The Light is Everything

“Still, what I want in my life
is to be willing
to be dazzled—
to cast aside the weight of facts

and maybe even
to float a little
above this difficult world.
I want to believe I am looking

into the white fire of a great mystery.
I want to believe that the imperfections are nothing—
that the light is everything—that it is more than the sum
of each flawed blossom rising and falling. And I do.”

― Mary Oliver, House of Light

Last year was a hard year. At this time a year ago, there were a couple of bombs about to go off in my personal life. One was that my elderly and much beloved cat, Fiona, was dying of cancer, but I didn’t know it yet. The other was that I was rapidly developing symptoms that, being a physical therapist, I would consider and reconsider, and finally realize I had to do something about or face disability. I variously wondered if I were developing a neuromuscular disorder, like multiple sclerosis, or if the neuropathy in both hands, the eroding balance, and the overall muscle weakness were the result of something more mechanical, but equally alarming, like a pinched nerve from a herniated disk or arthritis in my spine.

By the end of January, after three weeks of frustrating, apathetic vet care that caused Fiona — and me — a lot of needless suffering, I took her to a compassionate vet hospital where my sweet girl died of bowel cancer at the age of fifteen. And for the first time in thirty-five years, I had no pets in the house. A few weeks later, I adopted two feral female cats that had been separately rescued and brought to a local shelter, where they had languished for several months, waiting for some crazy human to take a chance on them. Not long after that, I had an MRI which showed that my spinal cord was being compressed by three bulging disks in my neck, and I needed surgery urgently. I went on leave from work in mid-April, had surgery, and did not return to work until late June. I had side effects from the mechanics of surgery for months — still do, in fact — but I could walk again without a cane, hold a pen and use a keyboard, feel my patients’ pulses with my fingertips, and do my job.

Meanwhile, in the online breast cancer community, we were losing people. Nothing new there, sad to say, but we were losing ass-kicking, brilliant, well-known and much-loved advocates and activists. People like Lori Marx-Rubiner, a long-time advocate and blogger whom I’d finally met in November of 2016 at a conference on MBC. Like Beth Caldwell, an attorney, activist and co-founder of MetUp. One of those we lost was my friend Susan Hamson, aka Scorchy Barrington, known to many from her blog, The Sarcastic Boob. Susan had been dying by inches of metastatic breast cancer herself for much of the time I’d known her, but especially in 2017, she was teetering on the edge, alternately in a hospice facility and in an acute care hospital. Not long after I was finally returning to work, Susan was beginning to lose the ability to communicate. Less than five months later, on November 14, 2017, she died.

I still cannot type about, or talk about, or think about her death at any length without feeling completely gutted. Many of you know what it is like to form a heartfelt, mutual bond with a sister in our cyber community that extends into all forms of communication. Many of you also know what it’s like to finally meet one of these precious friends in person. In October of 2016, I not only got to meet her, but I got to have her as a guest for a three-day weekend at my home, being snuggled by dear Fiona, who knew a cat lover when she met one, and who kept finagling ways to get the three of us in close proximity all weekend. I had tried to talk Susan into letting me take the train to visit her instead that weekend, but I think she knew it was the last time she would be physically able to attempt such a thing. And I’m a clinician, and I live down the street from the hospital system that employs me, and I knew if something dire happened, I could look after her. So, she came, by Amtrak, from NYC, to the charming, late-Victorian train station ten minutes from my home in southern New England. It was lovely, and I will always cherish the memory of that visit. But it makes my grief all the worse. She deserves, and will get, a post from me that is devoted solely to her, but not just now, not just yet.

Then there is the world, this country, and its politics. There is the sobering awareness of the scale of sexism and misogyny we’ve all experienced, an awareness brought about by the #MeToo movement. There are still and ever mass shootings. There have been ungodly natural disasters that have destroyed swaths of America by hurricanes, fires, blizzards, you name it. The drinking water crisis in Flint, Michigan is still unresolved. All of these things have affected the lives of countless individuals, changing them forever. One of my friends and colleagues was hit last year by a drunk driver while she herself was driving to visit a patient. She lived, but she has been unable to work since. And for me, there is the reality of working in home health care, and visiting people who are disabled or sick or old or poor, or all of the above. And of being astounded at how utterly ignorant, how lacking in any sort of compassion, that dozens of our national elected and appointed so-called public servants apparently are toward the reality of the people I treat every day. I’ve had to learn to ignore a lot, or limit my exposure to a lot, else I could not get out of bed in the morning.

