For Sepsie

While I love all animals, I’m known for being partial to cats. This wasn’t always the case – in fact, prior to having a cat, I really never understood their appeal. I questioned the redeeming value of owning something so aloof and independent. Dogs, with their unconditional love and constant want to please, were my preferred pet of choice.

Everything changed when my brother’s in laws asked me to take in an unusually social kitten that lived under the deck in their yard along with his feral mama and equally unfriendly littermates. I was a graduate student, devoid of any real responsibilities, on a meandering path towards becoming a veterinarian, and therefore the logical choice out of all the family members to adopt the kitten. I named him Cosmo, after the irrevocably laughable and notoriously clumsy character on the TV sitcom Seinfeld. Despite his tiny stature, Cosmo had tremendous personality, behaving more dog-like than I’d ever expect from a feline. I learned how to love cats because of, and sometimes in spite of, him.

Cosmo was a part of my life for only four years. He passed from complications related to infection with the feline leukemia virus. I was devastated and lonely without him. I’d grown accustomed to finding the tiny toy mice he would leave as a gift in my shoes, or his fervent greetings when I arrived home after class. I missed his kneading paws and throaty purr as we both drifted off to sleep. I tried living without a cat, but my home felt bizarrely empty. I was a veterinary student at the time, with the typical fortune of being surrounded by an abundance of animals needing homes, and it wasn’t long before I found another kitten to raise. Fast forward several years, numerous geographical locations, and one marriage later, and the number of cats I owned rose to five. Yes, five cats in one house. That was, until about two weeks ago.

Sepsis, or Sepsie as I called her, came to me during the first year of my medical oncology residency. She was my “first second cat”. The one that taught me bringing another pet into your household causes you to multiply your love rather than divide it. We were introduced during her brief stay in the SPCA wards of the teaching hospital. She was estimated to be about five months old and had a rocky start to her life, having been taken from a hoarder’s household. She was there as part of the student spay/neuter program and scheduled for surgery the day after I met her.

I visited the SPCA wards frequently, as a means to diffuse some of the stress of my training. Petting and snuggling up with stray cats and kittens was my form of meditation. I’d been considering adopting another cat for some time but wasn’t quite ready to open my home to another pet, already harboring guilt about not devoting enough time to my current animals; a fat young tabby and geriatric dachshund.

Of the many cats I came across in the ward, I couldn’t tell you a specific reason why Sepsie was the right one for me. Perhaps it was how she purred incessantly, even immediately after her spay surgery. Or it was her petite features, or that she was such a pretty cat, or simply fate that brought her to me at the perfect time. I just knew she needed to be a part of my family, and vice versa.

Sepsie was a mellow kitten, who preferred to snuggling and purring to practicing pouncing and clawing. She patiently endured my long work and study hours, eagerly waiting for me to return from the hospital or put down my research articles and spend time with her. She accepted my future husband when we started dating during my third year of training, willingly using his lap for a bed and sharing her love among the two of us equally. She did not, and would never, accept his cat, having become accustomed to her less crowded lifestyle outside of the hoarder’s home.

Sepsie moved with me six times. Some were short stints where we spent a few weeks in a temporary arrangement, while other were long-term residencies. She was there during the highlights of my life, including becoming board certified as a veterinary oncologist, starting my first “real” job, my engagement and wedding, and my move to North Carolina to take a faculty appointment at the veterinary school. Equally as important, she was with me during the darkest times including the loss of both of her original animal companions and several life choices and health issues that resulted in outcomes far less positive than I’d originally hoped for.

Perhaps it was our vagabond ways or her perpetual youthful behavior that confused me as to the length of time I had her. In the early years, whenever asked how old she was, I stumbled and had to count upwards from the year I adopted her. Later on, I’d always says she was about 9 or 10 years old, even when I knew she’d been with me much longer.

One morning this past February, while readying myself for work, I found Sepsie curled up asleep on the corner of my bed. This was abnormal as she’d usually be bouncing around the house, enthusiastically asking for food. I went over and pet her and she woke up and purred and I figured, perhaps she’s just getting older and needs a little more time to get going in the morning. I left for work and didn’t give her behavior much thought. When I returned, late that evening, she was not waiting for me at the door. This, along with the unusual lethargy earlier that morning, caused concern for something more serious. I frantically searched the house and found her, closed eyed and scrunched up in the corner of my closet. When I attempted to pick her up and bring her out, she growled.

I’ve always said cats are not creative in pronouncing signs of illness. Typically, regardless of the underlying cause, they will stop eating, hide in areas they would normally not be found, and potentially show other signs such as weight loss, vomiting, or diarrhea. Knowing this, I did a brief exam and when I palpated her belly, I felt a mass effect towards the mid-portion of her abdomen. I wasn’t sure if it was truly a mass, or potentially something stuck in her digestive tract. She was definitely the kind of cat to eat things she shouldn’t and I’d remembered that earlier in the week I’d lost a hair tie.

