Tuesday, August 16, 2011

Things Are Never So Bad That They Can’t Get Worse: Part III

Espresso held throughout Sunday, but this would be the first day I didn’t get to see or hold Espresso.

I was told no news was good news, but that my vet student assigned to the case would give me a morning and evening update. I was a nervous wreck, waiting. My mom did an amazing job, trying to keep me eating, keep my busy or at least functional. My mother had originally only planned on visiting through Sunday, but given the crisis we paid to extend her stay until Tuesday morning. By that point Espresso would be recovering and I could handle it...or I’d be booking my own visit back to California anyway. But in the mean time, my life was spent counting down the hours till my 8 pm call from the vet student.

The vet student assigned to my case was as critical to Espresso’s experience as Dr. Got-it-Right. I am going to call her Hope - because it was her words of comfort and reliable updates that sustained me during a trying time...and for a critical role she’d play later on.

I got a call from Hope that evening - essentially she couldn’t give me any news, Espresso was pretty much the same. I unfortunately can read through that kind of talk - it essentially means “I can’t really tell you anything because your dog is still dying.” She did tell me how she created a nice little nest of blankets in her kennel, that she was resting comfortably. It was some solace that Espresso could be buried in blankets, her favorite spot to be in the world.

I couldn’t rest comfortably that night. In fact I barely slept. I felt like I couldn’t breathe. I would cry, panic, toss and turn. The reality I was losing her had caught up with me. I think I passed out from exhaustion around 3 am.

It was Hope’s call around 8 am that Monday woke me. I took it. Once again, she was much the same. I felt bad, I think I was terse on the phone. But there was nothing she could say that would comfort me knowing she was the same. Like the last days, her blood work was submitted - I would later find out she was a rush case that day - and I would get a call from Dr. Got-it-Right when it was in.

I didn’t realize I had fallen back asleep until a call around 10:30 woke me. I grabbed the phone.

“This is Dr. Got-it-Right at Cornell Animal Hospital, is this Lindsay?”


How are you doing?

I’ve been better. What’s up.

So we got the results from her bloodwork in from this morning. It shows her kidneys are failing.

We talked about since her condition had held, she went ahead and her ultrasounded again - her symptoms had matched a bile duct obstruction but the small organ in such a small dog may not show inflammation till up to 4 days after the original blockage. However the second ultrasound showed a clear bile duct, a clear stomach, a same sized pancreas...but enlarged kidneys. The fluid build up had increased and now reached her chest cavity - she had an edema on visible on her chest. She was only continuing to deteriorate.

I honestly barely remember the conversation after that. I remember she asked me a question, and in a voice 3 octaves higher than my normal tone, I squeaked “Just a second please.”

I sobbed as silently as I could all the while screaming to my brain “GET IT TOGETHER THE VET IS ON THE PHONE YOU HAVE QUESTIONS GET IT TOGETHER.”

Dr. Got-it-Right could just say “I’m so, so sorry.”

After regaining the ability to speak I asked a few questions and hear about her treatment.

What was the treatment?(essentially the same fluid regime she was already on...hence why it was a bad sign to see her deteriorate).

The hardest question was “When do I call it?”

If it was a human, you never would, Dr. Got-it-Right explained. We would keep her on the fluid treatment, we had drugs and a stronger fluid regime we could do to support the kidneys. There was some hope as long as she kept peeing - peeing denotes that the kidneys are still maintaing their essential bodily function and are not in complete failure. If she stopped peeing...the game was over.

She told me I should come see Espresso today. In case I didn’t know it was that bad already.

“When are you available?”

“I can come” my voice trailed off as I started to feel the tears coming out. “I can come any time”

We arranged to meet in the afternoon when she had time. I thanked her and hung up.

Still in my bed, I laid my head down and sobbed. Uncontrolled, unrestrained, I sobbed. God knows I’ve cried hard before, but I never cried with such grief, such pain. Not when my grandfather died, not when my Dad was diagnosed with skin cancer, not during a breakup, not even during my recent move to New York where I felt like my heart was being ripped in two.

I explained her kidneys were failing to my mother who came in after hearing me. It was one of the only times she lost it too. She stood so strong or me this whole time but seeing her cry with me now almost just made things worse - it really, really was that bad.

This whole time I had been texting, calling people. I began to make the calls. I began to ask for comfort to help to prepare.

I barely managed to get dressed. But I had to look half way okay to visit my baby puppy. I had to look like happy and strong Momma, not the bedraggled, sleep deprived zombie I was becoming. My whole morning felt like it was in slow motion, but somehow went by faster than I thought and I was soon going to the vet hospital.

I sat in the waiting room. I actually smiled seeing doggies in cones, cats in crates being toted home out the front doors. I took some solace that even though my world was crashing down, other people’s were healing, recovering, going back to normal.


Two people in white coats came out a side door. I finally got to meet the people fighting for Espresso’s life.

Dr. Got-it-Right was a brunette with a no-nonsense appearance. I almost called her Dr. KickAss in these entries because she just gives off that vibe of I know my shit and I’m going to get shit done and done right. Exactly what I wanted from my vet. That was comforting.