One thing I’ve discovered though is that, miraculously, nine years after I was diagnosed, the personal aftermath of my own breast cancer and its treatment doesn’t bother me much these days. Sure, any year now, I could have a recurrence. But I don’t seem to live in the “could” of it anymore. The possible seems to have been shaken right out of me by the actual. A year ago, I was on the road to being permanently disabled by something that wasn’t cancer. Nothing like perspective. After the past year in particular, you can scarcely escape the awareness that there is a whole lot of other shit out there that can destroy life as you know it.

So, at the beginning of this new year, while I dig out of the large pile of snow Mother Nature just dumped on us here in New England, I want to thank my real-world and virtual-world friends, and my blog readers, for being there, and for helping to leaven the heart-breaking parts of the actual with the sheer vitality of your daily existence. I thank you all for being kind, and funny, and whip smart, and perceptive. I thank you for giving a shit about the world and about me, for laughing at my attempts at humor, and for cheering me on as I try to convince two feral cats that humans are indeed worth loving. I am so grateful to you and to the fur girls for helping me to discover that I can still be dazzled, and that I am still willing to be.

Double, Double, Toil & Trouble: It’s Okay to Ignore Pinktober

[Originally published as a Note on my Facebook page on Saturday, September 30, 2017 while my blog server was down.]

PTSD: Pink-Tober Stress Disorder

There’s more than one type of PTSD. There’s the post-traumatic stress disorder that many of us develop, to one degree or another, after having cancer and cancer treatment. It’s the kind that occurs when our existence is threatened and our entire notion of normalcy is ripped apart and tossed upside down. We are never the same again.

Then there’s the PTSD that comes of having a cancer recurrence. Or the PTSD of being diagnosed with metastases. Or of having someone you love diagnosed with a recurrence or metastases. Or of having someone you love die of metastatic cancer. Or of having several someones you love die of cancer. Or of refraining from trying to list how many people you have lost from metastatic breast cancer in particular, because you’re afraid you’d probably forget some of them because there have been so goddamn many.

And then there’s this year in these United States. A lot of us here have been suffering from socio-political PTSD. Last year’s presidential election campaign was a bruiser. And the outcome, along with what that has revealed about our legislators and our citizenry, is none too savory either. If you are reading this, you probably have a pre-existing condition, which means you’ve been enduring the cliff-hanger created by the GOP, while they have endeavored to make it harder and more expensive for you to have health insurance at all. Double ditto if you’re disabled, poor, or female. Or just not white, male, and wealthy. Apparently that’s all it takes to be disregarded by much of the gang in Washington.

I used to be a bit of a news junkie. I don’t have a TV, but I’d listen to public radio news every morning and evening at home, as well as in the car as I drove around visiting my homecare patients. Not any more. I stopped listening around the first of the year. Now, I read a very whittled-down selection of online news, and not from sources that have demonstrated their inability to stick to facts, no matter what end of the political spectrum they represent.

Which leads to another source of stress this year: social media. Social media is brutal these days. A lot of us have had to do some serious housecleaning. Blocking and unfriending have probably reached some kind of all-time high. Unfiltered posting is more rampant. Forgiveness is more problematic. Acceptance of differing views is more complicated. Me, I’ve become adept at selective scrolling on Facebook. I’ve become allergic to hype, and even more suspicious of so-called “news,” too much of which amounts to pandering. I stay away from Twitter altogether. Mind you, I admire the people there who track public figures and politicians, and endeavor to keep them honest. But Twitter feels like an endless cage fight to me, and I just don’t have the stamina for constant one-ups-man-ship. Which is saying something for a blogger who has herself employed ample snark.

