I reassured her I had thought no such thing, and she went on to tell me that my news persuaded them to go for two courses of chemotherapy, not least because Helen seemed to be doing so well.
“What a mistake,” she said, but didn’t linger. “Thankfully we got her teeth sorted out first. Dr. Able didn’t want to risk the possibility of her getting an infection that originated in her mouth when her immune system was being knocked out by the chemo.”
It made perfect sense to me. No amount of Listerine was going to defeat Helen’s bevy of oral bacteria. But what went wrong with the chemotherapy?
“She had to lose a lot of teeth and so what if she had a crooked smile, she was doing great. So we started out with intravenous carboplatin and I guess she did okay. But the doxorubicin … that was another story. It hit her really hard. She wouldn’t eat. She would drink but she couldn’t keep it down, throwing up over and over again. Eventually she fell over in her own pool of vomit and I didn’t know whether she had lost her balance, fainted, or was having a seizure. I rushed her right back to Angell, where she stayed in the critical care unit for a week.”
How had I not known about this? It must have happened when I was away on summer vacation, and for some reason, Dr. Able had failed to pass on this update during my absence. Maybe he had wanted to spare me the bad news, knowing full well how it feels to return to work, cheerful and revitalized, only to be crushed by a dispassionate e-mail documenting the travails of one of your patients while you were relaxing in the sun.
I tried to imagine how much second-guessing played out between Eileen and her husband, Ben, during what must have been a long and difficult week in June. Their anguish at having agreed to poison their dog, for all the right reasons, but without the dog’s understanding or consent. Dr. Able would have explained all the risks of chemotherapy, the potential for complications, and reiterated that the odds of recalcitrant side effects were slim. Even so, and even though Helen clearly pulled through and emerged on the other side, I could hear the remorse and distress in Eileen’s every word.
“It was so hard to visit her, to see her constantly licking her lips from the nausea, and even though the chemo had stopped, its damage was already done. Her white blood-cell count plummeted and I know the nurses did a wonderful job of caring for her and keeping her clean, but I can still see the discoloration of the fur on the feet of her back legs from where it had been stained by her endless bouts with diarrhea.”
The recollection caught Eileen in its net, and for a moment she was lost to me, swept away, dragged backwards through a painful quagmire of betrayal over her misguided enterprise. I couldn’t deny her this introspection. In fact I would encourage all owners to take this journey before they send their pet into battle against a determined and despicable enemy. Consider the darkest hours if things go wrong, what you might be asking your animal to endure, and be aware and accepting of this possibility and how you might feel if they get dealt an ugly hand. If, for you, the rewards still outweigh the risks, then sleep easy at night, because regardless of the outcome you have made the right decision. But if you hesitate, remain uncertain, or uncomfortable with the potential for predictable remorse and heartbreak, then be the friend brave enough to intervene, to ward off denial and assure gentle mercy.
Helen had proved herself to be, and clearly still was, a fighter, a tough dog who made her own luck, scavenging for food, avoiding coyotes, cars, and freezing to death during the throes of a New England winter. After all she had been through she wasn’t going to succumb to some chemically induced toxic conflict. She had surpassed her four months and so much more. Her summer had come and gone, and suddenly, though I realized I was ruining the chronology of Eileen’s account, I had an overwhelming desire to find out how a dream about a sick spaniel playing on a beach up in Prince Edward Island finally turned into a reality.
OF course it was nothing like I had imagined.
“To be honest,” I said, “I had this image of Didi bouncing around in the surf, goading Helen into taking her first dip in the ocean.”
Eileen laughed, because what transpired was far less predictable and, as a result, far more wonderful.
“Didi happens to be one of the few members of her breed who refuses to swim,” she said. “She might have the webbed feet and water-resistant coat, but she never goes in beyond her elbows and knees.”
“So what happened?” I asked.
“Oh, Helen never really swam in the ocean. I guess I’d describe it as more of a civilized saltwater foot massage, whenever she felt like it.”
Too funny, I thought. The only thing I had right was the only thing I could have guaranteed as soon as Helen crossed the Confederation Bridge from Nova Scotia to the island—the welling up of pride and wonder in Eileen and Ben at the accomplishment of a canine cancer survivor used to fighting for everything in her life. I didn’t have to ask. I could hear it in Eileen’s voice as she talked about their vacation. It didn’t negate all the fears and the perpetual uncertainty and I imagine it never felt like vindication for the tough choices Eileen had to make. I’m certain the reward came packaged in that moment, shared liberally between them, all-consuming, humbling, and unforgettable.
In truth, my Hallmark version of Helen’s happiness being so very wrong is one of the greatest pleasures I take in her achievement. How can any of us impose our version of happiness on others, let alone the animals in our lives? I asked Eileen if Helen had been happy playing on a beach for the first time, and as soon as the question got away from me, I realized it was futile. Can we take a reading from the canine wag-o-meter and determine a dog’s degree of ecstasy? Do the volume and frequency of your cat’s purrs crank up to eleven when she is approaching feline nirvana? Thankfully our pet’s version of happiness exists in a one-of-a-kind language, something far more subtle than what we read about in books on animal communication, something explored, cultivated, and gradually understood by those who take the time to learn. All they have to do is observe and they just know. It might have been clear from a certain look from Helen’s upturned eyes, the intensity in her concentration during her hours of crab herding, the ferocity of her newfound appetite, or the ease with which she slept, utterly exhausted every night. However she managed to convey her message, it was obvious Eileen and Ben saw it, over and over again, as plain as if Helen herself had written “having a wonderful time” on a tacky tourist postcard.
