At exactly 12:35 AM on Wednesday, June 10, 2020 our sweet little boy Rico “Bunny,” diagnosed with squamous cell carcinoma in early April, left us in the most quiet and subdued manner I have ever had the privilege of witnessing. I had just petted him and whispered in his ear that it was alright for him to leave if he were ready to do so because both his human and his feline family were going to be fine and would soon join him at the Rainbow Bridge. Within two minutes, Rico’s breathing suddenly became more rapid. He began gently paddling the air with his two front paws, arched his back ever so slightly but hardly ever uttered a sound. He took two quick breaths, followed by another deeper one a minute later, and then flew off to join his sister Mimi.
We had been praying so hard that his passing would be a peaceful one and that I would be with him in that moment. A dear friend once told me that as the daughter of one of her hospice patients rushed home to be with her dying father, she said “I don’t want to miss the miracle.” Had I left the room just a few minutes earlier—which I had planned to do to get a few hours’ rest—I would have missed my miracle. Rico must have sensed that, for I do believe he could still feel my touch and hear my words, and he wanted to be certain I would be there. His little, fragile, aching body had grown tired, and he needed to rest in the arms of the angel. Thank God for small graces and little blessings.
As we remember our little one, our thoughts also turn to those who have been there for us during our hour of need. Our deepest thanks go to Dr. Erin Smythe-Morey of PetHospice Services in Berkeley, who planned and outlined in detail Rico’s hospice care protocol and communicated with us every step of the way; Barb St. Amant, RVT, who came to our home twice to examine Rico, provided us with all the necessary supplies and medication, and kept in touch every day; Danielle Schloemp, RVT and Lisa Gigliotti, RVT, who always answered emails in a timely fashion, especially when getting answers to questions became crucial; and Mia Johnston, Jenna Guffy and Tatiana Smith—Care Coordinators on the PetHospice Team—who ensured that everything ran smoothly and never failed to send Rico their love.
We also wish to thank Dr. Linville and Dr. Gill of All Creatures Veterinary Hospital in Vallejo, who first biopsied and diagnosed Rico in early April and did their best to provide him with bi-weekly Simbadol injections to manage his oral pain. Thanks to their efforts, Rico was still able to enjoy the lively company of his siblings and feline friends for over seven weeks, cavorting up his favorite weeping eucalyptus tree, and relishing the unabashed glee of cuddling next to his pet parents every night—something he had not done in over ten years. Also paramount in Rico’s care was Dr. Lisa Marinho of Animal Healing Arts, whose homeopathy consultations were priceless in gaining our little boy a bit more time by improving his comfort level and his ability to eat his favorite foods when he could still do so. I am indebted to her for the profound spiritual and existential understanding she shared with me while dispensing her solid veterinary advice, and I am grateful for her genuine humility and her friendship
A very warm acknowledgement also goes to Dr. Jarred Lyons, at the Veterinary Cancer Group in Los Angeles, for his hour-long consultation with me about the potential benefits of stereotactic targeted radiation, which, sadly, was not an option for Rico’s squamous cell carcinoma. It was also Dr. Lyons’s detailed analysis of the pros and cons of traditional radiation therapy that convinced us this choice of treatment would not have been in Rico’s best interests. And a special mention must go to Dr. Alycen Lundberg, Assistant Professor of Medical Oncology at the University of Illinois, who took time to explain to me that her initial research on the new drug IB-DNQ, although promising for cats with SCC, was still only in clinical trials. Thanks are also due to renowned holistic veterinarian Dr. Gary Richter, of Montclair Veterinary Hospital in Oakland, who spent time with me discussing the benefits of THC, as well as to Charles Lozow, of www.right:ratio.com, whose veterinary cannabis company specially formulated an oral pain medication for Rico, although sadly, he was unable to use it before he left us. These veterinary pioneers, who are charting new territory on behalf of all our beloved pets, deserve high praise for their unremitting efforts at obtaining formal legal recognition by the FDA, and subsequently by the AVMA, for this new and promising avenue of pain management for companion animals.
