The vet students made a long incision beginning under the chin and continuing down Marcie’s chest. They began pulling out the “pluck,” which includes the tongue, trachea, lungs, and associated structures. They’d gotten as far as the tongue when the lab supervisor said, “Stop!” and immediately called for Marcie’s medical team from the day before.
When Marcie’s team arrived, the lab supervisor explained that they’d found something significant.
There was a fist-sized tumor on the far back of Marcie’s tongue. It had grown large enough, and was positioned in just the right spot, to begin blocking her airway. The blocked airway explained her abnormal breathing during our Saturday ride.
The tumor was a squamous cell carcinoma. Those are fairly common, but it was in an extremely rare location. No one, student or longtime vet, had ever seen this before. Even if we’d known for sure that the tumor was causing Marcie’s problems, we wouldn’t have been able to save her. The tumor’s location couldn’t have been reached surgically, and Marcie’s advanced age—she was thirty, which is quite old for a horse—would have made the surgery itself extremely risky.
We had our diagnosis and left the necropsy comforted by the knowledge that we had done the right thing for our sweet Marcie.
I had attended equine rounds during every one of Marcie’s frequent hospitalizations for colic, so it seemed only right that I attend pathology rounds the Friday after she died. In many ways, it was no different from what I had always done for her, even though this time it was the last rounds presentation about her. I made my way to the observation area outside the necropsy room. A line of trays inside the room held the organs of the various animals that would be the topics of this morning’s rounds. Marcie’s pluck was on the first tray, the cancerous mass on her tongue clearly visible.
Before pathology rounds began, the students on Marcie’s case gave me a hoof print with Marcie’s name embedded in it and a gorgeous braid they’d made from her tail skirt (the long hairs of her tail) with a pale green ribbon woven in. Before Earl and I had taken Marcie to the hospital, I’d brushed her thoroughly, put a rubber band around a thick hank of her white mane, and clipped it close to the skin. I have kept and cared for these precious mementos ever since.
My mom always said that kids should not have pets or grandparents because they just lead to grief and tears, but there is a lot to be said for the human-animal bond. I am a believer that things happen for a reason. I believe that Marcie lived so happily in her last year to help me relearn riding three times after the misery of my orthopedic trauma, which had begun the year before. After the broken hip, after surgery to replace the screws, and after surgery to replace the hip, Marcie was there, helping me recover and ride again. I was heartbroken that she was gone, and I was grateful she’d been with me for this tough journey.
Earl and I weren’t the only ones who grieved Marcie’s passing. Scooter whinnied all that night and into the next day, looking for her after we returned with an empty trailer. Hannah seemed puzzled that there was no one to trade stalls with to search for after-dinner morsels. Our dogs and cats knew too.
There is a quote from Stephen King’s book Pet Sematary that still brings me comfort: “. . . time passes, and time welds one state of human feeling into another, until they become something like a rainbow. Strong grief becomes a softer, more mellow grief; mellow grief becomes mourning; mourning at last becomes remembrance . . .”
The story “Rainbow Bridge” gives me hope for the future, with no fear of death when it comes.
The Rainbow Bridge
There is a bridge connecting Heaven and Earth.
It is called the Rainbow Bridge because of its many colors. Just this side of the Rainbow Bridge is a land of meadows, hills, and valleys, all of it covered with lush green grass.
When a beloved pet dies, the pet goes to this lovely land. There is always food and water and warm spring weather. There, the old and frail animals are young again. Those who are maimed are made whole once more. They play all day with each other, content and comfortable.
There is only one thing missing. They are not with the special person who loved them on Earth. So each day they run and play until the day comes when one suddenly stops playing and looks up! The eyes are staring! You have been seen, and that one suddenly runs from the group!
You take him or her in your arms and embrace. Your face is kissed again and again and again, and you look once more into the eyes of your trusting pet.
Then, together, you cross the Rainbow Bridge, never again to be separated.
