Love Is the Best Medicine

by Dr. Nick Trout

  ANGELL boasts twenty-six examination rooms—all fully equipped, basking in fluorescence, and uniformly painted “yellow finch” with a tinge of institutional green. Room 12 is my domain when it comes to most of my interactions with the public, a room tucked away in the far reaches of the building, a room with a tiny examination table and large floor space, an arrangement that encourages me to interview my patients on their terms, at ground level.

  Up until my follow-up consultation with a twelve-year-old female yellow Labrador named Rory, I had not given Dr. Sweet’s speculations about the lunar cycle a second thought. Cats and dogs had come and gone; advice and medications were dispensed, elective surgeries scheduled. Their owners had been attentive, with questions smacking of meaningful Internet surfing. Nothing we discussed had been remotely wacky or verging on irrational. Little did I know that Rory, and her “mom,” Mrs. Nadworny, were about to buck this trend.

  As it happened, Rory was well known to me, for two very different reasons. First of all, where I come from, “Rory” is a male moniker (in fact, Celtic in origin, it means “red king”). Consequently I kept referring to her as him. Gender confusion is a huge faux pas for any veterinarian and after countless slipups and polite reprimands Mrs. Nadworny finally pointed out that the name “Rory” was short for Aurora, from aurora borealis, the northern lights.

  Secondly, and most important, for the last eighteen months poor Rory had been living with a significant lameness in her left front leg that I had failed to define, let alone cure. As I walked to the waiting room, I promised myself that the least I could do was make sure I kept Rory’s gender correct.

  Mrs. Nadworny, professionally dressed, seemingly on her way to or from some sort of high-powered job, humbled me with her enthusiastic handshake, bright eyes, warm smile, and easy conversation—the kind of greeting usually reserved for a success story, the kind of greeting that reminds me how lucky I am to work with pet owners who appreciate my intent to heal even when my results fall short.

  Her four-legged companion was equally forgiving. Though not a fan of hospital visits and prone to bouts of trembling during examinations, Rory relinquished a coy tail wag when I tickled under her chin. She led the way back to my room, her head bobbing with each stride, a patent reminder of her unsolved ailment.

  In these situations, I like to start by backtracking with the owner and refreshing my memory of the chronology of the workup. It gives me a chance to step back and take a new look at the big picture, secretly praying for a bolt of inspirational lightning. I hope it gives the owners a chance to see that I have been methodical and conscientious in my quest. I also imagine it gives them a chance to reflect on how much money they have spent on my clinical dead ends.

  Mrs. Nadworny reached into her Marc Jacobs handbag, silenced her BlackBerry, and leaned forward in her chair to narrate Rory’s history while the retriever at the center of it all cowered by her side shedding fur, hairy tumbleweeds gathering at their feet. I noticed how evenly Rory balanced the weight on her front legs, as though she were faking a miraculous intervention that must surely enable her to go straight home.

  “If you remember, you started with her elbow,” said Mrs. Nadworny, matter of fact, nothing accusatory in her tone.

  “Yes I do,” I said. “The X-rays confirmed a mild case of elbow arthritis, but not bad enough to account for the severity of her lameness.”

  Mrs. Nadworny nodded her agreement.

  “So that was why you started to worry about her shoulder. You took more X-rays, you took some fluid from the shoulder joint and injected it with steroids.”

  I found the appropriate section of the cytology report, the cellular analysis of the joint fluid.

  “Mild chronic inflammation in the shoulder joint,” I read, “yet I see a note here that says the steroids failed to improve the lameness.”

  “Nothing earth shattering,” she said. “Juicing my dog didn’t make that much difference.”

  She smiled, as though enjoying the narrative and I wondered if this was cathartic for her.

  I went back to the record and here Rory had disappeared, fallen off the radar, lost to follow-up, hovering in a state of limbo in which the veterinarian might make believe “no news is good news.” I could imagine Mrs. Nadworny gave up on me, sought a third opinion from a better clinician than I. Or perhaps the problem resolved itself with a tincture of time. Based on the little of Rory I had seen so far, none of these conjectures was correct.

