The Gift of Pets: Stories Only a Vet Could Tell (9 page)

But, though this list of Lisa’s pets is not close to complete, it was only Tillie and Grizzly who accompanied Lisa around town in her Jeep Wrangler, the canvas sides smeared with doggy slobber and the windows steamed with the excited panting of the pair. Lisa seemed most like herself while on an adventure in the Wrangler with her two dogs.

Lisa kept the intimate details of her personal story close for quite a while. But with time, we learned that she had been the teenage bride in a shotgun wedding to her high school sweetheart, Steve. The two youngsters were soon raising two youngsters of their own, Melanie and a little boy named after his father. The realities of parenthood at such an early age had pushed Steve into a workingman’s trade as a painter and general handyman and sequestered Lisa within the confines of her mother’s home, tending to the needs of two infants before she was twenty, the ambitious plans of her childhood fading fast, the dreams flitting like an elusive butterfly further and further from her grasp. Neither Steve nor Lisa had been able to finish high school, though Lisa later completed a GED at home between diaper changes.

After the kids got a little older, Lisa landed a part-time job at a veterinary hospital. It was there that she began to reconnect with her dreams. However, as the sprawl of Washington, D.C. seeped ever westward and escalated the cost of living in northern Virginia, Lisa’s mother sought refuge by relocating her extended family to the valley. With Lisa’s access to her job cut off, her world compacted again, her passion for animals sated only by her own menagerie. For Lisa, dreams deferred had become dreams denied, and each day her hopes and ambitions deflated a little more, like a progressively sagging helium balloon.

It was in one of these low ebbs that Lisa answered my advertisement and was welcomed as the newest member of my staff. Given the harsh realities of her life, I suppose it was no surprise that Lisa’s outlook on life was so bleak. And yet, as time went on, I noted with pleasure that Lisa’s face began to reflect a little bit of lightness, her smile coming more quickly. She displayed a sardonic, self-deprecating wit and she involved herself with the group more.

In no time at all, Lisa’s skills with the patients were in demand. She learned to restrain patients as I gave injections or drew blood for laboratory testing. She became adept at reading stool samples, peering through the double eyepieces of the microscope and identifying the eggs of intestinal parasites by their unique shape and texture. She mastered the art of cowing the most rancorous of cats, bundling them into little kitty burritos with a double layer of towels as they hissed and swore, their fishy feline breath hot and angry, their sharp and swiping claws safely secured. As her responsibilities grew, so did her confidence, and a new Lisa emerged.

For some people, life tolerates no advantage. Each step forward is accompanied by a new tremor of emotion, an unexpected and undeserved new kick in the gut. Lisa was one of these people. For her, the next kick came with a nonchalant pass of her hand over Tillie’s neck. She had not noticed it before, but suddenly the lymph nodes stood out under Tillie’s chin like twin plums, and Tillie’s usually robust appetite flagged. I happened to be on vacation when these signs were first noticed, so Lisa brought Tillie in for my associate to evaluate. She found matching growths sprouting not only under Tillie’s chin but also in front of her shoulders, under her arms, and behind her knees. She had sucked a few cells from these growths with a syringe and evaluated them under the microscope and had judged them to be enflamed lymph nodes. Since she did not deem the cells to be cancerous, she had placed Tillie on a course of high-powered antibiotics to counter the effects of a suspected bacterial infection.

When I returned from vacation, Lisa told me about Tillie’s illness, ending her description with the good news that the aspirate of the lymph nodes had been cancer-free and the antibiotics were expected to do the trick. A little shiver of concern started at the base of my skull and sent tendrils down my spine.

“So, how long has she been on the antibiotics?” I asked, trying to conceal my concern.

“About five days now.”

“Is she any better?”

“Not yet. But I keep watching for her appetite to come back. She hasn’t eaten for so long that I think she’s starting to lose weight.”

“Why don’t you bring her in tomorrow for me to look at, just in case.” I was concerned to hear that she had shown no response to the antibiotics. Usually, bacterial diseases begin to respond to appropriate antibiotic therapy within two or three days. Failure to do so means that we have either chosen the wrong antibiotic or made the wrong diagnosis.

