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For Margo. Ch 3. From Heartache to Hope.

[Note from Robin: Stories need to be told in a timely manner, but due to the terrible weather, the near-miss tornado that wiped out power and our internet, I’m left feeling as scrambled as the branches of many downed trees in our area. I couldn’t finish this story when I'd planned to, but in some ways it was a blessing some time passed because now the tale will end a lot differently than I imagined. The power is finally back on. We’re reconnected to the world again, so here I go...]

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I understand the error of thinking that there’s a way to control the outcome of a situation, but that doesn’t stop me from trying. Determination, sleepless nights doing research, mixed with palpitations, fear, and anxiety is my offering to the “Gods,” who I hope will grant me my deepest desire. Certainly the sacrifice of my own pain and hard work will change the path of one little kitten, keeping her from dying, right? My suffering is her protective shield. But unfortunately it doesn't work like that.

Cute girl
©2018 Kathy Ray. Used with Permission. Margo in her tiny outfit that held her diaper in place.

It’s been barely three weeks since we ended our fundraiser for Margo, a tiny 13-week old lynx-point Siamese kitten who lives in Florida with her mom, Pearl, her human mom, Kathy, Kathy’s hubby, children, some chickens, another cat, a dog and a young, naughty cow named Daisy.

With mom looking on
©2018 Kathy Ray. Used with Permission. Mama-Pearl watching over her daughter.

Margo was surrounded by love. Even though she was blind, Margo navigated her world with grace, dignity and joy. Even though Margo also had many other birth defects, she was happy, plucky, and curious, still 100% kitten. She loved the amazing world she was just getting to know. In the photos and videos I saw of her it always seemed that Margo was smiling. I couldn’t help but fall in love with her from afar.

Nosy Chicken
©2018 Kathy Ray. Used with Permission. One of Margo's many chicken-friends looks in on her while Pearl gives her a bath.

Without ever spelling it out formally, instead of surrendering Margo to a local rescue, where her vet bills would be covered, I ended up being Kathy’s liaison and rescue-partner. I gave her advice for how to care for Margo, since I had so much experience with Freya. I helped her sort out the many vet appointments and tests Margo would need. I was in charge of fundraising. Our goal was to get Margo to surgery to reconstruct her biggest, baddest, scariest birth defect–Atresia Ani with Recto-Vaginal Fistula. In awkward terms, build her a butt-hole and close off the abnormal pathway that went from her colon to her vaginal vault. If it wasn't fixed, she would eventually die. Our dream was to relieve Margo from the buildup of stool inside her body, since she was only able to leak stool from her "lady place," and finally give her a way to void safely. We wanted the rest of her life to be the happiest it could be, and the most comfortable.

Kathy’s smart and capable, but anyone in a life or death situation with their cat is going to have brain fog from the stress of being a caregiver. I’m over 1000 miles away, so it was easier for me to keep things on track. I had Kathy’s back. I had Margo’s care as my top priority. I researched vets and found the surgeon, Dr. Gary Ellison at the University of Florida. He’d done this surgery before. He had the skills we needed to move forward, but before we could even have Margo see him, we needed to be budget-conscious and do some pre-operative blood tests with a local vet. More importantly, it would save some travel time for Kathy and Margo too, because Dr. Ellison was 2-hours away.

In cat carrier blood test vet run
©2018 Kathy Ray. Used with Permission. Off to yet another vet visit.

Kathy located a vet that was about 30 minutes away. I reached out to them to set up a rescue-account for Margo’s care. Somewhere in these early communications there was a disconnect between Kathy, the staff and Vets at Prime Vet in Orange Park and myself. They may have assumed that because I ran the rescue group, that Kathy was my foster mom, even though I said she was the owner. We were doing things differently than what is considered the "norm" , but as long as the bills got paid, did it matter? (Note: the assumption: rescue takes kitten if owner can't afford care, rescue deals with paying for care and for having someone else foster kitten, owner has no role so rescue is in charge.). This left Kathy feeling ignored when she brought Margo in for her appointments, but worse, she wasn't consulted or informed about Margo's condition, only I was, and that communication wasn't great, either. Though I was nothing but cordial, respectful and paid our bills immediately, I feel on their end there was something going on behind-the-scenes that they weren't saying to us.

