The Gift of Pets: Stories Only a Vet Could Tell

by Bruce R. Coston

  Since I had completed surgery just three days previously, entering Max’s abdomen again involved simply cutting and removing the sutures that had been placed at that time and separating the already-healing tissues. Once I had entered the abdomen, I was surprised at what I found. I was not surprised that there was a diaphragmatic hernia. The surprise was to find that the liver, part of the spleen, and the intestines were bulging into the chest cavity not on the right side as they had been before, but through a hole that was just as big on the opposite side. This shocked me so much that I double-checked myself by looking for the suture line I had placed previously. There it was, intact and holding strong.

  Apparently, the initial injury had resulted in a tear in the diaphragm on not just one side but both. The abdominal organs, however, had fallen through only the tear on the right side, the one I originally found. When I had tested the diaphragm for leaks during the first surgery, the liver must have fallen against the second hole, in effect sealing any leakage through it during the test. The second hole had remained undetected. It was not until the second day after surgery that the liver had once again slipped through this second hole, sending Max back into respiratory distress.

  The process of closing the rent in the diaphragm would have to be repeated on the other side. This was going along famously, the four of us idly sharing pleasantries as I stitched, when all of a sudden Max’s heartbeat sped up noticeably and he involuntarily coughed. It is not unusual for a surgical patient’s depth of anesthesia to vary a bit during the course of a procedure. This is easily managed by changing the dose of anesthetic gases administered with a quick twist of a knob on the machine. But because Max’s head was tilted downward and because the gauze tied around his nose had apparently loosened during the forced ventilation, when he coughed, the tube I had inserted into his windpipe shot out like a blow dart, hitting the ground with a thud. The tubes connected to the anesthesia machine, through which passed the anesthetic gases that kept Max asleep, fell with it.

  The sound made me jerk my head up from my work, my hands buried almost to the elbows in Max’s deep chest. My eyes went wide, and I was immediately stricken with alarm. I noticed that Susan’s eyes also registered concern. But nothing could match the ashen countenance on Ginny’s panicked face. It was frozen in slack-jawed terror. The three of us knew that it was now only a matter of time before Max started waking up—and not much time at that. If he came to with both his abdomen and chest cavities open, it would be catastrophic. I could envision the scene: Max bouncing around the surgery room, intestines falling through the incision, struggling unsuccessfully for a few frantic seconds to draw air into his lungs before crumpling to the floor.

  There was not a moment to lose. Jerking my hands from deep within Max’s insides, I picked the tube up off the floor and ran to the sink in the next room, where I rinsed it quickly under the faucet. Then I raced back into the surgery suite, where Max was beginning to huff a bit. Standing practically on my head, I pulled his mouth open and quickly stabbed with the tube at his airway, the anatomy appearing upside down from its usual appearance because of his position on the table. Fortunately, the tube slipped easily down his trachea. Tying the gauze tightly around the tube and then again around Max’s upper jaw, I secured the tube in place again before reattaching the anesthetic machine to it. The whole episode had taken less than a minute, but I was dripping with sweat and there was a noticeable ringing in my ears by the time I had finished. I could feel the blood rushing to my face, redness sweeping aside the astonishment.

  My gaze made its way around the room. Ginny’s eyes were wide above her surgical mask, the light blue of which contrasted sharply with the pearly white pallor of her glistening forehead. She pressed her back up against the wall, her palms gripping the vertical surface like a spider, her legs spread, knees bent and tense as if she was, at any moment, either going to take flight and run screaming from the room or slide unconscious down the wall. Susan was little better. Her hands, swathed in surgical gloves and bloody, trembled as she continued to hold a liver lobe aside at the spot where I had been working. Her eyes, too, were wide and rimmed with surprise.