I watched as Tillie dragged into the office the next morning, her demeanor and appearance unlike the Tillie I knew. Her eyes were not fixated on Lisa; her tail was drooping and languid. With foreboding, I ran my fingers along her neck and felt the plumpness of the lymph nodes, which usually disappear among the tissues of the body. Even in places where the nodes are usually not discernible, they stood out prominently, bulging the skin. My heart was in my throat as I plunged a needle into first one, then another of the firm, easily isolated nodules that I had trapped between my fingers.

After spraying the material from the syringes onto microscope slides, I first fixed them by holding them over the flame of a cigarette lighter, then stained them by dipping them into a series of blue, red, and purple dyes. Finally, I placed the slide under the microscope and focused down on the pink and purple cells.

Though I was not pleased to see what came into focus on the slides, I was not surprised. From one end of the slide to the other was a monotonous population of large cells, their nuclei prominent and displaying a coarse pattern of internal structure. Each nucleus hosted a number of large, bizarrely shaped structures, called nucleoli, scattered liberally throughout. There were also many cells whose nuclei were clearly in the chaotic throes of cell division, unchecked and unmitigated mitosis. All of these findings were ominous, unmistakably indicative of unrestrained growth, the hallmarks of malignancy. Tillie had cancer!

I looked through the microscope much longer than was necessary for me to make a diagnosis. I knew the telltale landmarks of lymphoma immediately. The rest of my time peering through the eyepieces was occupied in frantic rehearsal of the upcoming conversation with Lisa, which I did not relish. In her heart, though, Lisa already knew the bad news. She had suspected as much herself by the way Tillie’s energy had waned and her body contours had melted away, her nodes swelling and bloating more each day.

I turned to her. My eyes, filling with concern and sympathy, met hers, which were already full of knowing and sadness. “It’s not good, Lisa.”

“I knew it. I just knew it!”

“This is lymphoma. And it looks like an angry case of it.”

“So what does this mean?”

“Well, the prognosis is not good. Without treatment, Tillie probably has only about six or eight weeks. The good news, if there can be any good news with a diagnosis of cancer, is that lymphoma is one of the most treatable forms of cancer. In most cases, chemotherapy drugs will result in remission.”

I watched Lisa’s face for the familiar reaction of dismay at the mention of chemotherapy. Every client has known someone who has undergone chemotherapy for the treatment of one form of cancer or another. Everyone, it seems, reacts with some degree of repugnance to their memories of how awful the treatment regimen had been for their loved one—the racking illness that the poison of the drugs had caused, the nausea and vomiting, the draining weakness, the dehydrating diarrhea, the clumping handfuls of balding hair loss. Few clients can conceive of, or condone, their pet going through the same horrors. So it was not a surprise to see Lisa’s face cloud with furrows of emotion.

“It’s not what you think. Our patients don’t usually get hit as hard with chemo drugs as people do. Our goal is to maintain quality of life even while we work to lengthen it. Most dogs tolerate treatment really well. And with treatment, while we don’t generally achieve a cure, we can usually extend good quality of life for eight to twelve months or longer.”

“It’s wicked expensive, though, isn’t it?” I knew this was a factor for Lisa’s family. It is for most clients. It’s a fair and valid consideration, too. But I also knew that Lisa would sacrifice everything for Tillie’s benefit. It wouldn’t be easy, but it would be easier than doing nothing, easier than watching Tillie sink into the inevitable mire of illness, waning painfully to an unavoidable end.

We started Tillie’s first round of chemotherapy three days later, administering a cocktail of venomous liquid into her bloodstream, where it would target the rapidly dividing cells of the cancerous tissue. This was followed by a chaser of oral medications, which were given for four consecutive days. The next week, blood work was done to monitor the number of white blood cells. These innocent bystanders often suffer collateral damage from chemotherapy drugs and their absence can leave a patient unprotected from invading germs. Since the white-cell count was adequate, the whole process was started again. This became a weekly cycle.

