The Gift of Pets: Stories Only a Vet Could Tell

by Bruce R. Coston

  “Of course. You do what you need to do. We’ll get by.”

  When she returned to the office an hour or so later, I detected no relief on her face. In fact, she looked even more worried. She was carrying a large X-ray envelope in her hand and she motioned for me to follow her into an exam room, where she removed a large film from the envelope and placed it up on the lighted view box. X-rays of humans appear very strange to me. I am so accustomed to seeing the chest films of dogs and cats that the same views of people appear clumsily oversized and eerily distorted to gigantic proportions, like the seedy sideshows at the fair. But there are also enough similarities that I can recognize when things are amiss. Looking at Lisa’s film, my eyes immediately went to an area of excessive whiteness in the lung fields, where I was sure it should have been much darker. I felt a knot tighten in my stomach.

  “So what do you think?” she asked. It was flattering that my opinion mattered to her. I knew she respected my medical expertise. But this was completely outside my field of study and certainly represented dangerous emotional ground for me. The last thing I wanted to do was offer any medical opinion in areas I was not trained in, particularly regarding someone about whom I cared so much. I dodged.

  “What did the doctor say?”

  “He is concerned about that spot right there.” She pointed to the area that had caught my eye. “He isn’t sure what it is yet. So he has referred me to a respiratory specialist in Winchester. I’m supposed to go tomorrow and take the X-rays with me.” She was quiet for a while, studying first the film, then my face. Then she addressed me again.

  “So what do you think?”

  “I think you need to do exactly what he says. There’s no way to know precisely what that is without following a diagnostic path. That’s why he’s referring you to someone else to take the next step. And that’s just what you should do.” I turned from the film to face her. “It’s a little disconcerting, though, isn’t it? You doing okay?”

  “We’ll see. It does have me pretty scared, though.”

  “I don’t blame you. But, remember, it could be anything—perhaps scar tissue or an inflammatory nodule. Some people even have lesions that show up on X-rays and look bad, but end up being aberrant heartworms. I know it’s a scary thing to think the worst. But it doesn’t have to be bad. It could be something simple. Let’s let the doctors do their work.”

  And the doctors did do their work over the next several weeks. The respiratory specialist took one look at the X-rays and ordered an MRI, which showed the same lesion in more detail. The devil was in the details. Not only did it confirm the original nodule, but it also highlighted several additional areas of concern. The next step was a needle biopsy, followed by a few incredibly frightening days of waiting for those results. When the doctor’s office finally called, Lisa was again in my office.

  “Doc, they’ve called to let me know they have the results of the biopsy back.” Her voice was even, but her face was strained and taut.

  “What did they say?”

  “They want me to go in tomorrow to discuss the results.”

  My stomach lurched and I could sense the sudden taste of fear in my mouth. Good news is shared over the phone by the nurse. Bad news is discussed face-to-face with the doctor. This was not what I had hoped for. Lisa knew it, too. I could see it reflected in the drawn lines on her face and the set of her mouth. I tried to downplay the significance.

  “Okay, that could mean a lot of things. No—”

  “Don’t try to fool me, Doc,” Lisa interrupted. “You know as well as I do that it probably isn’t good news. Besides, they told me they have forwarded the information to an oncologist. My appointment is with the oncologist. I’m really scared now. ”

  I leaned forward and took her hands in mine. “I know. Me, too.”

  “I’d really appreciate it if you’d go with me to the appointment. I’m going to have Susan go, too. I don’t really have anyone else to go through this with, you know.”

  My mind teetered. Of course I would support her in any way I could. But this request, as much as it affirmed our friendship, pushed me far out of my comfort zone. I expected that the news the doctor had to share with Lisa was intensely personal and would have deeply intimate repercussions. The situation demanded a level of trust and personal vulnerability that took me off guard. It also frightened me. I realized that I could have difficult conversations with my clients about their beloved pets and do it with compassion, sensitivity, and tact, but to think that I might be involved in a life-and-death discussion about a person seemed more than I was prepared for.

