Love Is the Best Medicine (16 page)

In human hospitals it has been shown that relatives prefer to be present during a crisis, to witness the resuscitation. In this way there is no mystery, no wondering what happened, what more could
have been done, and as they watch everything unfold, they sense the determination of those committed to the fight. Their fears and questions must be addressed by dedicated support staff, prepared to answer questions and educate, but in practice such disruptions do not occur. The comfort comes from proximity to those you love.

For Sonja Rasmussen, any chance to prepare and brace for the bad news had passed. At five o’clock she was going to walk into this hospital, expecting me to smile, pat her on the shoulder, and let her know everything went fine. I gave her no reason to expect anything else. Sonja never had a chance to say anything other than a cursory good-bye to Cleo, and now she was about to live every parent’s worst nightmare, left with memories of a mundane, forgettable parting rather than something meaningful, something she would have cherished, if only she had known this would be their final farewell. Cleo was not the daughter who goes off to war. Cleo was the child who leaves for school and never comes home.

Over the past twenty years, I can recall no more than a handful of unexpected anesthetic deaths (but still an uncomfortable number to think about). Every one requires the clinician to make a full report on the circumstances leading up to the crisis and the efforts taken to correct it, and to speculate on the reasons for the outcome. Debriefing of the entire team is essential. If we could not help Cleo, we owe it to her and her family to learn from her loss so that the next time, and sadly there will be a next time, a more fortunate animal may benefit from our understanding and experience.

Beth Maganiello had personally chosen all the anesthetic drugs, calculated their dosages, and performed the epidural injection herself. She had been circling around Cleo, trapped in a holding pattern of no more than ten feet throughout the entire brief period Cleo was under anesthesia. All the usual suspects—allergic reaction, drug overdose, excessive anesthetic depth, decreased ventilation of the lungs—and many, many more had been given serious consideration, but we lacked the hard evidence to point the finger of blame.
Yes, we had all seen the bizarre heart arrhythmia on the monitor, tagged with its improbable French label, making it sound deceptively sexy or romantic as opposed to just plain deadly. But what caused it to occur? Was it genetically programmed as an electrical cardiac defect, invisible, impossible to predict, impossible to prevent? Was it triggered by a specific anesthetic drug? Chances were we would never know for sure. Torsades de pointes literally means “twisting of the points” and is supposed to describe the visual characteristics of the abnormal electrical activity on an EKG. For me this translation captured the sinister essence of what transpired, as though something cold and steely sharp had been at work. No matter what terminology I used, Sonja Rasmussen and her mother deserved to know why their dog had died and, for right now, I had no answer to give them.

I
STILL
had two hours before my pager announced the arrival of Sonja Rasmussen. Two hours to think about nothing else. I could imagine her sitting in the waiting area, as before, alone, anxious, coiled, desperate to be sprung by my surgical success, reading the fear in me from the moment she saw my face. I cannot let this happen, I thought. I will not let her suffer this pain in public. Could I smile, act as though all had gone well, waving away her barrage of questions until I had her alone, behind closed doors, then drop the pretense and my bombshell? Could I try to catch her before she entered the hospital, on the sidewalk or in the parking lot? There appeared to be only one reasonable option. I called the front desk and informed them that Ms. Rasmussen would be arriving at five o’clock to meet with me. She should be escorted to an examination room and I should be paged. I purposely avoided detail. The last thing I wanted was a premature consolation, an ambiguous remark from a well-meaning stranger. All the same, I knew I was taking a chance and I remained concerned that the perceptive Ms. Rasmussen might
sense some kind of a glitch—that this prearranged setting was a preface that could only mean bad news.

Alone in my office, I sat behind my desk, getting a feel for this new weight on my shoulders and the relentless tug at my heart. My patient was dead and I was responsible. I owned her passing. The fact that I never so much as raised a scalpel blade to Cleo’s skin made no difference. Perhaps it would have been easier if I had made an obvious blunder—a heart problem my ears failed to hear, a liver enzyme off the charts and somehow overlooked—something more tangible than my weak misgivings over a hat trick of broken bones. The agony of death would be shared by those of us left behind but I must take the blame. I would brace for the anger, absorb the accusations, and offer honesty and humility.