Last but not least, we wish to extend our sincerest appreciation to Gail Pope of BrightHaven and Dr. Ella Bittel of Spirits in Transition, both beloved friends whose advice, encouragement, and very detailed suggestions—orally and in writing—sustained us throughout these past two months with their candor, insightfulness, and professional guidance. Both of these well-known animal hospice practitioners did their best to keep our spirits buoyant, even in the midst of their own challenges, and provided us with keen, well-thought-out and highly relevant information for Rico, based on solid experience with squamous cell carcinoma as well as with the various scenarios that we necessarily had to ponder when choosing the best option for our little one. I am also particularly grateful to Ella for her suggestion concerning the use of [the rectal route] for pain in lieu of injections, [the latter of which] can still generate some degree of discomfort in moribund animals. Although we did not have an opportunity to use them with Rico, we intend taking this suggestion under advisement and hope that other animal hospice veterinarians will strongly consider their use in the future.
To all of these amazing people who were able to provide our little boy with the best possible veterinary care, who honored our wishes to give Rico a home hospice experience that would allow him to transition on his own in a pain-free manner, and who offered advice, options, suggestions, and the most welcome words of comfort—please know that you all have a very special place in our hearts and in our lives. The outpouring of support we have witnessed has been nothing short of moving, heart-warming and consoling. We could not have done any of this without you, and you were all a very integral part of Rico’s ongoing care, physically, emotionally, and spiritually.
And now, we must share with you Rico’s story—a unique one because he was a somewhat delicate kitty with special needs, although one would never have guessed it from his demeanor—a nonchalant attitude about his health that flew in the face of any physical ailments. To all intents and purposes, Rico always acted as if there were no problems and that he was a normal kitty. An adorable little striped gray tabby whose mouth was shaped like a tiny heart—a trait he inherited from his mother, Baby Mamma—he carved a special niche in our lives early on, and the void he has left behind is enormously deep. So fond of the outdoors that it was often difficult to invite him in, Rico had developed a keen sense for the wonders of Nature and true to his somewhat feral instincts, it took us awhile to convince him that we could be trusted. When he arrived in our yard with his five beautiful siblings in 2010, at about one year of age, we instantly fell in love with him. He had an unusual meow that sounded far more like a forced grunt, a sound that grew increasingly louder when he wanted food, and he had pink toes on all of his feet. But Rico’s crowning glory was his tail, which was as thick and lush as that of a raccoon’s.
Once he felt more comfortable coming into the kitchen, he took to brushing up against Gianfranco’s legs to get his attention, especially when Daddy was preparing dishes of raw meat for our usual bevvy of feline residents. Rico took an instant liking to the tiny fresh pieces of beef, and although he eventually learned to eat a variety of foods, he soon made it clear this was his favorite meal. Throughout his entire life, he never stopped relishing the lean eye of round that became part of his daily diet, right up until the last few weeks of his life when he could still enjoy it. Very much like his nephew Wiggle, Rico’s penchant for beef earned him the title of “beef man” although we often called him “tennis-shoe bunny” due to his white hind feet and later, “tree bunny” because he adored climbing our weeping eucalyptus and nesting comfortably in its branches.
Rico’s attraction for this tree became legendary, although he did not climb it all the way to the top very often. He generally preferred using its trunk as a scratching post, something he did regularly whenever he was in our yard. But when he did climb it, one glorious morning during his first year with us, we took a photo of him that captured that defining moment forever, etching it into our collective memory. He would return to that tree again, one last time, on June 3, a week before his passing, and spent the entire day among its branches, basking in the spots of sunlight that occasionally seeped through the leaves, ever present in that delicate moment of beauty that permeated every fiber of his being, listening to whispering voices in the wind that only he could hear. Being, in essence, cat. And we all clapped for joy.
Early on in his youth, as Rico stayed closer to home and began finding his comfort zone on our premises, we began noticing he would produce a rather loud and unusual stridor while he was eating as well as sporadically throughout the day, and even more markedly so when he slept. Although our veterinarian told us it did not seem to be serious and was probably due to a soft palate, Rico worsened and when he developed an upper respiratory infection shortly after he was neutered, his condition deteriorated to the point that he was having difficulty breathing. After hurriedly rushing him to the emergency veterinary clinic in Cordelia, we learned that whatever was afflicting his respiratory pathways was far more deleterious than a simple soft palate, and we were advised to transport him to the SAGE clinic in Concord. There, after an extensive endoscopic exam by two specialists, we were told Rico suffered from naso-pharyngeal stenosis, a condition he had most likely developed as a kitten, when scar tissue had formed in his nasal area due to a serious infection that very likely had been caused by a combination of corona and calici viruses.