  “What’s been going on since then?”

  Mrs. Nadworny looked at Rory, looked at me, and said, “Promise you won’t laugh.”

  She hesitated for a moment and I wondered whether I was required to make a verbal promise or perhaps a pinky swear.

  “I took her to a chiropractor.”

  If she imagined I would be amused, appalled, or offended she would have been disappointed.

  “Really,” I said, all morning-show smiles, business as usual. “How did it go?”

  Many of my clients worry that I will be skeptical about alternative treatment options. Maybe an image of Rory lying on a table, relaxing into her neck adjustment, the vertebral crack just shy of a fracture, does give me pause but who am I to criticize? After all, it’s not as though a chiropractor could do any worse than me. Or at least I hope not.

  Mrs. Nadworny wrinkled her nose.

  “Hard to tell. Maybe it helped a little. Anyway, we moved on to acupuncture.”

  Her sentences were interspersed with a tinge of nervous laughter, but once again I nodded and maintained serious eye contact. Truthfully I was far more intrigued by the notion of acupuncture. I wasn’t at all sure how Rory would tolerate having the polarities of her chi restored with tiny needles, and I have read that when you get really critical of the scientific data supporting the use of acupuncture in animals there is little compelling evidence either way. But I am comfortable with the notion of stimulating the body’s natural endorphins to relieve pain, and besides, it’s hard to argue with five thousand years of Chinese medicine.

  “And?” I said, assuming my asking was rhetorical given their visit today.

  “She didn’t really like it and, again, it was difficult to tell whether it was making a difference.”

  “Okay,” I said and stood up, thinking we had caught up to the present, ready to begin my examination. “So we’re back to good old Western medicine?”

  Mrs. Nadworny gave me a practiced mischievous smile as she confessed, “Not exactly.”

  “Look,” she said, as I backed down into my seat, “I am the biggest cynic ever. But my husband and I felt like we had tried everything so we thought, why not, what harm can it do?”

  “What harm can what do?” I said.

  “A pet psychic,” she replied, wincing with each word, her shoulders rising up, neck shrinking down, as if bracing for my outrage, or perhaps the intensity of my guffaws.

  I should have taken the opportunity to study her over the rims of my glasses, removing them slowly, with a heavy sigh of disappointment, a deliberate shake of the head as though she had gone too far. But I never had a chance—she was already into her next sentence, defending her position.

  “I know, I know, but you have to understand that I’m the kind of person who believes in God because I’m afraid not to. I read my horoscope every day. And occasionally, on a girls’ night out and after a few margaritas, I’ve even had my fortune read.”

  I thought again about Dr. Sweet’s comment about the shape of last night’s moon—he may have been on to something.

  “Our town has this annual fair, you know, stuff for the family to do, bring along the kids, and there’s this New Age store, one of those places you’d never go into with kids because it’s all crystals and glass.” Mrs. Nadworny gave a little shake of her head as she said, “But whatever—anyway, I saw they were advertising psychic readings for animals and I’m thinking, hey, for twenty bucks compared to what I’ve already spent, why not.”

  I nodded a “can’t ar
gue with that.”

  “So Rory and I go and check it out.”

  “Is this during the day or the night?” I asked and watched as this question caught her off guard.

  “Ten o’clock in the morning.”

  I didn’t reply because I was too busy imagining Mrs. Nadworny rapping her knuckles to the rhythm of a secret knock and whispering a Wiccan password through a sliding peephole before being engulfed in plumes of swirling incense and the music of Enya.

  I came back to reality.

  “Forgive me but all I’m seeing is a dark creepy room, candles, long shadows, and a swarm of carnie folk.”

  Mrs. Nadworny shook her head.

  “No, nothing like that at all. When Rory and I entered the store we were led to a back room. There were about a dozen ‘readers’ sitting at tables,” she said, miming quotation marks with her fingers. “A few people were seated opposite them, and everyone was speaking in hushed tones. I may have been looking for the woman in the black shawl or at the very least, a neck tattoo and numerous body piercings, but I was introduced to this well-dressed, fortysomething woman who looked like a soccer mom.”

