Love Is the Best Medicine (22 page)

I am not by nature a superstitious person, though I might avoid walking under ladders, I am cautious when hanging mirrors, and I
choose not to open umbrellas indoors. Like I said, most medical professionals, including surgeons, live by objectivity. Even so, there are times when superstition can still undermine a semblance of reason.

Young doctors, interns, and residents are perhaps the most prone to this. Maybe they seek the solace of knowing a higher power had a hand in their bad luck. Maybe they want to feel assured that an outcome was predestined, fated beyond their control. For example, if they are on call for nighttime emergencies there will be this tacit understanding that no one on the team should verbalize how quiet it has been for the past few nights lest they unleash the wrath of the ominous word
jinx
. That said, they may look upon a certain permutation of technician, intern, and resident and resign themselves to pulling an all-nighter because, for some inexplicable reason, that particular combination always has bad luck. Best of all, they will tell you that everything, no matter how obscure or how disastrous, always comes in runs of threes. And this was why I stared at Atlas, a creature trapped in some kind of purgatory between this world and the next, because all I could think of was Cleo. If everything comes in runs of three, which wretched case would be next?

Forty minutes passed. Technically Atlas was alive but only just. He refused to breathe for himself and the technician had been artificially breathing for him this whole time. His heart was still beating but the rate was down in the forties, a ridiculously low number for a rabbit. It waned in increments and was resistant to all chemical stimulants. Worst of all, just as with Cleo, the pupils of Atlas’s eyes were fixed, dilated, and unresponsive.

“Essentially he’s dead,” said Dr. Bain, looking at the heart monitor. “He’s been off anesthesia but he still won’t breathe for himself and his heart rate just keeps falling and falling. It’s like he’s slowly shutting down. Based on his pupils I think he’s probably already brain dead.”

It was as though Atlas had opted for hibernation and was slipping
away gracefully. Instead of ending his life with a screeching halt Atlas preferred to brake slowly and smoothly before coming to a complete stop.

Once again, here I was, undone by another unexpected and disastrous turn of events, but there was nothing more for me to do so I removed my gloves, called out the OR, and asked the anesthesia technicians to get going on my next case. I forced myself not to add “with all caution.”

“Hey, Nick.” It was Dr. Vega, Atlas’s primary doctor and a specialist in exotic medicine, poking her head into the surgical suites.

“I just spoke to the owner and she’s coming right down. She wants to say good-bye to Atlas while he’s under anesthesia. Do you think we can make him look
presentable
before she arrives?”

“Of course,” I said, thinking that he wasn’t really under anesthesia but more than able to understand her request. One of the basic truths in all of surgery is that no matter what you do on the inside, the quality of a surgeon’s skill and compassion is often judged by his or her handiwork on the outside. Make Atlas look pretty. Tidy up all the hastily shaved fur. Pull the catheters, the monitors that fasten and pinch and probe. Do a nice neat job of stitching the skin. If Atlas cannot reap the rewards of the hard work no one ever gets to see, at least he can leave this world looking his best.

And so I donned a new pair of gloves, picked up a few basic pieces of surgical equipment, and set to work.

About three stitches in something strange happened. This inert, unresponsive, velveteen rabbit twitched his skin. At the time, I considered the tic noteworthy but inconsequential, no more than an involuntary reflex, a final discharge from a dying nerve. Seconds later when the previously flaccid Atlas jerked his head and blinked, the entire resuscitation team succumbed to a dumbstruck moment of disbelief.

The choice phrases that ensued do not bear repeating here, but who could deny any clinician a joyful four-letter expletive or two with
the impossible realization that Atlas, bless his slowly beating heart, was back from the dead. The little rascal had been faking it all along. Oh, the thrill and relief of scrambling to close the wound before Atlas literally hopped off the table.

None of us had a clue as to what happened with Atlas. It really was more like hibernation than anesthesia, as if a particularly cold winter had nearly taken him and just when everyone had given up, spring had brought him back to life. I had willed it with Cleo, imagined it unfolding as we had worked on her, to no avail. Still, as far as I was concerned, Atlas had thumped lucky rabbit paws all over any superstitious twaddle that says bad things come in runs of threes.

Nevertheless, as Atlas went off to the critical care unit to recover, I privately remained concerned. Alive was not the same as being functional. One by one his body’s various systems had been saying goodnight, and a vegetative state is no quality of life for a rabbit or any animal. And if, by some act of God, he came all the way back to us, what had our surgery achieved? I had managed to leave behind a smattering of those antibiotic impregnated beads but the wound had been mauled by ungloved technicians and doctors like clumsy detectives at a crime scene. My closure had been a desperate race, the result not quite Frankenstein, but far from Joan Rivers.

By the time Atlas’s owner, Leah, arrived, this remarkable rabbit had undergone a complete transformation. Leah was a young woman in her early twenties, and she had hurried to the hospital prepared to say good-bye, eyes filled with the preemptive tears of shock and pain. Instead she was rewarded with shock and joy. The creature in the critical care unit, hopping around his cage, utterly unfazed and gnawing on pieces of carrot, insisted on saying hello and “When are we going home?” In short, Atlas was acting like a normal, healthy rabbit. And as it turned out, the surgeon in me need not have worried. The wound healed beautifully and some fifteen months later, his abscess has never returned.

N
OT
long after my encounter with the amazing Atlas another sick animal had me wondering about that elusive promise to Sandi.

“Nick, how about a gallbladder this afternoon?”