Maybe they felt it was a lost cause to bother with Margo, so why do tests? I don't know, but you can decide if you think this sounds like a great vet "practice" or not.

1. They wanted to do an enema on Margo. In any other cat we might have said yes, but this is a cat with no known pathway in how stool is moving through her body. An enema could have KILLED her on the spot. We said, no, and for good reason. We were both shocked this was even suggested considering the atresia ani.

2. EYE-Rolling. YES, I wrote: EYE-Rolling. Kathy told me that on numerous occasions she would ask a question of staff members and they seemed irritated that she had the nerve to bother them with her concerns. Advice to Prime Vet: If you're going to roll your eyes at a client, I think it's wise to do it WHEN THEY CAN'T SEE YOU DOING IT.

With stepdad
©2018 Kathy Ray. Used with Permission. Stepdad giving her comfort after lactulose made Margo feel awful.

3. They treated Margo like a circus freak. Atresia Ani is very rare. After Margo's second visit they asked Kathy to bring her back so a surgeon they knew could see her. Why? He was Board Certified and had experience with the surgery and just wanted to see Margo. Okay, so show-and-tell? Is that what is going on? We already had a surgeon. Kathy obliged, hoping we'd get a better idea of what we could do to help Margo until she was seen by Dr. Ellison, but that's not what happened.

This Dr. pontificated about Margo's condition, told us he would charge $10,000 or more for the surgery, then said we should do a barium study where they inject barium into her rear end and see where it goes. It would have to be under sedation. We didn’t even know if Margo could handle ANY sedation so why do it in a vet clinic that isn’t staffed 24-hrs if she tanked? We didn't have ANY BLOOD WORK at that point so we didn't know if she had underlying issues. Why do this when we don't have her with our surgeon overseeing the procedure? Or risk doing something, that again, could harm Margo? Again, we said NO and again we must have hurt their fragile feelings because we didn't blindly do what they suggested. I asked if he could send his notes to Dr. Ellison, to give him a heads up on Margo. Well, no. He wouldn't do that unless we PAID him a few hundred dollars. It was ok for Kathy to waste part of her day, stress out Margo for their show-and-tell, then not take 5 minutes to write notes to Dr. Ellison, who he already knew and was friendly with. So once again, we said NO. Why bother? We only learned that he's an expensive surgeon. It really felt like no one cared.

Heat Lamp
©2018 Kathy Ray. Used with Permission. Kathy feared she would lose Margo a few weeks ago after a dose of lactulose made her grow week, but that time with a lot of TLC and a heat lamp, Kathy got her perked back up.

4. NOT CONTACTING US WHEN MARGO WAS SERIOUSLY ANEMIC and they KNEW IT. All we wanted to do was simply have Prime Vet run some blood work, do an exam, make suggestions as to how to shore Margo up until we got her to see Dr Ellison. I'd explained that up front. I was open to suggestions as I always am, but I also have to take Margo's condition into account and therefore I declined some tests.

Instead, they got offended. One of the staff hinted at it to me during a phone call. I assured her we depended on them to guide us but that we also had a surgeon we would be seeing. Why do I even have to tell her this?

So I NEVER got contacted after Margo's blood test results came back in. I was the one who saw in her results OVER A DAY LATER (again I had to bug them for the information) that she was dangerously anemic. It shocked me that I wasn't getting alerted by the Vet. I asked them about it and got a cryptic reply only saying that maybe Margo’s anemia was from her birth defects, not that she had fleas. That was it. No suggestion about what to do about it because by then I'm guessing they just didn't want to help us any more. In the end, I was left to figure it out on my own. WHAT VET DOES THIS TO THEIR CLIENTS?! I consulted with my own vet, Dr. Larry, about what to do. He was alarmed that we hadn't been testing Margo for bartonella right away, that she wasn't getting supportive care for her anemia, that the Vet hadn't bothered to notify us or be concerned about this kitten.

Aching after lactulose
©2018 Kathy Ray. Used with Permission. Margo finds another warm spot for a kitten nap.