  I was afraid to look at Elaine. Throughout the ordeal, there had not been a sound from the corner where she stood. I wasn’t sure whether that was good news or bad. When I finally summoned the courage to look at her face, I was stunned to find there a serene and untroubled expression of complete calm. Her eyes were soft and steady as they returned my gaze, and though I could not see her mouth under the surgical mask, I was sure she was smiling sweetly. Her hands were clasped comfortably in front of her and she leaned nonchalantly against the wall. I could find not a trace of alarm or concern on her face or in her demeanor.

  Her steadiness snapped me quickly back to the task at hand. I had to go through the entire process of scrubbing, gowning, and gloving again before I could proceed with the surgery, but the rest of the procedure was anticlimactic. In short order, I had repaired the hole in the diaphragm, tested for leaks, placed another chest tube, and closed the abdominal wall and skin. In no time at all, we were carrying Max back to his cage and pulling off our masks, gowns, caps, and gloves. Max’s recovery after that was rapid and complete. He was ready to go home within two days and was almost back to normal by the time we released him.

  It was not until suture-removal time two weeks later that I dared to bring up the incident to Elaine. I asked her if she had been afraid or worried when things started to go wrong, and how she had remained so calm.

  “I did notice that the three of you were pretty stressed. But there was nothing whatsoever I could do to help. I was sure you would soon have everything under control. And I figured that the last thing you needed was for me to flip out on you. And I was right to be so confident, wasn’t I? Look at him. Max is one hundred percent back to normal. You did a great job!”

  I could have hugged her on the spot. How in the world it was that she had witnessed such unadulterated panic in the face of unexpected crisis without losing every shred of confidence in my skills amazes me still as I think about it. I had dodged a bullet!

  There was, however, fallout from Max’s surgery. Ginny’s career as a veterinary assistant did not survive it. From that day on, she vehemently refused to be the anesthetist for surgical patients. Within just a few short weeks, in fact, she left my employment, choosing instead to go to grooming school to master that less stressful aspect of pet care. To this day, Ginny blames Max’s surgery for her career change. The terror of it was just too much for her. When she completed her training, she opened a pet-grooming parlor in a nearby community, where she is still a groomer today.

  But there were no consequences with Elaine. Now, some ten or twelve years later, she is still a loyal client of mine. Sadly, Megan and Max are now both gone. But Elaine has two new dogs, young, exuberant, and wonderful chocolate Labs. Their pictures are pinned to the message board above my desk. In fact, as I look at the appointment book, I am pleased to see that Elaine has an appointment for both of her new dogs in the morning. I will remain forever grateful to her for her continued friendship and the confidence she still places in me, despite Max’s exciting surgery.

  Fighting the Good Fight

  There lies within some people an unseen and unseeable reserve of strength and energy, unbelievable optimism in the face of improbable odds, overflowing wells of goodwill, and constantly optimistic attitudes. Some of us are endowed with limitless stores of these qualities, stores which can be requisitioned in times of need—our own or the needs of others—despite the emergence of the burgeoning forces arrayed against us. Others, faced with similar circumstances, or even those not nearly approximating the same harshness, grovel and feign, wrap themselves in layers of excuses and complaints, thereby making their own lives piteous and unbearable, and casting the lot of those around them into deep shadow. Tragedy does not create in a person good character; tragedy only reveals the courage, the integrity, the forbearance, and the inner wellspring of str
ength that lie quiescent within those whose inner selves are constructed of these raw materials.

  Lisa’s therapy took on a life of its own. The awful weekly visits and the flushing of toxic medical sludge through an already-ravaged body assumed a sort of routine, as if it was normal, which, for Lisa, it unfortunately had become. Throughout the process, Lisa maintained a positive outlook, calling on stockpiles of courage she had not known she possessed. Most of the time she felt well, despite days when waves of nausea washed over her and crashed into her seawall of resolve and determination. Somehow that wall held. Early on, there were only a few days when she was too ill to come to work, and when she was there, her work was largely unaffected.