Then there’s my personal life. In January, my beloved fifteen-year-old kitty developed cancer and died, after a month of misery. At least I got to stroke her head and kiss her face before the vet started the IV that ended her suffering. [How to Be Loved by a Cat] But I was shattered. After 35 years, I had no more fur babies in my home, a chasm I eventually filled with two rescued feral cats from a local shelter. Meanwhile, I developed some alarming symptoms — neuropathy, pain, muscles spasms, weakness, loss of balance — that were caused by spinal cord compression in my neck, and I had to have surgery to fix it. Not fun. At all. Still recovering. But, heck, at least I still had job-based health insurance, which the nimrods in Congress could not repeal away. And my leave of absence from work was covered by paid sick time. And I was able to return to work eventually. And it wasn’t cancer. But let’s just say it’s been a rough year.

I’ve been blogging for nine years now. I’ve published over fifty posts, and created countless memes, that have to do with the pointless, puerile merchandising and fundraising extravaganza that we skeptics call Pinktober. There’s even a tab on my blog, called “Pink Peril,” that lists them all. [Fighting the Pink Peril] If you don’t know by now that pink is not a cure; that breast cancer is not a game; that there is only one day set aside in so-called “Breast Cancer Awareness Month” to acknowledge metastatic breast cancer; that only 7% of breast cancer research funding goes specifically to metastatic breast cancer; that Fancy Pinker (thank you, Katie) has yet to keep her promise to find a cure, the promise she made to her sister Susan G. Komen before Susan died of metastatic breast cancer, yet she continues to draw a six-figure salary as Komen chair while not fulfilling that promise; if you haven’t figured out by now that it’s not about our breasts, but about our lives, then WAKE THE HELL UP! And read this, right now: 13 Facts about Metastatic Breast Cancer

As for the rest of us, I hereby grant us all permission to do what we need to do to maintain our sanity. And if that includes ignoring Pinktober, then so be it. We have enough shit to deal with. After nine years, and the loss of too many friends to this cruel disease, while several more suffer endless treatment with the sword of Damocles hanging over them, I’m as aware as I’m ever going to be. And more than likely, so are you.

Why Am I So Tired? A Primer on Breast Cancer and Fatigue

About seven months ago, I started dealing with a serious health crisis that wasn’t cancer. Three of the disks in my neck were bulging and compressing my spinal cord, leaving me with neuropathy in both hands, weakness everywhere, decreased balance and coordination, and increased muscle pain and spasms. I couldn’t hold small objects or feel my patients’ pulses. I couldn’t carry my work bag over my shoulder by the strap. I had to start using a cane to walk. Because I’m a physical therapist, I knew that if I didn’t do something soon, I would not be able to continue performing my job. In April, I had surgery to remove the three bulging disks and to stabilize those three levels in my neck with hardware and bone graft material. I was out of work for nine weeks altogether, and recently returned, feeling very fortunate that I was able to do so.

Naturally, I thought of my last serious health crisis, which was breast cancer. Next month, it will have been nine years since I was told my biopsy was positive. My neck surgery was a lot more brutal than my partial mastectomy, and a lot harder to recover from. But I didn’t have to endure radiation and Tamoxifen after it. I was exhausted and miserable after neck surgery, but I couldn’t help noticing that ultimately, I felt better than I did before my symptoms started. I certainly cannot say the same about cancer. I still remember what I dynamo I was back then before I was diagnosed, and how, nine years later, I have not fully shaken the effects of the fatigue that moved in and never entirely left me. But I have learned a lot about it, and yes, I do feel a lot better than I did when it started. A lot better. So, it seemed like a good time to write about it once again.

I don’t have a magic spell to offer you about how to make fatigue disappear. But I can tell you a few really good things. Since I first started trying to figure it out back in 2008, the chronic, long-term, body-slamming fatigue that results from cancer and cancer treatment has been formally recognized and given a nice, logical name — cancer-related fatigue, or CRF. There has been a great deal of research on it, verifying its existence, its prevalence, and its biomarkers, and studying various treatments for it. Assessment tools have been developed for it, so that doctors can officially evaluate and diagnose it. And it has even been given its own ICD10 code so that insurances will pay for treating it. One thing that has not changed is that it still happens. Without a doubt, CRF has been one of the most onerous, long-lasting consequences of cancer and cancer treatment for me personally, and for many, many other cancer patients. So, here’s an updated primer that may help.

