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May 27, 2008

Reflections while cleaning Humphrey's litter box

As I was freshening it up yesterday it occurred to me that a person who really, really loved their cat and didn't have another person or living thing they cared for anywhere near as much might, upon the death of their kitty, be plunged into a depression so severe that it seemed nothing could ever make it lift.

In such a case I could see how leaving the result of the cat's last visit to its litter box intact rather than tossing it out would be a reasonable response to the grief and that keeping it for as long as it took for things to start to brighten up would be potentially a very helpful bridge back to the world.

Though I've never heard of anyone doing this, I'm certain that many people have but they don't dare mention it to anyone for fear of being thought strange or worse.

To me, whatever works is reasonable.

But then, I've always been accused of being far too practical.

This was oftimes demonstrated back in the ivory tower of academic anesthesia, teaching residents how not to kill people.

During induction — especially in children — premature ventricular contractions (PVCs) are quite common even when everything's done correctly.

And PVCs sometimes herald the imminent onset of far worse: ventricular tachycardia, ventricular fibrillation and cardiac arrest.

The resident, struggling mightily to maintain a mask airway, oftimes isn't aware that the EKG monitor's showing cardiac dysrhythmias, so focused is she on trying to keep gas from leaking around the sides of the mask.

So when I'd casually mention that the kid's got some PVCs as I took over masking for a minute to let the resident's hand muscles unspasm, she'd usually open the top drawer of the anesthesia cart and rummage around for a prefilled 100mg lidocaine syringe.

As she turned back to the patient to find an IV port I'd say, "You won't be needing that."

Because while lidocaine is the right thing to give for PVCs, in this situation it's not the best thing.

Instead, turning up the anesthesia concentration while continuing to mask ventilate almost always makes the PVCs disappear.

There is a huge difference — both in the OR and in the world outside it — between what's right and what works best.

Me, I'm always with what works, even if it's not the "right" thing.

As I said, I'm far too practical for most people's tastes.

Which has caused me endless grief interpersonally through the years.

And you know what?

I wouldn't have it any other way.

May 27, 2008 at 04:01 PM | Permalink


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Comments

Hope Kitty is OK! Mine is 13 plus, each day is a blessing, not to be religiosio.

Dr. Stirt, love your blog, keep it up.

KG, PhD

Posted by: Kevin Gentry | May 28, 2008 5:15:21 AM

Since you were taking the time to freshen up Humphrey's litter box, I'm gonna assume that he's fine & dandy & sugar candy. Because that works for me. But you'll probably have to reassure us.

I wish I felt so definite about it. I'm always dithering around: this does the trick right now, but is it for MY good to whoever else's detriment? short run or long run? repurcussions? blah blah blah? Compounded by the fact that I often can't even tell that something is working when it is.

Nothing wrong with hanging on to a cat poop. What works for me in that case is to immediately put away all the cat's belongings. Looking at them, being around them, is just unbearably painful. There is one thing, though -- I've saved some brushed-out fur (collected while they were alive & well, and flea-free) from each of the cats I've had over the years. I have these little perfectly round balls of compressed kitty fur in a box. It's very comforting, too. It works.

Posted by: Flautist | May 27, 2008 10:57:55 PM

joe,
you said you were wondering, but did you loose humphrey? that's so sad... if you did. i would be utterly lost without my dezzie. you are in good company, either way.

Posted by: jo | May 27, 2008 8:49:38 PM

I still have our Johanna's box, in the exact same location as before she died in the middle of this past Winter. I'm not sure when I'll deal with it. For now, I have the memories and photos for comfort. Whatever works.

Posted by: Matt Penning | May 27, 2008 5:17:49 PM

My sincerest condolences. Nothing that helps anyone get through the grieving process for a pet (if indeed one ever truly does)can be considered unreasonable. Perhaps Humphrey's life can be honored by the saving of another. Thank you for sharing the lovely picture of him...

Posted by: kitty mommy | May 27, 2008 4:46:08 PM

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