I COULD try to make excuses for what came next, claim I got caught up in a moment of euphoria, the romantic in me shirking objectivity and scientific reason, but I felt compelled to share what I had kept to myself for all this time.
“I have a confession to make,” I said, rewarded with a predictable moment of silence signaling Eileen’s confusion or unease at being privy to some awkward, unanticipated declaration. “I need to tell you about a little miniature pinscher called Cleo and her owner, Sandi, and where they fit into my version of Helen’s success story.”
I hadn’t confided in Eileen sooner because, well, to be honest, it felt ridiculous, even unprofessional, asserting that the spirit of a deceased dog somehow played a part in Helen’s extended survival. There had always been something appealing in Cleo’s role, if you could call it that, as a secret benefactor, working her magic from afar, generous and anonymous. But as I heard Eileen’s good news, part of me understood Cleo and Sandi deserved some of the credit for how well everything had turned out. Regardless of whether or not you believe they had any influence on the course of Helen’s disease, one thing is for certain, they had a profound influence on me when I set about fighting it.
Eileen listened attentively, a kindred spirit, instantly bonding to a mother, a daughter, and a dog lost to tragedy. She got it, like I knew she would, because, like Sandi, Eileen has also been cursed and blessed by an affinity for stray animals, animals who need her help. Two women, two dogs, one life ending as another was allowed to begin. A painful symmetry between strangers whose lives unwittingly entwined to become a testament
to the power of letting go and the possibility of a better future.
IN this new era of cancer treatment, we hesitate to use the word cured (perhaps for fear of jinxing ourselves). We are confused by the word remission because how can we be keeping cancer at bay if the disease appears to have gone away and we are no longer pursuing treatment? That leaves us with the concept of cancer as a chronic disease we need to manage over what time remains. This makes the “big C” sound more like bladder stones, eczema, or constipation. It is time that is the crucial variable here. In humans we used to think of five years in remission as a cure. In dogs and cats, especially teenage dogs and cats, five years might not be within their grasp even if they are perfectly healthy. I am not an oncology specialist, but sometimes when I discuss expected survival times for certain canine cancers with owners, I find it helpful to consider the future in dog years. Relative to their life expectancies, an extra dog year of quality living might equate to seven years cancer free for you or me. Of course this is hardly scientific, but, for some people, thinking in these terms can be helpful. Once upon a time the options for an animal succumbing to cancer were pretty much limited to a fatal overdose of a barbiturate. The owner had the comfort of knowing he or she had sought treatment, but veterinary medicine offered little more than an alleviation of pain and suffering through humane euthanasia. In the twenty-first century, veterinarians have smacked the ball deep into the pet owner’s court, bombarding him or her with detailed medical information, a huge variety of therapeutic alternatives, and, not least, the fiscal challenge of how to pay for it. Maybe, when faced with the inevitable and tough decisions in your pet’s health care, the vagaries of survival, and what you and I may think of as relatively small packets of time, a consideration of longevity in terms of animal years might not seem so ridiculous. And bear in mind, with all our advances, fifteen is the new eleven for dogs and twenty-two is the new fifteen for cats!
Not long after my conversation with Eileen, I hit the hospital library, trying to get a handle on the magnitude of Helen’s achievement. The scientist in me had a flashback to high school statistics, could see a bell-shaped curve on a graph, the one in which the majority, the average, stand in the middle, leaving smaller numbers of individual stragglers on either side. How far was Helen hanging out to the right side of the curve? After all, cancer is an accomplished and perverse killer. Clearly Helen had dodged a quick, vicious attack, and based on Eileen’s description, she did not appear to be the victim of a slow torture, taking its time and savoring an inexorable demise. Helen was beating all the odds, but she was still vulnerable to what some consider a most disturbing and heartbreaking assailant—cancer as a faceless assassin who catches you off guard, with your defenses down, stepping out of the shadows when you least expect him.
Wading through textbooks and scientific journals, given the particulars of Helen’s case, I concluded that Dr. Able’s estimate of four months had been reasonable, doable, that eight months might be a stretch but not implausible, and that twelve months deserved a little more credit than merely remarkable and might even be working its way toward the loaded “M” word—miracle. By now, Helen had been alive for well over a year.
Scientific indoctrination makes most medical professionals reluctant to describe a clinical outcome as a miracle. It feels theatrical, affected, even conceited. As I perused my pile of data, I imagined it would be possible to decipher the minutiae and language of Helen’s pathology report, trace the line of the appropriate Kaplan-Meier survival curve, calculate her percentile in terms of disease-free interval, and manage to come up with a perfectly logical explanation for why she was still alive. And then I stepped back from the numbers and charts and dry, detached statistics and thought about a filthy, foul-smelling black spaniel greeting a stranger in a parking lot on a cold November night—a dog harboring a cancer, a stranger who would do whatever it took to give an innocent animal a shot at life. Following Helen’s journey from then to now, with everything in between, it is hard not to be staggered by her change in fortune and those who brought it to bear.