What is this and why is it happening to me?

As soon as you hear that you have breast cancer, or almost any kind of cancer, your body starts reacting to the awful news. You may feel shock and disbelief. You may have dozens of questions. Your life starts to include a flurry of diagnostic tests and doctor visits. You have to find babysitters, take time out of work, deal with insurance claims, figure out if you can afford co-pays. Your body goes into high-stress mode. Stress has an immediate effect on your emotions, as well as wreaking havoc on the neurotransmitters and hormones that manage your state of mind, your sleep, and your energy. Most likely, your immune system has already been attempting to deal with the cancer cells in your body, long before you are aware of it, and now it has to deal with the physical consequences of uncomfortable tests and biopsies. Your concentration can be adversely affected, and you may find that you are too tired and frantic to deal with ordinary household tasks. And this is just the beginning. Before you even contemplate surgery, radiation, or chemotherapy, you may feel exhausted.

Each step of the treatment path for breast cancer can add to your fatigue. Surgery is often the first step, and depending on your tumor and the options you choose, may involve more than one type of surgery, and more than one protracted period of recovery. If you opt for radiation, it is usually scheduled within weeks of your initial surgery, and can require daily treatment sessions over several weeks. Chemotherapy, by infusion or by oral medications, may require months or even years to receive. If you are diagnosed with de novo metastatic breast cancer, your treatment will never end.

The side effects of each of these treatments can take a huge toll on your stamina. Meanwhile, your life is turned upside down. You may have to miss a lot of work, or not be able to work at all. Your bank account may shrink drastically, and you may need help from others who may not be used to providing care. Is it any wonder that, along with scars, treatment side effects, and anxiety, so many of us develop overwhelming and long-lasting fatigue?

According to a 2013 article, originally published in Brain, Behavior, and Immunity, “Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors.” It has been estimated that from one quarter to nearly all cancer patients experience fatigue during and after treatment. We may be warned about fatigue beforehand, but often these warnings do not begin to encompass the totality of its effect on us and our quality of life.

What is cancer-related fatigue?

Cancer-related fatigue (CRF) is a condition that researchers are still trying to understand. It is not simple tiredness that can be fixed by an extra nap or two. CRF is a persistent, whole-body exhaustion that you can’t ignore. You may sleep for hours every day, yet not feel refreshed or energized by that sleep. You may find it hard to concentrate or to engage in your usual activities. Although in itself, CRF is not the same as depression, you may also find that it affects your mood, as you struggle with or are unable to do the things you want or need to do.

Although CRF exists as a separate issue, there are a number of other physical and psychological factors that may contribute to fatigue. These need to be addressed separately. They include pain; nausea and diarrhea that can lead to dehydration; poor thyroid function; lowered red or white blood cell counts; menopausal symptoms brought on by surgery or chemotherapy; fever and infections; nutritional imbalance; anxiety and depression; and the sedating side effects of medications for pain or anxiety. The decreased activity brought about by fatigue can also make it worse.

A thorough evaluation of your symptoms should be done. This may be carried out by your oncologist or by your primary care physician. And don’t let your doctors brush you off with the usual bromides that you’ll be fine with more rest and more exercise. You need a proper assessment. One of the problems that cancer patients can encounter when trying to get help is that their doctors don’t really know how to assess them for this kind of fatigue. I had to dig up my own information and ultimately find a research study nearby that was able to assess my fatigue and help me get treatment for it. If need be, don’t hesitate to refer your doctor to this link at the National Cancer Institute website that describes CRF in detail, as well as how to assess and treat it.

A number of survey tools have been developed and researched to assess CRF. One of them, called the Fatigue Symptom Inventory, has been found to be consistently reliable. It is a survey that you fill out yourself, and may fill out again from time to time, to see if your symptoms are improving. It can be found and downloaded at this link: Fatigue Symptom Inventory. Don’t be shy about providing your doctor with a copy of it for your chart.