Left with no alternative but a balloon dilation to push the offending tissue away from his nasal passages, we had to leave Rico at the clinic, albeit in the hands of a skilled veterinarian who had performed this procedure very successfully in the past with virtually no recurrence of the stridor. But Rico turned out to be the exception and within two days, his breathing had become labored again. Frantic to secure the best possible outcome as quickly as possible, his specialist referred us to UC Davis, where Rico underwent the same procedure again but with a balloon that resected the offending tissue rather than simply dilate it. The operation was a success and despite potential fears that the condition could recur, Rico got his life back for the next 10 years, sparking a very grateful letter from us to his veterinary team.
For reasons we were never able to fathom, Rico spent the next decade of his life coming and going regularly from our property to the same “secret” location in the county that his sister Mimi had chosen as her personal hideout. He would mysteriously appear at our door every morning for breakfast and would do the same in the evening at dinnertime, but throughout the day, he would abscond to the leafy recesses of other places we never discovered. He would always come into the kitchen and eat with his siblings, but only on rare occasions were we able to pick him up and administer his flea medication or the oral lysine paste we had been told to make a vital part of his daily health care. Those were somewhat challenging times for us, but when we did succeed at medicating him or he decided to spend the evening curled up inside our triangular scratching post for hours on end, we rejoiced at our good fortune. Rico was a free little spirit, and that was who he was.
Then suddenly, in 2015, to our great chagrin, Rico disappeared from our lives for eight months, never giving us the slightest clue as to his whereabouts. Frantic, we searched high and low for him, posting messages on social media and waiting for responses that never came. Leaving out dishes with his favorite food or calling out to him night after night were fruitless efforts, and we slowly began resigning ourselves to the awful possibility that he might never return. As a last desperate resort, I began mentally reciting the “Meditation of the Golden Chain” that an animal communicator friend had shared with me years earlier. According to her, it was a fail-proof method to reconnect with missing animals by envisioning a beautiful golden cord entwined around the hearts of both animal and human that slowly wound its way toward home, leading the animal back to loving arms. In mid-August, I began reciting the meditation as often as I could and especially at night, conjuring the image of the cord in my mind as if made of golden fairy dust and telling Rico that all he had to do was follow it home. On August 28, silently and without so much as a sound, Rico slipped into our kitchen for his usual dinner—as if nothing were amiss, nothing had happened, and he had never left. He looked perfectly fine, and was none the worse for wear. From that day on, although he soon resumed his nocturnal routine of retreating to his secret place, he never vanished again.
In December 2019, however, quite unexpectedly, Rico’s naso-pharyngeal stenosis abruptly returned, and by the time we noticed the long-forgotten sound of its distinctive stridor, it was apparent that another visit to UC Davis would be in order. Dr. Lynelle Johnson, after ascertaining that Rico was otherwise in excellent health and that his bloodwork would in no way pre-empt the operation, performed his last balloon dilation. Due to Rico’s age, it was decided that resecting the tissue would not have been in his best interest, although we were warned that in the event of a recurrence, it might become a viable option in the future. Fortunately, the operation was once again a success, and after two weeks of in-bound recovery—during which he earned the new title “snow-shoe bunny snuggler” due to his habit of hiding under his white fleece blanket, Rico was able to join his outdoor friends again on December 25. It would be our last Christmas together
But something extraordinary happened after Rico rediscovered his “freedom.” Inexplicably, although we had assumed he would take to the road again and only return occasionally on his own terms, Rico’s behavior changed dramatically. He no longer left the property and never again sought out his usually haunts across the street or in the county area he had been so fond of all these years. Every day he would climb to the top of the hill in our yard and sunbathe, when he wasn’t enjoying the playful company of his siblings and friends. But every night, almost without exception, he would come inside the house, find his way upstairs, and snuggle in our bed. Wary of his inability to use a litterbox—something Rico’s feral nature had never allowed him to learn—I would rise early every morning to let him out, and two hours later, when the bell would ring for kitty breakfast time, Rico was there, waiting at the door, eager to come in and partake with the others.