My husband and I debated the pros and cons of bringing her back to his hospital to further investigate the cause of her signs. Despite the late hour and both of us having a full schedule at work the following day and me being 33 weeks pregnant, we knew the only option was to try to get some answers as quickly as possible.

We considered hypothetical algorithms on the drive to the hospital:

If it looked like a foreign body, would my husband do surgery that evening or the following day?

If it looked like a tumor, we would consider aspirates and submitting slides to the clinical pathologists at my teaching hospital?

If it was something terrible would we do everything or nothing?

How would we know what the right choice would be?

We continued the “if/then” conversation over the miles, and I tried focusing on how we could figure out what was wrong and what I thought would be the “right” thing to do.

When we arrived at the hospital, we performed lab work and radiographs and a brief ultrasound. Results showed no clear evidence of an intestinal obstruction, a possible mass in her intestines or enlarged lymph nodes, an abnormal appearance to her liver, elevated liver values, and anemia. The signs pointed towards a diagnosis of cancer, but we couldn’t know for sure. It was late and we were forced to leave with little answers but kept a plan to have aspirates done the following day.

Unfortunately, as can frequently happen, the aspirates returned inconclusive as to a cause of her signs. Our options were to take her to surgery for biopsies or to not put her through additional tests and keep her as comfortable as possible. During the 48 hours we considered our choices, Sepsie’s behavior returned to complete normalcy.

Many times, as a veterinary oncologist, I’d listened to pet owners debate the same options we’d considered in some form or another. Whether they were facing a known cancer diagnosis, or a suspected one, I’d witnessed their struggle between wanting to know and do more for their pet and ensuring their best interests are met. I’d always felt I connected with their intentions but it wasn’t until I was placed in the exact same scenario myself that I truly could understand how difficult it was.

Sepsie was a cat who did not travel well and would be excessively stressed if asked to undergo multiple medical procedures and treatments. She despised any physical manipulation that wasn’t done on her own terms. She was older and whatever was causing her signs was likely serious and only potentially manageable but would not be curable. The other cats had clearly noted the changes and had begun chasing her around and cornering her in areas where she could not escape.

Given these limitations, we ultimately chose to do nothing further, and to enjoy the time we had left. Our goal was to limit her to as few bad days as possible.

In the ensuing weeks, while my husband and I hovered over Sepsie, searching for signs of pain or illness, she continued enjoy life as she usually did. Potentially feeding off of our anxiety, she grew clingier and more food motivated than ever before. We would joke about how annoying she was, behaving more like a dog than a cat when it came to begging for treats or stealing food off our plates. She’d dig scraps out of the sink and eagerly awaited her special treat of canned food every morning.

We repeated an ultrasound and lab work after about a month to monitor her progression. Miraculously, the mass effect had resolved, but her liver still appeared abnormal and her liver enzymes had worsened, as did her anemia and she now had a low platelet count. She still seemed happy and we stuck to our decision to not pursue any aggressive measures. The only sign she showed was persistent weight loss, which prompted us starting her on an oral steroid as a palliative measure. This seemed to do the trick, not only further increasing her appetite, but also seemed to have stopped her weight loss.

For the duration of her illness, we achieved our goal, as Sepsie truly had no bad days. Until she had a terrible night. I was up with our newborn, when I heard her start vomiting. I considered leaving cleaning up after her until the morning, but figured since I was up already, I may as well just do it at that time. I was surprised to find a large amount of foul-smelling liquid that left the slightest pink tinge on the paper towels I used to wipe it up. Just as I returned to bed, Sepsie began vocalizing in the strange way cats do when they are extremely sick. I found her hiding in the corner of our bathroom, too weak to stand. She passed large amounts of diarrhea and began showing abnormal neurological signs. This all came on without warning, as just hours earlier she was begging for food while I ate my dinner.

Once again, my husband and I measured our options. Of course, we wanted to know why she had this sudden change in status and if there was anything we could do to help her. But overall, we faced the same considerations we’d had four months prior. We knew the right choice for her was to end her suffering, and to be grateful she had the amount of good time she did. We made the difficult decision to euthanize her just a few hours after she became sick.

Sepsie, I will miss you greeting me when I come home and your uncanny ability to know whether I’d entered through the front or back door. I keep looking to chase you off the kitchen countertops or away from my plate of food. I will miss your constant purring and watching you snuggle up with my husband at the end of a long day. I hope you’re sleeping deeply on a balcony in heaven, where you chase bugs, eat people food, and never have to have your nails trimmed. I hope you’ve found Nadir and Schnitzie and that the three of you are happy together again.

Thanks for being the best girl you could be to me. I’ll think of you always.

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