What can I do about CRF?

Before you can address CRF specifically, you need to be treated for any of the other medical issues your doctor may identify when you are evaluated. For example, if you are anemic, you may need to take nutritional supplements like iron or get advice about how to improve your diet to build up your red blood cells. Some cancer patients may need specific medications or even a blood transfusion, and their blood levels will need to be monitored.

Sometimes fatigue is confused with depression. It’s important, therefore, to be evaluated to distinguish between the two. You may experience one or the other, or both at once. But they are not the same. Depression is a mood disorder that usually includes feelings of despair or hopelessness, apathy or lethargy, a desire to isolate yourself, and an inability to feel pleasure in activities that you usually enjoy. Depression can be relieved with medications that help improve the levels of neurotransmitters effecting your state of mind. You may need treatment for depression before you can adequately deal with your fatigue. A link to a previous post about depression and cancer is here: Depression and Cancer: An Insider’s View

Once you have addressed any contributing medical issues, there are a number of strategies that you can try to help your fatigue. Learning to prioritize the things you need to do, and to map out a reasonable schedule, can make life more manageable. It’s hard to ask for help, but this is the time to do it. If your friends or family members ask you to call them if you need something, see if you can make a list of things that need doing, and give them a task. Oncology counselors and nurse navigators, or local cancer support groups, can help you identify sources of help, often at no cost, to get things done. You may need others to babysit, take care of your pets, do the grocery shopping and prepare meals, clean your house, or mow the lawn. If you are able to work, you may be able to do some of your job at home. You may also be able to arrange for shorter work hours. It may be hard just to organize all this, so ask someone to help you with that, too.

Cancer patients are often advised about getting exercise. Exercise can help relieve fatigue, but doing it may seem like an impossible task when you have CRF. As a physical therapist, I try to give my cancer patients various options that address differing levels of energy, from short movement routines that they can perform lying down, to carefully progressive walking routines. Sometimes, you will feel like you can barely get out of bed. It’s often not helpful to be given a complicated routine that you cannot easily complete on your own. The best exercise advice is to keep it simple. Even if all you can do is to walk around your house or down your driveway for five minutes, that will help. Some cancer patients find it useful to join an exercise group for cancer patients at a local gym or to practice yoga. You can try out different activities to see what works for you. Keep in mind, however, that many of your daily activities can also provide some exercise. Tasks like sweeping the floor or doing your laundry involve exertion and weight-bearing that can keep you moving. Make sure you keep periods of exertion short, and get at least some brief, quiet rest afterward. Your doctor may be able to refer you to a rehab therapist for help and advice. You may find a few suggestions here to help get you started: Exercise After Cancer When You Don’t Feel Like It

If you still find it hard to get CRF out of your way, you may want to ask your doctor about neurostimulant medications. Many cancer patients are able to take medications like Provigil, Nuvigil or Dexedrine to help their concentration and energy last longer. For more details about CRF and its treatment, you can refer to the complete PDQ on Cancer-Related Fatigue provided by the National Cancer Institute. The section on Psychostimulants will tell you more about these medications. I found Provigil very helpful for getting through my work day. I also found time-released Wellbutrin, aka Buproprion, an older, dopamine-facilitating anti-depressant, to be helpful, and still take it sometimes as needed. It has its own link in the PDQ.

Most of all, remember that if you have CRF that lasts for months or even years, you’re not crazy or abnormal, and you’re not alone. If you need some validation, just type “fatigue” in the search box on my sidebar, and you’ll find the fifty-eight other posts I’ve written about it. Here’s a link to one, prompted by an article headlined, “Breast Cancer Fatigue is Real,” that also has several other links to helpful information: Could Have Told You That.