As a veterinarian I should always be competent, caring, and communicative, but our innate talents and, more importantly, our ability to learn, are best tested in a crisis. Be it the operating room or the examination room, how we deal with a crisis situation can set us apart. In the OR, I have witnessed the surgical ego manifested in temper tantrums that lay blame on the technical failings of equipment or on the challenge of striving for perfection. Not that swearing or tossing instruments fools anyone. Everybody sees the fear and reads the insecurity. None of us are immune, but for the most part I try to acknowledge my fallibility because the surgeon who doesn’t get scared from time to time is like the surgeon who claims he never has complications. And I confess, as I waited for my encounter with Sonja Rasmussen, I felt fear—fear of her overwhelming sadness.

Police officers, military personnel, and health-care professionals will tell you there is an art to delivering bad news. I know for a fact there are many veterinarians out there far more gifted in this department than I, but I do know some of the basic moves. When I met Ms. Rasmussen, my opening line would not be the dangerously vague “I’m sorry but we lost Cleo.” It would not be the geographically indeterminate “Cleo has gone to a better place” either. I knew
I had to get right to it. No pussyfooting, no preamble, no excuses. Deliver the blow and deal with the consequences.

At some point during the two-hour wait, self-reproach paid a visit, the “what ifs” and “if onlys” attacking like mosquitoes at dusk. I knew it wouldn’t change anything but I accepted the bites as part of my burden. I didn’t see any point in swatting them away. I just hoped they might be something I could get used to over time.

Let’s not forget that Cleo had been a second-opinion case, so I needed to telephone her veterinarians in both Bermuda and Canada. The conversations were remarkably similar—a description of the anesthetic protocol, a summary of the resuscitative efforts, an inability to offer a specific explanation, and a sincere apology for having failed the dog, the owner, and their trust in me and the hospital. In both instances I was overwhelmed by their understanding, their compassion, and their appreciation for everything we had done. I had tried to be descriptive and dispassionate but no doubt sadness laced my every word. Perhaps they were relieved that it had not been them, that they had not attempted the repair themselves. More likely their empathy lay with the fact that they knew exactly what I was experiencing because they had been through similar situations themselves.

There was one topic I knew I must broach with Ms. Rasmussen, though I wasn’t sure I had the stomach for it. Truly unpleasant as it was, perhaps unthinkable with the shock of loss so fresh and superficial, I must make a difficult but necessary request for a postmortem examination of Cleo’s body. In veterinary medicine we might use the term
necropsy
rather than
autopsy
, but the premise remains the same, a scientific exploration of a dead body in order to discover what went wrong.

Cleo’s body was being held in a large walk-in refrigerator, pending a decision Sonja could never have imagined having to make. Desensitized by TV shows like
CSI
and
Bones
that lure the audience into vivid autopsy scenes with the phrase “viewer discretion advised,” we
all have access to a relatively unsanitized view of what a postmortem examination entails. So why would I suggest submitting Cleo’s dead body to such an investigation when reaching inside her chest to work on her heart had seemed too invasive when she was alive?

For me, the answer lies in the distinction between life and death and the transition between the two. Beyond the certainty of knowing there was nothing I could do to heal Cleo’s failing heart, part of me recognized a need to keep her body intact. If she was going to die, at least let her die with dignity, not slashed open and hastily stitched back together. Sonja Rasmussen might want to see Cleo’s body. Keeping her whole simply felt like the right thing to do as she passed from our world into the next. In death, however, the situation had changed because the essence of what I had known as Cleo had moved on. What remained of her was something she no longer needed, something she had left behind, and in this instance, I believed she was offering us all a chance to learn the truth.

T
HE
liquid crystal display on my pager announced her arrival—“Sonja Rasmussen here to see you”—the words feeling awkward, like a hostess whispering in my ear at a noisy party rather than a somber declaration before a wake.

