Love Is the Best Medicine

by Dr. Nick Trout

  “Please, you’re the ones with a two-hour flight to get here.”

  And with this I dipped down and risked a peek at the savage behind the bars.

  “And this must be Cleo.”

  My body braced for a playful “great white” lunge, a flash of ivory, and a throaty growl. Instead a docile, polite detainee in a black-and-tan jumpsuit stepped forward, pressed her nose up to the bars, and began sniffing my fingertips. She didn’t make a sound, not a cry or a whimper. She simply wanted to say hello. I berated myself for my foolish rush to judgment.

  We small-talked our way back to my exam room, Ms. Rasmussen clearly impressed with the hospital although she confessed she had already done plenty of homework on both Angell and me.

  Once inside, I placed the carrier in the center of the room and opened the little plastic door. Cleo stretched, dipping on extended front legs, a perfect downward-facing dog yoga position, before hopping out, talented and nimble on three legs. The right hind leg hung at an unnatural angle, toes lightly scuffing the floor as she picked up the many layers of scent from previous patients.

  Sonja unbuttoned her coat and squatted down, calling her name as Cleo hopscotched over. Wag would be too strong a word for the movement in that little nubbin of a tail. Frenetic twitching might be more appropriate. Regardless of what it was, the rate definitely picked up in response to Sonja’s call and I remember wondering, does a dog’s tail beat to the rhythm of her own heartbeat, or to the rhythm of ours?

  “Please, take a seat, Ms. Rasmussen. Cleo seems quite happy to explore while we chat about her history.”

  “I’ll do my best,” she said, “but Cleo’s not my dog. She belongs to my mother. I’m just looking after her for …”

  Sonja’s sentence stopped short, as though she had been stung by her own words, her being here the ultimate indictment of her failure.

  “Why don’t you start with what brought you to your vet, to Dr. Glynn, in Bermuda,” I said, easing my interjection into this awkward pause between us, though, even to me, it seemed clumsy and affected.

  She leaned forward in her seat, knees together, hands together, working something small and invisible between her fingertips, like imaginary worry beads.

  “Cleo was on a leash in our backyard. We have a Min Pin of our own, Odin. The two of them love to play tag, chase each other around. My husband said that somehow the leash got tangled up, twisting around her back leg, and she fell down awkwardly.”

  To me, it seemed like Sonja spoke carefully, economically, as if she were delivering a prepared statement. Though it was obviously painful for her, the brevity and simplicity of the description left me curious about what she might be holding back and why.

  Delicately I poked and prodded, came at the story from different angles, hunting for something more serious, more reasonable, but Sonja had little more to add. This left me with a relatively minor incident resulting in a major trauma, an unsettling notion in such a young and apparently healthy dog.

  “Do you think there’s something else wrong with her?” she said. “I mean this is the third time she’s broken a bone and she’s only fourteen months old. Did we do something wrong?”

  If this was a human hospital and my patient were a seven-year-old girl with a vague history of trauma and serial fractures, even an indifferent fan of ER would suggest contacting social services. And yes, sadly, the unthinkable can occur. Occasionally dogs and cats arrive at Angell and other hospitals with nonaccidental physical injuries and even Munchausen syndrome by proxy in which the pets are victims. But to be honest, this despicable possibility didn’t even cross my mind. Anyone who had been with me looking into the eyes of Sonja Rasmussen on that January afternoon would have seen clearly, unequivocally, how much this dog meant to her and her family. Frustration permeated her every word, and she visibly ached for me to make all their pain go away. She was so tightly coiled, almost petrified, as if she were still on the plane, someone afraid to fly, agonizing over every second she spent trapped inside a metal cylinder a mile above the earth. Despite her best efforts it had taken a few days to coordinate a flight, necessary travel paperwork for Cleo, and time off work. She knew this wasn’t a life-threatening disease, but even with medication to alleviate the pain, Cleo had to be sore. Far worse than the occasional squeak when she lay down or got to her three feet was the expression on her face—confused but entirely void of accusation. It was more than forgiveness, it was unbreakable trust and likely it crushed Sonja every time. It made her desperate to get to Boston and let the healing process begin, and now, finally, with the end in sight, the strain had became magnified, betrayed by the panic and guilt in her voice, as her resolve began to crack.