Author Unknown
I know that she will be there at the Rainbow Bridge, ready to carry me over riding joyfully on her back.
Marcie had what we all hope for: a life well-lived.
26
Ten Days
I didn’t want to talk about it, let alone write about it. He got sick, and he died. It happened at the same time Tipper got sick and died. What more is there to say? How can I possibly explain the anguish that comes from such profound loss? Why would I want to remind myself of that pain? Why would I want to burden anyone else with it?
It started with what looked like a scrape on his face, near his right temple. Earl, like many of us who had spent so much time outdoors in the days when no one thought about sunscreen, had had several basal cell skin cancers removed over the years. This didn’t look like one of those. When I asked, Earl shrugged it off and said it was nothing.
The scrape didn’t heal. By December, it had expanded to a large, round lesion covering most of his temple.
I spent Christmas week in Chicago, visiting my cousins. Earl stayed home to concentrate on finishing the paper he would be presenting at the North American Veterinary Conference (NAVC) in January. Two days before we left for the conference, his dermatologist used the Mohs technique to remove the rapidly growing squamous cell carcinoma from his face.
Layer after layer of cancer cells were removed, leaving a clean and cancer-free border—and an incision from Earl’s temple down his face to about the level of his ear. And sutures—his face was a forest of black suture threads. Not the most handsome face to put before an audience, but at least the worst was over, we thought.
We flew into Orlando, Florida, and met up with Earl’s mom, who had invited us to stay with her at her vacation condo. On Saturday, January 17, 2009, we both attended Earl’s presentation, “An Analysis of Greyhound Injuries: a 14-Year Study.” Bev returned home, and Earl and I treated ourselves to a night in a plush hotel, a nice dinner, a visit to one of the free Disney venues, and the just-released movie Marley and Me. It was a peaceful, relaxing trip, a brief vacation we both needed.
Our flight home was on January 19, the day before President Obama’s inauguration. Once home, all Earl wanted to do was sleep—unusual, but perhaps not surprising, considering how hard he’d been pushing himself and that he’d just had extensive facial surgery.
Inauguration Day was the same. I went by myself to retrieve our horses from where we’d boarded them during our travels, then picked up Tipper from the kennel. I was a little concerned that Earl didn’t want to watch the inauguration; we both shared an intense interest in politics, and Obama’s inauguration would be one for the history books.
Follow-up tests revealed that the cancer had metastasized into Earl’s facial lymph nodes.
One of the questions we ask when cancer appears is, “What caused it?” Often, there isn’t a clear-cut answer. In Earl’s case, the cancer, and everything that came after, had its beginnings in his kidney transplant.
When he was born, Earl’s kidneys were swollen due to a blockage that prevented urine from draining properly, a condition called bilateral hydronephrosis. Surgery corrected the problem, and although his kidneys were damaged, they did their job well enough through his childhood. They began failing in his teens, and he started dialysis when he was seventeen. He had a kidney transplant in 1970, when he was eighteen and the procedure was still relatively new. His Uncle Ralph wa
s his donor.
He’d done well with his transplant for thirty-nine years—he was one of the longest surviving transplant recipients at that time—but the antirejection drugs suppress the immune system, and that increases the risk of certain cancers, including skin cancers.
The next step would be radiation treatments. First, a form-fitting mask would be created. The mask would keep Earl’s head positioned properly so the machine would target the specific areas in his face to be irradiated. If all went as hoped, the treatment would eradicate the cancer. It would also damage his salivary glands and temporarily destroy his ability to taste anything. With no sense of taste, most people won’t eat enough, so standard procedure is to install a feeding tube, also called a stomach or gastrostomy tube, through which supplemental nutrients are administered.
Earl also had an incisional hernia—a hernia that had formed long ago at the site of his transplant incision. It had worsened and now needed repair. On March 11—our wedding anniversary—Earl had successful surgery to repair the hernia. At the end of March, his doctors gave the go-ahead for the radiation treatment preparations.
