. I’d be worried about this symptom and that symptom. I’d be worried about spending so much money. If the chemo didn’t work, I’d be worried about that (and I’d also feel guilty that I had made the end of his life miserable). If it did work, I’d be worried about it ceasing to work—which it is guaranteed to do, sooner or later. (My mother also pointed out that once upon a time, we didn’t have to make these kinds of decisions: If a cat got cancer, it died of cancer, and that was all there was to it.)
So Hammett continues on his prednisone and is still eating like a horse. His cat sitter said he might live years on prednisone. The internet says more like a couple of months, maybe six at the most.
BRBPR
That’s bright red blood per rectum.
A few days after my last post, I woke up to find a good amount of diarrhea produced by Hammett, including a bit of bright red blood. I carried him over to the vet in tears and was relieved when I saw his cat sitter standing out front on a break from work. She said that bright red blood is no big deal; dried brown blood would be the thing to worry about. I thanked her for talking me down, and she said, “You’re going to have to do that for yourself every day.”
Dr. Press agreed about the blood, saying it probably meant Hammett’s GI tract was inflamed. He prescribed antibiotics. (No blood seen since then, or diarrhea.) We had a discussion about chemotherapy and I decided to pay $300 for an oncology consultation. I asked if the cancer had likely metastasized already and Dr. Press said lymphoma is systemic (so, yes, by definition). I mentioned that Hammett’s bloodwork has consistently shown that his kidneys look great in the kidney failure sense and Dr. Press said that labwork cannot detect kidney problems until kidney function is 75 percent gone! This was news to me. Also, the methimazole he has been on for nearly five years for hyperthyroidism is an appetite suppressant. I never knew that, either.
Regarding chemotherapy, Dr. Press said the number-one objective would be for Hammett to thrive and feel great, so if he didn’t seem well after a treatment, that treatment would not be given again, or would be given differently. Dr. Press suggested that one approach would be for me to decide on my budget and we could offer treatment until that amount of money had been spent.
But it seems to me that if $10K might result in seven months of remission, spending one third of that might result in one third of seven months of remission, or even less, and then that would be spending what is still a decent chunk of money for not very much time at all. Also, I could easily see this being a slippery slope: If he seemed better after one month of chemo, I might well be tempted to pay for another, and then a third. Or if he didn’t seem better after a month, I might think that maybe a second month might do the trick.
And I also suspect that if Hammett did seem ill after a given day of treatment, I would be told that of course some fatigue is to be expected, or that I needed to give it a little more time for the chemo to kick in. That is, I think the thing about the number-one objective being for Hammett to feel great would prove to be ephemeral in practice. (That is, hogwash.)
But! What if he actually could have many months of comfortable remission? When I got the oncologist’s report, I saw that some cats actually live years after chemotherapy. I also saw that his suggested protocol was 22 weeks, not the 12-16 originally mentioned, meaning the whole thing would be closer to $15K.
A few days after my last post, I woke up to find a good amount of diarrhea produced by Hammett, including a bit of bright red blood. I carried him over to the vet in tears and was relieved when I saw his cat sitter standing out front on a break from work. She said that bright red blood is no big deal; dried brown blood would be the thing to worry about. I thanked her for talking me down, and she said, “You’re going to have to do that for yourself every day.”
Dr. Press agreed about the blood, saying it probably meant Hammett’s GI tract was inflamed. He prescribed antibiotics. (No blood seen since then, or diarrhea.) We had a discussion about chemotherapy and I decided to pay $300 for an oncology consultation. I asked if the cancer had likely metastasized already and Dr. Press said lymphoma is systemic (so, yes, by definition). I mentioned that Hammett’s bloodwork has consistently shown that his kidneys look great in the kidney failure sense and Dr. Press said that labwork cannot detect kidney problems until kidney function is 75 percent gone! This was news to me. Also, the methimazole he has been on for nearly five years for hyperthyroidism is an appetite suppressant. I never knew that, either.
Regarding chemotherapy, Dr. Press said the number-one objective would be for Hammett to thrive and feel great, so if he didn’t seem well after a treatment, that treatment would not be given again, or would be given differently. Dr. Press suggested that one approach would be for me to decide on my budget and we could offer treatment until that amount of money had been spent.
But it seems to me that if $10K might result in seven months of remission, spending one third of that might result in one third of seven months of remission, or even less, and then that would be spending what is still a decent chunk of money for not very much time at all. Also, I could easily see this being a slippery slope: If he seemed better after one month of chemo, I might well be tempted to pay for another, and then a third. Or if he didn’t seem better after a month, I might think that maybe a second month might do the trick.
And I also suspect that if Hammett did seem ill after a given day of treatment, I would be told that of course some fatigue is to be expected, or that I needed to give it a little more time for the chemo to kick in. That is, I think the thing about the number-one objective being for Hammett to feel great would prove to be ephemeral in practice. (That is, hogwash.)