  I crabwalked closer in my swivel chair, mindful of Cleo, who had taken an interest in me, methodically sniffing the hem of my pants as if her nose were a TSA wand frisking for metallic objects.

  “Of course not,” I said. “Fractures in toy breeds of dogs are quite common, especially when they’re young. They’re always jumping out of owners’ arms or getting underfoot. I can’t tell you how many times I’ve walked through the wards on a Monday morning and seen a Yorkie or a Chihuahua or a Pomeranian with a bulky fluorescent bandage on their leg and known exactly why they were here and what happened. I’ve even heard some surgeons joke about shoring up the opposite leg before it breaks.”

  Sonja smiled but I could tell I had hardly dented the surface.

  “But three times, and twice in the same leg? This dog means everything, and I mean everything, to my mom. You will never meet a more devoted or attentive pet owner and yet here we are.”

  “Believe me, this has nothing to do with you or your mother or your husband.” My assertive tone took her by surprise, but I felt like she needed some strong reassurance. “The break occurred at the point where the stainless steel plate from the first fracture repair ends and normal bone begins. This junction can be vulnerable to normal stresses and strains. It was an accident, plain and simple. My job is to make sure we’re not missing something other than bad luck. Now I’ve reviewed all of the notes from Dr. Glynn and Cleo’s vet in Canada, the blood work, the diet, and the bone quality on the X-rays and there is absolutely nothing jumping out at me. You’ve done pretty much everything possible to discover an underlying problem and come up empty-handed.” And then, with an attempt at levity, I added, “Or should I say, almost everything.”

  In response to her confusion, I smiled, silently saying “relax, everything will be fine,” and got to my feet.

  “Come here, sweetheart,” I said and Cleo skipped right over to me. I opened my hand to pick her up and as I did this she edged her flank into my fingers, as though she were positioning me to scratch her where she wanted, as though I wouldn’t be smart enough to understand what she was up to.

  “You’re funny,” I told her, lifting her under her belly and carrying her over to my table, confident no dangerous metamorphosis into Cujo would ever take place with this dog. Sonja came over to join us, and I began my examination.

  Cleo’s head was small, her features delicate and distinctly feminine. Each stroke of my cupped hand caught her little pricked ears. She appeared relaxed and comfortable, with the eyes of a wiser, older dog that had been through this routine a thousand times. The closest she would come to a snarl was when I lifted her lip to inspect a healthy pink gum line and the Hollywood-white teeth of a young dog.

  Pulling on the stethoscope draped across my shoulders, I listened to the normal rhythm of her plum-sized heart, feeling Cleo’s skin twitch briefly when she flinched as my left hand came around the inside of her thigh, locating the femoral artery, the beat inside my head synchronized with the pulsing blood under my fingers. I waited. The rhythm, the synchrony remained. My stethoscope moved around her chest, up, back, across, jumping between quadrants, listening for crackles and pops. All I heard was the faintest summer breeze, air moving freely and deeply into healthy lung tissue.

  I scratched under Cleo’s chin, or so she
thought, and watched her melt, all bashful, enjoying the pressure as I hunted for swollen lymph nodes at the angles of her jaw. Submandibular clean. I slid back and in front of her shoulders. Prescapular clean. Left hand only, left side only, I squeezed in the meaty muscle behind her left knee. Popliteal clean.

  I reached under her body, nails against skin, the belly scratch causing her to relax her rectus abdominus muscles so I could feel the loops of bowel, the edge of her liver, the position of her spleen, and a bladder full of pee. I was hunting for anything abnormal or painful, but apart from a need to use the ladies’ room, Cleo was giving nothing away.

  Obviously the elephant in the room was the dangling right hind leg and I had no intention of manipulating the limb anywhere near the fracture. Gently I laid my hand over the swollen thigh, fur hiding the black and blue that lay beneath. Cleo turned to watch me, her expression curious, not defensive or bracing or impatient. It would have been perfectly reasonable for her to snap, to ward me off, but I didn’t sense a warning. For a few seconds we stared at each other.

