Ever by My Side (27 page)

When the time came, Ms. Saunders’s entire class went along to witness Lucy’s release into the wild, feeling joy with a hint of sadness as the cage door opened and she bolted for freedom, sprinting into the scrub, fluid, powerful, and perfectly balanced. A year or so later, a client of mine claimed to have spotted Lucy through a pair of binoculars, disappearing behind a saguaro with a litter of kittens in tow.

There was nothing remarkable about what I did; I put my hands
in the right place and surgical training did the rest. For me, what was remarkable about this case was the creature’s uncanny determination to survive, which served as a reminder of something I was in danger of forgetting. My efforts with Lucy were never about my ability to guarantee a positive result, rather, they were about being open to the possibility of trying to achieve one. To be open to hope.

For a while, misguided vanity made me think I could go back to school, study to become an MD, enroll in an internship and residency and, in under a decade, know enough about my daughter’s disease to start making a clinical impact on her life. Alternatively, I could try to rekindle my science background, get a master’s, then a PhD and make my attack at the level of clinical research. What was wrong with me? Emily didn’t need a dad who spent his time becoming a pediatrician or a mad scientist, she needed a dad who would spend his time being her dad.

Maybe it all comes back to them and us, veterinarians and “real” doctors, pets and humans, because on some level I could feel esteem for my vocation slipping away from me. I had begun to devalue my profession. Driven by the fear of losing a priceless and irreplaceable child I questioned the comparative merits and worth of an animal. Of course it’s sad and painful to lose a loyal dog or a beloved cat, but come on, it’s only a pet, it’s not a child, not a genetic part of you. How could I get emotionally invested in my cases when they felt so inconsequential compared to my investment in my daughter?

Thankfully a golden retriever called Gracie decided to set me straight.

Gracie trotted into my examination room, working the retriever
bounce, doing that trick of carrying her own leash, showing off as though she was quite capable of walking herself.

“What’s with goldens in America,” I said to her “lady in waiting,” “taking themselves for a walk? I don’t remember noticing it in England.”

Ms. Carey laughed and introduced herself. It turned out she was the single mother of two high school students, a boy and a girl, working full time as a nurse to put food on the table and a roof over their heads. She wore colorful scrubs, presumably on her way to or from the hospital, had a tight frizzy perm, and exuded that upbeat no-nonsense attitude of so many health-care professionals who work in the trenches. But something told me she was toiling a little too hard to maintain her smile. Maybe, on some level, I sensed a kindred spirit, because I thought I recognized a familiar long shadow lurking behind eyes determined to remain bright and shiny.

“Gracie’s not really my dog. She belongs to Danny, my son, my eldest. He wasn’t able to be here today.” She waited a beat before adding, “but he would have been if he could. The two of them are inseparable.”

There are a hundred and one reasons why a teenage boy might not be able to attend a veterinary appointment for his dog, so I thought no more about it.

“Gracie got out of the house about two weeks ago, ran across the street, and got hit by a car. Oh, it wasn’t a big deal,” she said, as if she could make it better by hurrying her way through the details, “the car just clipped her. Gracie stumbled forward, hitting her chin on the pavement, and I’m no doctor but I know if a leg is broken or not and she seemed fine. I cleaned up the road rash on her chin and, okay, she seemed a little quieter than usual, but otherwise none the worse for wear. Then, a few days ago, I noticed she was having a hard
time breathing, so I took her to my regular vet and he took an X-ray of her chest.”

She handed over a film that showed a large distended loop of bowel where her lungs should have been. Poor Gracie had a hernia in her diaphragm. As a result of the trauma, the muscular wall separating her chest cavity from her abdominal cavity had torn, creating a sizable rent. With her guts in the wrong compartment her lungs were unable to fully expand, making it difficult to breathe.

I knelt down to introduce myself properly, hesitating for a split second, as my recollection of golden retrievers in England brought to mind a certain lion-hearted example of the breed. Fortunately, there was no chance of a Mr. Hyde transformation with Gracie. She had her flirty routine all ready to go—work the muzzle under the free hand, beat the veterinarian to death with the tail, roll over and flash the belly, defying him not to offer a scratch. Sometimes I wonder how I might feel as the owner of such a dog: proud of her trusting, friendly demeanor, troubled by the ease with which she betrayed me for anyone who showed her affection.

“Hope you have a decent alarm system at home. If someone broke into your house Gracie might love them to death.”

Nurse Carey smiled, but it never connected with her eyes, her mind was elsewhere.

“They said she’s got a diaphragmatic hernia, that she needs surgery.”

“They’re right,” I said. “When the X-rays were taken some of her intestines were trapped in her chest. Has she had any problems eating or drinking?”

“Not really. But she did throw up the other morning. Is that what made her sick?”

“It could be,” I said. “Either way, I need to get everything back in its proper place and close up the opening in the diaphragm. She
might be with us for a day or two but then she gets to go home and recuperate with Danny.”

The willful effort to curl up the edges of her lips began to intensify, as though my reply had sliced through the invisible strings that were keeping the smile in place.

“Here’s the thing,” she said, “Danny’s in the hospital himself. Has been for some time now.” The smile had essentially vanished and I could feel the pain coming off her, shimmering like desert heat. “He’s recovering from a serious head injury.” She let the statement hang there for a second, not for effect but because saying it out loud to a stranger had been an effort, an uncomfortable acknowledgment of the severity of her son’s situation. “He was …” and I lost her for a second. “God, you’d think I’d be over this by now, I’m sorry.” She took a deep breath, extended her hand to pat me on the arm, confirming her apology, and set off again. “He was with his buddies, riding in the back of a pickup. Don’t ask me what he was thinking. Well, he obviously wasn’t thinking, was he? First sharp corner, out he goes, landing on his head.”

