A Tribute

It’s snowing.  Casey loved the snow.  What an amazing, coincidental backdrop to this tribute to our boy.  It’s almost like he had a hand – well, paw - in it.

Who am I trying to kid?  There was no refuge in sleep tonight, but at least I can attempt to come up with a Casey’s Worlds post without crying.  One more for the kid, for now.  He’s been a loving intrusion to my every conscious thought anyway, ever since Victoria and I watched a clinician administer by IV a merciful overdose of Propofol. 

Time stood still until an ER doctor’s stethoscope could no longer detect a heartbeat, ending our boy’s suffering, while jumpstarting ours.

It’s just now starting to hit me how rapidly Casey went from catching Frisbees on Monday to gasping for breath on Wednesday afternoon.  No visible, at least apparent symptoms until a suspicious lethargy, accompanied by a shocking unsteadiness set in around noon.  Something was wrong, and this time we were nowhere close to overreacting, as had been the case in the past.  And we weren’t waiting.

Thanks to an opening at Fairhaven Veterinary Hospital, Casey’s lifelong veterinarian was able to conduct a thorough exam, but he wasn’t satisfied.  Dr. Mark Kummer needed a blood scan and set of x-rays.  This just wasn’t the Casey he knew.  And he seemed to have detected an almost imperceptible flinch near his stomach.  An hour later, the first bad news - abnormal red and white cell counts, and worse, an x-ray image clearly showing a mass on the spleen, with another less definitive spot on his liver.  His resulting, palpable concern was urging us to get an ultrasound as soon as possible.  Our best option was an emergency room triage, including an ultrasound and surgery if necessary, within a couple of hours, at the VCA Veterinary Specialty Center of Seattle, almost an hour and a half away in Lynwood, Washington.

Vic and I had no way of knowing it then, but we were literally in a race for life.  Casey was bleeding out internally, in the back seat of his favorite mobile kennel, from suspected lesions. 

Thanks to Mark, there was a team waiting for us.  By the time we arrived, our boy needed to be carried into the clinic.  The first priority was getting him stabilized after an ER exam confirmed not only the suspected bleeding, but several tumors on Casey’s spleen, as well as a spot on his liver.  The shift doctor advised that surgery wouldn’t even be a consideration until stabilization – his pulse rate was 70 and going south.  She didn’t come out and say it, but the vial of blood she was holding, withdrawn from Casey’s abdomen, as well as her body language, telegraphed every pet guardian’s worst fear, that is, the final compassionate solution.

In lieu of a worst case scenario, we insisted on seeing the results of a morning ultrasound.  We hadn’t heard the words cancer and malignant yet, and Casey deserved a shot.  He was settled in, sedated, and on his way to being stabilized.  And after all, we were only discussing the possibility of Hemangiosarcoma.  Right?  Let’s see what the ultrasound turns up in the morning.  Most of these spleen masses are benign.  This one had to be.  We had come this far and we had never let Casey down and weren’t going to start now.  We went to our boy’s clinic bedside, told him goodnight and to be good.  He watched us leave and our long sleepless night began, with cautious, though tenuous optimism.  While I usually think hope is for losers - not this time. 

At 1:37 in the morning the duty veterinarian called to report that Casey received a blood transfusion and seemed to perk up, even coaxing belly-rubs out of the staff.  The perpetual love-junkie’s vitals were good, the bleeding was stopped and his clotting would be checked all night long.  Hopefully, one transfusion would be enough.  The relief clinician would be in at 4:00am, and no news by then would be good news. 

There was no phone call, but no sleep either.  Casey memories and inevitable what-ifs, a mélange of joy and the bittersweet, deflected any semblance of much needed oblivion.  And we each conceded to our relentless processing of decisions to be made the next day, as we both tossed and turned and cried quietly in the dark.

The next morning – incredibly Thursday, February 2, and Casey seemed fine twenty-four hours earlier – I rushed to check on our kid.  A devastated, swollen-eyed Victoria was opting to wait for the radiologist’s arrival.  When Casey was led into a visiting room, my momentary - admittedly unrealistic - optimism was crushed at the sight of my Methadoned, nearly spiritless best friend.  Lying on a shared blanket in the middle of the room was therapeutic, at least for me, but Casey had been sedated nearly to the edge of disinterest.  His ears twitched only once or twice to “Momma” and “Frisbee” as I stroked and inhaled his essence, while burying my face his once glistening coat.  Shortly later I told the tech it was alright to return my boy to the ER.

The ultrasound results, as well as our follow-up meeting with the treatment veterinarian came much too quickly.  That’s always the case I suppose when the odds are stacked, but Victoria and I had decided to take Casey home.  Even if palliative care only bought him one day or one month, he deserved to die at home.  We were ready.

We were ready, at least until the ultrasound findings were summarized.  The readings were explained in detail.  Our resulting questions were answered, options discussed.  Numerous tumors on the spleen, with the liver likely involved but not definitively.  Metastasis was a certainty.  Yes, a splenectomy was survivable, but the prognosis was dismal.  Canine spleen cancer is incurable and undetectable without an ultrasound. Nothing we could have done had we known.  The guardians and medicine had done everything humanly possible…except make that last dreaded decision.  We were told Casey could die before we reached Bellingham; and then “death by HSA” was explained in detail.  The painful, reverberating worst case scenario echo chamber subsided and we were able to opt for sanity, our last gift to Casey - a simple, peaceful surrender to an endless slumber, without the nightmares of a rescue dog.

I hope the faithful readers of Casey’s Worlds have excused my therapeutic ramblings by now.  I’m certain some of you have been there.  You might even be in tears as I am, as you finish this post.  We’ve dreaded these inevitable bouts with the multiverse, even when our friends were stealing our hearts as puppies.  I will always choose to believe Casey was blessed, in spite of his relatively few trips around the sun.  Victoria and I could never come close to repaying him for the joy, and life, he brought to our earthly existence.  We devoured it like addicts, from his first morning wake-up nudge, to his early farm boy turn-ins at night. 

As an abused rescue dog, Casey taught me about healing from day one.  Right now, as always, it’s as simple as one foot in front of the other.  And don’t forget the Frisbee.