Diagnosis: infection


First came the diabetes, and all the dietary restrictions that accompanied it. Doctors and nurses often warned us about possible complications of diabetes, but it was ten years later, maybe longer, before there were any complications. And even then, we were never quite certain that it had anything to do with diabetes. At the time, what happened next just seemed strange and random.

Steph worked downtown, and she usually took the bus to work. There's a bus stop two blocks from our apartment, and the bus dropped her 2-3 blocks from her job, so it was an easy commute. One icy winter morning, walking to the bus stop, Steph slipped on the ice and smacked her shin into the sidewalk. It hurt, and it drew blood, but it was a minor annoyance. She went to work, put a bandage on it, and mentioned it in passing when she came home that night. Seemed like not-quite-nothing, but certainly nothing much.

A few weeks later, though, the bruise hadn't heeled, and that area of her leg pained her with every step. She went to her doctor, who said it might be infected and prescribed some antibiotics. The antibiotics gave Steph diarrhea but seemed to have no other effect, so a week later the doctor prescribed a different antibiotic. And still, the bruise wouldn't heel, and the pain was increasing.

When the second antibiotic didn't work, they x-rayed her leg and pronounced the infection "severe." The doctor recommended a surgeon, and at this point we knew we were dealing with something weird. Have you ever heard of a slip on the ice leading to surgery?

We met with the surgeon, whose explanation was "These things happen," which didn't really explain anything but by then we'd come to conclude that "why" was a question that wouldn't be answered. And if surgery could solve the problem, of course we'd be happy with surgery. The plan was that the surgeon would remove the infection, along with some of the skin and muscle around it. Steph was admitted to St Mary's Hospital in Madison, where she stayed for two, maybe three nights.

We found the experience odd. Their care was more than competent, the nurses were compassionate, and everyone seemed to care, but three different staffers volunteered to pray with Stephanie. Is that weird? We thought so. The name St Mary's Hospital is a clue; it's run by some non-profit that's connected to the Catholic Church. But we weren't religious, and nobody asked if we were religious; people just kept coming into the room, asking if Steph wanted someone to pray with.

The food, I remember, was quite bad. That's what you expect with hospital food, but Stephanie was always picky about what she'd eat, and meal after meal at the hospital she deemed inedible. I was "visiting" her room, but actually sleeping in a chair overnight, every night, at Stephanie's request. And after a few meals that she couldn't stomach, I began bringing her meals — McDonald's Filet-O-Fish one night, a sandwich from Milio's the next day, etc.

Before the surgery, Steph was scared but brave, and I was scared but not so brave. I tried to talk her out of talking about it, but at her insistence we discussed wildly-improbably worst-case scenarios before they wheeled her to the operating room. "If anything goes wrong, I want to be cremated, and please take good care of the cat." Dark humor, I'd call it, because we'd been assured and we certainly understood that this was minor surgery, with an infinitesimally small chance that anything could go seriously wrong.

The surgeon promised she'd come see me as soon as the surgery was finished, and she did. "Everything went well," the doctor said, "and your wife should be awake in half an hour or so." And indeed, half an hour later Steph was holding my hand, smiling, optimistic — my ordinary, extraordinary wife.

They sent us home with a machine attached to the hollow spot on Stephanie's leg, the hole where her flesh and infection had been. The machine loudly sucked up the pus and ick every few minutes, and twice daily we'd power down the suction, gently wash the wound, and reattach the pus-sucking machine. A nurse visited our home several times each week, checking on Stephanie's progress, and in six weeks or so the wound had healed, and the nurse took the pus-sucking machine away. Steph was soon able to walk, with minimal and fading pain. After a few months, there was no pain at all, and she was walking normally.

Other than the diabetes, Steph had no ongoing health concerns at that time, and nobody offered any warnings about kidney failure. A year later, though, a similar infection developed on Stephanie's back, addressed via the same protocol — antibiotics that didn't work, followed by surgery that left a hole in Steph's back, followed by a month and a half at home with another pus-sucking machine, as the hole slowly healed.

We asked every doctor, what's up with these strange infections? Why is this happening? And again the answers boiled down to, "These things happen." It was tremendously frustrating or worrisome. Obviously "these things happen" because these things were happening to Stephanie, but why?

