Thursday, June 21, 2007

White Foamy Vomit  

SO recently I found out I have arthritis in my right knee, a tiny patch the size of a dime right under the patella, which is not as bad as it seems, since the dull pain (whenever I kneel, sit wrong, or climb stairs too fast) is not caused by a torn ACL or meniscal tear or anything else requiring immediate surgery, but is instead something that can be palliated by slight changes of behavior - changing my sitting posture, using a elliptical machine instead of running, and so on. But I want to return to karate and backflips or even just pain-free climbing of stairs, so that makes it even more critical that I follow the active part of the treatment - the exercises prescribed by my doctor and physical therapist.

My doctor had recommended them when I first reported the pain, and we shoehorned the exercises into the already-running program of physical therapy for my shoulder (which had been injured while I was babying my then-broken opposite forearm). After he got the writeup on the MRI (not the MRI images themselves, of course, since the imaging lab failed to send them, even though I'd specifically confirmed that they could, and even though I helpfully reminded them when I arrived how imporant it was) I say, after he got the report of the MRI specifying "trochlear chondral degeneration," the doctor RE-prescribed the physical therapy, which in turn led to the physical therapist fleshing out my treatment and adding at-home exercises.

ALL OF WHICH is a roundabout way of explaining why I was so intent on finishing my exercises that night, stretching my straitened leg with a giant red elastic called a Theraband, two sets of fifteen repetitions each, in all four directions of the compass, so hard to fit in my packed day (or in our cramped house) but so crucial to my recovery that I was still standing there at one-fifty in the morning, before my shower, in my skivvies, in the foyer, obsessively finishing my repetitions in the only time I could find in the only place I could find, when I heard a small cough outside the front door.

I had expected a scratch at the door: one of the cats was outside. We were in that phase of the night where we had cat parity: if one cat came in, the other would go out. Currently manning guard duty on the front lawn was Caesar, our scaredy fraidy cat, and after checking the peephole to make sure Luigi the Thud wasn't making the little coughing sound I was hearing outside the door, I cautiously opened it, to find Caesar sitting there, his back to the door, not scratching to get in, but apparently coughing up a hairball.

Sandi, my wife, asked who was out and what was going on, and I told her. At that moment Caesar hacked up something fierce, a big scratchy bleeech sound, horking up ... nothing. Absolutely nothink. And then he came inside. I closed the door and looked down to see him trying to hack something up again.

A dollop of white foamy vomit the size of a quarter fell to the Persian rug in the hall - the last remnant of my Mom's superabundant gift of Persian rugs for our Atlanta home that now no longer fit in our California hovel, now landing zone for Caesar's gift, which was white, foamy, and clearly empty of all particulates, like a little mound of sea foam or shaving cream.

Caesar stumbled away from it, a little drunkenly. I went to wipe it up and Caesar skittishly darted off, then stopped and began to edge towards the OTHER piled Persian rugs that Mom wanted us to ship back to her since we couldn't use them. I stopped him and corraled him to the hardwoods of the great room, where he horked again - more white foamy vomit, with interest, maybe thirty-five cents worth this time. By this time Sandi had tentatively identified the phenomenon as dry heaves, but the foam was peculiar and disturbing and unlike anything in either of our experiences. It lay flat and sickly on the floor, unlike the beefy little cat-food burritos Caesar used to hork up before we got his food tuned right. Caesar and his brother Nero are both rescue cats, and at first we needed to do a lot of tuning.

But tuning was over, and we'd never seen him coming in from the outside, skittish and scared, foam and a little grass and sticks coating his mouth like a lopside moustache, little body shaking, almost convulsing, as he tried to throw up ... nothing. Nothing but white foamy vomit, now close to a dollar in change. "What should we do?" Sandi asked, following him around.

I looked at the vomit. I remembered Lady, a dog from my childhood that died of poisoning. "Oh, we're taking him to the vet."

"I have a cage ready to go in my room," Sandi said - Nero, our surly burly cat, has conjunctivitis in his left eye, and had been shuttled back and forth to the vet frequently. "I'll call the vet and see if they can recommend an emergency hospital."

I got rags and cleaned up as much vomit as I could, then changed back into the clothes I'd just taken off prior to my workout and intended shower. Sandi brought out the cage, and I retrieved Caesar. He was really convulsing, but when I picked him up he stopped and started fighting. I carried him to the cage and plopped him down in front of it, not shoving him in but stopping him when he tried to run away. After a minute or so I pushed gently and in he went.

Sandi by now had been referred to an animal hospital. "Do you know where Oakridge is?" she asked.

A light bulb went off behind my eyes. "Ask her if there's a Starbucks nearby."

"Across the street. On Blossom Hill. No, Santa Teresa."

Curious - there's no Starbucks there on Santa Teresa. But there is one on Blossom Hill, right next to Oakridge Mall and an animal clinic. Close enough. "Alright. I know where it is."

Sandi was already at the car with the cat carrier, and, flustered, I helped her and ran back inside to get my jacket. Thoughts of my dying father - and the time my uncle was cross with me because he thought me too slow fetching a spare oxygen cylinder - flashed through my head, and I seized the coat, leapt into the car, and with Sandi and Caesar - but without the name of the emergency animal clinic or Sandi's phone which held its number - drove out into the night.

