Hey Little Girl

Hello again to everyone here. I’ve been on a hiatus that lasted way too long. What the hell happened, I’ve asked myself? A lot of people have written about despair in the face of the war in the Ukraine and the multiple harbingers of climate disaster staring us down. I felt paralysed by the constant updates on these large scale calamities, and at a small scale level I was also busy with work (numbers of despairing children and teenagers are proportional to the level of community Weltschmerz — plus they feel the shock of televised war and the threat of climate change the most). There had been a lull in appointments over the Australian summer — warm weather and the long school holidays always seem to produce a land-of-the-lotus-eaters effect: it’s always afternoon, and there’s little to no motivation to get back to normal life. Then suddenly the school year started and the trickle of appointments became a torrent, and I spurred myself on with “Hey, this is not too bad, at least we’re not in lockdown.”

But wait, the universe had something in store for my preoccupation and false cheer: Sascha the girl cat got very, very sick. So sick that the local vet we rushed her to looked perturbed, and told us to get to the Small Animal Specialist Hospital that evening. Sascha was going to SASH, and thank god for Google Maps because the hospital was halfway across the city, and I couldn’t think straight.

There is something horrific about a small and defenceless animal who doesn’t know why their body has stopped working. Sascha was staring into space, wobbling on her hind legs, not responding to any of the usual pats or calling her name. It was like someone had replaced her personality — a creepy sense of my-cat-who-is-not-my-cat. I was not up for this sudden appearance of the unheimlich. As I stared into her vacant eyes I felt like saying “Who are you, and what have you done with my Sascha?” But the overriding sense I had was to get her to safety as soon as possible, hoping that this was not in fact what it looked like: neurological symptoms tolling the beginning of the end. I kept asking myself how could I have let this happen — she’s only six…this is not what should be happening to her.

The staff at SASH were amazing, and took Sascha in straight away, clearly used to pet-parent incoherence. At the front desk all I could manage to blurt out was “She’s not herself!” internally cringing that I couldn’t come up with something that sounded more medical, or actually urgent. Luckily they had received a fax from our local vet who at least was able to string several sophisticated sentences together — he had done the most detailed and thorough examination I’d ever seen, documented it, and emphasised the urgency to the SASH triage.

They kept her in overnight and after many test results and some IV fluids they let me know her kidneys had started to fail after a mysterious rise in the protein in her blood (globulins) had jammed them up. The globulin rise was thought to indicate the presence of some kind of blood cancer. I spent hours preparing myself that she would not last the night (kidney failure didn’t sound good) and that if it was cancer we wouldn’t have long with her. I don’t know anything about veterinary medicine (no surprise to any vets who might be reading). But I knew that some of the terms being used were not along the lines of a “She’ll be ok” vocabulary.

I felt at every stage of this nail-biting, pit-of-stomach sinking feeling that I should be coping with this better. Aren’t I one of those people who are doling out advice? Holding the feelings when the patient or the family can’t? It turns out that child and adolescent psychiatry is not really an insurance policy for feeling mad with grief about the potential death of a pet. Usually parents in this situation hold a double anxiety — how will the kids cope? How will I cope? My worries were the same.

After days of waiting early for texts and phone calls in the middle of the night that first night, we finally received the news that Sascha was doing a lot better, back to her normal self and “talking” to the vets, eating, and ready to come home tomorrow. I couldn’t believe it. It took me a while to turn the feeling of emptiness and grief to hope, and potentially, joy.

A few days later…The joy wasn’t to be. I had a followup appointment with oncology one week after discharge. The doctor was very honest and very comprehensive in his summary of what had happened and what kind of chemotherapy Sascha might be able to have. As he explained the ins and outs of the different treatments, Sascha, who had been let out of her carrier to roam the room, started putting on a show — the likes of which I hadn’t seen for weeks. She was gracefully leaping off the table to the floor with nary a wobble, sashaying around the room swishing her tail around the vet’s legs, meowing and rubbing her head on every surface, including his shoes. It was all very “Hello, Sailor” and I couldn’t believe she looked so well as we discussed her near-death experience and possible chemo. The vet finished up with an explanation of how they would do a blood test now to see how her kidneys were going, and after that we would make the decision about which chemo regime to use. He suggested I get a coffee and come back in 20 minutes.

