She's gone, my God, she's gone...

Cali is gone.  She was euthanized today at 1400.  She told me she was done.  She needed me to be her champion, her hero, her savior.  I did the best I could, aching and resisting all the way.  It came down to a choice between her suffering and my needs.  She won, using a desperate combination of obvious fatigue, tenting skin turgor, and painful sighs.  My needs are pitifully inadequate in comparison.  Dear sweet girl, you deserve a better level of existence.  I believe it awaits you.  

You will be sorely and constantly and truly missed.  You are my heart, you know my soul.  Your velvet ears have absorbed a million kisses and a million and one secrets of my soul.  I kissed them over and over as your tiny body cooled.  Emily said, 'Mom, kiss her ears while she's warm,' and I did.  These wise words from the girl, now doing woman's duty, who lost her sweet doggy less than two years ago.

It reminded me of when my ninety-three year old father-in-law died.  He was a DNR, Do Not Resuscitate. But, when the time came, my husband and mother-in-law were frozen, looking at me for answers.  I was not yet a nurse, but I had traversed the previous three years with him as an end-stage Alzheimer's patient caregiver, and I knew what he wanted and I knew what he would return to, if resuscitated.  I said, "He is a DNR."  The relief in the eyes staring desperately was palpable, measurable from a distance.   The hospital team and I arranged him on a bed, removed the ECG electrodes and cables.  As he lay in the hospital bed, I said, "Hold him while he's warm".  The words seemed harsh, but galvanized my husband to approach the body of his father and take it into his embrace, a hug that he says he will never forget.

I felt today like, if I held onto my puppy's body, some of her life force or energy would find it's way into me, through heat or smell or osmosis, and I would be a better person because of it.  I drank her doggy fragrance in, and poured my tears onto her soft fur.  She felt and smelled like ten years of love and tolerance and humor and laughter and forgiveness and virtue and purity.  She smelled like my Cali-girl.  I will so miss her and all she represents.  She embodies goodness in a crazy world full of badness.  She has been my antidote.

More later, I don't know when...

This sucks!

As I look back on my blog entries of the past week, I see a long list of 'Cali updates'.  Perhaps boring for the reader, but it sums up the focus of my thoughts and mental energy since Cali has been ill.  She is in the hospital, but yet with me, behind every conscious thought and every rote movement I make.  I can be deep in thought and analysis of a patient condition or personal conversation or charting vital signs, and suddenly, my tummy gets quivery and scared and my heart feels all achey.  Tears are just offstage, waiting in the wings to rush out.

Additionally, my hip continues to ache almost constantly, and give peaks of pain upon movement.  I chose not to go to work today, in order to stay off it for a few more days until I work next.  

All in all, it adds up to some very bad, no good, rotten, less than great days, as I used to tell my kids.  A gently sarcastic way of saying, 'This totally sucks'.  And, let me tell you, it does.  Suck.  My kids are safe and happy (as happy as college aged over achievers can be), I love my job, my marriage is solid, and I am grateful.  But, the rest of it sucks.  

Cali update; Sunday

Last night, the veterinarian surgeon called and said that Cali had gone into respiratory distress, and had to have thoracentesis performed, that is, needle drainage of the pleural space.  The labs on the fluid indicated huge quantities of protein.  She was transfused with protein and albumin, in an attempt to hold the liquid part of the blood in the vascular spaces.  Dr. Vornock suggested we visit at 0800 today to make a decision.  I cried a lot and slept poorly.

When Emily, Garrett and I arrived at the OSU hospital, we were told that Cali had rejected her transfusion, and was in respiratory distress again.  She has also begun vomiting again.  She said that she has been placed on broad spectrum antibiotics 'in hopes'.  The vet admitted that she is in 'uncharted territory'.  Studies indicate that post-op day 5 is the peak of complications in biliary surgery, and this is it.  She said that we could assess her during our visit to see if we think she is ready to quit fighting.  With heavy heart and hollow stomach, I went into the ICU.

Cali was sitting with her back to the cage front, enclosed in an oxygen environment.  When she heard my voice, she turned around, tried to walk to me and get out , and wagged her tail and licked my hands.  I put my face near the round port and she licked my face with her dry, pale pink little tongue.  The vet and students laughed and celebrated.  They were so impressed with her enthusiasm.  We took turns loving on her, but she looked past everyone else and gave me constant, direct eye contact. Finally, she leaned against me  and eventually fell asleep contentedly curled under my hand with her head on my hand.