  For weeks this pattern repeated itself: a round of chemotherapy, followed by illness, doctor’s visits, blood work, follow-up MRIs, then another round of chemo. Lisa was placed on antibiotics when her white-blood-cell count dropped; at these times she stayed away from the potentially contagious things to which she might be exposed at the office. The medications helped in large part to keep the creeping nausea at bay, except for a day or two after her treatments. Her hair thinned noticeably but did not completely fall out. She resisted shaving her head, falling back on wearing hats instead.

  Despite Lisa’s fears, Dave was a constant and ready source of help and support, though I cannot imagine the torment he must have endured in doing so. Steven and Melanie were stalwart in their support, although they were often absent. Steven’s assignment in the military prevented him from spending much time at home, though he called often and committed his few free weekends to his mother. Melanie had moved on to a job in New York, the city that never sleeps, where, it seemed, neither did she. Besides Dave, Susan was Lisa’s real ally, always ready with a meal, a shoulder, a word. She fed the horses when Lisa could not get out of the house. She ran errands to the pharmacy or the grocery store. She kept Lisa centered at those infrequent times when her mind veered unavoidably toward the morose.

  I tried to be available for Lisa, but our daily interactions really didn’t change much. They focused mostly on the ongoing flow of animals that eddied around us for treatment or surgery. Occasionally, Lisa asked me for clarification of some misunderstood medical terminology her doctors had used or wanted me to look at the latest X-ray, but usually the subject of her illness or its treatment was not broached. This left me feeling oddly guilty that I was not doing more for her, but I assuaged that guilt with the hope that if she needed help from me, she would ask. The fact that she had not done so, suggested to me that I was providing for her a sense of the normal, ordinary, mundane flow of “real” life that staked her to her world and allowed moments of blissful forgetfulness of the shadow within.

  I discovered a surprising emotional response to the situation when I shared news of Lisa’s plight with others. It startled me how often their initial reaction to news of her lung cancer was to ask if she was a smoker. It should not have surprised me. I had done so myself—many times, in fact—when presented with a similar scenario. But from my new perspective as someone intimately connected to the afflicted person, these questions struck me first as insensitive, then as offensive. The intimation was that since Lisa had engaged in such risky behavior, the resultant illness was a foregone conclusion, an expected and therefore an acceptable outcome—as if cancer in a smoker is somehow less tragic. It is true, of course, that smoking is often at the root of lung cancer. But even if a person’s poor choices lead to an awful disease, the tragedy for that person is no less intense. The family is still ravaged, the souls still tattered.

  This realization was an epiphany for me, one that gained credibility when I learned a few statistics regarding the occurrence of lung cancer in people. I learned, for instance, that 90 percent of lung cancer patients are or have been smokers. This was not a surprise to me. It came, in fact, as a self-righteous confirmation of many long-held assumptions. Serves them right, I would huff, gathering around my shoulders the blankets of assurance that, as a nonsmoker, my own chances of a similar diagnosis were minuscule. But the statistics that followed took me off guard. Only 10 percent of smokers develop lung cancer. My first thought was disbelief. Certainly that number was too low. But then doorways of deeper empathy and sensitivity were opened for me, swinging much easier on the hinges of my friendship with Lisa.

  Smoking is not an immutable sentence of lung cancer. It is, like any number of other things, just a risk factor for it—a very significant risk factor, to be sure, but nothing more. To assume more is simply an unthinking, self-absorbed response to our own fear of mortality. Though an understandable reaction, it diminishes in our minds the very real catastrophe for the stricken person, a mistake of enormous consequence, for it becomes an unconscious and unintended demonstration of insensitivity.

  This perspective is not some macabre defense of smoking in any way. There are reams of documentation linking cancer and a host of other maladies to smoking. High blood pressure, emphysema, coronary artery disease, chronic bronchitis, laryngeal cancer, asthma, and any number of other diseases have been shown unequivocally to be caused by smoking. I have, though, been struck with the realization that to lay the blame on the victims of lung cancer, or these other diseases, is useless and patronizing and compromises our ability to truly empathize with those who find themselves in the position that we most fear. I found myself saying in the face of statistics and risk factors and scientific associations, “Yeah, those are all true. But this is Lisa we’re talking about here. She isn’t a statistic. She’s my friend.” It was only at this point that I could really begin to care.