The answer came later, after Steph was diagnosed with kidney disease, and the answer came from our own research, not from a doctor: Diabetes can lead to kidney disease, and kidney disease leaves anyone more susceptible to infections.

The horror of it all still makes me angry, that Steph — while always brave — was living her life in fear. In her late-30s, she was dealing with these crazy, unexplained infections. In her early-40s, she was dealing with a diagnosis of kidney failure, or as they cruelly call it, End-Stage Renal Failure. "End-stage," right there in the name of the disease.

She was hospitalized five or six times, maybe more, for assorted infections. It's a wonder, living through that, that Stephanie didn't become a grumpy, dour, sad woman, dwelling on the negatives. To me that seems an almost expected response.

Why didn't she become an insufferable, pessimistic grouch, when she had to face all those infections without explanation, plus all the kidney-crap day after day? That's another unanswerable question, but somehow, Steph was only pessimistic on rare occasions. She was upbeat and optimistic a good 95% of the time, even during her darkest days. It's another of the many things I admired about her and still do, and it's something I try to emulate, but usually don't.

Minky


After we'd moved to Madison and found our apartment, the same day we finished moving in, we went to the local Humane Society to adopt a cat. We saw several, held them one at a time, and I remember we were a bit smitten with a black and while full-grown adult cat that reminded us of Toby.

To our surprise, though, the folks at the animal shelter asked us a great many questions, and the paperwork seemed extensive. As we were filing out a multi-page application, an employee mentioned that we couldn't actually take a cat home until the staff had inspected our apartment.

"You want to inspect our apartment?" Steph asked in disbelief.

"Sorry, that's a requirement."

"Well, I'm sorry too," Stephanie said, "but that's not going to happen.

On our way home without a cat, Steph said, "If we were adopting a baby, then of course there should be a home inspection. But a cat is not a baby, and I'm not letting some nosy busybody into the apartment to judge whether we're fit to have a cat."

Despite the many details of our lives that I've shared here, Stephanie and I were private people. We didn't host cocktail parties or a bridge club or poker every Tuesday. Exactly the opposite — we had guests in our apartment perhaps twenty times, total, in all the years we were married. Her parents, mostly, and a very few friends. We never had a welcome mat; that's for sure.

I always try to see the other guy's perspective, so maybe the Humane Society in Madison has had problems with people adopting pets and then trying to return them? I've heard stories — urban legends, probably — about crazy people sacrificing cats around Halloween, and it was September so maybe that's it? Well, we're not crazy, and I agree with Steph that we shouldn't have to prove to strangers that we're not planning to slaughter a cat.

When I was a kid, my family always had at least one dog and one cat, often more, and all our pets came from the Humane Society in Seattle, where nobody ever required a home inspection. As a single man in my twenties, I'd adopted a dog and a cat, both from the Humane Society, and again, there had been no hint or notion of an inspection. Back then the vibe was, You want to save an animal from almost certain euthanasia? Thank you! I guess those days are gone.

Well, the next day we went to Noah's Ark, a clean, friendly pet and pet supply store within walking distance of our new apartment. There's a sign on the door warning customers to watch for cats, because they roam freely throughout the store, and the moment we stepped inside we saw two cats in an aisle and one napping on a sack of dog food on a shelf. Toward the back, we found a dozen or so cats and kittens in cages, but there were another half-dozen just wandering the aisles.

I asked Steph, "How are your allergies?"

"My nose feels like it's going to explode, but that's because we're in a room with twenty cats. It'll be better when we're home, where there's only going to be one cat. Maybe – that one?" She pointed and giggled, and picked up a kitten, but there was no magic.

We walked through the shop, and picked up several cats and kittens, giving each prospect several minutes of cuddling and goofy talk. "Oh, pretty little kitty," and all that. We were having a fabulous time, even as Stephanie's allergies turned her nose red like Rudolph's.

"Even with a headache," she said, "shopping for a pet can't possibly not be fun."

Then Steph picked up a kitten with tiger-stripes and a dash of orange in its otherwise tan and gray fur. She held the kitty in her arms, and I came closer, and this critter looked up at me with huge and adorable kitten eyes, and then reached its paws toward me.

"Oh, this one wants you!," Steph said.