5. Which Vet are we dealing with anyway? We couldn’t even get Margo to see the same vet. She saw THREE different vets on her three visits. None of the vets examined Margo in front of Kathy. Instead, they took her in the back of the building and who knows what they did. No one asked Kathy how Margo was doing. I had to chase them down to get exam results and updates even though I'd asked for them a few times.

Being treated like this was completely unprofessional, unconscionable and potentially DANGEROUS to the well-being of Margo. I have never, in my life, dealt with such uncaring and passive-aggressive people. It's not like we were constantly bothering them, not paying our bills or being late for appointments or rude to the staff. We did nothing to deserve this! MARGO needed ALL OF US to be on her side and not act like petulant children because someone took their lollipop away.

Xray
©2018 Kathy Ray. Used with Permission. Most of the right side of this x-ray is stool inside Margo.

Kathy already had more than enough stress. Not being able to trust a vet almost made her give up right then and there. I had to encourage her to keep going. I even told her if need be, Margo could come here where I have vets I trust and who treat us with respect and compassion. We were both terrified that Dr. Ellison wouldn’t be any better.

Maybe this is how vets behave in Florida? I’d like to think that is not the case. I was so shocked I didn’t know what to do. I just kept trying to right the ship, to let all the vets know that we just wanted to help Margo and we were prepared to cover whatever costs were involved. They shouldn’t even assume Margo's case was hopeless and not to bother when we hadn't determined a definitive diagnosis. We were going to bother. We were going to get this done if there was any chance to do it. We were #TeamMargo.

Wrapped in Towel
©2018 Kathy Ray. Used with Permission. TLC time.

Finally, on May 8th, Kathy made the long drive to Gainesville with Margo to meet with Dr. Ellison. We couldn’t wait. We knew Margo had anemia and I was very worried about it. I wanted her to finally have a vet look over her results and give us a game plan. Dr. Ellison wasn’t too concerned about the anemia at the time, saying this is something he’d seen before. He felt that there were things that could be done and some tests needed to be performed, especially a dye-contrast CT scan. He was hesitant about the costs, knowing that my rescue, Kitten Associates, was responsible for the fundraising and payment of Margo’s medical bills. During our conference call I assured him we were ready to go. It took some convincing, but he realized we were going to go the distance for Margo. Once he understood, he became more invested. That was just what I wanted. I wanted him to care. It would make a difference for Margo and give some measure of comfort to Kathy. She and I quickly agreed that we both liked Dr. Ellison and felt like he was going to treat Margo right.

Dr. Ellison lightly sedated Margo just to probe her back end and try to get an idea of how serious her atresia ani was. He also injected lactulose, a stool softener, into her opening, so she might be relived of some of the bulk. A few hours later he called again saying that Margo might be a stage III which was not good news. It’s a much harder repair. It’s not that it couldn’t be done, but it would be more difficult, especially at her small physical size.

Feeling crummy
©2018 Kathy Ray. Used with Permission. Sweet slumber.

My challenge, years ago with Freya, who also had atresa-ani, was that I had to keep her going until she was nearly 4-months old. I didn’t dare do the surgery when she was too little, but she could have died on me from waiting so long. I had terrible anxiety from taking on such a risk and here we were again. I knew the next decisions could mean life or death for Margo.

Dr. Ellison wasn’t sure we could wait much longer, either. We went back and forth about what to do. We decided to try to get Margo back home and do the surgery on June 6th. We were to change up a few things to help her with the anemia and hopefully get her strong enough for what was to come next.

It had already been a long road, especially for Kathy, who had to manage Margo’s ups and downs. It seemed every time Margo got lactulose she tanked. She HAD to have the stool softener, but it made her so weak Kathy almost lost her a few times along the way. Margo’s appetite was poor after she got home from seeing Dr. Ellison. She was weak. We thought maybe it would resolve by the next day, but she still wasn’t doing well. They’d done an updated CBC and Chem Panel at U of FL. Dr. Ellison called just as Kathy was deciding on if she should rush Margo back to see him.

Feeling awful with mama 5 9 18
©2018 Kathy Ray. Used with Permission. Margo's refuge was always with Kathy.

Margo’s PCV (Packed cell volume) had gone from 24 to 21 to 14 (normal is 29-48).

