Love Is the Best Medicine (29 page)

“Theo! Stop it! Be a good boy, Theo! I’m sorry,” said Frances and every few seconds Theo would break his routine and circle back to her, aligning his head with her bony fingers, offering a cautious, healing lick to the tributary of bruised veins beyond the knuckles of her hand, meeting her eyes with the look of a guilty boy who knew what it would take to melt her heart and get away with murder.

They were like a comedy duo: Theo was the funny guy—loud, up front, in-your-face—playing it for every laugh he could get, whereas Frances was—and I dare say it because I know she would not be offended—the straight guy, apologetic, working her rueful brows as if she had any to work, keeping a smile at bay.

Between barks Theo sniffed the air, his neck extended, flaring his
nostrils, and I could tell that he knew I had some dog treats to hand, invisible from his low vantage point, but emitting just enough of a fragrance for him to sense an opportunity to eat.

“I think he can smell my low-cal dog treats,” I said. “Can he have one?”

I know, I know, this tactic will have the trainers and behaviorists shaking their heads in dismay. Oral bribery will only reinforce bad manners but if I was going to find out what was wrong with Theo, I needed to be able to hear Frances talk. Besides, my little bone-shaped treats are so tasteless, I knew exactly how this trick would play out. Theo bit the treat in two and worked it around his mouth for a moment before letting it fall to the floor, covered in saliva but essentially untouched. (Only my own Labrador will devour these dry, unpalatable morsels but then she would find the lint from the inside of my pocket to be mighty tasty!) Discovering the only food on offer inedible, Theo decided to quietly focus on sniffing the floor, my shoes, my socks, my pants, and back to the floor again. Frances saw an opportunity to tell her story.

“Theo has a tumor in his chest. He’s had a CAT scan and a biopsy taken and I’m led to believe that there’s a good chance that it’s benign, that it can be successfully treated by surgery alone.”

I noticed how the fear in her reedy voice seemed disproportionate to the words she was saying.

“I’ve seen the images from the scan,” I said, “and I’ve seen the biopsy report. Theo has what is called a thymoma, a benign glandular tumor, and with any luck, if it hasn’t invaded the surrounding tissues, he’ll do great with surgery. And even if it is invasive, Theo should still have a good long-term outcome.”

For a second I thought I saw her acknowledge my attempt at optimism, but any hint of gratitude was quickly overwhelmed by something resembling a physical ache, written on her face. She drew her clasped hands into her body, making me feel as though my statement had only made matters worse.

Frances Cardullo hung her head and then came back to me with an uneasy, affected smile that cut me like a razor.

“Life is meant to be full of surprises,” she said, her delivery flat. “But no one said whether they would be pleasant or not.” She waited a beat, thought about it, and added, “I’m battling stage four colon cancer, stage four meaning it has already spread to several other organs in my abdomen.”

“I’m so sorry,” I said, feeling the absurdity and futility of my polite response.

Frances kept going, as though she didn’t want to linger on any awkwardness I might be feeling. I took note of her concern and it only made what followed all the more difficult.

“I came here today to talk about the surgery, to find out what will happen to Theo during his hospital stay and what I will have to do to care for him afterwards. But more importantly, I need to share two major concerns that worry me more than anything else about Theo.”

“Sure,” I said, noting how Theo had finally tired of sniffing the room for other mammalian life forms, contraband, or explosives and settled at Frances’s feet.

“First of all I will need to organize all of this around
my
chemotherapy. They’re going to be pumping me full of chemicals for the next ten months, so I’ll let you know my schedule and we’ll do this so that with luck he’s home recovering during some of my good days.”

I reassured her that I thought we could make the schedule work and that Theo would make a great patient, certain to bounce back, with that buoyant, no-nonsense optimism so characteristic of his breed. I didn’t push for the second problem. The slow welling up and overflow of a single tear from her left eye let me know she was about to tell me in her own time.

“My other fear is what will happen to him when I am gone. I know he’s a handful and he’s not for everyone, but he’s a great dog and I love him. Who will be there to look after him?”