  “I’ll be glad to go with you and Susan,” I replied. Susan had known Lisa as long as I had. “But, Lisa, you do have someone who will be glad to stand by your side whatever the doctor says, you know. Dave will be there for you.”

  “I know, Doc. But this is like déjà vu for him. It hasn’t been that long since he lost his wife. I don’t want him to have to face this again.”

  The car trip to Winchester the next day was odd, the three of us riding along, trying hard to avoid the topic that was dominating our thoughts. I felt like a voyeur, peeking through private windows.

  “Lisa, I need to know just what it is you want me to do at this appointment today. Do you want me to ask all the questions? Do you want me push for details? Or do you want me just to listen and be there for you?” Susan had recently lost her mother to cancer, so I knew she was experienced at this process. She could either be the friendly shoulder for support or she could be an information gatherer. But I had no experience in this at all. I was a complete novice, and an intimidated one at that.

  “Just be there and listen. Ask any questions that you think need to be asked and might get missed,” she responded. “I just know this might be pretty hard for me. And in the emotion of the moment, I may not completely process or remember all the information he gives me.”

  We sat for a few minutes in the waiting room. There were very few places in the world I would have wanted to be in less than the waiting room of this oncologist’s office. It’s not like a pediatrician’s office, where most patients are perfect and full of endless possibilities. The patients here were older and appeared unfit. The room reverberated with illness and the imminence of death. Every person there, whether the patient or a loved one, vibrated with it, lived within its shroud, wore its presence like a cloak, heavy, dark, and stifling. Lisa was by far the youngest person in the room, and she looked the healthiest.

  One man, who appeared to be in his mid-fifties, shuffled stiffly in and dropped uncomfortably into a chair, wincing as he did so. A woman, who I assumed was his wife, followed him, pushing a cart that held a green oxygen tank from which six feet of transparent tubing emerged, making a loop around the man’s head and pumping oxygen into his nostrils. His grayish yellow skin hung loosely on him, like the fading draperies of an outdated home that had been decorated poorly. The effort of the walk into the office was evident in the loud wheezing rush of air through his open mouth and the staccato rate at which his chest heaved, punctuated by his desperate facial expression. It was as if there had been a run on the oxygen bank and he could no longer access his account. I did not want to look, but I could not pull my eyes away.

  A crisp nurse in an aseptic uniform called Lisa’s name, and the three of us ambled through the door, which she held open for us, smiling incongruously. I could feel the eyes of the others in the waiting room follow us; could feel their pity accompany us down the hall, squeezing through the door as it closed behind us. In the examination room, Lisa sat on the padded, paper-covered exam table, and Susan sat down on the one chair provided. I leaned against the wall until the door opened again and another chair was pushed through by the nurse. We spoke for a minute in hushed whispers, until we heard the doctor slide Lisa’s medical records and X-rays out of a pocket on the other side of the door. There was a slight delay as he scanned the records for a name before pushing the door open and whisking into the room, all smile
s.

  “Good afternoon, Lisa,” he said, extending a hand to Susan. “I’m Dr. Carver.”

  “Hello,” Susan responded, pointing to Lisa. “That’s Lisa over there.”

  Dr. Carver seemed surprised that his patient was clearly the youngest one in the room. “Pardon me.” He laughed easily, turning to Lisa. “Your respiratory doc sent over the films, the MRI, and the biopsy results. I’ve had a chance to go over all of them. Unfortunately, the biopsy confirms lung cancer.”

  He paused and gave Lisa a moment to appropriate the words fully, keeping his eyes on her face, his expression professional, calm, and empathetic. He had clearly done this before, and he was good at it. Lisa’s shoulders dropped and her breathing sped up a bit. But stoic and strong as always, she kept her eyes on Dr. Carver’s face. Susan’s eyes rimmed immediately with wetness, filling with tears, courage, and resolution, just the things she knew Lisa would need. Her hand went to Lisa’s shoulder. Lisa did not say anything, so Dr. Carver continued.