And so our new-found delight at Rico’s amazing transformation changed our lives, and we relished every minute of it. Our little “prodigal son” had returned home, and I had found him again—or perhaps, he had found me. Every single day, between the end of December and the beginning of April, when Rico’s dire diagnosis abruptly ruptured the joy of our reunion, I basked in the beauty of knowing he was my kitty again, feeling his slim body press against mine in the night, and watching his adorable heart-mouth quiver as he slept. We had also developed a very peculiar routine as we came down the stairs together in the morning, something that Rico had begun doing years earlier before he strayed from our lives for over a year, and that he now seemed to recollect as the “perfect game.” He would push up against my ankles very hard with his head and then proceed to lie down across my feet on almost every step, so that it was impossible to descend without tripping. Rico’s goal was to make me sit down on each step and play “bicycle” with his legs until, slowly but surely, we had made our way to the bottom of the stairs. Only then would he agree to step gingerly into the living room and then on to the kitchen to be let outside, although sometimes he would hesitate and lie down again, expecting to be toyed with once more before deciding it was time to explore what the morning dew had brought to the top of his misty hill.
Rico’s Final Journey
After Rico was diagnosed with squamous cell carcinoma in April, we immediately began exploring options that would allow us to deal with this insidious tumor, even though we knew we didn’t have much time. Sadly, none of them were viable without being horribly invasive or having massive repercussions. Ineluctably, as option after option dropped off the list, we came to the realization that honoring Rico’s will to live while simply electing palliative care was the best thing we could do for this dear little soul who so loved his outdoor life and who had already been through so much. It was a hard decision but the best one for Rico, and as animal hospice proponents, we knew we would be able to handle whatever came our way, especially with the expert assistance of the many specialized veterinarians we were certain we could count on. And so Rico’s final journey began—sixty-three of the best days of our lives.
Initially, Rico’s only symptom of the tumor that had gradually begun invading his tongue and lower palate was a constant drool of saliva that necessitated wiping his mouth as much as possible, something he did not like but that did allow him to drink and eat much more comfortably. As the days passed, however, the drool became bloodier and thicker, although Rico was still capable of eating as long as his food was mushier in consistency or—in the case of his favorite raw beef—cut into very tiny pieces. Amazingly, he would often forego the softer tuna or canned food in favor of the beef, despite the inherent difficulty of having to chew and swallow a much more fibrous meal. At times, his tongue would bleed from the effort, and yet, he persisted. His days were largely spent outdoors, in the company of his feline friends, and his nights on our bed or—when his comfort level began declining—in our bedroom closet, and eventually downstairs on the sofa where he did not have to contend so much with the other kitties for space.
With the exception of three days of intense heat during the month of May, Rico never slept outdoors or tried to wander off our property. He knew he needed to stay close to home, and we often wondered if he had known this all along after his last operation. As time passed, we began noticing that the Simbadol injections no longer carried their usual three-day effect, which had seen Rico typically alert, energetic, and indoors on the first day and then more subdued, slower and outdoors on the second day, followed by quiet languor and—we suspected—break-through pain on the third day. It was becoming increasingly obvious that Rico needed more intense palliative care and was ready to transition to a more pharmacologically-controlled pain management plan. By the time the PetHospice staff came on board in early June, Rico had stopped eating completely and was only drinking water.
Perhaps because he was thirsty, or perhaps because the wind in the willows that blew so gustily that week whispered to him of forgotten dreams or far-away places he would never see, Rico spent the better part of his last days sitting placidly at a lower elevation on our hill, so he could still see us in the kitchen while braving the wind. Regardless of the chill, he never attempted to come in until it was almost dark, and the next day, he perched on the stone wall of the water fountain and began staring deeply into its recesses, as if something moving in its depths had caught his eye, yet there was nothing there. Stephen Jenkinson, the renowned Canadian theologian and hospice counselor, speaks of grief and love of life as being twins, inextricably tied. In the ephemeral, fading splendor of his inner world, Rico understood that as he gazed into the waters; as much as he loved life, he quietly knew it was coming to an end, but as Dr. Lisa had said, he still had soul work to do.
By June 6, we had moved Rico completely indoors so he could rest in his crate and be examined by RVT Barb St. Amant, who began his new pain protocol that very day. In order to provide Rico with some semblance of his old routine, however, we moved his crate outdoors so he could still enjoy the sunshine and the breeze. He warmed up to this alternative quite readily and even allowed me to walk him in the yard briefly on a harness, although his body seemed driven by a single obsessive thought—to climb his hill and seek out a hidden hiding-spot. By the next day, however, he could only move ever so slowly, and we took to moving his rolling crate in front of the sunniest windows in the house, so he could still observe the morning activities that our little world continued to engage in: listening to the crows chasing away an intruder, watching the swallow-tails flit by, and closing his eyes tightly when the breeze blew across his face.