She told me she is not done yet.  She said she wants to get this behind her and come home.  The kids and I concurred; she lives to fight on.  The drive home was better than the drive up.

 

Cali update, Saturday

Cali is doing better today.  Her bilirubin is down, lower than it has been since her initial blood draws oh, so long ago.  She is slightly less exhausted, and is manifesting some motility of the biliary tree and the jejunum.  Today, they will increase her j-tube feedings and offer chicken baby food to see if she has an appetite.

My son is of the opinion that this health crisis is in part due to Cali giving up on life, due to a sort of depression.  In the past two years, she has lost the two other dogs she has known since birth, Lacey the Beagle to old age, and Gordita her sister to a terrible drowning accident.  Meanwhile, I have been working long hours and the kids have all left home.  It makes perfect sense.  Even people die of very real diseases and conditions that have no identifiable cause other than sadness or grief.  We've all heard of the married couples who die within days or weeks or months of one another.

Dare we hope that our  little bean will come home to us?  I do, against all odds.  I do.

Cali update; Friday

Cali is worse today.  She now has pancreatitis.  The vet says her case is not clear cut, not black and white. To them, she does not seem like a terminal patient.  She might pull through.  Tomorrow marks the limit of the 6,000.00 dollars I authorized for her care.  Do we want to save her, or continue treating her?

I do not feel qualified to answer these questions.  If I had thought a week ago that she was terminal, I would have spared her the surgery, the pain, the separation from me and home, the confusing strange environment. God, I feel like a reluctant God.  If she dies anyway, what have I given her?  A week of hell.  (I know, I know, Monday morning quarterbacking...)

I err on the side of the fighting chance, I err on the side of illogical love.  I want her by my side again in the leather recliner.  I long to hear her dramatically drawn out crooning when I come home at the end of the work day.  God, spare me from selfishness and self-serving decisions.  Give me the strength to let go if I have to.

And, Cali girl, forgive me my need to hold out another day for a better prognosis.  

Love,  

Me

Bad day

I saw Cali yesterday; she was soooo sad.  Tubes everywhere, moaning rythmically and softly.  Today, she needs a transfusion of PBRCs, packed red blood cells.  She is still in critical condition, her survival up in the air.  Bilirubin is 2.4, down from 10.  She will not eat food.  High point of her day was when Emily visited, that really perked her up.  I needed to stay home and work to pay for all the care she is getting.  I would love to be with her.

I am so tired.  I had a cortisone injection in my right hip Wednesday, before I took Cali to Corvallis, for IT Band tendonitis and trochanteric bursitis, brought on by leg presses on a weight machine three months ago.  I am in physical therapy, also.  But, today, I just hurt like an old lady.  Took over ten minutes to limp to my car after work, in the rain.  

So, tonite, I go to an uneasy rest.  Worried, sore, and feeling my age.  The good news is that my middle son and my daughter checked in spontaneously to wish me well, check on Cali, and repeat their offers of financial support for her care.  All  my kids have done so.  Is that cool, or what?

Good night, more later.

Cali, post-op morning 1: 7:00 AM

Last night, following what turned out to be a three and a half hour surgery, the vet hospital called Emily to tell her that Cali had made it through surgery, where her gallbladder was removed and a stent placed to keep the common bile duct open until healing occurs.  She had a hypotensive event during the procedure and had to be administered vasoactive medication.  This is common in dogs having gallbladder surgery, I was forewarned, because harassment/manipulation of the gallbladder tends to stimulate the vagal nerve, the nerve responsible for the tone of the vasculature.

This morning, I called and spoke with the senior surgical student who is caring for Cali in the hospital.  Later, when I visit, I will speak with the surgeon.

She is in intensive care, with a jugular vein catheter delivering a constant rate of Fentanyl, an opiate pain reliever, and Hetastarch, a colloid intravenous fluid that holds intravascular fluid within the venous space, increasing blood pressure.  She has a percutaneous endoscopic gastrostomy (PEG) tube, a tube that opens a port from the outside directly into the stomach.  It is placed for the introduction of food and medication and liquid when she can digest them safely, which will probably be tomorrow.

She has voided this morning, and walked a bit, albeit unsteadily, all very good signs in a dog given eighteen hours to four days to live!

It is likely that she will be in the hospital for days.  We can visit her upon prior arrangement.  When I do, I will update you.  Thank you for your kind thoughts and prayers.  I will pass them on to our little girl.