But before anyone could jump into surgeries for stomach tubes, I pointed out that Earl, who was fifty-seven, had never had a colonos-copy; perhaps we should start there.
The GI specialist who performed the colonoscopy identified a large mass. He was certain the mass was colon cancer.
In early April, fairly soon after the colonoscopy, Earl’s surgeon removed the suspicious mass, along with half of Earl’s colon.
I had dozed off in the waiting room. I woke when the nurse liaison knelt down in front of me and rested his hand on my forearm. He looked me straight in the eyes and said, “It is not cancer.” Relief flooded through me: finally, some good news.
The mass was a benign tumor that had formed from platelets clumping, which had its origins in a patent foramen ovale that had been discovered a little over a year earlier. The foramen ovale is a “hole in the heart” that usually closes and seals shut soon after birth. In about 25 percent of people, it doesn’t close (“patent” means “open”). For most of them, the hole doesn’t cause problems, even though blood leaks from the right atrium to the left. They’ll never know they have it unless it’s discovered while testing for something else. In Earl’s case, his thumb turned so blue it was purple, and I nagged him to get it checked out. That was in December 2007. I remember the timing so well because on Friday, December 28, as we were leaving to pick up the test results, I got the call telling me that my closest friend, Jean, had just died after her six-month battle with gastroesophageal cancer. I’d spent almost all my time with her during the months she was sick. I’d only returned home for dental work on Thursday and Earl’s doctor’s appointment on Friday.
After the colon surgery, Earl’s liver began to fail. His kidney was fine, but a biopsy showed cirrhosis of the liver, most likely caused by years of taking the antirejection drugs necessary to keep the kidney safe and him alive. The cirrhosis had created a body full of fluid, and his abdomen swelled with it, a condition called ascites.
Fluid began building up in Earl’s chest. He was having trouble breathing. His entire stomach had crossed the diaphragm and was now in his chest cavity. We were heading for another surgery. My mother-in-law, Bev, came to Fort Collins for a short visit to help out.
In mid-April, the doctors inserted the stomach tube. Earl had trouble with the anesthesia and landed in the intensive care unit. When the surgeon came into the recovery room, his mask still in place, I asked him if Earl was critical. After a long pause, he said, “Yes.”
Bev turned away and said, “Damn it.”
Earl was in and out of the hospital all of April. I finished settling Jean’s estate in April too—she’d named me as her personal representative—and finally let myself cry to Earl about losing my dear friend.
Throughout everything, Tipper and I had kept up with our usual routines of daily walks, pets, and playing. Then, in mid-April, I noticed that she seemed to be having trouble eating. A few days later, while Earl was resting, I was petting her and noticed that the lymph nodes in her neck were hard and swollen. Our dear friend and go-to vet, Dr. John Mulnix, thought it was because her teeth were acting up again, so she underwent dental surgery.
Despite the tooth extractions, Tipper started to slow down.
The problem wasn’t her teeth.
At the end of April, a needle biopsy revealed that the swelling was lymphoma, a common type of cancer in older animals. Tipper was twelve years old, which is fairly old for a large dog, and lymphoma treatment doesn’t have a great outcome in dogs. Earl and I would rather Tipper have four months of feeling pretty good without medicine than eight months—the best we could hope for—during which she would feel miserable from the treatment. Better her final days were happy and comfortable, we decided.
In early May, my mother-in-law came back to Fort Collins to keep an eye on Earl as he recovered from his latest round of hospitalizations, so that I could drive to Lubbock, Texas, to visit the campus of the Texas Tech University School of Law, where I’d applied before any of this began and had been accepted for admission to begin in July. When I returned home, Earl seemed okay, or at least no worse than when I’d left. But fluid continued to build up in his abdomen, and he felt terrible.
At the same time, lymphoma was taking a toll on The Wonder Husky. One day in mid-May, Tipper and I went on our regular walk around the neighborhood. About a fourth of the way in, she stopped in the middle of the street and wouldn’t move ahead. She just stood there until I turned us around, and we made our sad way home. That was her last walk for exercise.
