Meatball was the kind of cat that no matter how sick he was, he would headbutt your hands for pets and begin thunderously purring. When I lifted him out of his cage he snuggled up under my ear, entwining his claws deep into my scrub top, and purred even louder. As a formerly fat cat who had lost a lot of weight within a short time, he was emaciated with a prodigious belly pouch. Combined with his yellow-tinged skin, Meatball was certainly not the stereotypical cute patient. But I grew close to him over his nine-day stay in the hospital. It’s hard to describe the comfort I gleaned from standing there stroking him on my shoulder during the early mornings. I was midway through my internal medicine rotation, so sleep deprivation and low self-confidence were very real nemeses that would rise and fall like the tides, always threatening to swamp me. I felt like I was always treading water, barely keeping my head above the waterline, but several times I would fall behind and the waves would begin closing over my head. I began to realize that visiting Meatball helped keep the panic at bay, and grew to treasure those few quiet minutes when I could close my eyes, focus on his constant purrs, and regroup a little.
Meatball had liver disease. More specifically, a bacterial infection that ascended from his intestines up to his liver via the gallbladder and biliary tract. His gums, sclera, ears, belly, and even the shaved blood draw sites on his arms were tinged yellow. This phenomenon is termed icterus and occurs when a yellow-pigmented substance called bilirubin (a breakdown product of old red blood cells) accumulates in the bloodstream as a result of liver disease or rapid red blood cell destruction. He was put on IV antibiotics and liver protectants, and his bloodwork values were improving until one morning I noticed that he was more uncoordinated than usual. It was expected that Meatball would be weak—since he had lost so much muscle mass—but when I set him down on the floor and watched him walk around, it was obvious that something was affecting his balance. Over the next two days, Meatball’s incoordination drastically worsened until he could no longer walk more than a few steps, and would suddenly fall over even when standing still. Since Meatball was worsening so quickly, we immediately started treatments for our top three differentials: extension of the bacterial infection to his brain; a side effect of liver disease called hepatic encephalopathy; and thiamin deficiency. I was so scared that my snuggle buddy was going to die, and I couldn’t help tearing up when he snuggled up under my ear as usual.
The next morning, I again felt like crying when I saw Meatball. But this time it was happy tears— Meatball had improved! He still stumbled in the hind end but was able to catch himself before falling over completely. We still don’t know the cause of Meatball’s incoordination, since we started treating for 3 different diseases simultaneously. But the important thing is that he improved!
The next day I stayed late a few extra hours just for Meatball’s discharge appointment since his improvement meant he could continue treatment at home. We went over the discharge instructions, medications, and what follow-up appointments to make. We bonded over his sweet nature, and I learned that Meatball gained his name because his rotund body shape was reminiscent of said food item. At long last, it was time to say goodbye. After making sure all the ward techs had said their goodbyes, I scooped up Meatball and walked through the quiet hallways towards his owner, his thunderous purrs echoing in my ears.