Love Is the Best Medicine (30 page)

L
ESS
than an hour later I got the call requesting my presence in radiology and as soon as I arrived I noticed the presence of an ominous addition to the assembled anesthetic equipment. Off to one side of Tyson, amid all the various monitoring devices, sat what is universally referred to as a “crash cart.” It was like a big, mobile Sears toolbox teeming full of drugs to be used in the event of a cardiac or respiratory arrest. Clearly someone had seen fit to have the crash cart near at hand and that could only mean things were not going well.

There was no “told you so” moment, no pleasure in being right. The concern written all over Dr. Fisk’s face informed me the adrenaline junky had enjoyed her fix but now she was ready to come down.

“This case is a royal pain in my ass,” she said.

“The scope was too much?” I said.

Dr. Fisk nodded.

“It was one more thing jamming up his airway. Poor guy was blue enough when we started, let alone when we tried to grab the fruits of the forest. That acorn is one slippery little fella, and you just don’t have time to grab it before his oxygen saturation levels begin to plummet to dangerously low levels.”

I glanced over at the pulse oximeter monitor. In room air most humans would register 98 to 100 percent. Right then, on pure oxygen, young Tyson was hovering around 82 percent. His color was awful. No wonder the crash cart was waiting in the wings.

Then I noticed the unorthodox configuration of the tubing arching from the anesthetic machine to the dog. Normally the tube would enter directly through the mouth. Tyson’s tube entered though his neck.

“So you moved on to a tracheostomy?” I said.

Once more Dr. Fisk nodded, the whites of her eyes inclined toward the heavens.

“I thought I was being quite clever. We took an X-ray which confirmed that the acorn was sitting slap bang in the middle of his neck—primo location. Instead of having a tube down his throat and into his airway, I said, why not put the tube directly into his trachea
below
the acorn. This way Tyson gets to breathe, the acorn can’t go back down to the carina, and now we should be able to grab it easy.”

My summons and Tyson’s oxygen saturation level told me all I needed to know. Dr. Fisk handed over an X-ray for final confirmation. Yes, there was a tracheostomy tube in the appropriate location. Unfortunately, our wayward acorn had become trapped on its wrong side, now all but wedged into the carina.

“Do you think it’s time to open his chest, to go in there and pull it out surgically?” asked Dr. Fisk.

I considered the logistics of what she was asking me to do. Technically, opening up the windpipe in the chest is relatively straightforward. The problem remained the delivery of adequate oxygen to Tyson’s lungs. As soon as I cut a hole into the trachea to make a grab for the acorn, the biggest beneficiary of all those soporific anesthetic gases would be me. There was little chance that I would swoon into my incision but there was a good chance Tyson might succumb to fatal oxygen deprivation.

“I’d like to try one more thing,” I said, as we all headed back to the nonsterile prep area in surgery.

It wasn’t much of a plan but it was the only one that came to mind. Under anesthesia animals no longer possess a cough reflex, which meant the acorn’s erratic movement back and forth in the windpipe had to have been driven by three primary forces—breathing in, breathing out, and gravity. If I could take advantage of these three forces, I might stand a chance of keeping this dog out of the OR.

“Let’s get him lying on his sternum, head toward me.”

Tyson was placed on a table that stood about waist height. Two strong women stood on either side of him as I dropped to my knees as though praying to the gods of the mighty oaks for divine intervention.

“You ready?”

They were, and on the count of three they hoisted Tyson’s body and back legs into the air, head stretched out between his front feet like he was about to dive into a swimming pool. I pulled the tracheostomy tube out of his windpipe and introduced a pair of steel forceps into the opening left behind, forcing the serrated tips as wide open as they would go, waiting for that willful little acorn to “come to papa.”

“Give him a tap on his chest,” I said.

They began slapping either side of his rib cage, beating out a burst of hollow, resonant applause. This was when I expected something to fly into the waiting forceps sticking into his windpipe, but nothing happened.