The 20 minutes and the coffee were a very necessary break to refuel for what was to come. As I re-entered the room I could see from the vet’s gentle smile and his “please have a seat” invitation that something had changed. This was going to be the bad news chat. And sure enough, he explained that the blood test showed that her kidney function had deteriorated again, to the point were usually she would be hospitalised, but he could understand if I didn’t want to go with that option. He suggested some subcutaneous fluids and continue this at home some liquid prednisone to put with her food. If she did well over the week she could come back for a checkup and potentially start the chemo if her kidneys had regained their function. If she didn’t do well, it would be an emergency trip to our local vet and some hard thinking about whether to persist — back to hospital again or let her go.

He had said in our first chat, pre-disasterous blood test results, that chemo could be an emotional rollercoaster, as cats tended to do well, then become sick again, then respond, then sick — it would be an unpredictable course, and I should be prepared. I wasn’t quite prepared for how quickly my optimism about starting chemo would be dashed a few minutes later with the bad results news.

Again there was a bit of self-reproach about not processing all this with a kind of confidence and finesse. The psychiatry job-description is really about being prepared to handle stress, — other people’s, their family’s…but your own is always a challenge because you are not your own therapist — you can’t be the patient and the doctor. So I’m the patient all right — sad, stressed, overwhelmed, not able to sort it out alone.

Friends and family are being their warm, supportive selves. They know how much I love Sascha. That she is, in many senses, my third child. What parent doesn’t lose their mind at the prospect of losing their child?

This afternoon after some subcut fluids and a dose of prednisone down the hatch, she seemed to be slightly more like her perky self. She even moseyed towards the door when I came back from a walk, her usual move illustrating classic feline super-restrained but unequivocal affection. I was so delighted to see her communicating like this, rather than her new strangely sleepy pose on the couch.

Whether we lose human or animal loved ones the fear of grief is intense. The bargaining, denial, anger, are our waves of our desperate attempt at dealing with the fear of loss, and fear of what we might experience in that loss. I learned very early to disavow loss or any of the feelings it engendered. Better to say I’m fine. At boarding school they told us — if you do cry, cry in the shower. After years of therapy I’m happy to say I can cry fully clothed, and with friends. But it still terrifies me to cry at work, because of what it will signal to others. At work we are trained not to let our personal life intrude into the therapy, as it colonises the space that is supposed to belong wholly to our patients. I worry that if I lose Sascha, I will not be able to keep the grief in its cat-box at home, that it will leak out into every consultation, and I won’t be able to work.

I can hardly imagine the conversations with some of my patients who know Sascha from her telehealth cameos — wandering past the camera, letting her tail flick into view as she saunters behind the laptop screen, or bumping the whole setup as she rubs her cheek against the corner of the screen. I refer to her as my co-therapist, and she really is, even when she is fast asleep on the chair next to me. I can’t bear the thought of patients asking me where she is, how she is. To answer the question honestly after she’s gone seems unkind, intrusive on the patient’s time, an unwelcome and unforeseen grief descending onto the inner world of the consultation. But patients are relentlessly kind, as I’ve seen on mornings recently when I’ve looked tired. They notice, they comment and they hope I’m OK. I know I will be OK, but I’m doing everything I can not to lose my little girl. I don’t want to tell them that, but I know at some point I will have to share my big grief for this little cat who has brought everyone so much joy.

When my dear editor friend visited from overseas recently, she captured Sascha’s personality beautifully. Because she is so fluffy and sweet looking, so demanding of affection and has a meow that sounds like a newborn cry (patients and families on telehealth would always ask me “Do you have a baby at home??), my friend would kick into babytalk: “Baybee Girrrrlllllll! Baybee Girrrrrrrllll! Come here Baybee Girrrrrrllll!” But Sascha is also her own woman, and the Little Girl persona could switch to blithe disinterest in a heartbeat. “Oh it’s off between us is it?” my friend would say…”You’ve moved on.” And in the next second she’d be turning on the charm again. “Oh we’re back on now are we??” Just like this to-ing and fro-ing, Sascha is up then down in her energy and her function. I want this sad time to be predictable, and manageable, but it’s not. She’s running her own race like the independent girl she is. I’ll obediently follow her to the end.