Love Is the Best Medicine (21 page)

“And how big is Helen’s mass?”

It was Dr. Able’s turn to take a deep breath.

“Please, I don’t want to overstate the significance of a single parameter.”

But he saw she was still waiting.

“Six and a half centimeters. Normally, after complete surgical excision, with clean nodes and a small well-differentiated tumor, I would be telling you that about half the dogs will live for one year.”

Eileen began working the math.

“You mean if the surgeon gets it all and it hasn’t spread there’s a 50 percent chance Helen could be alive this time next year.”

“That’s correct, but I’m telling you this thing is big and awkward. Helen’s cancer may not be quite so well behaved.”

“So what are we looking at?”

Dr. Able stewed, weighing the numbers like a used car dealer about to risk a lowball offer.

“I know it’s not a fair question,” said Eileen, softening, realizing too late that her question had sounded like a demand for a definitive answer. “I won’t hold you to it, but if you could give me your best guess.”

Dr. Able came right back.

“Less than eight months, maybe as little as four. But like you say it’s just a guess.”

Four months
.

Eileen looked down at the star of the show, the shadow glued to her ankle. If she were to pat Helen’s head right then she knew with absolute certainty the dog would wake up, turn her way, and smile—content to stay, content to go. Worst of all, she knew that Helen was oblivious to both the malevolence looming inside her chest and the violent campaign to defeat it soon to be waged by those she trusted.

“It might be easier to make a decision if we get a CAT scan of Helen’s chest, that way we can see whether the mass is operable and have a better idea about the size of the lymph nodes.”

Four months would put us into the summer
.

Dr. Able waited a beat and then said, “You know choosing not to do anything is also a reasonable option. You’ve already gone way above and beyond for a dog you’ve only known for a couple of months. This is asking a lot of you. Besides all the nursing care and the follow-up visits there’s the actual cost of all this treatment. You’re going to end up spending several thousand dollars before we even think about the possibility of using chemotherapy.”

Eileen was still lost to him, coming to terms with his worst-case offer—
-four months
—but Dr. Able saw that familiar flinch when the word
chemotherapy
snaps a person out of their trance.

“I know what you’re thinking,” he said. “You’re worried all her hair would fall out and she’d throw up and have blowout diarrhea the whole time. Truth is 75 percent of dogs on chemotherapy have no side effects whatsoever and the remaining 25 percent have the kind of minor stuff you can easily cope with at home. I’m not even sure chemotherapy is indicated but part of me thinks that if we’re going to get this thing, then let’s go at it with everything we’ve got.”

Eileen nodded, to be doing something. What she had discovered on the Internet had skirted around this subject. She shouldn’t have
been surprised, but somehow the anonymous accrual of uncertain information had been tolerable. Here and now, whittled down to something precise and personal, the truth was worse than she had anticipated. She thought it would be bad but not this bad.

She had come armed to ask him what he would do if this were his dog, but even though this seemed like the right moment to ask, the words failed her, as though she were being unfair, assuming too much of a doctor she hardly knew.

“Can I talk it over with my husband?”

“Of course. Definitely.”

This time Eileen gently touched Helen’s head and, as predicted, Sleepy verified the source of the touch, approved, and bounced to her feet.

Dr. Able stepped forward.

“Here’s my card. And please, if you have any more questions for me, don’t hesitate to give me a call.”

They shook hands and then Dr. Able dipped down to pat Helen one last time. In doing so, he said something to her under his breath that Eileen couldn’t quite catch. She could have sworn he told Helen she was a lucky dog. But how could a dog with terminal cancer be so lucky?

T
RAGEDY
can demolish like an explosion—swift and indiscriminate and crushing and painful. But sometimes, for some people, what remains after the rubble of confusion has had a chance to settle is an amazing clarity. Suddenly, all the obstructions and debris and pointless minutiae of our life are wiped away, and for those who can open their minds, there are new, important vistas to take in, and a different way to look at the world.

To say that tragedy is unfair assumes that life can be led according to a set of rules, that by charting a certain course and staying between the lines, all will be well. Yet tragedy is pervasive, versatile, and ingrained as a universal component of life. It’s not sexist or ageist, it has no regard for socioeconomic standing, race, creed, or ethnicity. You can’t pay it off. It is the blackmailer who keeps coming back for more. It is a chameleon, a con artist, able to worm its way into any life at any time. It is ubiquitous and we need to be prepared to deal with it. Nothing can be more annoying to someone embroiled in tragedy than to overhear the whispered inanity “God only deals it out to those who can handle it.” Do they really think
they
couldn’t handle it, would be crushed by it, or worse still, are somehow above it? As I see it, tragedy will take its turn with all of us. Perhaps they should
rephrase their platitude to “God only deals it out to see
how
we handle it.”

Lost and dazed in the aftermath of Cleo Rasmussen’s untimely death, I knew that throwing myself into work was a good thing. I could still feel a tightening in my guts whenever I thought about her, still hear Sandi Rasmussen’s ethereal request rattling around inside my head like the ball in an eternal game of Pong, but the job offered a welcome distraction and something akin to relief. It had only been a few days since our encounter and I had yet to come to terms with the promise she had made me swear. What was she
really
asking me to do?

Promise me to take Cleo’s spirit on a journey, to realize all the wonderful qualities she embodied and to pour all the skill, effort, and talent you had intended for Cleo into the lives and health of other unfortunate animals
.

This request was big, broad, and, from an objective, scientific point of view, flawed. Even so, I could see the conviction in Sandi’s eyes, assuring me this was possible. I had no idea how to make this happen, I simply knew I had to try. This could be the path to restitution I so craved, the chance to make things, if not right, better. At the same time, I didn’t want to feel rushed simply to scratch a check in a box so I could put this event behind me, move on, and forget. At the very least this mission deserved a little preparation and a good deal of thought. Besides, my meeting with Sandi had exposed a serious chink in my emotional armor. I needed to explore this wound, acknowledge its existence, and defend against future susceptibility.

