Love Is the Best Medicine (20 page)

It started in the muscles around my top lip, taking me back to my childhood, and by the time I recognized the telltale tremble it was too late, the first fugitive tears getting away from me, her words reaching into my chest, making me gasp, hearing that initial catch in the breath before the real crying began.

I stood up, wiping my palms down my wet cheeks, trying to suck it up, to get a grip, but Sandi sealed my fate. Without hesitation, she stepped forward, opened her arms, and gave me a hug.

It didn’t last long. Several deep breaths and my diaphragm decided to behave, responding to instruction, overriding emotion. We parted, but her hands maintained their grip on my upper arms. I shook my head,

“I’m so sorry. I can’t believe it. I’m the one who’s supposed to be consoling you, not the other way round.”

She smiled, and now, in her eyes, I could see all that she had lost and the proportions of the enormous void in her heart. Only by her being here, face-to-face, telling me these small stories, letting me in, could I even begin to appreciate the size of this emptiness, of all that this dog meant, and how much of this special animal would remain with her.

“I need you to make me a promise,” she said. “Cleo would never blame you for what happened to her, and neither will I.”

She caught herself, and suddenly laughed.

“I was going to say she didn’t have a bad bone in her body, but you and I know that’s not true.”

I joined her, thankful for the release only laughter can bring at such moments.

“But I would like something positive to come of this.”

I wasn’t sure where this was going but I knew enough to keep quiet.

“I want you to 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.”

At this point I wasn’t saying anything simply because I was stunned into silence. Without doubt, this had been a powerfully affecting experience and I had been awed by Sandi’s grace, her otherworldly wisdom, and her magnanimous approach to this tragedy. No one can tell you how to grieve. There is no correct way to grieve. Suffering is not proportional to the volume of our tears. Sandi’s grief was striking, unusual, and in its own way, special. This appeal, however, had thrown me, and though I was never going to refuse, I had no idea what this would entail, let alone how it could possibly be fulfilled.

Naturally I nodded my assent, gave my assurance, as though nothing would please me more or be simpler to achieve. But looking back, this should have been my cue to ask for guidance. Okay, so I had inadvertently shown her my soft side, but this was hardly an admission of spiritual beliefs—an appreciation of the soul, of heaven, of a greater understanding of life’s purpose. Then again, this might have been part of Sandi’s plan, forcing me to make my own interpretation, to define a purpose that I alone saw fit.

We hugged one more time and then, in silence, I led the way toward the main hospital entrance.

Before we said good-bye, Sandi turned to me and said, “Be generous, and if you get a chance, please let me know what happens.”

She smiled and once more I felt myself having to fight against the grief and kindness in her eyes. How could someone in so much pain appreciate that loss was simply a part of life and not an end of life?

I watched her go, disappearing into a waiting room full of animals, watching her as she was forced to witness the reunion of humans and sick animals with a future together.

A
S
the daughter of a registered nurse, Eileen possessed a judicious balance of medical smarts and emotional sensitivity. And like so many other pet owners in her position, she dove into the Internet, attempting to discover the truth, to sift some nuggets of hope from the unfiltered mounds of negativity. She kept an open mind and focused on being informed, regardless of the injustice of what she discovered and how much it hurt.

The first surprise came packaged with an assurance that her spaniel Helen was not alone. Far from it. In fact, Eileen discovered, 45 percent of dogs that live to ten years of age or older ultimately die from cancer. That’s four million dogs in the United States developing cancer every year.

The second surprise came as a statement she needed to see in writing. She had heard it before on TV interviews, a well-intentioned platitude, easy to appreciate, even easier to brush off, reserved for the less fortunate few. This time, however, the phrase hit home and she grabbed it, grateful, vowing to keep it with her. It was nothing more than a simple sentence, but it would be her new philosophy.

“Cancer is not the same as death.”

A few days later when she and Helen returned to Angell, Eileen felt prepared, rational, and open-minded about what the oncologist might say.

Dr. Able was not the cancer specialist of her dreams. That is to say she had imagined a much older man with less hair on his head and more wisdom lining his face. This man seemed altogether too young for all those letters after his name, his double-boarded specialist status and all those years of training in both medical oncology and radiation oncology belying the gold-rimmed John Lennon glasses and a neatly gelled Tintin haircut. To her surprise and satisfaction though, Dr. Able seemed like a man used to the introductory reaction playing on Eileen’s face. Though secretly he might enjoy it, he was quick to prove he had earned his credentials.

He began with a detailed history, provided by Eileen as observer, running through her statement one more time and feeling frustrated by everything she didn’t know about Helen’s former life. They moved on to the physical examination, Helen at ease, tail wagging off the chart, apparently forgiving Dr. Able his joke about someone being in desperate need of a Tic Tac as he examined her mouth. He saved the stethoscope for last, taking his time, in no hurry now that her secret was out.

“There are two kinds of approaches we oncologists use,” he said, inviting Eileen and Helen to take a seat as he rolled closer in his swivel chair. “One could be described as a guardian, the other a teacher. Based on a given diagnosis a guardian will tell the owner how best to treat the problem without much input from the owner, whereas a teacher will educate the owner, give them all the data regarding treatment options, but not offer any help in the decision-making process. There are clearly flaws with both approaches.”

His smile did little to reduce Eileen’s confusion, so he pressed on.

“Some owners like to be guided, to have their vet make the tough calls for them. But if things turn out badly, then who foots the blame?”

Dr. Able drove a thumb into his chest.

“Some owners like to be involved in the decision-making process but sometimes this can feel frustrating, even overwhelming.”