“How about shaking him up a bit?”

The two of them looked at each other before synchronizing their contempt and aiming death glares at the presumptuous reprobate kneeling in front of them, the one happily giving out the orders, the one doing absolutely nothing while they carried all the puppy’s dead weight between them. Consequently Tyson’s jiggle was a little lackluster. I was hoping for a major upheaval, something akin to a full-blown grand mal seizure. What I received was more of a Jell-O wobble, a quiver, little more than a nervous twitch.

From my genuflected angle, I couldn’t tell if their ruddy complexions and toothy grimaces signaled physical exertion or anger toward me. Shrewdly I opted not to criticize their efforts.

“His oxygen saturation is starting to fall,” said Dr. Fisk. “He’s dropped into the seventies.”

I looked up at the monitor flashing scary numbers directly at me.

77 … 76 … 75
.

Tyson wasn’t breathing and his heart rate was beginning to slow.

And then, riding on the back of a bored schoolboy sigh, Tyson finally exhaled as though he meant it, and I sensed something had struck the tips of my instrument. Regardless of whether it was real or not I knew I had to stop. Tyson was in big trouble and I needed to replace his tracheostomy tube. Just in case, I squeezed the forceps together and felt them grab hold of something, which I plucked from the wound in a dramatic flourish. Uncertainty kept me from destroying the moment by proclaiming “voilà!” but even before I looked, the whoops and screams all around me told me what had happened. It wasn’t Jack Horner’s plum and it certainly wasn’t Excalibur, but right then, I reckoned the fetid, slimy brown acorn in my hot little hand felt just as good.

Tyson was one of those cases veterinarians relish. His was the complete package—nothing magical, nothing heroic, just the right mix of drama, fear, instant gratification, and best of all, a certain if creative cure. The technicians and doctors who kept Tyson alive long enough for me to take my turn were the real talent in this case. I may have been the one who pulled out the acorn, but no one gives the kid in the stands who catches the ball the credit for hitting the home run.

Heady with success, I bounced upstairs to my office, intent on switching off my computer before taking off for the evening. Over the years I have learned to quietly bask in the clinical victories, however small, whenever they come my way, because the flip side, the daily struggle of medicine, lurks around every corner, whistling a bleak and insistent tune determined to worm its way inside your head. I figured Tyson would tide me over for quite a while, and that was why I was caught off balance when I saw it, a pop-up message from the hospital’s communication center, my heart sinking
before the words vanished from the screen, before they could crawl into my in-box and dare me, no, demand that I take a closer look. Finally, after more than a year of waiting, news about Helen had arrived.

“Eileen called. Says it’s urgent. Needs you to call her back. ASAP!”

I
DIALED
the number, nervously thinking this was like catching up with an old friend from high school, your association, your common ground, tied up in a brief period of history, trapped in a bygone era, outdated, disconcerting, and left behind for good reason. How could our conversation be anything but awkward? Too much time had passed. Any discussion at this point only served to highlight my apparent indifference to Helen’s recovery.

To my surprise Eileen sounded upbeat, shocked by my prompt reply, not expecting a call back until Monday. It was all the push I needed. I resolved to hide the fear in my voice, step into the spotlight, face the demons in a critical audience of my own making. Finding an optimistic, almost nonchalant, tone, I asked, “So, how is Helen doing?”

I heard the tense I had used—“How
is
Helen doing”—pleased I had managed to speak in the present, making a show of hope and optimism.

“What?” said Eileen, obviously confused by my question.

The silent pause stretched between us, time enough for guilt to jump in, interpret her surprise as incredulity, the impossible notion
that I had not learned of Helen’s demise, that I could be so insensitive as to ask such a question about their beloved and deceased dog.

“No, no, no,” she said, “you’ve got it wrong.”

Wrong. Of course I got it wrong. I never got it right. I never got it all, for starters. I left some of Helen’s cancer behind. Too much and just enough. Survival for four more months had been a pipe dream. She would have been lucky to see the end of the spring let alone the middle of summer. God, I hope she didn’t suffer. I hope they did the right thing and let her go with her dignity intact.