But! What if he actually could have many months of comfortable remission? When I got the oncologist’s report, I saw that some cats actually live years after chemotherapy. I also saw that his suggested protocol was 22 weeks, not the 12-16 originally mentioned, meaning the whole thing would be closer to $15K.
Monday, January 20, 2020
Sentry
Hammett guarding our new pressure cooker.
Furthermore, I am not sure it is proper to spend a small fortune to keep a terminally ill pet alive for several extra months when there are people sleeping on the sidewalk, even if it is the most precious cat ever, as this picture demonstrates. If there were the possibility of an actual cure, that might be different, but there is not.
(Click photo to enlarge.)
Furthermore, I am not sure it is proper to spend a small fortune to keep a terminally ill pet alive for several extra months when there are people sleeping on the sidewalk, even if it is the most precious cat ever, as this picture demonstrates. If there were the possibility of an actual cure, that might be different, but there is not.
(Click photo to enlarge.)
Chemotherapy for a Cat
Now we have arrived at the reason I just put up so many posts in a row: because I needed to say this, and didn’t want to say it and then veer months into the past in subsequent posts. I took Hammett to the vet a couple of weeks ago because he lost a quarter of a pound in one week. His weight had been hovering around seven pounds for a year or so; all of a sudden, he weighed six and three-quarters pounds. I also told Dr. Press that his hind end had looked a little wobbly a few times.
Dr. Press suggested that we do bloodwork and urinalysis, followed by an ultrasound if the first two tests didn’t find anything. The first two tests didn’t find anything. Dr. Press said his bloodwork, including in regard to his kidneys, looked great. I scheduled the ultrasound, and then almost decided to cancel it. Hammett seemed to have perked up, and veterinary bills often seem astoundingly large. But then I decided that it’s just one of the rituals of being a cat owner to periodically pay a small fortune to find out nothing is wrong.
I was standing outside The Butcher’s Son (an all-vegan deli in Berkeley) waiting for a friend from school to join me for lunch when I got a call saying Dr. Press would like to talk to me. I was expecting only a call saying when to pick Hammett up after his ultrasound, so this was worrisome. K. and I paced up and down University Ave. while I waited for Dr. Press to come on the line. When he did, he said that the ultrasound had found two abnormalities: both kidneys looked abnormal, and Hammett’s pancreas was inflamed. It was the day Hammett turned thirteen and three-quarters years old.
“I’m worried that this is lymphoma,” Dr. Press said.
K. and I had an absolutely scrumptious lunch, and an interesting conversation. I was able to put Hammett out of my mind after sharing with K. what Dr. Press had said, but after she and I parted later, I walked to BART in tears and wept pretty much all the way back to the city.
When I fetched Hammett, I was given a bottle of prednisone, which Dr. Press said to start right away. It was in liquid form, and was a nightmare to administer. Hammett, a sick little cat of six and three-quarters pounds, fought like a champion wrestler to avoid it, and after I got it into his mouth, he foamed at the mouth horribly.
We went through the same ordeal the following morning, the following night, and the morning after that, while we waited for the results of a needle aspiration of his kidneys. By then, I was ready to euthanize that very day, before I had to put Hammett through taking prednisone again. The bottle said it had to be given every 12 hours, and the person at the front desk at the vet had said those instructions had to be followed precisely.
Dr. Press called that day to say that Hammett does indeed have renal lymphoma. I had been thinking that if it turned out Hammett had cancer, no way was I going to agree to chemotherapy for him, but that is precisely what Dr. Press suggested. He said only 10% of cats get sick from the chemo, and that it has an 80% chance of affording a remission of 10-12 months. Hammett would need to spend one day a week at the vet’s for three or four months, at a cost of $600-700 per treatment: $10,000 total, give or take.
Dr. Press said the prednisone does shrink tumors, but only for “several weeks.” He said that chemo would not be an option unless Hammett responds well to the prednisone. I said that if he did respond well to the prednisone but I was unable to spend $10,000 on cat chemotherapy, would he support Hammett’s being euthanized in that case? He said that he would, and that we could also discuss some cheaper options.
As for the prednisone, he said it comes in pill form, and that the doses do not have to be 12 hours apart. He said you can give them one hour apart if you feel like it. I went and picked up the pills, which are very easy to give Hammett using a pill shooter.
At the moment, he is doing fine in that he is eating, pooping and peeing, and seems reasonably content. He’d lost even more weight when I weighed him yesterday.
I have shed many tears since the day of the ultrasound, and even had moments of suffocating panic, for instance, when I picture the spot by the wall where Hammett likes to lie on a sunny day. It is a beautiful sunny day, but he isn’t there, because he is dead. The sweetest, most placid and most precious cat on earth has gone. I am trying to balance the natural and real experience of anticipatory grief with not terrifying myself with excursions into the imaginary future. It will be a future version of Bugwalk who sees that spot with no cat in it. It’s not happening right now.