Tipper always slept inside, often pressed against the back door. By late May, she couldn’t get up when I came through in the wee hours of the morning, after spending the day at the hospital with Earl and then cleaning the barn. Cleaning the barn at two in the morning may sound odd, but I derived a lot of comfort from it. When I’d finished in the barn, almost tired enough to sleep, I’d have to push the door hard enough to slide Tipper across the floor so I could enter. Once I helped her up to all fours, she could still walk, though sometimes I had to run a towel under her like a body sling to help her along.
She was no longer a happy dog. She had that look in her eyes that animals get when they’re close to death. I knew it was time.
Earl was in the hospital again, and I couldn’t stand the thought of that “last ride” for Tipper, so John—Dr. Mulnix—agreed to come to the house early on the morning of June 2 to euthanize Tipper.
The night before, I slept on Tom’s old couch in the family room, Tipper by my side, a DVD movie playing so I could fall asleep.
It had been raining and hailing on and off all spring, turning our corral into a small lake. The next morning, it was pouring rain again. I heard Tipper’s tags rattle; she was standing ramrod straight at the back door in her “I have to go out” position. I let her walk along the sidewalk at her own pace. It was really quite beautiful at six o’clock. Everything smelled so good—the blooming peonies in our flower garden, the spruce and pine trees in our yard, the wet grass.
We stopped by the barn so she could see the horses for the last time. Then I took her in the house and fed her a peanut butter and jelly sandwich laced with pain meds and tranquilizers, which she snarfed down. She had reached the point where I was feeding her anything so she would eat at all; regular dog food was not on her end-stage cancer menu.
John arrived promptly at seven in the morning and gave her an anesthetic before administering the euthanasia solution. The instant he gave her the stinging shot, I gave her a Hershey bar to distract her. Chocolate is extremely toxic for dogs, but chocolate was not going to be her cause of death this day.
I told her to go to bed, and she obediently went into her crate. I stroked her beautiful head as she fell asleep for the last time.
After Tipper was peacefully released, I asked John if he would have someone come take her crate away so I could put the
house back in order before Earl came home the next time from the hospital. We threw the crate into the backyard so that one of John’s staff members could pick it up when they had time.
We wrapped Tipper’s body in a large black bag and carried her to John’s car, a Porsche, which I thought was perfect, as she had been a good dog and deserved the best. I confirmed that we wanted Tipper cremated and her ashes saved. I already knew that I’d keep them beside Keli’s, in a discreet place in the living room where visitors wouldn’t notice them.
Earl had been taken by ambulance and admitted to the hospital the day before Tipper’s euthanasia. It was his fifth admission that spring. When I arrived at his room, I hung Tipper’s collar from his IV pole. He was conscious but so ill that he didn’t notice her hot-pink dog tag.
He came home again on June 4. We woke up early that next morning, June 5. I remember thinking that it was my late mother’s birthday. Earl said he wanted to feed the horses. I asked him if he wanted me to come with him. He said no.
I honored his request, but I peeked through the bedroom window curtains and watched him make his way to the barn. I didn’t want him to think I was spying on him, but he was so weak, I worried that he’d fall. He didn’t; he went slowly about his tasks and made his way back to the house unattended.
Later that day, I was at the eye center ordering new computer glasses. Earl called, literally breathless, saying he couldn’t breathe.
His mother was there at the house with him but never called 911. What could she be thinking?
I called 911 immediately from the eye center and bolted out the door. I ignored every speed limit and got home just as the ambulance arrived.
At the hospital, Earl’s doctors inserted two painful tubes in his chest and began pulling fluid out of his pleural and mediastinal cavities. They discovered that the fluid from both sites was infected, one with bacteria and the other with a fungus. The bacterial infection might be treatable, but the fungal infection had a 99 percent mortality rate.
Drinking from the Trough Page 24