I didn’t know what to say. Most pet owners fear the end of their relationship with an animal, the letting go and the acceptance of loss. Frances Cardullo’s candor and foresight left me speechless. This woman had the presence of mind and more than enough love to see beyond her own mortality, able to understand that in all likelihood she would be outlived by her dog. She made her own needs seem relatively trivial next to Theo’s long-term security and happiness.

Parents frequently proclaim their children will be the death of them. Do they mean more than the frustration and challenges of guiding them to adulthood? Or are they really referring to the pain they might inflict, the desolation they will leave in their wake, if they are lost before their time? As the parent of a sick child, I would say yes. But of course, the reverse is also true. The idea that I might leave my daughter in this world, that she might need my help, that I might fail to protect her is just as excruciating to consider, and I saw that exact same fear trapped inside Frances when it came to caring for Theo.

“Don’t worry,” I said, beckoning to Theo, rewarded with a sloppy grin and a body slam from across the room, “if laughter is the best medicine I have a feeling that you two are going to be together for a long time to come.”

Frances succumbed to a smile and once again, from out of nowhere, I was being reminded of Sandi Rasmussen, another woman blessed with clarity in the midst of so much pain. Do we need these dark hours to discover who we really are? For those open to discovery, is it possible that in every crisis, every struggle or tragedy, another truth exists? Perhaps the only real challenge is whether or not we have what it takes to acknowledge this truth and speak it out loud.

A
ND
that’s how the next twelve months went by, memories of Cleo and Helen paying me a visit, usually when I least expected it. For
Cleo, it might have been a minor anesthetic hiccup with one of my cases, some David Blaine dog who found it amusing to temporarily hold his breath. The topic of anesthetic risk kept finding its way into my preoperative discussions with my clients, and though Cleo had so much more to offer, I began to fear that this might be her greatest legacy. Her mark was a scar guaranteed to last a professional lifetime. Though it was beginning to fade, I recognized that I still felt the need to show it off.

For Helen, the flashback might have flickered when a lung tumor popped out of a dog’s chest like a jack-in-the-box, clean margins an absolute certainty. And then, every so often, when the pathologist patted me on the back with those magic words “excision complete,” I could see that refugee spaniel and wondered what became of her.

I had thought my letter to Sonja Rasmussen and her mother, Sandi, might garner a reply. But as the months passed without further correspondence, I decided they were probably trying to get over their ordeal, and distancing themselves from me was probably good medicine.

When it came to Helen my approach was completely different. To be honest, my philosophy was more along the lines of “don’t go looking under rocks if you are afraid of what you might find!” Eileen never called me back after I called her with the pathology report, and so I took the easy way out, capitulating to the adage “no news is good news.” I could have picked up the phone. And it wasn’t that I didn’t think about it. I simply chose not to place the call. The summer, Helen’s beach summer, had come and gone. I clung to the belief that she must have made it, had her moment in the sun and the sand. Then again, there had been no postcard. No photograph documenting this incredible accomplishment. Wouldn’t Eileen have shared the celebration if it had actually happened?

Then, one Saturday afternoon, more than a year after I operated on Helen, everything changed. My appointments over, the operating
rooms uncharacteristically empty and silent, I was ready to call it a day, but Dr. Fisk had other ideas.

“What do you think of these?” she said, accosting me in the surgical prep area, presenting me with a series of chest X-rays.

I held them up to the overhead fluorescent strip lighting, unsure as to what I was looking for.

“Do I get to hear a story or is that part of the challenge?”

Dr. Fisk, one of nine critical care residents on staff, grinned, clearly enjoying her advantage. I don’t know how these young emergency doctors do it. Hooked on the buzz of fast-paced medicine, addicted to the everyday life-and-death tug-of-war, they constantly deal with people and pets at their worst. More often than not, their clients are in a state of shock, unprepared emotionally and financially for a crisis involving those essential nonhuman members of their family. Arguably, emergency medicine offers the most chances to actually save an animal’s life and sadly, at the same time, the most chances to be the recipient of harsh words and complaints from owners unable to handle or to afford an emergency affecting their pet. Despite this inescapable yin and yang, Dr. Fisk defied the gloomy gray of her department’s scrubs with a contagious excitement for what she did so well.