I have mulled over the chemotherapy option. If I had to, I could come up with that money; I would be spending money I had planned to save. I love the thought of having ten or 12 more months with Hammett. Saying no to the possibility feels like I’m doing something bad to him, but that is not true. There will never be a moment when he thinks, “I’m angry that she deprived me of what could have been ten great months!” It’s all the same to him whether he has a peaceful death ten minutes from now or a year from now. He will not be able to judge the difference between those; he won’t be here to do it.
What he can tell the difference between is whether he’s snoozing peacefully in his little bed by the radiator or being stuffed in his cat carrier and hauled over to the vet. Even if he was going for a weekly spa day, he would not enjoy having to leave his house. Also, I have a gut feeling that he would be in the 10% made ill by chemotherapy and/or the 20% who don’t end up in remission. He has had a number of health challenges throughout his life. I wish he were going to live to be 20, but it’s wonderful that he made it to be thirteen and three-quarters. My mother’s favorite cat of all time died at just seven or eight years old. Dr. Press commended me for having taken “meticulous” care of Hammett.
Hammett has cancer. He is going to die. I understand from the Internet that chemotherapy is much less awful for a cat than for a human, but I have decided to embrace the inevitable and focus exclusively on his quality of life. Once that is gone, I will have him euthanized. If possible, his last day will be a good one, or at least not totally terrible.
I named this post as I did this so others in the same boat might find it. I have read so many posts from people who are glad they chose chemotherapy for their cat that it made me worry that I am doing the wrong thing. But working in palliative care, reading book after book about it, and having just written a thesis about it have bolstered my feeling that it is OK to make a different choice, as has talking with trusted advisors, including Lisa C.; both of my parents; Hammett’s cat sitter, who is a vet tech; and, somewhat weirdly, the manager of my apartment building. There has been some strain between us since the flood in May, but after I texted her about Hammett, she immediately sent a warm and loving response, with many heart emojis, and told me to follow my heart when it comes to choosing care for Hammett.
I have found out what his own vet charges for euthanasia and cremation, and have also spoken with an emergency animal hospital that is always open, and with a vet that does house calls. (The latter said that if you arrange for euthanasia at home but change your mind by the time the vet arrives, they just charge for a consultation and go away again. I thought that was nice. That is precisely why Thelonious was euthanized at the emergency animal hospital: I couldn’t bear the idea of waiting for someone to come over to kill my cat. My mother kindly said, “You don’t have to do that. If it would be easier to take her somewhere, then it is fine to do that.” Tom came with me.)
I can clearly remember the day I adopted Hammett. I remember the first night he was here, looking fearfully over his shoulder at Tom, and crawling up into my armpit after I went to bed.
Here’s the first line of the medical log I have kept for him all his life:
Adopted on 10/14/06. :-)
How quickly it has gone.
Dr. Press suggested that we do bloodwork and urinalysis, followed by an ultrasound if the first two tests didn’t find anything. The first two tests didn’t find anything. Dr. Press said his bloodwork, including in regard to his kidneys, looked great. I scheduled the ultrasound, and then almost decided to cancel it. Hammett seemed to have perked up, and veterinary bills often seem astoundingly large. But then I decided that it’s just one of the rituals of being a cat owner to periodically pay a small fortune to find out nothing is wrong.
I was standing outside The Butcher’s Son (an all-vegan deli in Berkeley) waiting for a friend from school to join me for lunch when I got a call saying Dr. Press would like to talk to me. I was expecting only a call saying when to pick Hammett up after his ultrasound, so this was worrisome. K. and I paced up and down University Ave. while I waited for Dr. Press to come on the line. When he did, he said that the ultrasound had found two abnormalities: both kidneys looked abnormal, and Hammett’s pancreas was inflamed. It was the day Hammett turned thirteen and three-quarters years old.
“I’m worried that this is lymphoma,” Dr. Press said.
K. and I had an absolutely scrumptious lunch, and an interesting conversation. I was able to put Hammett out of my mind after sharing with K. what Dr. Press had said, but after she and I parted later, I walked to BART in tears and wept pretty much all the way back to the city.
When I fetched Hammett, I was given a bottle of prednisone, which Dr. Press said to start right away. It was in liquid form, and was a nightmare to administer. Hammett, a sick little cat of six and three-quarters pounds, fought like a champion wrestler to avoid it, and after I got it into his mouth, he foamed at the mouth horribly.
We went through the same ordeal the following morning, the following night, and the morning after that, while we waited for the results of a needle aspiration of his kidneys. By then, I was ready to euthanize that very day, before I had to put Hammett through taking prednisone again. The bottle said it had to be given every 12 hours, and the person at the front desk at the vet had said those instructions had to be followed precisely.