  “There are two common kinds of tumors that affect the lungs—large-cell and small-cell carcinomas. The biopsy shows that this is the small-cell variety. Unfortunately, this type generally carries the worse prognosis. It tends to be a little more aggressive and a little less responsive to chemotherapy.” The news settled heavily in the room, silence wrapping each of us in our own thoughts. Dr. Carver broke the somber silence. He sat forward briskly and wrapped his locked hands around one knee, pulling it up as he leaned back again.

  “That’s the bad news. But we don’t want to dwell on the bad parts.” He hurried on, knowing, I’m sure, that the bad parts would consume all our attention anyway. “The fact is, this cancer is treatable. There are a lot of things we can do to keep it at bay. And we’re going to get started right away. Now, I know I’ve hit you pretty hard already. I’m sure you have a million questions. So fire away.”

  Lisa continued to look at him, but I could tell her mind was far away in dark places. Susan took the helm.

  “You said the cancer was treatable. What exactly does that mean?” she asked.

  “Yes, it is treatable, though it may not be curable. With aggressive therapy, we can usually extend survival times significantly. And from the films, it appears that we’ve caught this pretty early.”

  “What kind of therapy are you talking about?” Lisa asked evenly.

  “We usually use a combination protocol of several chemotherapy medications, all given intravenously. We can follow up with radiation to get the tumors as small as possible. I know chemo sounds scary, and honestly, it’s no picnic. But we’ve come a long way in how well we’re able to control side effects. Most of my patients continue to feel pretty good throughout.”

  “How long?” Lisa asked quietly.

  “We usually start with a six-to-nine-week course of chemo. Then we’ll adjust our schedule depending on response.”

  “No,” she said. “How long are these extended survival times?”

  “The research indicates that the average patient lives about a year or a year and a half with chemo. But you have to remember, that’s an average. And averages are made up of some people who live much longer.”

  “And some who don’t live as long,” Lisa said.

  “That’s true, of course, but you have a lot of positive factors on your side. You’re young and healthy. We’ve caught this pretty early. And you obviously have the support of some very good friends and family. Those are really important considerations.”

  “What causes these types of tumors?” Lisa asked.

  “Are you a smoker?”

  “Yeah. I’ve smoked since I was a teenager.”

  “That’s the biggest risk factor. But here’s the thing. It doesn’t matter anymore what caused it. What matters now is how we go after it. I’d like you to stop smoking now, though. Do you think you can do that?”

  “I don’t have much choice now, do I? I’ll do whatever I have to do.”

  “That’s the spirit. It’s really important for the patient to have a positive, can-do attitude about the disease and its treatment.”

  “Can I keep working during my treatment?”

  “You can continue to do everything you feel good enough to do. Most patients end up needing to take some time off, though. They tend to get pretty nauseous and tired, and that often interferes with how much they can do. But we’ll give you plenty of medicine for your tummy. What is it that you do?”

  “I’m a veterinary technician. We’ve treated quite a few cancer patients at our clinic. Dr. Coston is my boss.” Lisa nodded her head in my direction.

  “Really!” Dr. Carver turned to me with interest. We spoke for a few minutes about chemotherapy in my patients, the types of cancers I saw the most, the drugs I used, the methods employed to control side effects. He was intrigued, but I felt uncomfortable with the focus turned away from Lisa. He turned again to her.

  “Okay, Lisa,” he said cheerfully. “I want to get you started right away. The nurse will come in and take you to our chemotherapy room in a few minutes for the first round. We’re going to get through this together. Are there any other questions?”

  Susan jumped in. “What kind of side effects should she expect from this?”

  “The typical side effects hit one of three areas: the GI tract, with vomiting and diarrhea; the bone marrow, with low white-blood-cell counts; or the hair follicles, with hair loss. That’s why you see a lot of cancer patients with shaved heads. The GI stuff we can usually control pretty well with medications. The bone marrow effects we watch pretty closely. Sometimes we need antibiotics if the white cells drop too low. Those things, we can do something about. The hair, not so much. Anything else?”