  My raised eyebrows conveyed surprise. I kept the disappointment to myself.

  “She seemed very nice, very comfortable around Rory.”

  “How much did you tell her about the lameness?” I said.

  Mrs. Nadworny immediately understood where I was going.

  “Yes, I decided to give her a little but not a lot. I simply told her Rory had been lame for some time in her left front leg but no one seemed to know why.”

  Rory had a tendency to hold her left foot off the ground when seated, in the manner of “giving paw,” so essentially Mrs. Nadworny had given the psychic nothing.

  “So she rubs and squeezes and Rory trembles, but other than that Rory just sits there.”

  I’m still imagining faraway looks, pensive nods, a one-sided dialogue broken by intense moments of apparent concentration, ear lined up with snout, waiting for the silent communication to get through.

  “Then she told me two things that grabbed my attention. First she said Rory was stressed because there was something troubling going on in my life. Now I know this is incredibly vague and superficial but at the time my husband had just been laid off and I was coming to the end of my contract at work so, to be honest, the term stressful was an understatement.”

  “What was the second thing?”

  Mrs. Nadworny paused and studied me, as if anticipating my response.

  “You were always convinced that the problem was in Rory’s shoulder.”

  She was right. Rory’s shoulder was still my prime suspect.

  “Well, completely without prompting, the psychic says, ‘You know it’s not her shoulder. It’s her wrist.’”

  Narrowed eyes and a sideways glance betrayed my skepticism as I asked, “And you never mentioned anything about the shoulder?”

  Mrs. Nadworny shook her head.

  “That’s why we’re here,” she said. “I want you to check out Rory’s wrist.”

  I deliberated a beat, considering her request to abandon a scientific workup in favor of a metaphysical inkling divined by a canine swami.

  “Sure,” I said, crossing the room and squatting down on the floor next to Rory. “Let’s find out what she will tell me, aside from ‘Not you again!’”

  I did the elbow thing, I did the shoulder thing, and once again I struck out with nothing. Mrs. Nadworny arched her eyebrows as I hovered over Rory’s wrist, as though I had been keeping her on tenterhooks. Out of a misplaced sense of courtesy I arched mine back, trying to hide the fact that I was simply going through the motions, indulging her and her fanciful pet psycho.

  Confident, embracing this cynicism, I flexed and extended the joints of the wrist, thinking about how best to break the news when I felt a palpable click between the bones.

  Subconsciously I must have hesitated long enough for Mrs. Nadworny to pounce.

  “Did you find something?”

  My fake smile became a nervous smile as I repeated the maneuver and once again my fingertips discerned the alignment of the small bones of Rory’s wrist, feeling them jostle and settle with an unnatural and reproducible snap.

  How could I have missed it? Suddenly this malady seemed so obvious. Had I been bested by an animal guru with supernatural powers?

  “Um … well … I’m not sure why, but there does appear to be something unsual about Rory’s wrist.”

  Mrs. Nadworny studied me with a mix of surprise and downright satisfaction.

  Still reeling, I tried to regain control by suggesting we get an X-ray of Rory’s wrist, and half an hour later my humiliation was upgraded after objective black-and-white proof revealed that one of the small bones at the back of her wrist appeared to have been displaced.

  Poise abandoned, my mouth suddenly dry, I sputtered:

  “It’s … well … unusual… this bone here … this bone here shouldn’t be here. It’s the kind of injury we occasionally see in racing greyhounds.”

  Mrs. Nadworny looked at me, astonished.

  “I can’t believe you said that. People were always telling me that Rory races around like a greyhound.”

  Don’t get me wrong, I love Labradors and there are few breeds out there with better endurance skills or a better work ethic, but I felt like Mrs. Nadworny was comparing a Toyota Land Cruiser with a Lamborghini. I knew the comment was meant as nothing more than a dog park compliment for Rory’s enthusiastic play during her heyday but somehow the improbability of the statement and the peculiarity of the injury suddenly hit me like a two-by-four. The clinician in me, temporarily waylaid and bullied by the talents of a paranormal canine communicator, finally came to his senses.