Here are a few other research links you may find helpful:
1) I’m So Tired: Biological and Genetic Mechanisms of Cancer-related Fatigue
2) Inflammation and cancer-related fatigue: Mechanisms, contributing factors, and treatment implications

Paws and Purrs: How to Be Loved by a Cat



Yes, They Make Their Own Decisions

It goes without saying that admiring her incomparable beauty is the first step toward getting any cat to love you. Next, you might try some respectful adoration. And it’s advisable to bear in mind at all times that cats are not dogs. One hesitates to make generalizations about any species, but cats are not slavishly motivated to please you, as dogs often are. They don’t necessarily like to ride in cars or fetch your slippers. A lot of cats don’t even like to be picked up and hugged. When they choose to love you, they do, in their own way. But they don’t, as a rule, jump up to greet you and lick your face. There are exceptions, of course. Once, when I visited my friend who runs the local animal shelter, I ended up adopting a cat who, upon my opening his crate to say hello, stood up on his hind legs, put his front paws around my neck, and licked my face. I wasn’t planning to adopt a cat just then, but what choice did I have after such a greeting? However, that is another story for another post.

This post is about Fiona. I first met Fiona in 2009, about a year after I had been diagnosed with breast cancer. At the time, Fiona was eight years old, and was, I was told, a dilute, or muted, tortoiseshell, something I never knew existed. She lived with a neighbor who had herself recently been diagnosed with breast cancer. My neighbor was already disabled and was trying to simplify her rather chaotic home. She had three small dogs who were adorable, but not particularly well-behaved or nice to cats. She also had three cats, who had established a strict pecking order, with poor Fiona at the bottom. Between the yappy, aggressive dogs who chased her, and the other two cats who bullied her, Fiona was a very frightened, unhappy girl who spent most of her time hiding in a small storage room. My neighbor had a heart of gold, but not necessarily the wisdom to realize that she ought perhaps to have stopped adopting pets at one of each. She did, however, realize that Fiona was miserable and asked me if I would adopt her. At the time, I had one cat, a shy, inoffensive black Persian male named Jett, and Foxy, a gentle, old, Nordic mix dog who happened to love cats. So, I agreed to take Fiona home.

Fiona emerges from under the bed.

The first thing I did was to let poor Fiona have her own room until she felt equal to meeting any new animals. She spent the first several hours of that first day hiding under the guest room bed, but by the afternoon, she began to emerge when I visited her. It took a few days for her to brave the rest of the house, but when she did, she soon discovered that Jett only wanted a mother substitute for my cat Chloe, who’d fulfilled that role until she died earlier that year. And Foxy was savvy enough to keep his distance, and approach gradually, until Fiona realized he wouldn’t bark at her or chase her.

Within weeks, Fiona was relaxed and happy. Her amazingly soft fur was even fluffier, and she now slept with the rest of us on the bed at night. She and Jett would usually bracket me while I slept, with Foxy at the foot of the bed, facing the door as he always did at night to guard us against potential marauders. Eventually, Fiona even snuggled up with Foxy for the odd nap.

Five weeks after Fiona moved in, I ended up adopting another cat, a gray and white tail-less Manx named Teddy, who was twice as big as Fiona and Jett. It wasn’t the best timing ever, but I’d promised another friend that, if she ended up having to live in a nursing home, I would take Teddy in. Well, she did, and I did. I was worried about how Fiona would react, but she clearly felt she had the upper hand, since she was there first. Poor Teddy, on the other hand, had never lived with any other animals before, so he won the guest room for a while until he learned that it was not acceptable to boss around the other cats, and that it wasn’t entirely horrifying to live with a dog. It all worked out. After all, I was the human, it was my house, and my rules. Everyone got loved, and I didn’t put up with any nonsense. If Teddy needed any further convincing, Fiona flipped all twenty pounds of him on his back one day right into the water dish when he got a bit rambunctious. He behaved himself after that.

Shy little Jett preferred to sit beside me, but not on my lap. Teddy liked to be picked up and hugged when I came home, but mostly, he liked to lie on his back, displaying his white tummy in hopes that someone, anyone, would rub it. Fiona became my lap cat. She hated being picked up, but if I left her to her own advances, she would hop into my lap or onto the table whenever I was using a computer. Thus, she appointed herself my blogging assistant. A close-up from this photo became my Gravatar icon, and shows up whenever I comment on a blog. Indeed, she became an all-around champion snuggler, attaching herself to some part of my body when I was sleeping, reading, having my morning coffee, or checking my email. She had a particularly endearing habit of draping herself on my arm in bed, and tucking her face into my hand. My Facebook friends have seen ample evidence over the years of her snuggling talents. Here are a few illustrative photos.

