"And, when you want something, the entire Universe conspires in helping you to achieve it." -The Alchemist, by Paulo Coehlo



Tuesday, May 23, 2017

Tales From the Trenches: The Cat That Was Named After a Queen


The main joy of returning to work in the veterinary ICU is having my own patients again: the hospital I work at believes in continuity of care, so we get to keep assigned patients until they are either discharged or our workweek ends, whichever comes first. And so the stories are even better now because I'm getting to establish a full-blown relationship with the dogs and cats in my care.

I last worked in the ICU environment in South Florida and wrote a few posts on the subject way back before "Tales From the Trenches" was a thing on this blog. One of my favorites is this one. When we moved to Maryland I took a job at a hospital that had separate ER and ICU departments: I worked in the ER so my job was to triage, admit, work up and assist with the diagnoses of incoming patients before transferring them to a separate group of veterinary technicians in the Intensive Care Unit. ER helped ICU when we were slow, but otherwise we rarely got assigned our own patients. 

Critical Care was the one thing that I dreamed of doing from the time I started tech school; I wanted to specialize in it, I wanted to be one of those techs that helped train newer techs and doctors (experienced technicians play a huge part in training veterinarians doing rotating internships at specialty hospitals), one of those goddesses that could look at an animal from across the room and have a clear idea of what was wrong with it, that could place central lines (jugular catheters) and nasal oxygen cannulas and urinary catheters and arterial lines, and anesthetize anything without batting an eye, and suture things in place, and restrain animals without stressing them out, and run bloodwork and set up oxygen cages and read urine sediments and calculate drugs while remembering the concentration of just about all of them, and knowing side effects and common toxicities and what they look like in two different species, and being able to read telemetry (constant EKG) and recognizing arrhythmias and lifting 80 lb dogs single-handedly onto the x-ray table and being able to hit any vein on an animal with a blood pressure of 30 mmHg and and and...

I worked my ass off to become that tech, asking endless questions of doctors, my interns, new techs, old techs, credentialed techs, techs that had never gone to school but had been working in the field for so long they knew more than most techs with a formal education and sometimes even more than the doctors they worked with. I wanted to know everything: in how many different ways can you arrive at the same answer and still do it correctly? I learned them all. (And am still learning!) I deliberately worked in the lab (the job nobody wants) and learned to read blood like it was a third language; I did a year in general practice so I could see where it all begins; I worked in Internal Medicine and Oncology so I could see how the weirdest and saddest diseases get diagnosed and treated; I worked ICU mostly and then ER only in all shifts available: days, nights, swing, so I could see the changes in staff and caseload and the switch in hospital environment from day into night; I was mentored by two of the gods of Veterinary Emergency and Critical Care, including the founder of the society for this specialty; I read about nutrition, both the conventional and unconventional and talked with internists and nutritionists and saw how so many conditions can be managed and/or improved with diet; I geeked out on animal behavior, reading both layman's books and veterinary-level textbooks on the subject; and I then worked in Surgery running anesthesia for two years so I could have the experience of sailing my patients through the controlled death of anesthesia and safely back to life on the other side.

Why did I do all of this? Because from the beginning, I wanted to be able to know what was going on in an animal's insides just by glancing at its outsides. I'm not a doctor and I have no interest in being a doctor: veterinary nursing is my life, my jam, and I've put 10 years so far into being the very best vet tech I can possibly be. 

And now I have returned home to the ICU floor.

This past weekend was my first working what will be my regular weekend shifts. I was assigned the patients in a bay of three cages: two kitties and one dog. Eric, the technician that had been taking care of them overnight rounded me, telling me their initial problems, diagnostics, and how they had been doing in-hospital. 

"And this is Victoria," he said, introducing me to the third and last patient. 

Victoria was a tiny golden kitty with black-tipped fur and brilliant green eyes. A long feathered tail that looked like a plume was curled around her front paws. She was labeled a "domestic medium hair" but looked like a Somali cat; she wore her blue paper e-collar as if it was a mink stole around her shoulders and blinked lazily at us. She had bright orange stickers on her cage card and treatment sheet labelled "Caution." I had already read through Eric's notes from working with her the night before and had grinned at some of the details, "Patient very vocal but is easy to handle," stood out like neon lights.

She looked up at Eric when he mentioned her name, pupils dilating slightly at him as she opened her mouth wide. The most hideous screech came out, "MEEEEEEAAAAAAAAAAHHH!" 

I startled: even after reading Eric's notes I was not expecting such a loud, ear-piercing sound from something so small. Eric burst out laughing. 