I held out my hand, and the tiny cat walked right onto my palm, and Steph was all, "Awwww." I lifted my hand and its passenger toward my face, and the kitten pushed its nose into my beard, over and over again. After a few minutes of this delightful schmaltz I handed the kitten back to Stephanie, and it reached toward her just like it had reached toward me, then started nuzzling her face.

"What do you think?" I asked.

"I think this kitten has made the decision for us."

"This is our cat?"

"Yup, this is our cat."

At Noah's Ark, there were far fewer questions than at the Humane Society. We'd called in advance and knew they wanted a note from our landlord, saying cats were allowed, so we'd brought that note. And that was pretty much it. The lady at the register wanted to know whether we'd ever had a cat before, and when Steph said no, she handed her a brochure and told her to call if she had any questions. And they wanted $75, plus whatever we spent on their cat food and supplies that afternoon.

"Seventy-five bucks for that cat," Steph said several times over the years, "makes her the best bargain ever for your entertainment dollar."

We named our kitten something for a few days, but I can't remember what. The name didn't feel quite right, so we gave her a different name which I've also forgotten. That second name lasted longer, weeks instead of days, and Stephanie and I (but especially Stephanie) was always delighted to play with the cat, pet the cat, and talk about the cat.

During its first night in our apartment, the cat was frightened of everything, and didn't eat anything. Steph worried, and when the cat was watching, she got down on her hands and knees to mimic eating cat food at the dish. The kitten was still wouldn't eat, and Steph grew more and more concerned, but she whispered in joy the next morning, when we heard the delicate sound of something crunching, and it was the kitten eating her kibble.

Steph always felt a sense of satisfaction when she saw the cat eating, drinking water, licking itself, or even using the litter box. She would watch with fascination, and make an awestruck announcement:
     • "We taught that cat to eat."
     • "A creature of a different species shares our home!"
     • "All cats are beautiful, I suppose, but our cat is especially beautiful."
     • "It's below freezing outside, with six inches of snow on the ground, but this particular animal is safe and warm, well-fed and loved, curled up and sleeping in the hamper."
     • "This is my family a man I love dearly and who loves me, and a miniaturized, domesticated tiger."

And one evening, Steph exclaimed, "Her fur is so smooth and silky, she's like a mink stole."

"Should her name be Mink?" I asked.

"Well," Steph said thoughtfully, "she's not actually a mink, she's just mink-like, so maybe her name should be Minky?" And three weeks into her life with us, our cat finally had its proper noun — an adjective.

Usually Steph was the one marveling at Minky, but I sometimes marveled, too. With Stephanie, though, it was something truly special — that darn cat was the first and only pet Steph ever called her own, and she never stopped being amazed at the cat's softness, punctuated with claws that might accidentally draw blood.

Steph was new to pet stewardship, and wanted to be more affectionate with the cat than most cats want. At first she softly stalked the kitten, picking her up frequently for petting, holding her longer than the kitten wanted to be held, and Steph received numerous scratches as a result. Not yet understanding cat communication, or choosing to ignore Minky's restlessness and meowing, Steph would hold the cat tighter when it stopped purring and simply wanted off her lap. Sometimes Stephanie continued holding the cat even after Minky began a guttural growl that said almost in English, "Now it's time to let me go."

I hadn't had a cat in perhaps 15 years, but still spoke fairly fluent feline, so I understood these signals and explained them to Stephanie. Even when frustrated, though, Minky was always gentle, and Steph's scratches were incidental, not intentional. The cat was only trying to get away, not trying to hurt her. Through all of Stephanie's cat-learning curve, Minky was always happy to be held and petted by either of us for a few minutes, but what the cat wanted and insisted upon was the right to choose when those few minutes were ended.

Steph, of course, was smart and eventually learned how to handle the cat, and when not to. She began letting the cat come to her, instead of always chasing and catching Minky, and she learned to let the cat go at its first sign of discontent — folded ears, or darting tail. Sometimes, she'd let the cat go even before any "let me go!" signals had been sent. Knowing she'd be free to go when she wanted, Minky began jumping into Stephanie's lap more and more often.

Minky is the seventh or eighth cat I've had in my life, counting all the critters my family had as pets when I was a kid, and she is far and away the best cat I've ever had. For that, most of the credit goes to Stephanie, and the loving care and attention she gave that kitten, right from the start and all through the years. If Steph could hear me, there are about a billion things I'd thank her for, and the cat is one of them.

