Endoscopy

Yesterday, Sumis underwent an upper GI endoscopy. She was put under general anesthesia before a veterinary internal medicine specialist inserted a videoscopic tube into her throat/esophagus and threaded it down into her stomach and small intestine. The doctor discovered several lesions in both her stomach and small intestine. He took biopsies of these lesions and sent them out to a veterinary pathologist. We are awaiting the final results today. Endoscopy involves a process called insufflation, which means that they inflate the stomach and bowel in order to get a better look at everything that is going on. Needless to say, some of the air used to expand the GI tract remains and causes bloating and discomfort. When Sumis and I returned home yesterday, she was still very groggy from the anesthesia. She wanted to be in a dark, quiet room, but wanted me close by. So, I stayed with her as she recovered. I talked to her, petted her, and just stayed close. She got up at one point to use the litter box and must have tried a little water on her way back to bed. This caused a violent episode of vomiting. When the nausea had passed, I cleaned her up and she settled back in. The next time she got up, the same thing happened. This time though, she collapsed into her vomit. In that moment, I panicked. She looked like she was letting go, giving up. I picked her up in a towel, cleaned her up and called a close friend of mine who is a veterinarian. Yes, my significant other is a veterinarian, but diagnosing and treating your own pets is next to impossible. You lose perspective and objectivity ever so quickly. Talking to this friend helped tremendously. We gave Sumis something for her nausea and a small amount of pain medication to take the edge off of the gas pain without slowing down the gut too much. From that point on, she rested comfortably. This morning she is still groggy and I think exhausted. But just her small mannerisms look more like Sumis than I have seen in days.

Perhaps the most important part of the conversation I had with my friend was about setting parameters. Do it now, she told me, while you still have perspective. How far do you want to go with treatment? What indicators are you going to use to tell you that it is time? While this was hard to think about, heart-wrenching really, she was right. I did have perspective and I have always promised Sumis – no suffering. I will not prolong her life with invasive procedures just for a week, or two, or three. Before continuing, let me say that this is a very personal decision that not only differs from person to person but also from pet to pet. Every pet has different tolerances and different strengths. As my significant other reminds me, “she will tell you when it is time. You will know if you are listening.” I knew before my friend asked where I would draw the line, but it helped to say it out loud and to tell someone else. I will treat her cancer with chemo, provided that she tolerates it well. But if the disease metastasizes into other areas I will not put her through invasive surgery to briefly prolong her life, and I will not make her suffer any painful secondary ailments that may arise. “Okay, that is good to know,” my friend told me. And so I put it out there, I said the words, and in doing so turned my world upside down by acknowledging head on Sumis' mortality. She will not live forever; she will not set the record for the longest lived cat in history. But I still have many precious moments ahead with her and will always have our nine years together as a part of me.

So, now I write, wait and remind myself of the Serenity Prayer:
God (whoever that might be)
Grant me the serenity to accept the things I cannot change (her diagnosis and her sickness)
The courage to change the things I can (her quality of life)
And the wisdom to know the difference (I know it in my head, but not quite yet in my heart).