"And this is what she does. She screams." He opened the cage door, grinning, and reached in to scratch her ears. Victoria couldn't decide whether to continue yelling at him or let him pet her, but indecisive or not I could hear her purr loud and clear as she pressed against Eric's hand for more. I got an instant reading on the cat and started giggling uncontrollably: this was a cat with Opinions, with a capital "O". My favorite.

He gave me a run-down of her problem list, how she had been doing, and what she was like to handle. She was labelled a "Caution" simply because she verbally objected so much to anything you did with her, but had never tried to actually hurt anyone. "She literally doesn't do anything; she just screams. You might be able to do everything with her by yourself if you can win her over," Eric said. 

"She also likes to bat at you with her paws through the cage bars and yell at you while you're doing treatments to the other patients," he added as an afterthought. I burst out laughing. I loved her already. 

Eric walked away to finish up his end-of-shift duties and I turned to Victoria. 

I opened the cage door. (All of my parts of the conversations with Victoria that I am about to describe were actually said out loud. Italics are interpretations of her part of the conversation based on her attitude and body language at the time.)

"Hi!" I said brightly. This is how I say hello to the majority of my patients.

Victoria screamed at me.
"MEEEEEEEEEEAAAAAAAAAAHHHHHH!"
"Who are you? Don't touch me without me approving of you first!"

"I'm going to take care of you today. Can we be friends?" I slowly reached out towards her with an upheld finger, holding it at the level of her nose about 6" from her face. This is one of the most important and polite ways of introducing yourself to an unfamiliar cat: you're giving the cat the chance to sniff you and also letting the cat decide to interact first. Here is a fantastic behavior article explaining the science behind this method. 

Offer finger from a safe distance.
Don't shove it in the cat's face, please: that's rude and you might get bit.
Let kitty reach out and sniff.
Wait for kitty to finish sniffing: they'll tell you what they think of you then.
How the cat reacts to that finger will pretty much tell you what their behavior towards you will be during their hospital stay:
1. If they sniff and look away, they're scared: you can win them over if you take it slow and give them opportunities to hide.
2. If they back off growling with ears flattened, they're more scared than #1: you might still be able to win them over by doing the same things as with #1.

Do NOT reach out and still try to touch the cat that backs away from you! This cat is even backing its whiskers away from this toddler's outstretched hand (this is why the lip is curled: he is moving his whiskers away. This is not a snarl.) The constricted pupils and skewed ears pointing sideways indicate a highly offended kitty.
3. If they hiss and don't back off, they are terrified, defensive and have already had bad experiences in veterinary environments: be extra extra cautious when handling this cat because they will most likely react with fight mode before flight mode. These cats make me sad because it is not that hard to keep a kitty from reaching this point, but even in vet med there are a lot of people that either don't understand cat behavior or are outright afraid of them. It takes tact and skill to handle a fractious cat without permanently traumatizing it, but it is doable if you understand their behavior. Contrary to popular belief, cats aren't usually assholes for the sake of being assholes. At least, not in the veterinary hospital. ;) There they're just scared. How would you feel if you were abducted by aliens that wanted to poke and prod you and stick you with needles?
4. If they reach out and sniff your finger, they are friendly shy cats: take it slow and you'll just make them friendlier and friendlier!
5. If they reach out and rub their faces against your finger, you're golden.

A very friendly cat. Notice the curious yet relaxed ears pointed forward and the relaxed eyes and whiskers as he stretches out to sniff this person's hand.

Victoria closed the distance and sniffed at my finger. I watched her pupils dilate ever so slightly as she looked first at my finger and then at me, making eye contact while still sniffing. I looked back into her vivid green eyes, smiled and blinked slowly at her. Yes, most cats and dogs learn what a smile means. Slow blinks in cat body language = kitty kisses. Behavior article on that here.


"Hello gorgeous," I said to her. 

Victoria blinked slowly back at me...then very delicately rubbed the corner of her mouth against my finger, marking it with her scent glands. 

"You will do."

I choked back the giggles as I slowly scratched around her chin and ears. She leaned into my touch...but out came the screech, "MEEEEEEEAAAAAAAAHHHHH!"
"Don't get too cocky now. I might change my mind!"
"Got it, Your Highness." I gently rubbed the fur between her eyes, still laughing to myself, and she squeezed her eyes shut tight in pleasure...while still grumbling. 

I stepped back and swung the cage door shut as Victoria screamed at me more, "Why did you stop?!"
"I need to do my other patients' treatments, little girl."
"Hmmf."

Victoria herself didn't have much on her treatment sheet for 8:00 am but my other two patients were far more sick than she was and had a few things on their sheets that I needed to do.

