Love Is the Best Medicine

by Dr. Nick Trout

  Methodically, images were produced and measurements made. Eileen watched as probes came and went, twisting this way and that, slicing the beating heart into transverse and longitudinal sections, the flow of colors adding splashes of blue and red paint dancing to the whoosh and slosh of venous and arterial blood. Eileen felt lost, her eyes moving between the digital chaos on the monitor and the calm smile of the dog she loved on the table.

  “Please God,” she thought. “Give this poor dog a chance at a real life.”

  “Very good,” said Dr. Molotov.

  For a second Eileen thought it was over, that “very good” meant Helen must have a clean bill of health for her heart.

  “Let’s see if she will be just as helpful for the other side.”

  Eileen kept the groan to herself while Helen, more than happy to oblige, flipped over and was wriggled into position above the aperture by the technician. Same beat, same dance moves on this opposite side, the side Dr. J. had hesitated over months before. The eternity dragged on, the desire to know if everything was okay building to an unbearable crescendo. And then, as if she were delivering a throwaway line she might have slipped into the conversation at any time, Dr. Molotov said, “Well, I don’t see anything wrong with her heart. Her measurements check out fine for an older spaniel. Her valves appear to be in perfect working order.”

  Eileen inhaled deeply, overcome by the mixture of relief and pride welling up inside.

  “So that just leaves us with a couple of chest X-rays,” said Dr. Molotov, wiping the Ghostbusters slime off Helen’s chest. “We should be able to do them right away, and based on how good Helen was for the ultrasound, I doubt she’ll need any sedation. Let me take you over to the radiology waiting area.”

  Eileen and Helen were led down a corridor to a small waiting room occupied by an elderly gentleman with a golden retriever lying at his feet.

  Man and dog existed in an invisible shroud of nicotine. He, the man, was long limbed, angled forward, elbows on thighs, his body speaking the language of someone unable to relax. His gaunt features relinquished a brief forced smile as Eileen and Helen took a seat.

  The dog shared this lean, skeletal appearance—another example of master looking like dog, or maybe it was the other way round. This was a particularly blond golden, the bony features of his skull prominent, unnaturally unmasked by wasted muscle. He lay with his chin resting on the cool floor, his eyes looking tired and unfocused.

  For a while the four of them maintained their silence, like strangers on an elevator watching the numbers over the sliding metal doors count down.

  A technician in Oxford blue scrubs appeared.

  “I’m here for Helen, for her chest X-rays,” he said.

  “Do you need me to come with her?” asked Eileen, handing over her leash.

  “No, that won’t be necessary,” he said. “The X-ray machines are just around the corner. If she lies still we’ll be back in a few minutes.”

  Eileen watched them go and then turned back to the old man and his dog, suddenly aware that Helen had been taken out of sequence.

  “I’m sorry,” she said, “I feel like I’m jumping the line.”

  The old man waved away the apology with a large, weathered hand. It smacked of a lifetime’s manual labor but Eileen focused on the indelible dirty yellow V between his cigarette fingers.

  “No biggie,” he said, tar and gravel clinging to every word. “Sam’s supposed to be seeing the cancer doctor before he gets his X-rays. We’ve got nowhere to go.”

  Eileen leaned forward and down to run a hand along Sam’s head, neck, and back, feeling every bone along the poor dog’s spine, the damning reality of an emaciated dog. It was remarkable how much a dog’s fur could hide. Perhaps, thought Eileen, it was more telling that Sam made no response to a stranger’s touch. No look back. No swish of the tail. The old dog continued to stare straight ahead.

  “I get the feeling this is going to be his last set of X-rays,” said the man, the words sounding detached, as if he were trying them on for size, seeing if they fit, if he could say them to a stranger and keep the pain and fear inside him from spilling out. He dropped his head slightly, focusing on a spot on the floor next to where Sam lay, and seemed to take stock of how he had done, how it had felt. He seemed unsure of his performance, a tough old man trying to save face in public, to deny how much he was being hurt by his best friend’s unrelenting demise.