The question, delivered like an invitation to try an hors d’oeuvre at a cocktail party, came from Dr. Carroll, a specialist in internal medicine. Her trademark clinical style lay somewhere between Energizer Bunny and Tasmanian devil. She always spoke in fast clipped bursts, words unleashed like bullets from an Uzi. Her candor and dedication garnered a loyal clientele despite the fast-talking, fast-walking urgency of someone who always managed to look like she had somewhere else to be.

“Kyoza’s a Siamese, eleven years old, and her liver’s toast. She’s not eating, her enzymes are off the charts, and her skin color lies somewhere between the yolk of a free-range egg and pureed carrot.”

Dr. Carroll was talking about jaundice, the cat’s failure to rid herself of the waste product called bile. Bile is normally excreted into our gut. If it can’t get out, sometimes due to a blockage in the gallbladder, it will find its way into the circulation, quickly turning the skin and mucous membranes a disgusting shade of yellow or even orange.

“I don’t know if she’ll make it through surgery but the owners want to give it a try.”

I heard the caveat loud and clear. It was the need to try, the reassurance of knowing there was nothing more that could be done. For so many owners, no matter how long the odds, there can be solace in knowing they have given their pet every chance.

“Sure,” I said. “I’ll see what I can do.”

Dr. Carroll was already on the move, heading down the corridor.

“Hey,” I shouted after her. “What’s this cat like?”

She slammed on the brakes, turned, and looked at me.

“Why? Does it make a difference?”

I shrugged, shook my head. Of course it didn’t matter one iota, but from a management standpoint, a difficult and testy cat requiring extensive aftercare may be more of a challenge than a granny-loving lap cat, purring amid knitting needles and cups of tea.

“I’ll let you be the judge,” she said and was gone.

Y
ELLOW
cat belly is weird. It’s eerie, like the faces of those three men in Blue Man Group. And in Kyoza’s case, the discoloration went beyond skin deep. What little fat this poor cat had left was yellow, her intestines were yellow, her stomach was yellow, and even her kidneys were yellow. Normally the gallbladder lies between the lobes of the liver like a tired old party balloon, barely distended. Kyoza’s gallbladder was inflated to the point of bursting, its surface tight and thin, all ready to pop.

I set to work on this diseased plumbing, teasing and coaxing the gallbladder out of its glandular alcove lest it rupture and spill its green poison. I followed up with a little Roto-Rooter action, suctioning and flushing the duct system, making sure that all the unwanted bile could flow downstream, into the intestines and out of the body. All that remained was that old chestnut, much loved by those internal medicine types.

“Oh, while you are at it, I don’t suppose you could just get me a biopsy or two.”

This was a request to sample a surgical tasting menu, if you will, of tiny pieces of tissue such as the liver, jejunum, and pancreas. Eager to please I acquired my requisite specimens, cultures, and aspirates and closed little Kyoza up.

Many hours later I checked in on her in CCU. She was hooked up to fluids and monitors, lying on her side, weak and unable to raise her head. Now I could appreciate how sick this cat really was and how our anesthesia team had done an incredible job of just getting
her out of surgery. They had achieved their goal, the relay baton had been successfully passed on to critical care, and now it was their turn to keep Kyoza in the fight.

I lay my hand across her xylophone chest, nothing but fur and ribs. Her eyes were closed but to my surprise, as soon as I touched her, she began to purr. Not a subtle purr either, a grinding, booming variant, like a Geiger counter homing in on a radioactive cache. Cats don’t just purr when they are happy. Sometimes they purr when they are in pain or frightened. It has even been suggested that these vibrational sound frequencies possess healing properties. For me, this purring was not initiated by distress but was Kyoza’s way of letting us know she was still in there, hanging on, grateful to be alive. It took me back to my question for Dr. Carroll.

“What’s this cat like?”

Well, I had my answer. Kyoza was clearly a fighter.

I
T IS
quite common for hospitalized pets, particularly those destined for an extensive stay in critical care, to be accompanied by a favorite blanket or stuffed toy, family photos, and even “get well soon” cards. Kyoza’s heartening cage accessory, however, did not seem to fit this bill. Set off to one side, inside a transparent plastic frame, was a very different type of card. I picked it up and on the front was a photograph of a gentleman called Harold Klemp. Mr. Klemp was probably in his sixties, with a receding hairline just shy of bald, functional glasses, a blazer, striped tie, and a warm smile that felt more like an introduction from a doctor than a used car salesman.

It turned out that Mr. Klemp was neither. He is the spiritual leader of a religion I had never heard of called Eckankar. Apparently I was holding what is referred to as a “Hu card,” the flip side of which said,

“You have to say the word
Hu
whenever you are around Kyoza,” said a passing technician who saw me eyeing the card. “It’s supposed to give off good vibes or something like that.”

I thanked her and placed the card back in the cage like a child ordered by a shopkeeper not to touch the goods. Now I was curious about Kyoza’s owners but, if I am being perfectly honest, I also recognized a tinge of relief that these clients still belonged to Dr. Carroll.

K
YOZA
struggled through the next few days, needing a feeding tube to deliver liquid kitty gruel because she showed no interest in food on her own. For the most part, skin and bones just lay there, staring out at the world, what remained of her body being turned by attentive nurses every four hours because Kyoza was simply too weak to move herself. When her biopsy results came back they provided the explanation for her faltering recovery. Kyoza had one of the worst cases of liver infection the pathologists had ever seen. Wily gut bacteria had taken advantage of all the sludge clogging her bile ducts, swimming upstream to colonize her entire liver. Based on the lab results it was hard to imagine any cat surviving their malicious attack. Perhaps all we had done was to prolong the inevitable.