She eventually curled up into a golden ball of fluff and fell asleep, head tucked in with her chin resting on her blue e-collar.

Once I was done with my other two, I returned to her. I like to change my patients' bedding at the beginning of my shift, even if it's fairly clean. There was a fair amount of litter that had been tracked onto her bedding from the litter box. 

She was still curled up in a ball. I quietly reached out and roused her by petting her. She woke up slowly. 

"Your Highness," I said, "I need to change your bedding."

I figured there would be lots of objections if I tried to lift her off of her bedding in order to remove it: we weren't at the "You can pick me up" stage yet and I wasn't going to overstep those bounds unless the treatments had required it. Since she was lying on the very edge of her towel, I decided to just gently pull the bedding from underneath her. There was a LOT OF SCREAMING anyway. 

"HOW DARE YOU THIS IS MY BEDDING!"
"Victoria, I understand that you don't like change but I am going to give you even better bedding!" I really was. I had picked an extra fluffy fleece blanket for her. 
"MEEEEEEEEEEAAAAAAAAAAHHH!!!"
"I don't care! This is MINE!"
I finally succeeded at extricating the towel from underneath her while she tried half-heartedly to swat my hand away (her claws were sheathed but she still didn't touch me) and replaced it with the fleece blanket.

Victoria screamed at me some more and then hissed loudly at me when I was done placing the blanket as far underneath her as I could. 
"HOW DARE YOU!"
I was snorting with laughter as I closed the door. 
I later pretended to not notice when she got up, re-arranged the bedding somewhat, then curled up to sleep again. She approved.

Later in the morning I paused to check on her; she was curled up at the front of the cage. I realized she had urinated in her litter box. I opened the door.

"MEEEEEEEAAAAAAAAAAHHHH!"
"Why are you opening the door?"
"I need to clean your litter box."
"Why?"
"So your cage won't smell like pee!"
"Hmf. Okay."
I was allowed to remove the litter box and replace it without screaming, and was then offered a fuzzy head for petting.

Victoria was a riot.

Later in the day I had to get a full set of vitals, which of course involved the dreaded temperature taking. I enlisted the help of one of the head techs who is really good with cats: she removed a screaming Victoria from her cage, wrapped in a towel without having to scruff her. I gently and quickly got everything done with minimal stress: she legit just lay wrapped in her towel, voicing her objections loudly but seeming to understand that we had to do this. My helper put her back in her cage with her towel and Victoria yelled at me some more. I reached in and petted her while she closed her eyes and grumbled.

"Okay. I forgive you."



I did have to give her one dose of oral medication...which was easy: I simply put a hand behind her e-collar, which made her object:
"MEEEEEEAAAAAAAAAHHHHH!"
"What do you think you're doing?! I haven't given you permission to touch anything other than my head!" She was right: she had not.
"I just need to give you this," I said quietly, and deftly popped the pill in her open mouth. I immediately removed the hand from behind her e-collar. She swallowed in surprise and then grumbled at me.
"See, that wasn't so bad!" I said cheerfully.
"It was awful."
"Such a hard life, Victoria."
"Such a lack of respect for your superiors."

I closed the cage door laughing.

A GI medication was added to her treatments in the afternoon. This involved giving it in a syringe pump, a separate fluid pump specifically for syringes, which allows you to administer small doses of drugs over a longer period of time.

Victoria did NOT approve of the syringe pump in her cage.
"YOU ARE NOT ALLOWED TO RE-DECORATE!"
"I'm sorry Your Highness, but I have to do this."
"I DON'T LIKE IT."
"It's not doing anything, really, other than giving you this drug to make you feel better!"
She batted at my hand, claws sheathed.
"Stawp!"
"Victoria."
I quickly set up the pump, rubbed her forehead while she continued yelling at me in indignation, and closed the cage door.

30 minutes later, the pump beeped to let me know the medication was done.

I went to remove it from the cage.
"I SAID YOU CAN'T REDECORATE! WHY ARE YOU REMOVING THAT?"
"You didn't want it in here before! I'm taking it back out."
"I want it there now."
"Well, it's leaving."
"Hmf."

By the end of the day she was purring while yelling at me, and I was allowed to give her butt pats.

Elevator butt in response to butt pats/pets/scratches.
Cats are such weird creatures.
I don't think I've laughed so much with a patient's antics in a while.

Eric was in charge of her that night again, and she was my patient the next morning still. She interrupted rounds to come to the front of the cage door so she could yell at me up close.

"MEEEEEEEEEAAAAAAAAAAHHHH!"
"Why did you leave yesterday?! I didn't give you permission!"