I closed the books and pushed the papers aside, smiling, the sentimental part of my brain telling me to lighten up, to live in the moment, demanding I surrender to the spirit of victory. Helen’s story may be as good a candidate as any for the term miracle. And besides, if I may bastardize the words of the legendary writer Cormac McCarthy, “If it ain’t, it will do until another one comes along.”
FOR better or for worse, thinking about Helen inevitably and appropriately led me straight back to Cleo, and given this unexpected and marvelous update, I was eager to share Eileen’s news with Sandi Rasmussen and her family.
Over a year had passed since I wrote to Sandi via her daughter Sonja, who lived on the island of Bermuda. During that time I had received no response. I had suspected that they were not ready to revisit the wounds, had moved on, but surely they would welcome this amazing news.
For over two weeks I waited patiently for a reply, happy to impugn the inadequacies and tardiness of international snail mail until my second letter to the Rasmussens sailed all the way back into my mailbox at work, branded with the discouraging label “Return to Sender, Address Unknown.”
Puzzled and a little perturbed I went back to the computer record and managed to discover Sonja’s work phone number. Calling her during office hours, stirring up what were still likely to be painful memories in the presence of her colleagues, was less than ideal, but remembering my promise to her mother, believing there might be a measure of comfort in my news and left with no alternative, I dialed the number.
The dial tone gave way to an automated phone system at an insurance company (no surprise there, given Bermuda’s prowess in the business). I was guided to a staff directory based on the first three letters of the last name and I punched in R-A-S.
“I’m sorry. We are unable to locate an employee by that name.”
“Hum,” I thought. “I wonder if she’s using her maiden name or married name.”
Though my disappointment was offset by the charm of the preset British accent, managing to make my dismissal sound polite but authoritative, I dialed again and bided my time until I could speak directly to a company operator, who informed me I should call back on Friday, after four thirty local time, and speak to a supervisor. This I did, only to be informed that Sonja Rasmussen no longer worked for their company and had left no forwarding address.
Running into this brick wall was a double whammy. Not only was I unable to get in touch with Sandi, but now there was an even greater probability that my first letter, fulfilling my promise to report on a deserving case, missed its mark, my silence interpreted as a dismissal. For days, whenever I had a spare moment between cases, I went online, hunting for leads, trying to track down mother or daughter, coming up confused and empty-handed.
In the end I printed out Cleo’s entire medical record. Thankfully it included the paperwork put through our financial department, and there, scratched in curly female cursive, I discovered Sonja had provided an e-mail address.
I didn’t hold out much hope. People change their e-mail addresses all the time. If she was no longer living in Bermuda there was a good chance she had changed her Internet provider. And this was when a troubling thought crossed my mind. What might have prompted Sonja to leave Bermuda in the first place? Did this have anything to do with the death of Cleo?
I copied and pasted this second letter into the body of an e-mail, added an apology that once again I was directing this communication to Sonja and not her mother, Sandi, and hit “Send.”
IT ALL happened so fast—I arrived at work the next morning to find replies in my in-box and messages on my voice mail. There was a time when sadness and trepidation might have given me pause before picking up a phone and calling Sandi Rasmussen, but not now, not with what I wanted to share. And there was something else that made it easier, woven into her written and spoken words, sentiments that touched and pained my heart—delight and gratitude.
“I’ve written you so many letters and never mailed them,” said Sandi. “You have no idea how much impact you had on all our lives.”
“Oh, God,” I thought. “This can’t be good.”
“I will never forget the day I walked out of your hospital, how much I ached for Cleo, how much I appreciated our time together, that you hadn’t rushed me, that you were genuinely interested in what I had to say. You remember Sonja, my daughter?”
“Of course.”
“I love her with all my heart, but she and I have always had a tough relationship.”
Sandi touched on her childhood, her emotional estrangement with her mother, her emotional fulfillment through the animals in her life.
“It’s taken me a long time to realize that Sonja is not like me. She never will be. She never should be. And the only reason I finally came to this understanding was through Cleo. I’m sorry, do you have time to hear this?”
“Please,” I said, and even though she was calling me from thousands of miles away in Canada, I could remember and feel her aura, the resonance and power of her attitude, her understated, selfless interpretation of life’s vagaries and conceits. I was all ears, hanging on every word.
“Heading home to Canada from Boston I had plenty of time to think. Plenty of time to think about Cleo. And I found myself remembering this one time when we were in Bermuda visiting Sonja, her husband, Dave, and their Min Pin, Odin. I think I told you how Cleo and I were always together, I mean always.”
“She traveled with you on business. Loved airports,” I said.
“That’s right. Good memory.”
I said nothing. Given the sad circumstances and my concern about our confrontation, there wasn’t much about our meeting that I was likely to forget.
Love Is the Best Medicine Page 23