We spent inordinate hours dawdling over Minky, and wasted money on cat-toys until we discovered that her favorite plaything was the piece of plastic that peels off when a jug of milk is first opened.

Watching the cat wrestle with that piece of plastic — for hours, for days — we wondered what goes on it the cat's mind, and that question became one of our cute clich├ęs. Related questions we asked ourselves include, "Does the cat know that we love her?," and "Does she give us any thought at all, or are we just the two large pink creatures?" Most folks who fancy cats probably ask the same questions.

In some ways, Minky behaves more like a dog than a cat — she usually comes when she's called, she runs toward the door to greet us when we come home, and she's happy to be with us, most of the time. She doesn't fetch my slippers, but sometimes she coughs up a hairball in them.

After a difficult day at the office, Steph would sit down and the cat would trot over to visit her, for nuzzling and petting and treats, purring all the while and pushing her nose into Stephanie's face. Steph would say, "How did the cat know that I needed a friend tonight?"

As Steph's health issues accumulated, Minky often showed an amazing knack for knowing when Steph needed cat-attention. Many times, after an awful day of dialysis or an appointment at the ice-cold kidney clinic, Steph came home in a sour mood and the cat would insist on giving Steph extra attention and affection.

So why am I telling you about our cat? Well, when I came home from work one day a few months back, there were several messy, soupy hairballs on the carpet, and two fresh plops of cat-poop in the shower. Hairballs are a fairly common occurrence, but Minky never poops or pees outside of her litter box. Plus, she usually jumps in my lap as soon as I sit down, but that day she was hiding inside the Shrine, unwilling to come out no matter how much I coaxed her.

I phoned the neighborhood veterinarian, and because they're always excellent, they booked Minky for 7:00 that same evening. It took ten minutes to catch the cat, and another ten minutes of a genuine cat-fight to force her into the carrier, and then she howled all the way to the vet — all very un-Minky behavior.

Minky was well-behaved as she got poked and gave a urine sample via a syringe. The clinic ran tests, and they have their own laboratory, so it wasn't a long wait for the results. The vet scrolled through the tests on a computer screen, showing me each result and explaining the color coding. "The black is a normal result, and anything in red is a problem."

We progressed through a couple of pages of normal results, "That's fine, and that's within the normal range…," but when we got to the results in red, I knew the diagnosis before the veterinarian said it, because the words on the screen, in red, were familiar: Creatinine, and Blood Urea Nitrogen (BUN). That's kidney-speak.

Minky has kidney disease, the same diagnosis that took Stephanie. Turns out, kidney problems are not uncommon in cats, especially older cats, and Minky is 14 years old.

If Steph was here, she'd scream bloody murder. She did occasionally scream, literally, when she grew unbearably frustrated by the treatment and mistreatment she received for her kidney disease, but she allowed herself the luxury of a good scream only rarely, and only at home. But now, her beloved cat has the same diagnosis? Yeah, Steph would scream long and loud.

It's strange that our cat has the same disease that took Stephanie's life, but it's not a fraction as catastrophic, because c'mon, we love her but Minky is just a cat. It feels like a ghoulish and weird coincidence, though, and it triggers a slight echo of the rage and regret that Stephanie and I felt when she was first diagnosed.

The veterinarian prescribed kidney-pills, which I've started popping into Minky's mouth twice daily. The cat doesn't like that, but she likes me well enough that she doesn't put up a struggle. Per doctor's orders, I spent a few hundred dollars on renal-support cat food, which the cat absolutely refused to eat, so now she's back to her ordinary fishy stuff in a can. The prescription pills are expensive, but that's OK. As previously noted, Minky was a bargain at $75, and for all joy she's given us, we owe her a debt.

It seems fair to say that Minky was always Stephanie's cat, more than mine. Steph spent more time with the cat than I did, gave the cat more petting and treats than I did, and Minky usually slept on Stephanie's side of the bed.

But I do like the cat, and these days I spend much more time with Minky on my lap than I ever did when Steph was alive. Petting the cat and giving her treats, cleaning her box and making sure she gets her meds ... to some silly extent it all makes me feel like Stephanie's still in the room.