“So what kind of an oncologist are you?” said Eileen.

“I’m like most oncologists,” said Dr. Able, “a bit of both. Mixing it up, focused on keeping our goals realistic and never losing sight of patient quality of life.”

Eileen saw that he meant what he said. She liked what he was saying and could feel her earlier apprehension about this young man beginning to subside.

“I’ve looked over all Helen’s blood work, her cardiac ultrasound, and her chest X-rays. Normally I would insist on a definitive diagnosis before recommending a specific treatment option but in Helen’s case I believe we can argue for an exception.”

“Because almost all canine lung cancers are malignant,” said Eileen.

If she was expecting to score points with an appreciative arching of a single eyebrow, Dr. Able did not deliver. Then again, she thought, almost by definition, if you have taken the time to seek out a veterinary oncologist, you are highly likely to go to your meeting armed with a wealth of pertinent cyberspace factoids. Perhaps Dr. Able would have been more surprised if she had kept quiet.

He rose to his feet and switched on the X-ray viewing box. Eileen instantly recognized the picture on the screen, the enormous white mass in Helen’s chest, an ominous moonlit cloud scudding across a night sky. Seeing it again was like recognizing your attacker in a lineup.

“Here’s the mass.” His index finger traced the outline. “It’s quite large for a dog of Helen’s size.”

He paused to look over at Helen snoozing on the floor, an apologetic expression on his face, as though he didn’t want to be talking about her behind her back.

“It’s also solitary, meaning it is more likely to originate in lung tissue rather than having spread to the lungs from somewhere else.”

A thought suddenly occurred to Eileen and she was surprised that it had not struck her sooner.

“Is it possible Helen spent her life among people who smoked?”

She was remembering Sam, the sad old golden retriever she had patted while waiting for Helen’s chest X-rays. The smell of nicotine and cigarettes had permeated the room. Had his frightened owner inadvertently contributed to his best friend’s demise?

Dr. Able frowned, a moment of deliberation playing over his features.

“The jury is still out on secondhand smoke increasing the risk of lung cancer in dogs, though it does appear to cause an increase in the frequency of certain cancers in cats. To be honest, I’m not sure it matters
how
it got there. What matters is how we deal with it from here on out. Most dogs with this disease would show up at their vets having been coughing for weeks or even months. An owner might report their dog had slowed down, been reluctant or unable to exercise. When it comes to Helen, I think you should consider yourself lucky to have found a problem you never even knew existed, before it could produce a single clinical sign. It’s called an incidental finding and we don’t get to find them too often.”

Eileen latched on to this word
incidental
. It sounded like something unplanned, casual, even minor, and for some reason she imagined a fender bender on the far side of a busy highway, something that makes you slow down and check it out but ultimately something you can choose to drive right by.

“Could it have been there for some time?”

Dr. Able answered without looking at the image, as though he no longer needed its help, as though he instinctively knew where Eileen was going.

“Maybe,” he said. “But probably not.”

He paused for a beat and added, “It can be a whole lot easier when disease comes packaged with a problem you can see or hear or smell. Owners often consider incidental findings to be a mixed blessing:
for some they offer a welcome opportunity to act sooner, for others they create an unsolicited burden of having to act at all.”

He tapped the X-ray cloud twice with his finger.

“We can’t pretend this never happened. I think we have to accept it as the ultimate ‘heads up.’”

Eileen followed his finger and did not avert her eyes.

“So where do we go from here?”

Arguably, more than any other speciality, later, another difficult veterinary oncologists have chosen to deal with pet owners who are desperate for hope. A few of these owners will be on a reconnaissance mission, meeting with the oncologist in order to satisfy their curiosity and their conscience that at least they looked into the future and didn’t like what it held. And of course, there is absolutely nothing wrong with this motivation. Then there is the other end of the pet-owning spectrum, this meeting proof of their intent to keep their animal alive at all costs.

Dr. Able already appreciated that the old black spaniel sleeping on the floor in front of him was special. She had to be. She might be “the best dog in the world” or “the best dog Eileen has ever known.” Not that the malignant tendrils brooding inside this dog’s chest could give a damn. Courtesy and respect for this disease can only go so far. It will fight dirty and Dr. Able knew that sometimes you have to be prepared to give back as good as you get.

In formulating a plan of attack it pays to keep a grip on reality. Sugarcoated speculation is for the purveyors of snake oil. Dr. Able had a responsibility to scientific fact, evidence-based medicine, and the data of the journals he devours. It was time to balance empathy with honesty, to temper encouragement with the truth.

“It would be nice to have a biopsy but sticking a needle into a lung mass is not without risk, even with ultrasound guidance. In theory, taking it out gets rid of it
and
gives us our diagnosis.”

Eileen was all over the caveat.

“What do you mean ‘in theory’?”

Dr. Able pursed his lips and sucked back on his teeth.

“A couple of things about this mass bother me. First,” he extended his thumb, “its location. Ideally a tumor should be located on the edge of a lung lobe where it can be cut out more easily. Helen’s lump is deep, at the base of the lung, which makes it far more difficult to get.”

Eileen took a noisy, deep inhalation and let it out, thinking “Most people give out the good news first.”

“Second,” out came the index finger, “primary lung tumors have the best prognosis when you catch them early. A no-brainer really, the smaller the tumor, the less likely it is to have spread to the regional lymph nodes. X-rays are notoriously difficult for detecting enlarged lymph nodes but we do know that solitary masses less than five centimeters in diameter carry the best prognosis.”