Sit Stay Heal Page 2
* * *
Mrs. Johnson elects the most advanced chemotherapy option for Daisy, and she wants to start right away. Giving me a peek into their family life, she tells me how much they really need the little cocker. She’s a vital member of the team, and they love her very much. She provides great joy and is a steadfast companion for Kathy, spending hours by the little girl’s side. Kathy is unable to use her hands and arms well enough to dress Daisy—she can’t even dress herself—so her parents work as the stylists, decking out Daisy to look like Elsa, Kathy’s favorite Disney princess. Kathy relies on her parents—and her dog—to do the many things for herself that we all take for granted. As it turns out, though Daisy has received no formal training whatsoever, she’s become a seizure alert therapy dog. Just before Kathy has one of her epileptic episodes, Daisy signals the family so that they can respond accordingly. Ironic as it may be, Daisy has epilepsy herself, though fortunately hers is well controlled with medication. Most important, Daisy doesn’t see disability—she sees only Kathy, a loving girl. It doesn’t matter that “her” girl can’t use words. Daisy knows what Kathy is saying, because she understands her on a deeper level.
As parents, the Johnsons do not know how to broach Daisy’s impending mortality with their daughter. Clearly, the prospect weighs heavily on Mrs. Johnson’s brow. Talking to a nine-year-old child about their dog’s terminal cancer would not be easy for any parent, but for the Johnson family, this has bigger implications. Not only is Daisy a beloved family member, but she’s also a necessary part of Kathy’s support care.
“Doctor,” Mrs. Johnson said, “we really need you to help her live.”
Great, I thought. No pressure here.
“We’ll do our best,” I say, then give the woman a hug. From time to time, we all need a good, long hug.
I take the leash from the woman’s hands. Daisy doesn’t hesitate. She trots to the back of the hospital with me, curious as to what is around the corner. There will be people back there who will care for her as if she were their own. Cassidy, one of my techs, is quite partial to cocker spaniels, schnauzers, and pit bulls. It’s an unusual grouping, but I know that she will love Daisy just a little bit more because of her breed. All my veterinary oncology technicians will carefully administer chemotherapy to help her live and—the big payoff from Daisy’s point of view—a treat of a biscuit or two (or three). Daisy clearly loves her treats.
Not surprisingly, Daisy is a very accommodating dog. She readily comes up on the treatment table and allows us to do what we need to do to take care of her. My team flocks around this darling in a blue dress. Cassidy is beside herself with the cocker’s cuteness. The professional begins making cooing and baby noises while rubbing behind the spaniel’s ears. Daisy presses into her. Clearly, this dog makes friends wherever she goes.
I brief my team about Daisy’s cancer and Mrs. Johnson’s decision regarding treatment. After weighing the cocker, I calculate her drug dosages and give this information to my head oncology technician, Jackie. I need to decrease Daisy’s dose a bit, because some of her weight is due to love handles, rather than muscle mass. Just as in a human hospital, when dealing with chemotherapy, we have to calibrate cautiously for each patient. We also can’t risk exposing any employee to chemotherapy, especially when we use it on such a repeated basis.
Jackie makes further calculations, forever meticulous, then begins the process. As will be the case with each chemo treatment, each of us wears a blue chemo-safe gown (aka Smurf-style) over our scrubs, as well as chemo-safe gloves diligently placed over the cuffs of the gown to ensure a tight seal. We also wear safety goggles to protect the eyes and draw up the medication itself in a biologic safety cabinet (think a large, nerdy machine with a big HEPA filter and a fan that exhausts air out through the roof). Jackie puts her long, dark hair up in a ponytail, lest it get in the way of Daisy’s chemotherapy.