By June 9, as much as we wished that Rico would have had more time to live each day to the fullest, it was clear his pain was gradually becoming unmanageable and triggering sporadic tremors. He had stopped drinking water three days earlier, and I had taken to wiping his chin gently with a damp tissue and squeezing small drops of water into his mouth so he could swallow enough to give him some soothing hydration. His meows had become softer and his eyes had narrowed. Thanks to Barb’s excellent crash-course in administering injections, I had been giving Rico his medication on an “as-needed basis,” all the while communicating with Dr. Smythe-Morey and her team, so we all knew exactly how much to dispense and when. When the decision was made to initiate terminal sedation, everyone was on board with the plan.
Although it took several hours before any appreciable difference could be noted, Rico did begin to sleep more deeply, and it was evident that he needed the deep restorative rest his body had been craving for so long. We all knew the signs of impending death, whenever these would become manifest, and were clear on how to proceed, going forward. What we did not know was how much Rico had been waiting for the opportunity to find relief. Once his body realized he could sleep more soundly and be in far less pain, he began to slowly let go. Thinking he would be with us for several more days, I had begun lubricating his eyes to keep them moist and turning him over gently to avoid bed sores, every 6 hours, but I never got a chance to do any of this more than once. As soon as I gave Rico “permission” to go, he quietly took his leave.
Rico has left us a lasting legacy by making medical history as one of the very few feline patients with squamous cell carcinoma to undergo terminal sedation in order to keep him comfortable until his sweet spirit could be freed from his mortal coil. If the lessons we all learned from administering the most beneficial pharmacological combination possible and progressively increasing his sedation levels to ease his passing have taught us anything, it is that aggressive palliation at the end of life can work just as well for animals as it does for humans Rico showed us that he wanted to enjoy life as much as possible for as long as possible, but that when the end is near, addressing physical suffering is paramount if we want to give our companion animals the opportunity to leave on their own terms while still in hospice care. Providing him with the best comfort care available was not only our goal but our duty; doing anything less—or ending his life prematurely—would not have respected the sweet little sentient being that Rico was and continued to be until his very last moments. We are so grateful to those who helped us walk this path with him.
Now, as we wait for Rico to return to us from Bubbling Well Memorial Park, where we took him for our last trip together, we have to learn to deal with the deafening silence that surrounds us all. His sister Wolfie paid her respects just before we left, putting her tiny gray paws on his body, and taking one last sad look. His friend Savana looks for him in all the empty spaces of our house, and his nephew Wiggle now sleeps in the same closet where Rico spent a good deal of his time during the last month of his life. The fountain that Rico stared into so intently for hours on end while he was still enjoying the outdoors is now muted, but Rico’s name has been inscribed on our hearts forever. “My soul flies free,” will say the inscription on his urn, “like a willow tree.” We are counting the days until he comes home to us again, in a different form perhaps, but no less loved. Meanwhile, Patti Smith’s plaintive voice on the CD player continues to evoke the agony of loss: “Little blue dreamer, go to sleep. Let’s close our eyes and call the deep . . .”
The mourning dove who came to coo on Rico’s favorite tree the afternoon of the day he died returned to our yard the next day, alighting on our fence with her mate. Our neighborhood hummingbird continues to visit us, bringing with him all the joy that can possibly fit in the palm of our hands, and he bestows it lovingly, everywhere he flits. And ever so softly, the universe has conspired to form a chorus of voices that gladdens the spirit by day and embraces it at dusk. At night, whenever I am wracked by doubt and fearful that I may never truly know where Rico is, it is the memory of these wondrous signs that quells my aching heart. Yet, there is so much regret for what could have been and never will be. I want to cry out, like Antoine De Saint-Exupéry in The Little Prince, “[…] please comfort me. Send me word that he has come back.” And so I wait. But then I remember that the real miracle has already occurred, and that the only true prayer that should have been uttered to begin with wasn’t “Dear God, please don’t let him die,” but rather, “Dear God, thank you for letting him stay beside me, day after day, for the past six months.” The fairy dust from the golden chain is still swirling now, like an elusive magical feather on the breath of twilight. Rico is here, and somewhere in the stillness, I can hear his heart-beat.
Kathryn D. Marocchino, PhD
Fellow in Thanatology: Death, Dying & Bereavement
President and Founder
The Nikki Hospice Foundation for Pets