I Owe Him Words: Luke’s Journey Through Feline Squamous Cell Carcinoma

He started wobbling in the middle of the night as if drunk. Taking a few tottering steps before falling, that was how it began. With disquietude we place Luke in his carrier and drive him to the Veterinary Hospital. His meowing echoed through the unoccupied lobby a-lit with harsh florescent lighting. After a brief explanation, we hesitantly hand the carrier over to the staff and eagerly waited. Powerlessly standing outside while starting out at the darkness, apprehensive to say what was clearly being thought as if doing so speaks it into existence. Suffocated by the question neither one of us wanted to ask. Was this it? Was this the moment?

 

When entering the examination room with Luke, the sight of him alone being a relief, they recommended that we schedule an echocardiogram. They prescribed Clopidogrel, a medication to treat blood clots, which has been known to cause similar symptoms. He for the time being seemed as if he was going to be okay. We left the hospital hoping whatever diagnostics awaited served as a clarification that the answer to that critical question was no.

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Thankfully, there was some time before the echocardiogram. Through this time Luke was in fair health. Intermittently, it would seem as if we could almost forget what happened. We placed Luke in his carrier and returned for the echocardiogram. This time, we sat beside him as he lay uncommonly patient. The results frustratingly led to a continuation rather than a conclusion. We were advised of the presence of Hypertrophic Cardiomyopathy, a condition in which the walls of the heart thicken, and the probable cause was Hyperthyroidism. His thyroid was tested, confirming the diagnosis of an overactive thyroid, and we were given the prescription for Methimazole.

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It was quiet for a while after that. We settled back into a routine, into life. Each day furthering the increasing impression the earlier events were a chapter able to be closed. An impression I now know to be born of false hope and complacency, taken with one moment. The moment I now recognize as the turning point. When he had done so up until the day before Luke had stopped eating. It was not a reduction in his intake, but a complete surcease of it. I did not know where we would be led, but I knew at once what it meant. We had not reached the end of something, as I had previously thought. We were seeing the beginning.

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I pleaded with him to eat. We tried various brands of foods with various ingredients. We warmed it a bit before serving it, added water to it. Once clear Luke’s ability to eat had not improved the veterinarian prescribed him Cyproheptadine, an antihistamine that through altering serotonin increases appetite. Though it seemed to work for a while, he quickly was unable to eat once again. His appetite did not seem to diminish, he would sporadically gaze towards the food as if wanting to eat yet never did so.

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Soon after Luke’s appearance became gaunt and his fur appeared matted and disheveled, despite efforts in aiding to groom him. He desperately tried to eat as if the appetite was there but unable. To ensure he would obtain some nutrition I began to syringe feed him and he did take to it, a small victory but a vital one. Luke would, at least for now, would not succumb to starvation providing some reprieve which would come to be short lived. In the absence of further information, the formulation of a diagnosis was challenging. Further information would come, though it would do so in a brutal way. Luke would begin to constantly lick lips as if he had eaten. Fluid began to leak from this mouth, sticking to the side of his face as well as an odor. Worse, at times he seemed to struggle to breathe.

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Veterinarians theorized Luke may have had Asthma or some other respiratory issue, despite X-Rays and other imaging showing the lungs were clear. He was prescribed a wide variety of medications. He was given Atenolol, Enalapril, Terbutaline and Prednisone. Our routine a cycle of waking up and administering morning medications and syringe feeding before work, navigating the workday, evening medications and feeding (usually broken up into two rounds) and repeat (barring intermittent visits to the veterinarian). It was exhausting. It was time consuming and a time I would come to cherish.

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Although Luke struggled on some days he kept a quality of life. He would play, though not as much, and he would do many things with little to no effort. Gradually these abilities would diminish his stoicism however remained. On one of his many visits to the hospital, a scan would reveal a long-awaited diagnosis. That finality would come at a heavy price, hope. The veterinarian exited the hospital and walked to our car, teary eyed and despondent, and provided the news no one wants to hear. Luke was diagnosed with cancer. It was Oral Squamous Cell Carcinoma, a particularly aggressive form of cancer which carries a prognosis so poor that only ten percent of cats survive the first year. Luke made it exactly one week after diagnosis. It is often diagnosed in late stage as it is incredibly difficult for even highly trained veterinarians to spot. Once a diagnosis is reached, being it grows so quickly and difficult to detect, it is already too late. They offered the choice of a feeding tube, yet advised this would only extend his life and not the quality of it to which we declined. The moment is indescribable, a moment riddled with numbness and disbelief. Once it finally hit us, we broke down in the parking lot of the hospital. The moment we feared while waiting in the parking lot that first night had been realized.

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We took him home, still coming to terms with revelation, and just sat. Adjusting to the new reality that treatment was no longer the focus, the focus now was hospice. We carried on life as is and held on to every moment. I dreaded going to sleep, with the certainty that this night could be his last. I dreaded waking, with the knowledge that this day could be the day. Since I was young my dad would say to me “don’t wish your time away”, I now know what that phrase means. I held on to every second, futilely, as if grasping air.

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One morning, I awoke to find Luke particularly lethargic. I continued as any day, Luke becoming less responsive each passing moment. When I tried to feed him, it was as if the food was sliding down his throat. There was a sense of alarm but not urgency. We contacted the veterinarian for an appointment later that afternoon. By this time Luke had become barely responsive, the grievousness had set in. Though understood nothing would be able to prepare us for the recommendation to end Luke’s life. Once signing the consent to do so, I completely collapsed. My legs felt as if they were buckling, and powerlessly exclaimed “OH GOD!”. To this day, that decision is still one of the most challenging decisions I have ever made. No matter how many times you are told it was the right choice, and no matter how many times your mind weighs the pros and cons it you will perpetually second guess it. I do not regret decision to end Luke’s suffering, which declining would result in the same inevitable end, it was not about regret. I didn’t want to lose him.

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We were with him as he drew his last breaths, still fighting ambivalence as the syringe entered his withered little body. The voice within my head with this primal scream shouted “NO!”. I wanted to take it back, I wanted it to go away. When the veterinarian placed the stethoscope on him and confirmed he was gone, that second was not accompanied by relief. I wanted to disappear, to crawl into a space where none of it was happening and the cavernous hole filled with only excruciating pain didn’t exist. As humans, many times we approach an obstacle with the intent to fix. No words, no action exists that can fix that moment. We went home, laid on the bed and cried. Luke’s journey was over, ours continued.

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Luke is gone and life will never be as it once was, and we were not okay. The only way forward is straight through, to let that reality hit you. To accept the pain never goes away, grief has no expiration date. To accept possibly years later you may find a photo or come across a possession or tell a story and that wave of grief will be as strong as the day you lost them. Let it hit you and let it pass. Accept though things will never be the same, you can and will be okay again. Those same stories that initially inspired tears begin to inspire laughter.

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Though painful there is a beauty in that deep sense of loss, as such loss can only be felt in the presence of unconditional love. That love stays with you, everything they gave and everything they were stays with you. I awoke the next morning, thinking of how odd it felt to no longer prepare his medications and to no longer prepare the food for the syringe. I went outside, looked at the birds and squirrels and rabbits. I watched people begin their day. Life, all around was life. Life to get back to, life to experience. There was life. Though that journey of grief continued, and always will, there was a glimpse of the other side of it. I could see the path to okay. I carry his loss, I carry the lesson it taught. Don’t wish away your time away.