When I receive my own chemotherapy, I wear my yoga pants (which have never been to yoga) and a zip-up hoodie sweatshirt, not a blue gown like Daisy. I wonder what my doctor would think if I showed up to chemotherapy dressed as Elsa. I never see my treatment team drawing up the drugs, which is done in the hospital’s pharmacy. (It’s hard to believe they refer to my meds as a “cocktail.” “Waiter, any chance I can get a Cosmo instead?”) The two nurses on my case come to my hospital room with the chemo drugs, as well as syringes filled with medications to help limit any nausea or allergic reactions. They set these up on the metal stand right next to my bed. It seems like a lot of needles, which is a little intimidating, as is the fact that both nurses are sporting full safety gear. I feel insecure. I’ve been protecting myself from these scary medications for decades, and yet there I sit, fully exposed, the only one in the room not wearing protection. What’s worse, they inject or drip these medications into my vein for hours. Much of this seems to go against the safety precautions I’ve trained myself to practice. But here I am the patient, not the doctor.
We place Daisy on the treatment table lying down like a sphinx, her forepaws out in front of her. Cassidy gently holds the dog in place while another tech finds a vein on Daisy’s right front leg. This isn’t easy, with all of her thick, blond fur, but my work team is experienced, and they quickly get a butterfly catheter placed in the vein. Daisy is such a trusting, calm dog—she doesn’t even flinch. Cassidy’s blond locks rest on Daisy’s back as she holds the pet still. I suppose the old adage is correct—some people do look like their favorite dog breeds! Not sure what it says about me, but I like wrinkly, smush-faced dogs and cats.
Daisy receives her chemo through the access port, and within minutes, she’s done. She sits up, wagging her tail. She holds no grudges over what just happened. She accepts what has just transpired and is happy to go on with her day. She doesn’t look back or worry.
I, on the other hand, agonize about what side effects the chemotherapy has in store for me. I convince myself that if I know what the negative possibilities could be, I can will them away, before they happen. That’s a lot of power to presume I have over my outcome, I know. But I imagine I could rise to the occasion.
I bring Daisy back to the waiting room, where Mrs. Johnson and Kathy sit patiently.
“She looks good,” the pet parent exclaims. “Did she get her treatment already?”
“Yes, she did great,” I assure her. “But we’re going to send Daisy home with these two medications, just in case.” I hand her a bag with her dog’s name on it. “They’re to be used if she gets sick—we don’t want her to have any side effects. If she has diarrhea or seems nauseated at all, please start the medications right away. Her quality of life is the most important thing. Oh, also, we’ll call you tomorrow, to check up on her and see how she’s doing.”
“Okay, thank you so much,” Mrs. Johnson says warmly. We hug again. I can feel the woman’s shoulders drop, as if her entire body took a deep sigh.
“Can I help you to your car?” I offer. This mom needs a third arm.
“No, I’m good. Thank you, though,” she says, as she navigates Kathy’s wheelchair while holding on to Daisy’s leash, her X-rays, and the bag of medications.
* * *
The following day, I call Mrs. Johnson to ask how Daisy’s doing after her chemotherapy.
“She actually seems better than before. Is it possible she would have more energy after treatment?”
“You know, a lot of people ask that. Many dogs do seem to feel better on chemotherapy. I think we don’t realize that the cancer causes a pet to be quieter at home, competing with some of its energy. Some people chalk it up to arthritis or age, and then once their dog receives chemotherapy, they realize it was the cancer causing the lethargy. Either way, I’m so glad she’s feeling good.”
Mrs. Johnson pauses, then asks, “Why did Daisy get the cancer? Should I have done something differently?” I can hear the guilt in her voice. So many times, I am asked about the water a pet drinks, the food they eat, chemicals spread on the lawn. And the list goes on .
. .
“You didn’t cause Daisy’s cancer,” I begin. “Cancer in pets, just like in people, can happen for a multitude of reasons. Some cancers are more prevalent in certain breeds because they’re passed down genetically. Some cancers have a higher rate of occurrence for pets that live in households in which family members smoke. Some cancers can be caused from the sun. There is even one cancer in dogs that can be spread through sex! In cats, one-third of all those afflicted with feline leukemia virus (a poor name, because it’s not really leukemia at all), will eventually develop cancer from that virus.”
“So, I didn’t cause this to happen to Daisy?”
“Not at all. Lymphoma is often, though not always, genetically spread, and the genetics of it tend to go back many, many decades. Even so, animals have been getting cancer since the beginning of time. We have proof that even dinosaurs developed some malignant forms of cancer, such as bone cancer and leukemia. You take very good care of Daisy. You feed her a high-quality food and give her lots of love.”