I opened the cage door while Eric burst out laughing.
"Good morning Victoria!" I said brightly.
Purrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr

Since her labwork had improved and she was eating and acting normally, she was scheduled to go home later that day.

A couple of hours later I was sitting in the cage underneath Victoria's while checking the blood pressure of my canine patient.

"MEEEEEEEEEEEAAAAAAAAAAAAAHHH!" from above me.
I looked up to see her golden face squished up against the cage door, green eyes glaring down at me.
"I didn't give you permission to touch anyone else!"
Her doctor was in the ICU checking on her other patients and she laughingly pointed out, "I think she's jealous! You can't be anyone else's nurse!"
"I'm so sorry, Your Highness," I said to Victoria. Cue laughter from everyone else in the ICU.
"Hmf." 
When I was done with my patient, I opened Victoria's cage door. More yelling.
"Pet me nao!" She put her paw around my hand and pulled it towards her cheek.
"Here, pet me here."
Purrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr

My weekend was made later when I stopped to spend time with her during a brief slow moment and not only did I get purrs without screams, she stretched her little head out and touched her nose to mine.



I was also allowed to graduate to the "You can pick me up stage." Success!

Her owners arrived in the afternoon and I got to hear the full Victoria story from happy owners grateful for the care she had received. It is a very good one, but not one I can share.

I went back to the ICU to get her. I finally removed her blue e-collar, smoothed her fur out, kissed her forehead, "Good-bye, Queen Victoria. I love you!" and held up her open carrier. She grumblingly hopped right in.

I was both sad and happy to see her go: sad because I would miss her antics, but thrilled because she was a happy ending. As all endings should be.












14 comments:

  1. Replies
    1. Sunday was kind of a shitty day on the emergency front. Having her as my patient made all the difference. :)

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  2. Replies
    1. Me too! She was a total rockstar and she knew it.

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  3. Weird, I always do the finger greeting with cats, but had no idea why, or that it was a thing. Perhaps my cat taught it to me cuz she's a wild thing and we're not allowed to touch her much.

    Have you seen the video of the cat removing another cat from the vet's table? What do you think that is about? https://www.youtube.com/watch?v=R8x-1LJKhgc

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    1. I had seen the video before and wondered about behavior at home: does the darker kitten do that with the orange kitten at home too? There are more effective ways that the dark kitten could have gotten the orange kitten to leave as well, such as batting or nipping at his hind feet to get him to jump off the table (my two herd one another this way) and then herding him into the carrier. Scruffing young cats (under a year old) makes them instinctively curl up into a ball like they would when picked up by their mom (it's a submissive instinctual response and it tends to fade with age), and that's why the orange kitty is so slow to move where his sibling wants him to go. He's trying to curl up. I do think the darker kitty is trying to lure him to safety though. I think in this case they're too young to make the association that vet = bad, but because cats are prey animals they do tend to consider new environments a negative thing. It would make sense that the darker kitty wants to take his slow-moving sibling to safety (in this case the carrier.)

      Great question, Lytha! :D

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  4. God I love cats. You always have good stories:)

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  5. When I was 8 we moved into an old home, furnished cuz the previous owner had died, and in the kitchen was a plaque on the wall with a painting of a cat. It read, "Cats are such agreeable friends, they ask no questions, and pass no criticisms."

    At 8 years old I thought that was great. Now I look at the long infected scratch on my husband's chest - we had to remove another tick from our cat - and I see that as her criticism. And about questions - they're asking, we just often don't hear, cuz it's not always the audible question, "food?" For instance my cat often tries to lure my out to the horse pasture, so she can frolic and hunt in my company. Her questioning is in silent language. But as soon as I open the door, she says, "Let's go, daft one!"

    It turns out that quote was from George Eliot, and not about cats, but about animals. Not so clever afterall.

    In my ideal life, I'd have a housefull of cats. In reality, my cat won't let me.

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    1. I don't think cats (or animals in general) criticize. They have opinions and sometimes they have VERY strong ones, but it's just that: an opinion. "No, I don't want to have my nails trimmed." "I don't want that tick removed." "I don't like this chair in this spot here." "I don't like the neighbor's dog." But I agree: they do ask questions. All animals do. They ask one another and they ask us. <3

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  6. I was roaring with laughter reading this :)

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    Replies
    1. So happy you enjoyed! :D I always think of you when I write these tech posts!

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    2. They're enough to make me think I could get back into it some day. At a real hospital.

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  7. I love those kind of patients.

    Have you seen the movie Kedi? It's about the feral cats in Istanbul. I enjoyed watching the cars behavior and body language.

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