“He’s a four-month-old male boxer puppy. Presented half an hour ago in severe respiratory distress. Check out his trachea.”

I did as I was told, moving through the series of films and back again, seeing the abnormality with the surprise of a head-turning double take.

“It’s an acorn,” she said. “Or at least I think it is.”

The boxer’s name was Tyson and like most puppies, he embodied all the pleasures and foibles of any four-month-old dog. He was fawn with instant curb appeal drawing curious onlookers; a clumsy, adorable flirt, effortlessly charming his entourage. He did, however, possess that most dangerous trait common to all of
puppydom—relentless curiosity. Sometimes smart dogs like boxers discover their environment in a relatively harmless lesson of action and consequence. Wayward backyard toads may be fun to play with, but they make my mouth all foamy and I want to throw up (though my five-year-old Labrador has been held back in remedial amphibious studies). That brown stuff that fell out of my bottom doesn’t taste nearly as good as the little brown nuggets of kibble sitting in my dog bowl (unfortunately, from time to time, my Labrador will still graze the lawn looking for “seconds”). Occasionally, however, an unlucky puppy can fall victim to a small, forgettable, seemingly innocuous object, and as they say back in England, “come a cropper.”

For Tyson it started with a sudden-onset hacking cough, a visit to his local vet, and an X-ray confirming the presence of a round object about the diameter of a dime stuck in his trachea. Under anesthesia a thin, flexible endoscope was snaked down the widest part of his windpipe, fiber-optic images revealing a pink cartilaginous tunnel trailing off into darkness, the intruder nowhere to be found. However, when they passed the scope down his esophagus, the camera popped into his stomach, and up on the video monitor, nestled in a corrugated pink lining, lay half a dozen acorns.

It was assumed that young Tyson had managed to cough up the straggler and swallowed it whole so it could join its nutty siblings for a short burst of gastric indigestion. Temporarily, the cough appeared to improve, but twenty-four hours later, Tyson was rushed into the Angell ER foaming at the mouth, his tongue and lips a stormy blue, his head and neck stretched out in full extension, hungering for air.

Dr. Fisk narrated this story while I continued to stare at the X-rays, nodding my appreciation of her theory as to why the previous vet had been fooled. The acorn had to have been acting like a ball valve. The X-rays were snapshots in time, one showing the object fired halfway down the neck in a cannonball cough, another taken while it was
sucked deep inside the chest to a point called the carina, the anatomical location where the trachea separates into the smaller branches that supply each individual lung. When the acorn rattled around in the wide bore of the neck it would be irritating and induce a mild cough, but Tyson would be able to breathe around it. Lodged in the narrow carina, the obstruction would prove devastating, inducing suffocation, panic, and a coughing frenzy. Presumably the vet had been unable or reluctant to root so far down the trachea and besides, the evidence in the stomach suggested the acorn had already found an alternative route back to terra firma.

“Makes sense to me,” I said. “Not that it makes it any easier to get out.”

“What do you mean?” she said, obviously slighted by my pessimism. “I figured we could just grab it.”

I flashed back to a previous experience with an object trapped in a trachea. When I was a veterinary student, we had a case of a three-year-old German shepherd who was performing retrieval exercises when he aspirated a six-inch-long metal wrench. Fortunately the wrench was removed, and the dog made a full and uneventful recovery and was working again within two weeks. What astounded me was the use of a wrench as a training aid, and the ability of a dog to generate enough physical force to inhale such a weighty metal object into his chest.

Regardless of the offending object, these can be particularly difficult cases. Under anesthesia, even with a tube in the airway, it can be impossible for the patient to breathe if something is obstructing the carina. Oxygen simply cannot get to the lungs.

“I hope you’re right,” I said, pretending to walk away.

“Whoa! Whoa! You’ll be around to help us, right?”

I handed her X-rays back.

“Of course,” I said and I watched her expression of consternation melt away as she registered my smile. “I’ll be in my office doing paper work. Just give me a call.” But mischief got the better of me,
and over my shoulder I couldn’t help but add, “Assuming you need me.”