“Well, she takes good care of us. Oh, and I forgot to ask, will she lose her fur?”
“No, she shouldn’t. Cats don’t lose their fur on chemotherapy, and the majority of dogs don’t either. It’s because Daisy’s fur is different from a person’s hair.”
“That’s interesting,” she said. “But we’d love her just the same if she were as bald as a cue ball.” And with that, we hung up.
A week goes by, and Daisy returns for her recheck appointment. Once again, Mrs. Johnson is accompanied by Kathy, seated in her wheelchair. I greet them both in the waiting room. Bending down next to Kathy, I ask her how her day is and how her dog is doing. If she was shy at the initial consultation for Daisy, today she is very eager to interact with me. I tell her how good Daisy looks in Elsa’s dress, and that she has good taste. It’s clear she understands what I’m saying, and she shows her delight with a beaming smile. I then look up at Mrs. Johnson, who asks how I am.
“I’m fine, thank you. More importantly, how’s Daisy?”
She gives me her own warm smile as she pushes back a strand of dark hair from her daughter’s face.
“If we didn’t know it, it’s as if nothing is wrong with her. Is that normal?”
“That’s how it’s supposed to be. I’m so glad! If it’s okay with you, I’m going to take Daisy to the back for some blood work, and then I’ll do a physical exam on her.”
“She’ll follow you anywhere as long as you have biscuits,” Mrs. Johnson says with a wink.
She hands me the dog’s leash, then I wave at Kathy, who throws me another smile that lights up the waiting room. Daisy trots alongside me, through the door and into the oncology treatment area.
I lower the exam table and the cocker hops on top. I raise the table while Daisy sits there calmly. Cassidy is eager to see her new friend. After my team draws her blood to check her white blood cell count, I feel under the dog’s neck. These lymph nodes are normal. I check her prescapular, or shoulder, lymph nodes. Normal as well. Both her axillary and groin lymph nodes are just fine. And her popliteal lymph nodes, the nodes behind her knee region, have gone back to normal size as well.
I suspect that the Johnsons could really use positive news, and I look forward to telling them Daisy’s results. After reviewing her blood work, I head back to the waiting room while my team treats the canine with her next chemotherapy drug. With a big smile on my face, I tell Mrs. Johnson the wonderful news, and a tear falls down her cheek. Kathy watches her mom quickly brush it away, and I give the woman another hug, a happy embrace. My technician brings Daisy up to us, and I remind the pet parent that we need to see the dog back in one week.
Mrs. Johnson diligently returns as scheduled, and each week the dog comes dressed as a Disney princess: Belle, Cinderella, Snow White. But just like Kathy, I think the best is Daisy as Elsa. Girlfriend looks good in blue. Many times, Mrs. Johnson brings Daisy in alone. Occasionally, Kathy will be at her side.
One day, on a routine chemotherapy visit, Mrs. Johnson arrives with a worried look on her face. In her wheelchair, Kathy seems unusually subdued. The mother tells my technician that she noticed some lumps on Daisy and thinks the cancer has returned. There is no princess dress on the dog, no radiant smile on Kathy’s face. My tech, Cassidy, is concerned as well, and brings the canine to the back for me to examine. With the cocker atop the exam table, I feel her lymph nodes—in her neck, in her shoulders, the axilla and groin regions, and behind her knees. I palpate them all a second time, wanting to be sure. They are all fine. Daisy continues to be in a remission. She does have two new soft tissue masses on the top of her back, but in no way are these related to her lymphoma.
“You’re such a good girl!’” Cassidy exclaims, happy for the good news. The technician then holds the dog still as I take samples from both masses with a needle and syringe. Under the microscope, it is evident that these are lipomas, or benign fatty cysts. As an older cocker spaniel, Daisy has numerous warts and sebaceous cysts on her body. While her blood work is being processed, I head to the waiting room to alleviate Mrs. Johnson’s fears.
“How is she, Doc?” she asks, rising quickly from her chair. Her blue eyes eagerly scan my face.