  Suddenly, for Eileen, this fragility on both sides of their relationship filled the room, as if she could share his unimaginable burden of losing his dog. She stared at him, reading the battle playing out in the wrinkles around his eyes, unable to find the right words. Any words. Eileen had had pets her whole life but she had never been in a situation where an animal had endured a relentless illness and lost.

  “Eileen.”

  It was Dr. Molotov, standing before her, large manila folder in hand, Helen at her feet on the end of the leash, appearing pleased all this overrated medical attention was over.

  “We’re all done so why don’t you come with me.”

  Eileen took Helen’s leash from Dr. Molotov and followed her, the silent farewell from the old man as she left no more than a subtle nod, dry lips pursed, a message that said, “Don’t look so worried, your dog’s going to be just fine.”

  Directly off the radiology waiting area was a private room with viewing boxes where owners could be shown their pet’s X-rays. The room was dark until Dr. Molotov turned on a viewing box, removed an X-ray from the folder, and hung it in place, the fluorescence transmitted through the shades of black and white creating an eerie glow. She stepped toward the door and closed it behind them, the action too deliberate to go unnoticed by Eileen. Eileen turned to face her, hoping to speak first, the preemptive strike, but the shadows couldn’t mask the sadness written on the doctor’s face and that moment of speechless shock was all it took for Dr. Molotov to get there first and say, “I’m so terribly sorry.”

  THE rest of what followed was a blur.

  There were the words of the messenger, Dr. Molotov, a woman unable to conceal her surprise and disappointment as she delicately marinated every phrase in genuine kindness and empathy.

  There were the X-rays themselves, the cold hard facts regarding this dog’s past and future. They were bold and blatant, leaping from the film, inducing a dumb nod of understanding even to the untrained eye.

  What Eileen walked away with was a new, foreign, and paralyzing vocabulary, ugly phrases absorbed like blows in a beating, frightening medical terms that rained down on her until she could take no more. Pulling herself together, placing one foot in front of the other, she walked out of the room with Helen in tow. Perhaps what struck her the most as she passed through the radiology waiting area was the absence of the old man and his fragile retriever, as if neither of them had ever been there in the first place.

  Back home, with Ben, she went over these verbal wounds one by one, the ones that stuck, the ones she had to say out loud: massive tumor … potentially inoperable … probably malignant … terminal cancer …

  All the while the tears kept coming and the little black dog at her feet wondered what all the fuss was about.

  Ben held Eileen in his arms, pained by his inability to protect her from this grief. The shock came in waves, the brief lulls while tissues caught the tears an opportunity for carefully chosen words.

  “So the tumor is in Helen’s lungs?”

  He felt the nod in his chest.

  “But she has no problem breathing. She runs. She plays. And I’ve never heard her cough.”

  Eileen pulled back, wiping her nostrils.

  “I know,” she said. “But something wasn’t right when Dr. J. checked her over the very first time. She said she had a problem hearing her heartbeat.”

  And then Ben lost her, could see and feel her slipping away, those few seconds of composure melting into an expression of dread, words distorted by her heaving sobs.

  “I sh-should h
ave had … her ch-chest X-rayed … sooner. This is all m-my fault …”

  These would be the first of many second guesses, Ben knew, but he beat them into submission, sent them into exile, and tried to give pragmatism a chance.

  “Who knows how long it’s been there?” he said. “What if Helen’s had this thing for months, even years? Surely that makes it less likely to be malignant and more likely to be benign?”

  The shuddering inside his arms continued, as if she had not heard him. Ben bided his time.

  “Here’s what you do,” he said during the next respite. “You go and meet with an oncologist. Find out what they have to say. Let’s not jump to any conclusions before we have all the facts.”