She was so anemic she was at the point where she could die. Kathy packed Margo up and raced to Gainesville. We weren’t even sure Margo would make it to the hospital she was so weak. Kathy had been syringing pedialyte into her and some food, but it wasn’t enough to perk her up.

We had another conference call with Dr Ellison. He didn’t mince words. Margo was probably severely dehydrated, a possible side effect of the lactulose. They needed to get an IV into her, then see if she would perk up. You have to keep one thing in mind-Margo didn’t even weigh 2 pounds. She was so tiny, the only place an IV could go would be into her neck. We didn’t want to do that to her, but it was that or die.

He sketched out the game plan for us. They were to cross-match Margo with a blood donor cat. If needed, she’d get a transfusion. They would see how she did. If she survived the night and showed improvement, they would sedate her and do the CT Scan, then either do the surgery or if she didn’t do so well, send her home until Monday, then do the surgery Monday. Also, there was a chance Margo had a liver-shunt on top of all her other birth defects because maybe that was the reason Margo tanked after getting lactulose. If she did, it was “game over” because it could not be repaired along with her atresia-ani. It was just too many birth defects at that point. So they were going to add a bile acid test, too and see if she had the shunt.

Farewell
©2018 Kathy Ray. Used with Permission. Goodbye, sweet girl.

Kathy said goodbye to Margo. Margo curled her paw around Kathy's fingers, as she had done so many times, late at night while she snuggled on Kathy's chest. Kathy didn't know if she'd ever see Margo again, as she looked down at Margo's sweet smiling face. She could only pray it would be ok and that Margo was in good hands. Kathy later told me that the techs reported that Margo held their fingers, too and that they already loved the little kitten. I sat with my gut knotted up, hoping that all the love and kindness and great skill of the staff and Dr. Ellison would be enough.

And so we began the ever-painful sitting-by-the-phone-waiting-game. We held our breath until we got some answers. We were distracted and couldn’t think about much until we found out what would be next. We prayed, asked for prayers, I lit a candle, we thought good thoughts. We did all those things many of us do hoping to tip the odds in our favor, so things will go the way we most desire.

We got an update a few hours later that Margo had perked up. She was eating and drinking. Her PCV was up from 14 to 21! No need for a transfusion! This was very promising news. I knew that Margo, being a kitten, still had that “kitten power” in that she could respond to treatment well because she was so young. Kittens could bounce back. I’d seen it before. I hoped that in the morning we’d get more good news.

I didn’t sleep that night. Catshew, one of my sick foster kittens, went into heat. She’s been too ill to be spayed and I’ve already had to crate her once to keep her brother, Pistachio from impregnating her. I heard her moan, then saw her squat low with her hind end up in the air. Pistachio ran over to her and mounted her. I clapped loudly to keep him away. I couldn't go to back to sleep because I couldn’t physically lift the big dog crate and bring it upstairs into the foster room without waking Sam. If I couldn't set up the crate to keep Catshew from her brother, then I had to stay awake.

Catshew would have to be crated for the next 10 days. So I was left to keep distracting the cats, while I sat on the pile of old blankets I use as a makeshift sleeping nest. I watched an awkward romance movie featuring Daniel Radcliff that made me realize he's sort of odd looking. I tried not to think about Margo.

The phone didn’t ring that night. I took it as a good sign. No news is good news. If Margo passed away, they would have called regardless of the time.

Around 6:30 AM Catshew got tired and went to sleep. I decided to set my alarm for 8:30 AM and take a nap. I got up just as the phone rang. It was a tech who sounded like the most depressed person in the world. She told me in as few words as possible that Margo’s PCV dropped to 17 and they had the donor cat on standby to do the transfusion. They were going to go ahead with the CT scan and report back later.

My heart sank, but I still still hopeful.

I got up, my back aching badly. I began the “rounds” that take about 2-hours to feed and clean up all the cats and kittens. I did what I had to do to try to keep my mind off Margo. I felt like a zombie. I could only imagine how Kathy was doing, but I didn’t want to bother her.

Then the phone rang again. It was Dr. Ellison, though he simply refers to himself by his last name, which I found both curious and somewhat endearing. His tone was matter-of-fact, with no emotion to betray what he was about to tell me.