  For a time, it appeared that the enemy within Lisa was being beaten back. Lisa’s shortness of breath improved, in fact, as did her intolerance to exertion. Even the cough abated for a while. For a few months, it seemed that the war might have been won. But it is often easy to mistake winning a battle with the harder task of victory in the war. After a few months of apparent victory, it was as if the powerful medicines became no more effective than waving flimsy branches at the attacks of a lion, a pride of lions. It became apparent that to continue the feeble offensive was not the height of bravery, but would be instead the foolishness of cowards, afraid to face the certainties of defeat. Lisa was no coward. When the time came to acknowledge that her treatments were not working, she was able to do so with the same strength and resolve with which she had endured them.

  The intent of her therapy changed at that point from attempts at cure to efforts at minimizing the impact of her disease. Medications to diminish the intractable discomfort and pain replaced those that inflicted short-term suffering in hopes of long-term resolution. Lisa’s interactions with her family began to focus on equipping them for the inevitable; with expressing to them her visions for how she hoped their lives would unfold. She displayed an awareness of issues deeper and more overarching than those to which her day-to-day routines gave voice. I’m sure she must have grappled with the fundamental questions common to us all, but hers were private thoughts. Dave was a source of strength for her, remaining by her side even when she demanded, for his own good, that he desert her.

  One evening after work, I drove to Lisa’s house and sat down with the two of them. She had asked that I come by to discuss a few details that were important to her. She was completely in control of the discussion that evening, indulging in neither sentimentalism nor self-pity. It is a conversation that I relive with a sense of disbelief, wondering if I could be so endowed with dignity and rationalism if I was presented with similar constraints of time and future. I sat on the edge of an overstuffed chair in her living room, facing the two of them on the couch. Grizzly lay at their feet, looking up at me suspiciously, as if I was there to inflict upon Lisa some of the same insults, injections, and probing I had imposed upon him through the years.

  “How are you doing, Lisa?” She knew it was not a casual non sequitur, and she didn’t treat it as such.

  “For the most part, I’m still doing okay. But I can tell things ar
e going downhill.” She responded with an openness and honesty that smarted. “They tell me that the tumor has spread to my liver and kidneys.”

  “Have they seen that on MRIs?”

  “No, they quit doing those. There’s really no point. They can just feel the liver getting bigger. I can, too, if I press a little bit.”

  “Are you in pain?”

  “Not really. The morphine does a pretty good job most of the time.”

  Dave sat beside her, holding her hand and nodding in agreement and affirmation, seeming no more affected by the articulation of these realities than when they remained an unspoken, although very constant, presence. Expression, in fact, seemed to minimize the impact for both of them. The disease was their abiding companion, having become now a familiar reality. It was a cheerless presence, to be sure, but it was not for them what it was for me: a faceless Evil with whom I was only distantly familiar, the source of a dreadful, unarticulated fear whose confluence I was unaccustomed to confronting.

  “Doc, there are a few things I’m going to need your help with from here on out.”

  “You know I’ll do anything I can for you anytime.”

  “I’m concerned about Grizzly.”

  I had suspected he would be one of her priorities. He was advancing in age, though not yet truly geriatric. He had been suffering recently from a series of undiagnosed pains. His neck was the source of significant discomfort. To avoid shooting pain, he kept it still and rigid, moving only his eyes instead of his whole head. There was muscle wasting over his hips and shoulders for no apparent reason, as if he was tiring from the chore of carrying the vast weight of Lisa’s world. He had developed a grouchy, unpredictable attitude around everyone but Lisa, whom he continued to idolize. I suspected that the degree of her illness and the limits imposed by the physical and emotional trauma of her treatment were not lost on Grizzly, inflicting their toll not on Lisa alone but on this noble and devoted soul, as well.