Oakridge Mall is less than fifteen minutes from our home, and we drove quickly but not recklessly, trying to not further disturb Caesar. He'd stopped vomiting, but took a dump in the cage the moment the car got rolling, and then became so ominously quiet we feared he was dead. As the mall hove up, I started thinking about the curiosity discrepancy in the street names and asked Sandi if she remembered the name of the clinic. "No," she said slowly, "I thought you knew where it was."

"I do, or I think I do, but there's something weird about their directions. Can you call them back?"

"No," she said simply, "When you said you knew where it was ... I left my phone."

I let out my breath and said nothing. It made me very angry, but there was nothing to be done about it and expressing my anger would not help the situation. Part of my anger was self-directed: I'd claimed knowledge of our destination and had assumed responsibility for navigating, and was about to be proved wrong, with a possibly-poisoned, possibly-dying cat at stake. Another part of me was angry at the very idea that someone would leave their cellular phone behind in an emergency. Sure, I've done it, left my keys or phone or directions or watch just when I needed it, but at that moment I wasn't reminded of those occasions: I was just reminded of a fair number of earlier relationships with women who made it a habit to not bring phone, keys, or even a watch. At that moment I all I could think of was that in that crisis I was the only one who could tell the time, call for help or even get back inside the house. Perhaps Sandi felt similarly about not being able to rely upon my claims about my sense of direction; after all, I asked some pretty darn specific questions and sure sounded like I knew where we were going, even though I didn't. Regardless, fuming would not help; only finding the hospital would.

The mall appeared. The road mentioned in the directions did as well, sans a Starbucks or a visible animal clinic. Worried, we circled the mall, hoping the road came out at the other end. There we found a Starbucks cattycorner from an animal clinic - with all its lights off. Sandi ran in and checked - they were as closed as the rest of the mall at two-fifteen in the morning. Proved wrong, I was. Even more worried, still fuming, we drove around the mall, and found the road mentioned in the directions again. We carefully looked at all the shopping moons around the main mall planetoid, and were about to drive away when, just as we turned back onto Santa Teresa, we saw it, wedged in a minimall just off the main road they had mentioned, but without the aforementioned Starbucks in sight.

Fine. We were here for help, not coffee.

The sign on the door was confusing and hard to read and implied that they should be closed, but the clinic was nevertheless open, lit and friendly and they let us in right away. The night nurse took Caesar and handed us a pile of forms. When we'd finished killing that tree we walked down to exam room three where the nurse was still trying to coax Caesar out of his cage. Eventually, we did, and the now oddly passive cat weighed in several pounds less than when we rescued him, a tribute (we hoped) to his now-frequent outdoor exercise and not a part of a larger problem.

The nurse left to go get the vet, and we trashed the foul-smelling bedding material and comforted our cat, who continued to try burrowing into the crook of Sandi's arms whenever she petted him.

"We can't see him at all," I said, echoing the vet that we had first brought them to out here.

"No, he's completely invisible," Sandi said, petting him, letting him nose his way into her jacket until his head was covered. Never mind that his whole body was still visible: cats think they are invisible when their heads are covered, as Caesar's brother Nero proves whenever he hides behind a two inch tree and peeks out around it with one clouded eye ... big black furry butt clearly visible..

Eventually Caesar perked up and we let him roam the room; after a few minutes looking for an exit, he hid under the owners' bench and I positioned myself by the vet door he was watching, making sure he didn't bolt.

The vet arrived. She was kindly and darkhaired, with a slightly condescending manner you took as reassurance and not as insult. After inspecting Caesar's mouth and squeezing his abdomen, the vet gave us the good news.

"This is always scary the first time it happens," she said. "The first thing we look for with this kind of vomit is burn marks in the mouth - this reaction can happen if he had been electrocuted, biting down on a cord and trying to throw up an irritant that's not there. The next thing would be some kind of gastrointestinal distress, but I'm squeezing his abdomen fairly hard right now and he's not complaining. So that leaves ingestion - he probably bit down on a spider or bee and threw it right back up, and then spent the next hour trying to puke up the rest, except, again, nothing was there."

The vet's condescending manner and a few quiet snide remarks by the vet staff we weren't intended to overhear made me feel foolish. "So ... did we do the right thing by bringing him in?"

The vet looked at me. "If you were convulsing and threw up twelve times in fifteen minutes, what would you want someone to do for you?"

"Take me to the emergency room."

"Exactly. We'll give him a shot of Benadryl, and you take him home. If anything else goes wrong, call me; otherwise, I think you'll be all right."

So we settled up the hefty but not unreasonable bill, collected Caesar, and drove back into the night. We all felt better, and by the next evening Caesar was eating like a tiger and feeling fit to form. But the thing in hindsight that really strikes me is that throughout the whole ordeal, from the noise at the front door to the palliative antihistamine shot, even when I was kneeling by the door to keep Caesar from bolting, my knee and its newly discovered arthritis didn't bother me, even though it was my knee exercises that had put me next to the front door so I could hear his pitiful little cough.

Amazing what a little perspective will do for pain.
-the Centaur



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