April 20, 2005
Yesterday I was numb. Today I am miserable and crying. Even the beautiful weather turned miserable and crying today. I can't do anything I should be doing, so I've decided to write about Ripley's last 24 hours.
Ripley did pull out of the DKA. She had an ultrasound of her heart - perfect. The ultrasound of her abdomen was horrifying. Both kidneys extremely enlarged, a large area of the stomach wall thickened, thickening throughout the intestinal wall, changes in her spleen and liver. As Dr. Wise read me the report, I knew immediately that Ripley had lymphoma, probably starting in her kidneys. I've seen too many human ultrasounds with exactly this same pattern. And I also knew what the ultrasound didn't show - the probable tumor growing into her vena cava and the brain metastases. I'll never forget my first lymphoma patient, when I was a medical student. Ron was only in his early 30's, very healthy, and suddenly became ill. His lymphoma was like Ripley's. He didn't ever get well enough to go home. He was such a nice guy and craved grape popsicles. Everyday when I came in, I would bring two popsicles with me and go see Ron and we'd sit and talk while slurping on our popsicles. Of course, no matter how much I love and value my pets, the loss of a pet cannot ever begin to compare to the loss of a human friend. It is beyond my comprehension how people deal with the loss of a child. I am crazy with the loss of losing Ripley. How do people do it?
Dr. Wise and I talked about the options for definitive biopsy, the probable stage of the cancer, possible chemotherapeutic options, and the prognosis. Ripley's lymphoma was a lot worse than Eugene's, almost like a totally different cancer. Ripley was very debilitated by this advanced cancer. Looking back, I see that many of her odd, neurological type symptoms recently that had me so worried could very be explained by brain metastases. To say nothing of the extreme weight loss.
I told Dr. Wise that Paul and I would talk that evening and try to make some decisions. We went to the clinic after a long talk, not sure what we were going to do. Ripley was fairly alert, but still unable to walk much, and still refusing to eat or drink. We stroked her for awhile and then I just said, "Let's take her home, right now." So, the med tech called Dr. Wise, got discharge instructions, and left Ripley's IV catheter in place. We bundled up poor, weak Ripley and drove her home. She wanted to lie on the floor behind the driver's seat, her typical position when she travels by car. She cried out a few times when we hit bumps in the road but was otherwise collapsed quietly. Paul pulled into the driveway and we sat there a few seconds before I went around to take out Ripley. When I opened the door, Ripley lifted her head, then stood, then leapt out of the car into the pine needles. She pawed the pine needles a few times, then turned and with great haste for a cat that could barely walk, made a beeline for the front door. Paul and I were amazed and also had to laugh at her obvious determination, direction, and pace. She made it around the corner of the garage before she had to lie down and rest again but she was in site of the door! I picked her up and carried her to the door at which point she made another rally and leapt to the floor so she could lie down and rest once more. Beckley rushed up and starting licking her on the head and all the other animals gathered around. Ripley was home. We had made the right decision.
Ripley slowly made her way around the house, tough when you don't have much balance and can't walk more than 4 feet at a time. She visted all her places, made sure everything was in order, and I swear she smiled with relief. We took her to bed with us and held her, knowing our time was short. She was quite restless through the night and unable to sleep, clumsily jumping off the bed and continuing to slowly move from place to place.
In the morning, we still hadn't decided what we would do. Paul went to work and I stayed with Ripley. I made breakfast for us but she not only didn't want any milk, she didn't want to lie on the table, even with the blanket I put down for her. I called Paul to tell him she was actually worse and as I was talking to him, Ripley tried to jump off the table but instead fell onto her head in a heap. Horrible.
Paul came home for a few hours at lunch and I called and made an appointment for Ripley to be euthanized at 4 pm. I sat with her the last 3 hours and I thought she would die before that time. She was so exhausted and her breathing became so slow and shallow. I wish I'd had some pain medication to give her, or at least a sedative. She had the dry heaves about 2:30 but then laid on the bed with her head in my hand and seemed to sleep some. I wanted to lie there forever with her.
Paul came home to get Ripley and me and I wanted to shout, "NO," grab Ripley and run away. Paul was stronger, somehow. With Ripley lying on her side with my hand between her front legs rubbing her chest, with Paul's hand behind, Ripley slipped away. She truly slipped away. She was so weak, so close to death anyway, I couldn't even tell any difference after the injection was given. When Dr. Fasth put the stethoscope to Ripley's chest and confirmed she was gone, I couldn't believe it. She slipped away. Maybe she died before the injection. I don't know. I just know Ripley went to the Bridge very quietly with no indications at all to us.
I wrapped Ripley in her blanket and carried her out the door. Just as we stepped out, a large raindrop fell right in the center of the blanket. I looked up, surprised, as a rainshower started. It rains so rarely here in semi-arid Colorado. The last rain I saw was probably nine months ago. Ripley loved falling water. She loved to have the faucets and the shower dripping slowly so she could play with the drops. The rain came from her, from Rainbow Bridge. Just before we got home, the sky cleared partially, with lovely light, and a pale rainbow glowed briefly in the southeast. All for dear, sweet, pissy Miss Ripley.