When I scrolled down, the pager display told me she was in Room 25. Most of our examination rooms have two doors, one providing an entrance to the public, the other providing an entrance to the staff from a central work area. The staff door has a peephole, a tiny fish-eye lens to prevent people from barging in on an examination in progress. I remembered that I had this chance to pause, to take a final look into Ms. Rasmussen’s world of “before,” but I decided against it. Accepting the invisible violence in my chest, I took a deep breath, opened the door, and stepped inside.

There was Sonja smiling, relaxed, as though she could taste the relief, glancing up at me under her red eyelashes. Once again she
was wearing that long gray winter coat, numerous bulky shopping bags at her feet, as though she had been enjoying herself splurging on Newbury Street as a distraction.

I had my hand on the handle, closing the door behind me, when I noticed the door at the other end of the room had been left wide open, affording me the sights and sounds of a bustling waiting room. My anger at this failure to achieve my goal of privacy rushed up to meet me, all consuming. I could feel my facial muscles betraying anxiety and I willed them to regain concern and solemnity.

Who left that door open? Don’t they understand what is about to happen?

No time for “Why would they? How could they?” No time to blame myself for this glitch.

After only the briefest eye contact, the open door forced me to look away. I moved past Sonja, knowing she was searching my eyes the whole time, feeling like the action of closing the second door was loaded, inappropriately intimate, and a signal of hesitation.

I felt the silence tighten all around us and Ms. Rasmussen tuned in to it, up now, on her feet as I began to speak. Adrenaline had worked its predictable sorcery in my mouth, the sudden absence of saliva making the consonants crackle, underlining the tremble dancing on my tongue. I cannot remember the exact language I used, but I remember it happened fast, terror building in her eyes as I watched my words worming their way inside her, helpless as her pain took shape, suddenly bright and hot and razor sharp.

The scream came first, a piercing, agonizing wail filling the room, and then the weight of the disaster took hold, pulling her down, and she collapsed in increments, agony giving way in layers, from top to bottom, like a tower crumbling to the ground leaving nothing but rubble.

Hand clasped across her mouth, she warned me she couldn’t breathe, that she might be physically sick. Clearly my message had found its mark, but then she asked me to repeat myself as though I
must have made a mistake, as though the last twenty seconds had never taken place.

I was kneeling on the floor beside her for the repeat performance. She began to swear, not in anger but in anguish, curses bent by pain into another frightening scream. If it was possible, she lost even more color, blanched enough to accentuate her freckles once more. Her body began to shake, and like a nervous fool I was talking through her tears and mucus and her fight for air, describing the details, how we tried and did everything we possibly could and how it came from nowhere and how we got nowhere. Feeling helpless I watched her reel and swear and cry, pummeled by my description, trapped on the ride, beginning the transition from shock to grief. The pain had taken all the light from her eyes and I watched as they faded toward waxy and dull.

Every examination room is stocked with a box of tissues in case of an emotional outburst. Precisely where they were hidden in Room 25, I had no idea. It would have been tactless to walk in, box in hand, telegraphing my bad news as if I were wearing a black armband. So I was forced to reach for the only alternative at hand—brawny, coarse paper napkins—the kind used to mop up urinary accidents. Ridiculous the way a small thing could make a difference, leaving me convinced I had compounded her sorrow as she worked rough wads into bleeding black mascara.

Not that Sonja appeared to care. After her initial shock, the pain began to change its shape, becoming tidal, hitting her in waves that would crash and ebb away. She got it together. She fell apart. She smoothed her breathing. She began to gasp in jagged little breaths. After a time, her questions began in earnest and so I told my story over again, slowly, in detail, retracing every step, and she listened intently, interrupted occasionally, but I could tell she heard only 50 percent of what was said if I was lucky. In the end, at this stage, I felt as though there were only a few facts that really mattered. I needed her to know that healthy young dogs are not meant to die
under anesthesia. I needed her to know I didn’t have an explanation at this time. I needed her to know that we all fought long and hard to save Cleo’s life. Most of all I made her see the assurance in my eyes that Cleo’s passing occurred without fear or pain, that we may have been relative strangers, but she left this world surrounded by people who cared.