  “Excuse me a moment,” I said. “I’ll be right back.”

  Sometimes, in the heat of the moment, even an experienced vet will forget that our four-legged patients are kind enough to bring along a perfectly good and normal opposite leg for comparison. Rory’s front right leg had never had a problem. It was the “control” I had foolishly chosen to ignore.

  I checked out her other wrist and convinced the radiologist that our ability to interpret the first X-ray would be enhanced by getting the same view of the opposite side. This was done, and armed with new discoveries I sought out the devoted and long-suffering Mrs. Nadworny.

  “Your pet psychic was right, there is something strange about Rory’s wrist, but I can feel the same click in her opposite wrist and look,” I positioned the images of the left and right leg on a viewing box, side by side for comparison.

  “They’re identical. The bones may not be in perfect alignment but this is normal for Rory. She’s simply a dog who can click the joints in her wrist.”

  Mrs. Nadworny took another look at the X-rays. I could tell she saw the truth hidden amid their shades of gray and it had burst her bubble.

  She turned to me unable to hide her disappointment and I wanted her to see that I too shared this sentiment, buying into her psychic’s hunch as much as she had because we were both frustrated and motivated by a desire to help this poor Labrador. If Rory entrusted her secret to a soccer mom in a New Age store that was fine by me. Cut me a slice of humble pie if it means the patient gets better! Of course it was quirky and unconventional but it was rooted in what counts—trying to advocate for a creature in pain. I might joke about the cycles of the moon and crazy clients but there is a big difference between well-intentioned and irrational, indulgent behavior.

  “I’m sorry,” I said. “Once again I can tell you what it is not, and not what it is.”

  Mrs. Nadworny patted my elbow, gave me an appreciative smile, and then cracked up laughing.

  “I’m sorry,” she said, “I was just remembering how I was so impressed by what she told me about Rory that I instantly slapped down another twenty bucks and demanded she give me a reading.”

  I really didn’t want to ask and fortunately Mrs. Nadworny bailed me out.


  “I should have known better because how many real psychics start out by asking ‘What seems to be the problem?’ I mean, isn’t that what they are supposed to be telling you?”

  THERE was a package of X-rays waiting for me outside my examination room door, no doubt a gift from my final patient of the day. I stole a peek and my memory conjured a conversation with a referring vet in Bermuda. Time to put a face with a fracture.

  If I’m being honest, the miniature pinscher is not in my all-time top-ten favorite canines when it comes to veterinary bonhomie. Please believe me when I say I have nothing against the breed (ranked twenty-second in popularity by the American Kennel Club in 2008). This is purely professional negativity based on the fact that, for some reason, most of my experiences with Min Pins have involved them becoming genuinely bipolar around people in white coats, transformed from angelic lapdog to homicidal junkyard dog with the first touch of toenail on metallic examination room table. When I think of Min Pins I imagine the kind of dog that might force Cesar Millan to reach for his rabies pole or tranquilizer-laden dart gun, the kind of dog that comes with an owner warning “Yeah, sometimes she doesn’t like vets,” which we all recognize as international code for “Dial 911 now, so the ambulance arrives before you bleed out!”

  Sonja Rasmussen may have stood alone in the waiting room but the small pet carrier seated on the bench beside her was the giveaway. It bore a sticker with the airport letters for Bermuda—BDA. She was tall, in a long winter coat buttoned up tight, with her hair tied back in a loose ponytail, long red hair in contrast to pale winter skin, shy freckles in hibernation. Taking tiny steps back and forth, arms folded across her chest, she was keeping vigil, features at the mercy of one all-consuming, all-powerful force—anxiety.

  “Ms. Rasmussen?”

  Preoccupied with her worries, she was taken by surprise, and gave me a nervous smile as I reached out to shake her icy hand.

  “Dr. Trout?”

  I nodded and she looked relieved.

  “Thanks for seeing us at such short notice.”

  I shook off her unnecessary gratitude.