  Eileen chose to hear this, her nod and audible swallow suggesting that his message had gotten through. She pulled back and glanced down to lock eyes with the dog at her feet. Innocence stared back, she was certain of that, and though Eileen hunted for more, she could be confident that one emotion was missing—fear. In all her years shared with animals, she had never sensed a dog or a cat was afraid to die. What do they know that we do not? Why are we the only ones burdened by the fear of death? In those big brown shiny eyes Eileen saw it, so obvious and uncomplicated. For all her fussing and struggling to interpret the minutiae of Helen’s expression, it was all there, written in the unspoken language of contentment and security, one dog’s blatant declaration of trust.

  THE uninitiated may be forgiven for thinking the “soaping” of hospitalized animals alludes to a daily ritual of sudsy patient cleanliness. In fact SOAP is a convenient acronym for a brief yet thorough early-morning evaluation of clinical well-being, followed by a summation and a statement regarding the day’s purpose.

  “S” stands for subjective and calls for me to make a spontaneous, gut-feeling appraisal of how my patient reacts to my presence.

  “Hi, sweetheart, how are you this morning?”

  I opened the cage door, squatted down, and squeezed into Cleo’s overnight accommodation.

  “Did you sleep well? You look like you did. I hope your neighbors kept the noise down.”

  Cleo rushed forward to greet me, jubilantly waltzing on three legs (and two left feet) before crawling into my lap and poking her face into mine.

  “Look at you, all fresh and frisky,” I said, scratching her under the chin, impossible not to. When I let up, Cleo’s ears pricked, head canting to the right. I mirrored the maneuver, the puzzled expression. She paused and then tried to see if I made more sense with her head listing to the left.

  “What is it? What are you after, little one?”

  There was a giggle behind me and I turned to see a technician cleaning bowls in a sink stealing a glance over her shoulder, amused by my coquettish remarks. The snout rooting in the breast pocket of my shirt brought me back to the task at hand.

  “Hey, stop that, you little rascal.”

  Now I understood her confusion. Cleo was looking for food. She had assumed I was about to deliver her breakfast and, finding me empty-handed, planted her face in my shirt pocket like she was strapping on a feed bag.

  “I’m sorry,” I said. “I’ll get you something to eat as soon as you wake up from anesthesia. But first of all we’ve got to fix that leg of yours, okay?”

  Cleo appeared to listen, but it was obvious that Uncle Nick had lost most of his credibility with this indecent disruption of her gastronomic routine. I decided I would write Cleo up as B.A.R.—bright, alert, and responsive (accurate, if unimaginative)—and moved on to the O part of the proceedings.

  Objective refers to all the hands-on stuff and the numbers it generates. Cleo’s heart rate said she was calm and, more importantly, not in pain, as did her breathing. Her belly felt fine and she stood quietly, if a little self-consciously, for her rectal temperature, which was in the normal range.

  “Good girl, Cleo,” I said, producing an enormous orange marking pen resembling a giant Popsicle, designed for tagging livestock. At first, I could tell all was forgiven. An ice lollipop might not have been the breakfast of champions but Cleo obviously thought it was better than nothing. One lick, an unpleasant aftertaste, and her confused expression told me I was right back in the doghouse.

  Which of Cleo’s legs was broken was patently obvious, but in veterinary medicine, every patient has three right legs. This is why operating on limbs fills almost every surgeon with a degree of trepidation. Forget about falling off a cliff or running down a crowded street in nothing but your underwear, my worst nightmare is the omnipresent possibility of taking a patient to surgery and operating on the wrong leg. My patient cannot sanction my decision or offer me any last-minute verbal reminders (“Remember, it’s this one, Doc”).

  For surgery involving the right leg, I need to clarify between right front, right hind, and right meaning “correct.” In an attempt to avoid any mistakes we have a strict policy requiring the clinician responsible for the patient to label the leg with a swath of waxy orange paint or some other mark that categorically defines which limb will be going under the knife.

  For Cleo, my orange daub was redundant but I still identified the broken leg. If I didn’t do it now, the anesthesia technicians would be all over me to do it sooner or later. Cleo watched me swipe the orange crayon in a safe zone, below her right knee, her gaze turning from my hand to my eyes, her expression suggesting I would have to do better than this to redeem myself.