“This is about Didi,” said Eileen.

Of course it is. Your Newfoundland—the other dog in the family. But what about Helen, I wondered, even if I was also a little relieved at the subject change.

“She’s injured her opposite knee. Oh, and by the way, Helen’s doing great.”

Sometimes I can be slow on the uptake, especially when the words playing out in my ears contradict the certainty playing out in my mind. I don’t know how long the next pause lasted, but I do know it was long enough to negate any attempt to hide my surprise, or my relief. I didn’t care, so I didn’t even try.

“She is? That’s wonderful. I mean that’s incredible. I can’t believe it. I can’t tell you how many times I’ve thought about her, and what she went through, and the wonderful thing you were trying to do for her. And to be honest, I was afraid to know how things turned out.”

Suddenly, my voice was in a hurry to catch up to real time, and I heard myself rambling on like some schoolkid desperate to tell the teacher his version of the story before his friends ratted him out with the truth.

“Well, I can’t say it’s been easy,” said Eileen. “But she’s a remarkable dog.”

“She’s got to be,” I said, and I couldn’t have cared less that I sounded all punchy and that I was drifting way off track from the
real purpose of this phone call. This was incredible. Helen was alive and well and she wasn’t playing by anybody else’s rules but her own. I heard the voice of the scientist in me wanting to pooh-pooh my promise to Sandi Rasmussen as the only reason Helen continued to thrive, seeing the claim as no better than one of those anecdotal advertising testimonials touting a veterinary product of dubious merit simply because “Mrs. Smith of La Jolla, California” said it worked wonders for her pet. But then the image of a boisterous Min Pin puppy popped into my head and my inner scientist was speechless.

And so, over the next twenty minutes, Eileen and I played catch-up, starting from the moment Helen left the hospital.

“I couldn’t believe how fast she bounced back from your surgery. I picked her up and brought her home and she gave one little whimper when she was riding in the car, just the once, and that was it. And Didi was really sweet—very gentle and cautious around her, as if she understood what Helen must have been through.”

Oftentimes other pets in a household can be less than sympathetic when one of their own is recuperating from an operation. That fresh incision cross-hatched by stitches or staples deserves more than a cursory sniff, and hey, with an Elizabethan collar impeding good grooming habits, it’s the least they can do to offer complimentary lick-and-chew service. And what’s with that big bald patch and bad comb-over job? What’s with lying around all day? What’s with all the attention? Isn’t it time we caught up on a little roughhousing or are you going all soft on me?

“And I have to apologize,” Eileen said, “for the phone call where you told me about the dirty margins, about leaving tumor cells behind. I didn’t want you to think I was being indifferent. Truth be told I was just trying to stay alive. The rain was ridiculous and traffic was crazy and I couldn’t believe I didn’t get into a crash while I had you on the phone.”

I reassured her I had thought no such thing, and she went on
to tell me that my news persuaded them to go for two courses of chemotherapy, not least because Helen seemed to be doing so well.

“What a mistake,” she said, but didn’t linger. “Thankfully we got her teeth sorted out first. Dr. Able didn’t want to risk the possibility of her getting an infection that originated in her mouth when her immune system was being knocked out by the chemo.”

It made perfect sense to me. No amount of Listerine was going to defeat Helen’s bevy of oral bacteria. But what went wrong with the chemotherapy?

“She had to lose a lot of teeth and so what if she had a crooked smile, she was doing great. So we started out with intravenous carboplatin and I guess she did okay. But the doxorubicin … that was another story. It hit her really hard. She wouldn’t eat. She would drink but she couldn’t keep it down, throwing up over and over again. Eventually she fell over in her own pool of vomit and I didn’t know whether she had lost her balance, fainted, or was having a seizure. I rushed her right back to Angell, where she stayed in the critical care unit for a week.”