  “I’m trusting you not to bite me,” I tried to convey. “And I hope you can trust me not to hurt you.”

  Whatever language passed between us, it worked. Cleo let me check out her knee and ankle and toes, and I kept the fracture perfectly still throughout. She never squeaked or moved in protest.

  I thanked her with a pat and returned her to the floor and her ongoing olfactory investigation, then invited Sonja to have a seat.

  “What an absolute sweetheart,” I said. “I have to confess that a lot of the Min Pins I deal with can be a little … how shall I put it?”

  “Testy?” Ms. Rasmussen suggested, and I could tell she got it.

  “Thank you,” I said, appreciating her understanding. “Of course she has every right to give me a hard time, letting me check her over with a broken leg.”

  “But can you fix it?”

  She could stand it no more, the need to know written all over her face, and it had been wrong of me to keep her waiting.

  “Of course,” I said. “I can fix Cleo’s broken leg.”

  I could almost feel the air leaving her lungs with the “thank God” sigh of relief.

  “I’m going to have to raid the war chest and get a little creative, but as far as I can tell there’s no good reason why we can’t put her back together again.”

  For a moment she seemed lost, overwhelmed, and because I still had an important point to make I leaned forward and unleashed a three-letter word guaranteed to bring her back.

  “But,” I said.

  It worked.

  “There is one more thing I think I should do at the time of surgery. I want to take a small piece of Cleo’s bone and submit it to the pathologists, have them take a look at it under a microscope and make sure there’s nothing wrong.”

  Sonja nodded but I sensed she wasn’t really listening. I briefly went over anesthesia and epidurals and narcotics, insisting that Cleo would be extremely comfortable and pain free, and I paused, as I occasionally do, waiting for a nervous owner to interject some variation of “Do you think I could have some of what she’s getting!”

  But Sonja said nothing, and as I spoke and watched her watching me, I realized something about her had changed. It was as though she had made up her mind. She had decided to trust me, unreservedly, and now Cleo’s and every member of her family’s future was in my hands. I believed she wanted to hear what I had to say, but it didn’t really matter now that she had committed to my care.

  “Would you like me to speak to your mother?”

  For a few seconds she seemed to give my offer serious consideration before shaking it off.

  “Thank you, but that won’t be necessary. I’ll call her later.”

  And once more Sonja Rasmussen drifted off, visibly uneasy at this prospect.

  “So let me put the paperwork together, the various requests for anesthesia and radiology, an estimate, and then I can take Cleo back to the wards. And please, don’t worry about her feeling lonely. I guarantee this little dog will be so popular with the technicians I’ll have to organize visiting hours.”

  As I ticked boxes and scribbled details, Sonja picked up Cleo in her arms, whispered in her ear, and gave her a kiss. At the examination room door, our exchange took place and I watched the blood squeezed from Sonja’s lips as they clamped down, pinching her guilt into a pale scar that she would wear until this was all over, until, hopefully, Cleo’s broken leg was reduced to a vague memory, something to “remember when.” My heart seized at her attempt to mask it, to twist her pain into something approaching a passable smile, while all it revealed was how much effort it took. Despite my attempts to absolve her of blame, she still wore the burden of responsibility for what had happened to Cleo like a heavy, unwieldy cloak. I wondered if it would disappear after this was all over. I wondered if I could help to make this woman really smile again.

  As Cleo lay in my arms, the two of us watched Sonja head out to the front desk looking like a mother leaving her child in day care for the first time. In a daze, she checked out, negotiating the unsightly financial paperwork, signing without reading, unable to process how she got here and why.

  “Don’t look so worried,” I said to Cleo. “I’m sure she’ll be fine.”

  FOR some, the idea of brushing a dog’s teeth is no less ridiculous than teaching him or her to use a flushable toilet. They sneer or roll their eyes in disbelief at the increasing demand for root canals, crowns, and braces, arguing that dogs have been doing just fine for centuries, gnawing on bone or rawhide. Since when does a dog owner need to purchase a toothbrush and edible chicken-flavored toothpaste?