Tillie tolerated the barrage of noxious toxins very well. Within a week, the size of the lymph nodes had shrunk to almost normal. This was accompanied by a marked improvement in her appetite and general well-being. At the first recheck a week later, Lisa was vastly more optimistic and had begun to see the old Tillie reemerge. By the third week, her cancer was in remission and her lymph nodes and blood work were normal. She was gaining weight, and except for a day or two after each treatment, she was back to acting like her normal self.

After a six-week induction period, Tillie’s chemotherapy sessions were reduced to every three weeks, a schedule that we planned to maintain indefinitely. With the exception of a bit of barely noticeable thinning of her coat, Tillie was the picture of health for about ten months. Then Lisa once again noticed that her lymph nodes were beginning to swell. She brought Tillie back to me. I could tell by the look on Lisa’s face that the situation was not good.

“Her nodes are up again. And her appetite has begun to drop off, too.” Lisa reported the changes to me with calm resignation. We had known all along that this time would most likely come. When it did, we were not surprised.

I examined Tillie from nose to tail. There was no doubt about the diagnosis. Lymphoma is an awful diagnosis when first made, but resurgent chemotherapy-resistant lymphoma is worse by far. Achieving the second remission is more difficult by several orders of magnitude than winning the first round. Rescue protocols are well described in the veterinary literature, but success rates with these are lower, and disease-free intervals are much shorter than with first remissions. I knew Lisa was aware of these realities both from her own research and from experience with other cancer patients.

“Do you want to pursue further chemo for Tillie?” I asked.

“The second course would be a lot harder on Tillie, wouldn’t it?”

I nodded my head.

“And second remissions don’t last as long, do they?”

“You’re right on both counts.”

“I don’t think we should do it again,” she responded quietly. “I’m glad we did it the first time. It helped her a whole bunch and gave her many months of good life. But to do it again wouldn’t be for Tillie. It would be for me. It’s not fair of me to ask that of her.”

Later that week, I made my way to Lisa’s house. She, Tillie, and Grizzly were behind the house, in the pasture down by the river. Destiny trotted around the fence line, no doubt expecting us to chase her down. When Grizzly saw me, he immediately squatted and peed in the grass. Tillie’s head remained down, though her sad eyes tracked me across the pasture. She clearly felt awful, the whites of her eyes beginning to radiate the subtle yellow hue of jaundice, evidence that the cancer was now affecting the liver. Lisa’s decision to put Tillie to sleep, though excruciating, had clearly been the right one.

It is an incredibly intimate thing to encroach upon the dynamics of an unraveling partnership, fleeting for the person, lifelong for the pet. But as a veterinarian, I have been invited into such a position innumerable times. It is a responsibility that never ceases to plunge me deeply into the substance of the bond between human hearts and the hearts of trusting and faithful animals. At no other time is the current of that bond more tangible to me, its waves washing over the aching people, crashing onto the unyielding rocks of the pet’s illness and suffering, high tides of emotion eddying around the owners and the pet, their undercurrents pulling at me, too. The vulnerability of the people, the helplessness and dependence of the patient, the mortal significance of the owner’s deliberations, the emotional consequences of a loathsome decision, the weight on my shoulders of my professional input all combine to make this event one of the most intensely difficult of professional interactions. But to do this for Lisa and Tillie produced an added layer of emotional expense.

Still, though all of these factors were present that afternoon in the field by the river, there remained in my mind an odd serenity that what I would do next would be a smoothly dovetailed continuation of the care I had provided for Tillie and for Lisa. Together, we had faced the worst of medical diagnoses, the contemptible ogre, Cancer. Through the art and science of modern medicine, we had chased him away, his tail tucked like a coward, running from our poisons and persistence like some dangerous quarry that, when finally trapped, turned on us with vicious teeth and inflicted the mortal wound.

Our battle had been valiant, our purpose worthy. But in the end, the foe had been too vigorous. Fighting on would serve only to accentuate our own impotence and the overpowering might of the disease. The adversary could not be beaten. But the triumph of his conquest could be appropriated by stealing from him the right to decide the time and circumstances of his final victory. It was for us to choose how and when to ease the agony, to release the anxiety. We could administer the demise as we had administered the remedy. And this was a victory of sorts, a feeble finger in the eye of the evil monster. If the war must be lost, we could at least surrender on our own terms.