  A stands for assessment, and though I might have touched upon Cleo’s charisma and stoicism, I kept my wording practical, pertinent, and informative for the other doctors or technicians who might interact with Cleo but not know the details of her case. She was a healthy young dog with a right femur fracture that was three days old. The fracture was at the site of a previous surgical repair. Her blood work and urinalysis were normal. Any concerns I had about some sort of a predisposition to fractures, an underlying pathology, did not fit here. They had no basis in fact. There was no section in the patient record for niggling doubts or the tingle of my “spider sense.”

  P stands for plan and this was easy. Take Cleo to surgery this afternoon for right femur fracture repair. I might have said more—leg heals, Cleo does great, daughter overcomes sense of guilt, and everyone lives happily ever after—but I still had to call Sonja and then I had a special case to see.

  FOR a twentysomething, twenty-first-century woman, Sonja Rasmussen was guilty of an unimaginable communications faux pas. Lost, broken, or forgotten, whatever the reason, she was without a cell phone. In this throwback to the Dark Ages, the only available means of contact was the telephone number to her hotel room in downtown Boston.

  She picked up the phone before the second ring, and I imagined her perched on the edge of the bed, ready to lunge, picked-over room-service food on a nearby silver platter, ordered because she had been afraid to go down to breakfast and miss my call.

  “Hi, Ms. Rasmussen, this is Dr. Trout.”

  “Please, call me Sonja, how’s Cleo?”

  “She’s great. She’s funny.”

  “What do you mean?”

  I caught the stiffness in her reply, the silent tension between us, as though I had meant “funny peculiar” and had news for her.

  “I mean she’s entertaining, quite the character, though she was less than pleased to be denied her breakfast this morning.”

  “Oh, I see,” she said, her tone more measured. “When is she going to have her surgery?”

  “Well, I have an urgent appointment coming in shortly and from what I’m told it might need to go first. So Cleo will be second in line.”

  Silence gave away her disappointment.

  “It will probably be first thing this afternoon,” I said.

  “And how long do you think it will take?”

  “I’m not sure,” I said. “Couple of hours, then I’ll need to take some X-rays to make sure everything looks good. I can’t imagine I’d be calling you later than five.”

  An audible sigh crawled into my ear.

/>   “I’ll go out of my mind waiting here all day for your call. Maybe what I’ll do is go shopping this afternoon and then swing by the hospital around five o’clock. Would that be okay? That way I can speak to you in person.”

  “That sounds great,” I said. “I can show you the postoperative X-rays when you arrive.” And then I added, “How’s your mother doing?”

  It was really none of my business but I imagined they had spoken after Cleo’s consultation.

  “She’s good,” said Sonja, clearly caught off guard by my question. “It should be the other way around, but she’s the one looking after me, helping me keep it together.”

  There was a pause and for a moment I thought she was going to say more, but she didn’t. I wouldn’t want you to think I handle all my conversations with pet owners like a homicide detective interrogating a prime suspect, but once again I sensed an element of mystery shrouding what she said or rather what she didn’t say, omissions speaking louder than words.

  “She sounds like a remarkable woman,” I said.

  Another pause, as though my remark had taken her by surprise.

  “Yes,” she said, “I guess you’re right.”

  I CALLED the cat’s name, Henry, and a man wearing a black turtleneck sweater and suede jacket stood up. He made a deliberate adjustment to the parting of his neat black hair like a slow military salute, picked up his copy of the Boston Globe in one hand, and strutted toward me swinging a cardboard cat carrier in the other. The guy looked like a character from central casting, the wannabe author type. I was wondering where he had hidden the Starbucks Venti Chai and the laptop containing his unpublished novel.

  “Sorry to keep you waiting, Mr. Sharpe.”

  I gestured toward the open door of a nearby exam room.

  “I’m not Mr. Sharpe,” said Dan Brown Jr., brushing past me, rudely depositing Henry’s mode of transportation on the table between us. “Henry is my fiancée’s cat, not mine. I’m just the delivery boy.”

  I checked the owner’s name on the patient record and read “Susan Sharpe.”