  We were all quiet. This had been what we had expected, but we were stunned nonetheless. Dr. Carver stood, shook hands all around, and walked out the door. Silence settled on us like white in a snow globe. Susan turned her attention to Lisa, searching her face for clues of how she was dealing with the news. Lisa’s eyes were haunted and hollow, searching the ground. Her face was drawn. She sat on her hands and rocked slowly back and forth.

  For my part, I was sad, deeply so. But in short order, I realized that I was also angry. This was just not fair! It was not fair to Lisa, who had suffered one slamming defeat after another in her short life. It was certainly not fair to Melanie and Steven, who likely would be orphans in a few months, having lost first their father to a freak accident and then their mother. It was not fair to Lisa’s mother, Amelia, with whom Lisa still lived. A parent is not supposed to bury her child. It’s supposed to be the other way around. How could this make sense in any way?

  The reality was, however, that my anger was a wasted emotion. There just wasn’t anyone to be angry at. Certainly not Lisa, though her teenage choice to smoke had most likely led her into this room. The nicotine habit had long ago taken that choice away from her, imprisoning her in a practically escape-proof psychological fortress of addiction. Besides, what Lisa needed most from me now was not anger but support. I vowed to do what I could to help her.

  The nurse pushed the door open again, interrupting our private ruminations. She led us down the hall to a large room where perhaps eight or ten plush armchairs were situated in two rows. Behind each chair rose a metal pole from which was suspended a bag of medication. Every chair was filled with a patient in some degree of decline. The people sat patiently in their chairs, reading paperbacks and listening to music through headphones. Most of the chairs hummed and vibrated, their automatic massage functions working at full capacity. Nurses fluttered among the chairs like waitresses, carrying more bags of fluid from the back room, checking on patients, taking blood pressure readings, and delivering snacks and drinks.

  Lisa was directed to an empty recliner, and a nurse landed in a chair next to her. Before we knew it, Lisa had a catheter in her arm and fluids running rapidly into her veins. An ominous, darkly colored bag was hung over her head and the nurse hooked its tubes into the plastic plumbing that was alr
eady flooding fluids into her. The treatment took an hour or two to complete, and then the receptionist expeditiously penned in an appointment for her next treatment. Lisa was issued a ream of prescriptions, which we needed to fill at a pharmacy. And then we were back in the car, heading home.

  The news struck the office like a tornado, leaving disorganized piles of emotional debris scattered among the staff. We were a close team, and having one of our own down seemed a heavy load to bear. Cynthia was deep into the planning of our Christmas party, but the developments with Lisa took the joy out of it. The staff just could not stomach a Christmas party that year, and the plans were scrapped.

  Cynthia and I gave much thought to how we could best help Lisa through the long ordeal ahead of her. The biblical injunction to help the widows and the orphans figured prominently in our discussions; Lisa and Melanie and Steven certainly fit that bill. We discussed several options, settling at last on a plan. Two days after the trip to the oncologist’s office, I made my way to Lisa’s house after work. Lisa and I sat down in her living room.

  “Lisa, I’ve given this a lot of thought. I can’t imagine how hard this must be for you. I know there must be a thousand things occupying your mind these days.”

  “You could say that.”

  “Here’s what I want to do. I want to take as many worries away from you as I can. The doctor said when we were there that most chemo patients have to take some time off from work for their treatments.”

  “Yeah, I’ve thought about that, too. I don’t want to leave you in the lurch, though. And frankly, I really need all the hours I can get now, with all the medical bills and everything. So I don’t plan on taking any more time off than absolutely necessary.”

  “Here’s the thing, Lisa. I don’t want you to worry about that. The office is my responsibility. As far as I’m concerned, your full-time job right now is to get better. So I’m going to continue to pay your full-time salary throughout your treatment. You work as much as you’re able to. But if you need to take some time off, do what you need to do to get well. I know you well enough to know that you will be at the office whenever you’re able. But if you’re not feeling up to it, don’t worry. You’ll still get your hours.”