Change Happens

Early in 2010, sweet little Jett died of an abscessed tooth combined with old age. Later that year, in November, I had to make the awful choice to let Foxy go, after watching him suffer with advancing arthritis, increasingly painful mobility, and confusion caused by dementia. A few years later, Teddy succumbed to feline infectious peritonitis. It was heartbreaking to lose each one of them, but it helped that I still had a fur baby or two to comfort me after each loss.

I was worried that Fiona would now be lonely at home while I was out at work, but she rose to the occasion and reveled in having me all to herself. She began to talk more, in her slightly raspy, expressive voice. She had never been very sociable when humans came to visit, but now she became Miss Congeniality, greeting friends and contractors alike. She was particularly fond of my electrician. I did finally realize that she missed her big, fluffy cuddle-buddy Foxy, when she took to sleeping on the guest room bed during the day, curled up with a toy horsie who was about Foxy’s size. Still, she was happy, healthy, and gracefully approaching her old age. Until she wasn’t.

The first crisis occurred a few years ago, when she developed hyperthyroidism, a common ailment in older cats. After fiddling with oral medication for a year, I had her treated with radioactive iodine in August of 2015. It worked. No more pills, and she was once again robust. A year later, she started to have a few brief bouts of vomiting, nausea, and diarrhea, but they cleared up in a day or two. Until they didn’t anymore. A few weeks ago, she began having these episodes every other day. Her regular vet was maddeningly passive. Fiona was not getting better, she was not getting enough nutrition, and she was becoming dehydrated. I got the vet to order full labs and an abdominal ultrasound, all with inconclusive results. Not once did the vet offer relief for Fiona’s symptoms, until I insisted on it. Finally, I’d had enough, found another, much better vet, and took Fiona to see him this past Tuesday. We came up with a provisional diagnosis and a treatment plan. If I wanted further diagnostics, he suggested I take her to the specialty emergency vet hospital. I decided I’d see how she responded to treatment and go from there. Later that day, she became exhausted and weak, and by nightfall, she developed labored breathing. I was scared now. I drove through the pouring rain at nine o’clock that night to the emergency hospital. The vet on duty was kind, persistent, and worked hard to assess her as quickly as he could, with a minimum of misery to Fiona, to come up with some answers. The answers he arrived at were that she had extensive cancer of the small intestine and sepsis. He did say that surgery was possible, but given her current weakened state, I felt it would be risky and that she had suffered enough. He agreed. At 11:30 p.m. on Tuesday night, he gave her the appropriate injections, and Fiona died while I kissed her forehead.

I can’t begin to describe how shattered I have felt this week. I have not been without at least one pet since 1981, and usually, I’ve had two or three. The house is so empty, so still. Sometimes, I imagine I hear little paws pattering on the floor or seem to feel the pressure of four feet landing on the bed to keep me company. I never can seem to get warm enough at night, no matter how many blankets I pile on or how high I turn up the thermostat. For thirty-six years, there has always been a furry face or three waiting to greet me at my door when I came home. I grieve mightily for sweet Fiona, but also for every pet I’ve lost. I’ve never set out to adopt any of the strays or rescued pets I’ve loved. They’ve always appeared, on their own, or at the instigation of someone else, when they needed me. Eventually, I am sure that another will arrive when I’m ready. But for now, I need to sit with this enormous grief that I know is just the flipside of the enormous love that all these fur babies have shown me over the years. People who think that animals do not love are fools.

So, I feel heartsick and blessed at the same time. I will admit that I often prefer animals to humans, but the outpouring of concern and affection I’ve received from so many friends, in person and on social media, has touched me and given me much comfort. More than that, it is a needed balm at a time when many of us are flabbergasted and concerned about our present political climate. It’s a reminder, when I very much need one, that there is still decency in this world. Thank you all for the love, and not only just this week, but over the years. And especially, I thank those of you who’ve loved Fiona, too.