  This question occurred to Eileen as she and Helen sat patiently in the Angell waiting room before their appointment with the cardiologist, Dr. Molotov. Arguably, with twice-weekly brushing, Helen’s dental crisis would never have evolved to the point where close proximity to her breath required a “severe” terror alert. Then again, given her sorry state when she entered their lives, the niceties of oral hygiene must have been low down on a list of bare necessities for survival. Eileen imagined Helen living, for the most part, like generations of dogs before her, wandering and scavenging, devoid of meaningful contact with humans. Now that she had become a modern canine and moved into the heart of a family, killer halitosis could seriously curb quality social time. And aside from the smell issues, a decade of neglect also meant unremitting mouth pain. The poor dog’s teeth needed professional attention, even if that demanded a detour to a cardiologist to get things done properly.

  So why did Eileen feel nervous about this appointment? In part, she realized, it was due to Helen’s age, the fear of putting a geriatric animal through any elective procedure, especially when the dog’s entire medical history was a mystery. There was also her inkling that Dr. J. had either heard something she shouldn’t, or couldn’t hear something she should, during her examination of Helen’s chest. But most of all it was how this urchin dog, in her life for such a brief time, had so completely, so effortlessly, crawled into Eileen’s heart, padded down, and come to rest. Helen had this way about her when she looked at you in response to every small kindness, like a Make-A-Wish kid living every day at Disneyland, unable to believe her luck.

  “Helen?”

  Eileen looked up to see an older woman in a long white coat standing over her. The woman wore no makeup and Eileen supposed pigment had never flirted with the long gray hair secured by a nest of bobby pins to form a tight precise bun. Thick glasses made her eyes look even smaller, giving her a chaste, mousy look—like an austere parochial school educator. But when Eileen said, “This is Helen,” the woman glowed, as if this meeting were a fortuitous pleasure and privilege.

  “Hello,” she said, “I’m Dr. Molotov, one of the cardiologists on staff. If we may, I’ll have a listen to Helen’s chest, then we’ll take a closer look at her heart with ultrasound. Would you please follow me?”

  Eileen and Helen trotted along behind
her, moving deeper into the heart of the hospital, guided toward a room with an entranceway labeled “Echocardiography.” Here Dr. Molotov began her examination, starting with Helen’s history.

  “I wish there was more I could tell you,” said Eileen. “Helen was a stray. She’s been with us a couple of months now. I had her vaccinated and tested for heartworm. She was heartworm negative. Hopefully you have a fax from my vet for the rest of her blood work.”

  Dr. Molotov smiled and nodded, turning over a number of stapled sheets of paper in her hand. She ran a finger all the way down the page.

  “You’re doing a wonderful thing for this dog,” she said. Despite the compassion visible behind the thick lenses, this candid remark took Eileen by surprise. She managed a self-conscious, whispered “thank you” as Helen was picked up and placed on a table for examination.

  Quite where this reject cocker spaniel acquired her dog-show manners Eileen did not know, but for the gentle hands of Dr. Molotov, Helen stood square and still, appreciative of the tactile affection, even if her old spaniel ears filtered out all the compliments.

  “Okay then, let’s see if Helen will let us take a look at her heart.”

  With the assistance of a female technician in plum-colored scrubs, two neat symmetrical patches of fur were shaved, one on each side of Helen’s chest, and she was laid down on a transparent plastic table with a small square window cut into its center. The overhead lights were dimmed so as to optimize image contrast on the screen. The ultrasound machine was a bulky, high-tech, hospital-white unit, touting buttons and dials and sliders and mouse pads beneath a large screen bearing Helen’s details in its top lefthand corner. The main body of the image was shaped like a generous slice of cake. Dr. Molotov selected a probe, applied a liberal coating of blue gel to its head, snaked it under and through the hole in the table, and made direct contact with the bald skin of Helen’s chest. Instantly, within the sweeping radar triangle on the screen, beating muscle, chambers, and valves came into remarkably sharp focus.