A Cat with More Than 9 Lives

By: Christopher Fulkerson

Class of 2010, Purdue University

I met Barnum during my first small animal medicine rotation.  A scrawny cat at best, Barnum had survived more than most cats would have been capable of and his owners had supported him through more than most would have been willing.  Before I had ever met him, he’d survived hyperthyroidism treated with I¹³¹, septic peritonitis after a gastrostomy tube leaked, inflammatory bowel disease, heart disease, chronic pancreatitis, chronic kidney disease and persistent anorexia.  He was nothing much to look at – nearly toothless, he was more skin and bones than cat and spent much of his time lounging lazily in lateral recumbency.  He sported a bright blue vet-wrap neck bandage that made his head look several sizes too large for his impossibly thin frame.  The bandage covered his bright orange esophagostomy tube, a permanent fixture since his failed gastrostomy tube.  This visit was more bad news for Barnum and his owners – a diagnosis of gastrointestinal lymphoma had been made by endoscopic biopsy.  Where some owners would be disheartened to learn that their beloved pet had cancer, Barnum’s simply took it in stride.  Her only response was, “What do we do now?”

And so it went.  Barnum stayed with us off and on for medical boarding over holidays or when his owner knew that things might be hectic at their house.  She was more concerned about her beloved cat receiving the best care possible versus the financial implications of frequent stays at a teaching hospital.  Barnum did more than linger on after his diagnosis with lymphoma – he thrived.  He gained weight though his appetite would wax and wane.  We gauged much of his progress by how much he’d let us do without protesting – it turned out he was quite the feisty cat when he felt well!  He picked his favorite students and his favorite clinicians, offering us much more affection and leeway than he’d afford most.

Other times, Barnum would visit us for real medical issues like a clogged esophagostomy tube that prevented him from receiving the medications and supplemental feedings he so desperately needed.  I’ll never forget the praise his owner offered when we used a syringe full of Dr. Pepper from my lunch to clear his esophagostomy tube or the excitement in her voice when I’d call to let her know that he had eaten his daily caloric requirement while in the hospital.  Each time he was in, I got to know his owner a bit better and we developed a great rapport.  She confided in me that her husband’s sister had passed away and that Barnum had been her pet.  Though he looked like nothing more than a dirty old barn cat, Barnum was actually the last tangible connection between a family and their lost loved one.  And with that, Barnum’s struggle and his family’s sacrifice made all too perfect sense.  She told me that no matter what they would never give up on Barnum and they would do whatever they could to see him through any illness.  More importantly, she told me that she thought Barnum could fight his way through any illness, and I came to believe that too.  I came to regard Barnum and his family as friends and I cared for him and rooted for him like he was my own.

When it came time for my final small animal medicine rotation, I found my friend Barnum waiting for me in the intensive care unit of our hospital.  He had become such a fixture in my medicine career at Purdue that I wasn’t entirely surprised that he was there.  He had presented over the weekend for weight loss, decreased appetite and lethargy, like many times before.  I called Barnum’s owner first thing that morning and she immediately recognized my voice.  We chatted easily and caught up on Barnum’s adventures over the holidays and the preceding months.  We both agreed that it seemed like we were headed down a road we’d been on many times before and suspected that Barnum would be home by the weekend.  Much to my surprise, Barnum didn’t improve over the first 48 hours he was in the hospital.  As a point of fact, Barnum’s condition seemed to deteriorate, rapidly.

With an abdominal ultrasound we discovered that Barnum had a pancreatic pseudocyst.  An fPLI and fTLI confirmed that Barnum had an acute, fulminant case of pancreatitis.  Things moved fast from there.  Barnum’s condition continued to deteriorate and we began treating him with fresh frozen plasma.  Barnum began having episodes of syncope, one of which happened when I was ausculting his heart.  I heard his heart rate slow – first 180 beats per minute, than 120, than 60 and then he collapsed.  And just as fast, he recovered.  The tone of my conversations with his owner shifted and each time we spoke I was less optimistic and had less encouraging news to share.

Barnum’s blood pressure became erratic and we placed a jugular catheter.  A right lateral radiograph intended to confirm placement of the catheter instead revealed pleural effusion.  His central venous pressure was sky high and we discontinued his intravenous fluids and cautiously administered fluids through his esophagostomy tube.  Eventually Barnum could no longer maintain his blood pressure, despite an increasing constant infusion of dobutamine.  We called Barnum’s owner and suggested she come in one last time.

Over the course of clinical rotations at Purdue, senior students come to know many patients and many clients.  We spend many hours talking to owners and many more taking care of their pets.  Even if we’re lucky, we only really get to know a handful or more of our patients and clients.  I can’t remember the names of all of the pets or the names of all of the owners that I’ve met over the past year, but I know that I’ll remember at least one cat and his loving family for the rest of my career.