Dr. Press called that day to say that Hammett does indeed have renal lymphoma. I had been thinking that if it turned out Hammett had cancer, no way was I going to agree to chemotherapy for him, but that is precisely what Dr. Press suggested. He said only 10% of cats get sick from the chemo, and that it has an 80% chance of affording a remission of 10-12 months. Hammett would need to spend one day a week at the vet’s for three or four months, at a cost of $600-700 per treatment: $10,000 total, give or take.
Dr. Press said the prednisone does shrink tumors, but only for “several weeks.” He said that chemo would not be an option unless Hammett responds well to the prednisone. I said that if he did respond well to the prednisone but I was unable to spend $10,000 on cat chemotherapy, would he support Hammett’s being euthanized in that case? He said that he would, and that we could also discuss some cheaper options.
As for the prednisone, he said it comes in pill form, and that the doses do not have to be 12 hours apart. He said you can give them one hour apart if you feel like it. I went and picked up the pills, which are very easy to give Hammett using a pill shooter.
At the moment, he is doing fine in that he is eating, pooping and peeing, and seems reasonably content. He’d lost even more weight when I weighed him yesterday.
I have shed many tears since the day of the ultrasound, and even had moments of suffocating panic, for instance, when I picture the spot by the wall where Hammett likes to lie on a sunny day. It is a beautiful sunny day, but he isn’t there, because he is dead. The sweetest, most placid and most precious cat on earth has gone. I am trying to balance the natural and real experience of anticipatory grief with not terrifying myself with excursions into the imaginary future. It will be a future version of Bugwalk who sees that spot with no cat in it. It’s not happening right now.
I have mulled over the chemotherapy option. If I had to, I could come up with that money; I would be spending money I had planned to save. I love the thought of having ten or 12 more months with Hammett. Saying no to the possibility feels like I’m doing something bad to him, but that is not true. There will never be a moment when he thinks, “I’m angry that she deprived me of what could have been ten great months!” It’s all the same to him whether he has a peaceful death ten minutes from now or a year from now. He will not be able to judge the difference between those; he won’t be here to do it.
What he can tell the difference between is whether he’s snoozing peacefully in his little bed by the radiator or being stuffed in his cat carrier and hauled over to the vet. Even if he was going for a weekly spa day, he would not enjoy having to leave his house. Also, I have a gut feeling that he would be in the 10% made ill by chemotherapy and/or the 20% who don’t end up in remission. He has had a number of health challenges throughout his life. I wish he were going to live to be 20, but it’s wonderful that he made it to be thirteen and three-quarters. My mother’s favorite cat of all time died at just seven or eight years old. Dr. Press commended me for having taken “meticulous” care of Hammett.
Hammett has cancer. He is going to die. I understand from the Internet that chemotherapy is much less awful for a cat than for a human, but I have decided to embrace the inevitable and focus exclusively on his quality of life. Once that is gone, I will have him euthanized. If possible, his last day will be a good one, or at least not totally terrible.
I named this post as I did this so others in the same boat might find it. I have read so many posts from people who are glad they chose chemotherapy for their cat that it made me worry that I am doing the wrong thing. But working in palliative care, reading book after book about it, and having just written a thesis about it have bolstered my feeling that it is OK to make a different choice, as has talking with trusted advisors, including Lisa C.; both of my parents; Hammett’s cat sitter, who is a vet tech; and, somewhat weirdly, the manager of my apartment building. There has been some strain between us since the flood in May, but after I texted her about Hammett, she immediately sent a warm and loving response, with many heart emojis, and told me to follow my heart when it comes to choosing care for Hammett.
I have found out what his own vet charges for euthanasia and cremation, and have also spoken with an emergency animal hospital that is always open, and with a vet that does house calls. (The latter said that if you arrange for euthanasia at home but change your mind by the time the vet arrives, they just charge for a consultation and go away again. I thought that was nice. That is precisely why Thelonious was euthanized at the emergency animal hospital: I couldn’t bear the idea of waiting for someone to come over to kill my cat. My mother kindly said, “You don’t have to do that. If it would be easier to take her somewhere, then it is fine to do that.” Tom came with me.)
I can clearly remember the day I adopted Hammett. I remember the first night he was here, looking fearfully over his shoulder at Tom, and crawling up into my armpit after I went to bed.
Here’s the first line of the medical log I have kept for him all his life:
Adopted on 10/14/06. :-)
How quickly it has gone.
Breakfast of Bugwalk
I've been trying to think of a name for this salad I have nearly every morning and haven't come up with anything that seems quite right, but here's what it looks like. There are two cups of tea because I used to finish my first cup of tea and wish I had another, so now I just make two to begin with.
(Click photo to enlarge.)
(Click photo to enlarge.)
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