He explained that after he saw the contrast study he knew that Margo was staged at a III. She had her fistula well inside her body. It was only 1 inch inside her, but that inch was the difference between reconstruction and no surgery at all. Margo was too tiny. He could try a procedure where they take the fistula and make it into a rectum. It’s just basically a tube after all, but in her body it was more like a thread. It wouldn’t grow with her. How could she live passing stool out of a thread? I knew the answer.

I wanted him to stop talking, not to say what I knew what was coming next, but there was nothing I could do. He told me he’d spoken with Kathy already. She’d given permission to humanely euthanize Margo. He explained that due to the very long distance Kathy could not be there to say goodbye, plus Margo was still sedated and they couldn't keep her like that for the hours it would take for Kathy to get there. Kathy loved Margo very very much and she fought so hard for her. It’s a terrible choice to have to make. I think she was very brave, but it broke my heart that none of us were there with her at the end.

I had to remind myself that Margo was still sedated from the scan so she wouldn’t suffer at all. She would just drift off to sleep gently and peacefully with the staff by her side.

Dr. Ellison also added that Kathy had agreed to allow him and his students to do an autopsy on Margo (called a necropsy). He was very appreciative of the opportunity and grateful that Kathy understood why it was important to allow them to do the procedure.

This will be very difficult for many of you to know, but please read on. It’s horrible for us to imagine ever carving up a precious creature, but this is a teaching hospital. Kathy understood that perhaps someone who examined Margo, and learned about her condition, might be the same person who one day pioneers the solution that results in saving the lives of other kittens. Margo’s life gave so many joy and now in death, Margo's body would allow others to learn and someday save more kittens born with atresia-ani. Again, it was the brave choice to make, albeit so very very painful.

But no one would be with Margo in her last moments. I could not hold back my tears any longer. Choking out the words, I asked Dr. Ellison a favor. I asked him to please kiss Margo goodbye from me. I heard him say to his assistant that of course they would both say farewell and give her kisses and a peaceful passing. I thanked him for trying, for caring so much.

I asked about what would happen to Margo’s body afterwards. He told me that she wasn’t going to be cremated unless we wanted that. That the necropsy would take a few days. Kathy had asked for a paw print (I later found out she kindly asked for two so I could have one). It was the distance that made her choices so difficult, with no time to prepare those choices. She would love and honor and remember Margo always, in her way. She wanted to remember Margo as she was, a playful, happy kitten. Whatever she wanted I would respect. You can’t judge someone for their choices about how they handle mourning or the final arrangements for their cat.

Dr. Ellison was very kind. He thanked me for what I do as a rescuer and for not giving up on Margo. He was sorry he couldn’t do the surgery. I know he would have tried if there had been any chance, but he said it wasn’t fair to her. I would have fought to try to change his mind, but this time it would have been foolish. There are some things you can’t fix and because of that, early this morning, Margo began her journey to the Rainbow Bridge.

All that hard work, sacrifice, begging for donations, anxiety about what we should do next, what test we should do, what the results might mean, what Doctor to work with, what advice to take, how to help Margo feel better...it was over in the blink of an eye. We were not ready. It happened so fast. Kathy and I really thought Margo was going to make it. Losing Margo was completely devastating.

Fly free

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So began the all too familiar crying jags over the loss of a precious life we had tried so hard to save. I never even met Margo, though I had dreams of flying to Florida one day to meet her after the surgery was over and she was stable. It would never happen now.

I wondered about Kathy. We’d become friends. I really liked talking to her. We’d share stories late at night. I’d given her all the comfort and support I could, knowing her road so well from all the times I’d not slept or cried over losing a foster kitten. One night a few weeks ago, in a text she asked if it was too early to tell me she loved me (but “not like that”). She made me laugh and feel honored all at the same time.

Diaper big girl
©2018 Kathy Ray. Used with Permission. Kathy created this little wrap so Margo could still run around the house without making a mess.

Our connection was because of a little kitten we were both fighting to save. We had joined together without any real discussion about it. We just did it and worked hard and worked well as a team.

Kathy is gutsy and brave. She fought like a tiger for Margo. She would have taken on all her post-op care needs, even dealing with a feeding tube, which was likely going to be done had Margo survived. She would get Margo through this and it would be okay.