Hope was petite and cute and redheaded - she looked kinda tired and emotionally invested like most the vet students I’ve seen around Davis honestly. Her sweetness comforted me that Espresso was in caring hands for her treatments and her concern in the days to come comforted me.

They led me to a private room - originally I was going to go to the ICU to see Espresso (another indication of the severity of her case) but someone was having to be ultrasounded, so we talked while we waited.

They reaffirmed the prognosis given on the phone, but there were small comforts. We could be very sure it wasn’t an obstruction - 2 different ultrasounds with 2 different radiologists and both confirmed no obstruction was present.

I know ultrasound is as much an art as science, I said, so I appreciate having had the two done.

However that meant it was either a toxin or Leptospirosis, a bacterial infection. The kidney failure ruled out the less severe possibilities like pancreatitis.

They told me about the IV fluid that was saving her life by treating her liver and kidneys was becoming a concern since it was obviously accumulating - hence the edema in her chest and the fluid that was in her stomach and around her organs from the first ultrasound. Since her veins were leaking this fuid into her body, they had switched her to a less polar, colloid based fluid to hopefully allow ti to pass through to the kidneys where it was needed.

I asked a lot of questions which Dr. Got-it-Right fielded respectfully and in detail. She had remarked in a previous call that I seemed to understand the scientific terms so she used the real language to describe Espresso’s condition. I may know plants better than animals, but I have taken enough biochemsitry to understand most of what was going on and appreciated the intellectual respect.

After I was out of questions, I turned to the doctors.

I just want to put it out there, that I want to know if you think its time to end it. I know you want to comfort me, but keep your priority of keeping her comfortable your priority. Don’t hold back about the severity, about her condition, for my sake.

Dr. Got-it-Right assured me that Espresso’s comfort was her priority. I figured she was that kind of vet anyway, but it never hurts to put it out there when I could be rational and face to face, not when I’m sobbing over the wish I could do more for my baby puppy as she was crashing.

Deciding not to wait any longer, they just brought my baby - IV bags and all - to the room for me to see.

A critical moment happened right then, a moment I didn’t realize would determine Espresso’s future.

So weak she couldn’t lift her head, Espresso saw me and wagged her little tail - the only part of her protruding from her blanket.

She wagged her tail.

She was bundled up in blankets and Hope gently placed her down on the examining table. I bent over, wrapping my arm around my baby and using my other hand to gently pet her face.

Technically, since it could be a dog-to-human transmissible bacterial infection, I shouldn’t have let her mucus membranes touch me...

yeah right. she was too weak to do much, but she did slowly lift her head and partially close her eyes just like when she goes to lick my face. Too weak to do that, she did manage to gently bump her nose against my cheek.

She bumped her nose against my cheek.

My mom and I were left alone in the room to just be with my puppy.

Momma loves you. Momma loves you so much. You are so loved. Auntie Rachel loves you. Auntie Amanda, Auntie Alison, Auntie Nicole love you. Auntie Jen loves you. Uncle Zach loves you. So many people love you baby. Daniel, Christine, everyone at Mumm - Stephanie and Lindsay and Jessie and I’m sure even Doug because he likes me and Tami - Linda and Jesse and friends you haven’t even met are all rooting for you and praying for you and thinking about you. Momma loves you...

It was almost a mantra for me. Just saying names of people who were helping me and loved me and loved Espresso.

However. I couldn’t be selfish here.

My arm was around her as she lay on the table, my thumb gently stroking her back. She had lost so much weight I could feel her vertebra. My other arm was rested so she could lay her tired little head on it.

I leaned in close and while petting my baby said -

Momma loves you. You are so loved. Momma loves you. Momma is so proud of you, you are fighting so so hard. Fight as hard as you can, as long as you can baby. But its okay if you need to just rest. You fight until you just need to rest. Momma is here, Momma loves you, and you just do what you need to. Momma loves you and will always love you and will always be here.

I then just sat in the quiet with my puppy.

They eventually came in and had to take her away. Right before, I stroked her ear and said Momma loves you and you do what you need to do baby. Momma loves you.

I couldn’t watch as they took her out the door. As she was taken, Dr. Got-it-Right asked me about inserting a central line - currently to test her blood, blood sugar, enzyme levels, etc -Espresso was being poked almost every hour. Also, it would have been 5 full days since she ate her last real meal so she suggested a feeding tube to help get her some nourishment. She even suggested putting in a catheter, so we could carefully monitor her urine output, our only signs that her kidneys were hanging on. I agreed to all, even if it meant my baby would now be tangled in tubes - it would help her long term comfort I hoped.

Right before leaving, I mentioned how Espresso's breathing was much more audible than normal. It wasn't wheezy per say, but even when she is excited her breath doesn't normally carry such a noise. The vet said she'd listen to her chest and lungs again and appreciated my comment.

Dr. Got-it-Right walked me and my mom to the door. This was my Mom’s last day so she told the doctor it would just be me from now on.

I left feeling so lost, so scared, so in love with Espresso. With her kidney failure, I was likely going to have to come in tomorrow and euthanize my puppy when her body just couldn’t function anymore.

But things are never so bad that they can’t get worse.

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