The first unofficial report regarding Cleo’s postmortem examination reached me by e-mail. I should have been petrified, about to be unmasked as a sloppy, even dangerous clinician. But for some reason I wasn’t. I’m sure my encounter with Sandi made some of the difference, but there was conviction in my assertion that I would not have done anything different with my workup for Cleo. Fallibility and negligence are not the same thing.

Pathologists talk about “gross” findings, meaning blatant and
obvious rather than disgusting and nausea inducing. Though there were still samples of tissue from vital organs awaiting microscopic examination, there was news to report. Based on visual inspection alone, Cleo’s heart appeared to be completely normal. There was nothing remarkable, brittle, or delicate about any of her bones. There was, however, something unusual about her kidneys, a finding both infrequent and incontrovertible. Cleo had been born with only one kidney, her left. Her right kidney was missing.

For me this anomaly triggered speculation about a possible link between some sort of renal insufficiency and a weakened skeleton, of anesthetic drug sensitivity due to impaired drug excretion from only having one kidney. But in the light of her perfectly normal urinary function and blood work and previous unremarkable encounters with anesthetics, any possible relationship quickly fizzled out. Anyway, plenty of humans and animals can thrive on just one kidney. Why should Cleo have been any different?

A
FEW
weeks later, another difficult case had Cleo’s death and Sandi’s unprecedented request right back in the forefront of my mind.

The patient in question was a four-year-old male rabbit called Atlas, cursed by a large firm swelling attached to his lower jaw. Earlier I defined the term
gross
as used by pathologists. One exception to my forgiveness of their jargon relates to their affinity for culinary metaphors. By definition, pathologists are drawn to the nuances of disease, dedicated to sharing their enthusiasm through vivid oral and written descriptions, and apparently food analogies offer superior sensory impact, evoking fragrance, texture, and even flavor. The lump on Atlas’s jaw demanded surgical excision and I had no doubt an epicurean pathologist was standing by, waiting for his slice, eager to describe the contents of this abscess as having “the consistency of fluffy white cheese.”

Atlas had received a visit from the dentist and had exhausted more conservative options, and now it was my turn to play mission impossible, trying to best a resilient foe. Unlike a split-pea-soup cat bite abscess (my apologies, but you get the idea), so common among outdoor fighting cats, the rabbit variety does not lend itself to simple drainage. Treating it like a tumor, completely cutting it out, is the preferred approach. There is, however, a fundamental flaw in this plan—it necessitates general anesthesia.

Rabbits and gases that induce unconsciousness are about as dangerous a mix as naked flames and gasoline fumes. For starters, rabbits flout the basic anesthetic principle of airway control by refusing to open their mouths wide enough to allow easy tube placement in their windpipe. Think about it, when was the last time you saw a rabbit yawn, or exhibit a look of jaw-dropping surprise? Crowded molars and tight lips make it virtually impossible to snag more than a glimpse at the back of their throat, let alone visualize the airway. Blindly tubing a rabbit becomes all touchy-feely as the anesthetist carefully pushes the transparent endotracheal tube into the mouth, listening for the softest breeze, its to and fro matching the rhythm of a swirling mist of condensation inside the tube. If the noise of breathing is replaced by a gurgling noise, you know you’ve gone down the wrong way.

With the tube in place, the fun has only just begun. Rabbit heart rates can run in the three hundreds per minute, and their respiratory rate can be only marginally slower. Thank goodness for their big ears. At least they offer a decent-sized vein in which to place a catheter.

By comparison, as the surgeon, I was doing the easy stuff, and while Atlas behaved himself—no doubt dreaming of daring raids in Mr. McGregor’s garden, plundering abundant carrot booty—I cut and dissected and teased the offensive item off of his jaw. Part of my plan involved implanting a handful of tiny green antibiotic-impregnated beads. These magical “petits pois” would slowly release their medicine in high concentrations precisely where it was needed rather than risking the broader side effects of a systemic assault.

Cognizant of the clock and the anesthetic risk, I moved quickly within the confines of my surgical field, oblivious to the mayhem all around. For anesthetists, where possible, access to the head is paramount and with my smothering Atlas in sterile towels and drapes, they were struggling to gauge anesthetic depth. Simple, meaningful observation of eye position and the color of his gums and lips had been reduced to blind ferreting in the manner of a nineteenth-century portrait photographer rustling under his shroud before he exclaims, “say cheese.” And it didn’t help that I kept on knocking off every probe and monitoring device they had on him.

“I don’t think he’s breathing.”

Obviously the technician who made the comment put it out there in search of assistance, to raise the alarm, but for a few seconds its effect was paralyzing, making us all stop and scrutinize the drapes for the slightest flutter of Atlas’s chest. I looked into my incision, trying to glean some meaning from the shade of red in the small amount of lost blood. Was it bright enough, sufficiently oxygenated for our patient to be breathing and therefore still alive?

“Can I get by,” said Dr. Bain, a critical care specialist, muscling in like a serial bridesmaid after a tossed bouquet. I was so focused on my work I had failed to notice her circling the OR, as though she had sensed a looming crisis.

I backed off, gloved hands clasped in front of me as the drapes were peeled away, my surgical site contaminated by naked hands pawing for proof of life. Suddenly my efforts, my being there, became inconsequential; far greater concerns were at play. It was as though my services were no longer required. Reduced to voyeur, I watched the resuscitation unfold and naturally I couldn’t help but think about Cleo. So this time I got a little bit further in the surgery, but once again I was watching an anesthetized animal beginning to die.