“Daisy’s just fine. Those lumps you noticed are benign lipomas. They have nothing to do with her cancer. She’ll likely get more of these fatty masses as she gets older. Just like the cysts she already has.”
I watch as relief sweeps over Mrs. Johnson’s face. I bend down and put my hand on top of Kathy’s leg. Kathy understands that the news is good. An ear-to-ear grin lights up her face.
“We say those are her old lady warts,” Mrs. Johnson says with a chuckle. “But we love her, warts and all. In our house, we’ve learned to celebrate all of our imperfections. And Daisy certainly has plenty to celebrate, doesn’t she, Kathy?”
She says this with a bit of a giggle, then gives me a hug of gratitude. I turn to go to the back to check on the cocker’s blood work and approve her chemotherapy dose.
Mrs. Johnson has given me something to think about. If only we all felt free enough to celebrate our imperfections, life might be a little less grim, a bit more joyful. I say that as my hair grows thinner on top of my head. I have officially set the steps in place for a w-i-g. I prefer not to say the word, but I want to be ahead of this concern, so I consider my options. I have also considered self-induced “house arrest,” just staying home until everything grows back. However, regrowth may take more time than I could stand to hide out. But there’s a confounding issue. I feel like a fake in a w-i-g, and I have never been fake. I can’t even do fake nails. Not even when Lee Press-On Nails were all the rage. I feel like a wig or a hat would be me hiding behind a costume. I want to be me, warts and all.
As another option, I heard something about a type of cooling cap that can be worn on a person’s head to try to save one’s follicles. I will investigate this further to see if it is a decent option for me. I know my hair obsession isn’t rational. If it were a girlfriend of mine or even sweet Daisy, I would not look at them any differently whether they had hair (or fur) or not. And I do know that my friends would feel the same about me. But I would feel as if everyone were feeling sorrow, or pity. Deep down, I don’t want to seem “different,” or simply without hair (can’t say the word “bald”), for Peter, my dear son. I am supposed to be strong for him. I don’t want him to feel bad or pity me. I guess I’ve chosen the right profession. A running joke among veterinarians is that our patients don’t care what we look like, what we’re wearing, or whether we’ve combed whatever hair we have or don’t have. Throw in a pass for not brushing your teeth, and this might be a good job for a middle school boy.
* * *
Five months pass, and thankfully Daisy continues to do well. Her warts grow a bit, but no one notices when she sports her princess outfit. Mrs. Johnson is a master at balancing her home responsibilities with bringing their cocker spaniel in for treatment. I am in awe at how she handles it with such a swe
et, peaceful outlook.
But one day, the Johnsons don’t show up for Daisy’s routine recheck chemo appointment. The receptionist calls the family in an attempt to reschedule, but she is limited to leaving a message on their voice mail. At first, I don’t think anything of it—everyone forgets things at some point. The following day, however, the Johnsons have not returned our call. Something is not right. Days go by and still there’s no word from the family. Despite a few more calls made on our end, I do not hear from Mrs. Johnson until a full two weeks have gone by.
“Line one, Mrs. Johnson with Daisy, line one,” blares over the intercom. I rush to the phone.
“Hi, how are you?” I ask in a hurried tone. There is a deep sigh on the other end of the receiver.
“We’ve had a bit of a doozy these couple of weeks,” Mrs. Johnson offers. “I’m so sorry that we missed Daisy’s appointment.”
“It’s no problem at all. Is everything okay? We’ve been concerned.”
“Kathy had a bit of a setback. It started with what we thought was a cold, but because she’s so sedentary, the infection quickly moved into her lungs. We’ve gone through this before,” the mother confides. “She couldn’t breathe. We ended up having to take her out of state by ambulance, on oxygen, to the children’s hospital that has helped her with other medical problems. Kathy was in the ICU for ten days.”
“I am so sorry. How is she now?” I ask cautiously.
“Oh, she’s better. We’re home. We still have to do nebulization treatments on her, but she’s better.” I can hear the exhaustion in Mrs. Johnson’s voice.
“I’m so glad she’s better. You’re an amazing mom and a very strong woman. Your family is fortunate to have you.” With that, I book Daisy an appointment for the next day and hang up.