A hint of anger flashed behind her eyes, fueled by her son’s stupidity.

“But I swear, he’s coming back, slowly, every day, a little bit at a time. Dr. Trout, what you have to understand is how important Gracie is to his recovery. Danny can’t really speak, no more than a few words, but he can see and he can touch and every time this dog pays him a visit he lights up, as though he remembers, like I get a little glimpse of the boy who used to be my son.”

And like that, she had me, tears welling up in my eyes with the empathy that comes from witnessing the pain of another vulnerable parent. Even for a child with perfect health, the future will always be fraught with uncertainty. The only thing we can control is the attitude with which we embrace this future.

“I wanted you to know what Gracie means to my son so you’ll take extra special care of her. Promise me you will.”

And I did, without hesitation, taking comfort in my previous surgical experience dealing with the problem at hand. Her confession prompted me to open up a little about Emily. Like her, I was awkward, my feelings new and difficult to articulate, but she got it in the same way I got her.

“Believe me,” she said, “I’m not trying to put you under too much pressure. I just thought it might help, knowing where I’m coming from.”

I assured her it was all good, that I completely understood and I was all in. Only later would I berate myself for forgetting one of the cardinal rules from my surgical training—the more emotionally invested you become in a case, the more problematic it is destined to become.

Gracie’s hernia repair went well. The challenge lay with the lazy loop of bowel that had become pinched off. Its blood supply had been compromised, an extensive length of the intestinal tract left purple and lifeless. It needed to be cut out and the two fresh, healthy ends sewed back together to restore normal continuity. Not a problem until a few days after the surgery when Gracie spiked a fever.

I placed an urgent phone call to Nurse Carey.

“Her temperature’s one hundred four point five Fahrenheit and she’s got free bacteria in her abdominal cavity.”

She didn’t need an explanation. She understood that Gracie’s intestinal surgery had to be leaking, spilling bacteria-laden fecal contents into her abdomen. A raging peritonitis was a given. Getting her guts to heal in the face of overwhelming infection and contamination was going to be a major uphill battle.

“Do what you need to do,” she said, her tone surprisingly calm, as though nothing could be simpler. Why wasn’t she furious, cursing
my incompetence? Why wasn’t she reiterating the essence of my mission—save the dog to save the boy?

Humbled but determined, I took poor Gracie back to surgery, going with a simple plan—unzip the previous midline incision, find the leak, repair the leak, clean up, and get out. But when I looked around the abdominal cavity I discovered fine particles of partially digested food liberally sprinkled over every organ like seasoning. Imagine your dinner guest tells you she is highly allergic to pepper and you have to go back and remove every last grain from every steak waiting its turn on the barbecue. You might as well invite her to uncap the needle on her EpiPen syringe because the chances of you getting every ground and dusting of the condiment are slim to none. The same held true for Gracie. I could do a decent job, but even if I removed every obvious piece of contamination those invisible bacteria would still be lurking in their gazillions.

“The surgery went well and the leak’s fixed but I had to leave Gracie’s abdomen open.”

Sometimes, working with a nurse can make life a whole lot easier. An “open abdomen” meant that I had not stitched up Gracie’s belly, at least not to the extent of making a tight, permanent seal. I needed to let the “bad vapors” out because I couldn’t risk locking all the residual bacteria inside, so I had loosely whipped the walls of her abdomen together. This afforded her some natural, gravitational drainage into a meticulously applied sterile bandage wrapping its way around her entire abdomen, a bandage that helped hold her guts and every other abdominal organ in place. It would have to be changed at least twice a day. There was a significant risk that more bacteria might get in than got out, but given the amount of homespun pollution I had witnessed I felt as though I had no choice.

Ms. Carey instantly grasped the gravity of Gracie’s situation, the touch-and-go nature of her dilemma, but she also understood
that I would not have gotten into this situation through carelessness or negligence or hasty judgment. She let me know that she lived the uncertainty of modern medicine every day. She made sure I felt her trust. In short, she was the one reaching out to me, doling out the reassurances. Relieved and grateful, I shared my unwavering commitment to do the only thing I could guarantee—my best.

It is nothing short of amazing what animals will tolerate in the name of veterinary health care, all the unnatural interventions we impose on them. Having had my appendix out I know what it’s like to have your belly cut open, but if I were left with some halfhearted attempt at closure, stitches like loose shoelaces, wondering if I were going to spill my guts every time I coughed or sneezed, I’d be inviting my surgeon to get himself a good lawyer! But here was a dog who greeted me twice a day for her bandage change as though I were a long-lost relative flying across an ocean from afar, and she was there amid the smiling throngs, waiting for the moment I burst through the arrival doors after clearing customs. Ironically it was her desire to please that created one of the biggest challenges to her recovery, her feathery tail wagging into the sterile surgical site, her proclivity for rolling on her back in need of a belly rub when I needed her to stand still. We place so many strange demands on our patients, make them endure interventions that would be so much easier to deal with if we could communicate our intent. Remarkably, despite these drawbacks, our patients are largely cooperative. Gracie certainly was, and after one more minor surgery I am happy to report she healed like a champ.

In the end Ms. Carey and I never had a specific conversation in which she told me her secret for moving forward with her life. She didn’t need to. It was written all over her, woven into her body language, her attitude, intrinsic to the way I perceived her. She made me understand that she had no choice in the matter, that drowning
under the weight of grief and pain helped nobody, certainly not the person who needed her help the most. What was the point of believing her son would never get better at this stage of his recovery? What kind of future can you possibly offer your child if you are constantly saying goodbye?