Except that it wasn’t.

I went for a long walk. I took a shower. While I was in the shower something was nagging at me. I wanted Margo cremated. I wanted her ashes. Creepy and weird as it may seem to Kathy, or any of you, I would ask her for her OK. I have a shrine that’s filled with little boxes and urns. Some are the ashes of my kittens who passed away, like Fred, his siblings, Pebbles and Bam-Bam, like Fiorello, who only lived a day. I have a candle burning year-round in their honor. Though Margo, in life, would never be with us, Margo’s ashes have a place here. I can honor her in my way, as Kathy is doing in hers.

I use humor when I’m feeling scared, I suppose as a defense mechanism. Naked, still wrapped in a towel after my shower, I grabbed my phone and dialed Kathy. I somehow found a way to make her laugh before I asked her the difficult question. She, as always, was gracious in her answer. Of course I could have the ashes and she liked the thought that Margo would be with our other kitties. Maybe it was her way of sharing her with me in a way she never could have done if Margo had lived.

It’s so unfair that this precious life is over so soon. Margo was one of those magical kittens who never let anything get her down, who so wanted to live. Blindness, bent spine, atresia-ani, it didn’t matter. Margo had a smile on her face until those last moments. Now it’s up to us to honor and remember her and maybe for some of us to learn so we can help others not suffer.

Rest in Peace. Go with Love. You left deep paw prints in my heart, Margo, and I will never forget you.

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24 Hours Later...

Kathy and I shared a few text messages after Margo’s passing. In our way, we were both saying goodbye to each other and thank you for everything. My heart was so heavy. Kathy is no longer a stranger asking for help. She is my friend. I feared that in time we would lose our connection. It made sense. It was how it was going to be without Margo.

Kathy lightened the mood by saying her cow Daisy busted out of the fence and was using the patio as a rest room (again!) and that today would be fence-repair day. Then she wrote something odd. “Ok....so I went....but, not to get a fence. Hubby is doing that with the boys.”

Followed by a photo and this message: “My heart is so empty without Margo! All this love and no kitty to give it to...As soon as I walked in here, they reached their paws out to me and started crying!”

The boy kittens
©2018 Kathy Ray. Used with Permission. Ricky & Bobby.

Kathy was in Clay County Animal Services. Not even sure why she was there, once she saw the kittens begging for love and care she took action. She does what so many rescuers do, they direct all their heartache into rescuing another animal. She wasn't there to adopt. She was there to help.

I was floored, thrilled, gutted, delighted, but it didn’t stop there. Kathy continued saying that she was inspired to do more after Margo died, but what, she didn’t know until that morning.

Scared Mama
©2018 Kathy Ray. Used with Permission. Mama-Moon with her newborns tucked beneath her.

She also saw a scared mama cat with 3, 2-day old kittens. She looked at the mom, cowering in her litter pan, with her kittens snuggled under her, and knew she had this cat’s back, too. She asked if she could foster them and was given the green light. Getting them out of Animal Control would help keep the kittens from getting sick and being euthanized.

Kathy turned her grief and love for Margo into rescuing 5 kittens and 1 adult cat. I couldn’t think of a better way to honor her sweet baby. In that moment, Kathy joined the sisterhood of cat rescuers. I wish I could have given her a big hug, I was so proud. She’s so brave and selfless. It doesn’t mean she’s going to forget Margo, in fact it’s because of her that this happened at all.

Holding newborns
©2018 Kathy Ray. Used with Permission. Little lives saved because of Kathy and to honor her love for Margo. If you'd like to follow Kathy's rescue adventures, visit Margo's Friends on Facebook.

Six cats have a chance to live full lives and one day find their forever homes because one person decided to turn their grief into a gift and their heartache into hope.

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Yesterday Margo’s ashes arrived in an absurdly big red plastic heart-shaped urn. I lifted the lid and saw the tiny plastic bag inside the urn, filled with all that was left of Margo. As tears ran down my face, I kissed the bag and said a silent prayer. I gently placed the urn on the shelf alongside the urns of so many others cats I’ve lost over the years. I lit a candle. I imagined Margo's curious smile and the way she cocked her head when navigating her world. I hope that wherever she is now she's still smiling.

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