The Patron Saint of Lost Dogs: A Novel (31 page)

Harry frowns, shakes his head. “Thanks, but I need to be here by her side.” A liver-spotted hand reaches for the top of Clint’s head. The way Clint leans into his familiar touch is subtle, but important in a way I wouldn’t have understood just a week ago.

“She won’t get up,” Amy says. “Won’t eat, won’t drink. I tried to help her to her feet, and she moaned in pain. You’ve got to be able to find what’s wrong with her.”

It could be criticism. It could be encouragement. I can’t read her blue eye or her brown eye so I turn to Harry for guidance.

“Take one last look for me, Doc. But if you can’t give me an answer, I’ll let her go. You with me?”

I nod, which I think is enough for Harry to know that I understand and respect his decision.

Amy puts her arm around her grandfather. He’s watching me and she’s watching him and I know I must ignore them and focus on a funny-looking female dog named after a movie star.

Clint’s stats are not good. Her pulse is quick and thready, she’s dehydrated, her temperature is 103.5°F. She’s depressed, reluctant to stand let alone walk, and there it is again, that wince, that moan, when I press down hard on her spine behind her shoulder blades. I revisit her X-rays on the viewing box, once more scrutinizing her spine, her chest.

Nothing.

“What do I know? I know that if I touch her in a specific location I elicit pain. What sort of pain? Well, what types of pain are there? Gnawing, throbbing, burning, stabbing, pressing, postoperative, colicky, muscle, and … referred. Referred.”

“You do know we can hear you talking to yourself.” Amy sounds genuinely concerned.

“Referred,” I repeat, ignoring her. “Referred pain occurs when a painful sensation is felt in a site other than the one where it is actually occurring.”

I go back to the X-ray. I stand back. I move close. I squint, tilt my head this way and that.

Maybe.

“I need to take another X-ray of Clint’s chest. Amy, can you give me a hand positioning her?”

Carefully, I carry Clint over to the machine, Harry shuffling along at her side, his hand never letting go of her fur. Amy grabs a couple of sandbags, purely to help stretch Clint’s front legs forward for her picture. I clear the room (though it’s a struggle to pry Harry off his dog, even for a few seconds), snap a shot, and process the image.

“There,” I say, pointing to a fuzzy, fluffy patch of whiteness, “that’s a little different from last time.”

“What is it?” asks Harry.

I’m already on it, pulling out drawers and opening cabinets in the X-ray room. I’m looking for something Bobby Cobb would keep in stock—cheap, practical, and often a remedy in its own right. The fifth chemical element in Group Two of the Periodic Table—barium. “We’re about to find out,” I say, showing off a gallon container half full of a viscous white liquid.

“What are you going to do with barium?” asks Amy, and I sense she’s worried where I’m going with this and thinking this is getting a little desperate. Maybe she’s chalking it up to the clinical ramblings of a doctor who can’t accept failure.

“I’d like to give Clint a small dose by mouth, let her swallow it down, and take another X-ray.”

Where it comes from I don’t know—determination, conviction, lack of viable alternatives—but I’m lucid and calm.

Amy takes her time, as though she’s reading more into my state of mind than considering what I’m suggesting.

“Grandpa?”

I like the way this is Harry’s decision. Harry nods, and I draw up ten milliliters of the liquid barium in a syringe, and that’s when another piece of my past catches up to me. I flash to a postmortem examination from my days as a pathology resident, to the lungs of a dog that accidentally inhaled barium and subsequently died of pneumonia.

“You okay?” asks Amy, tuning in to my reverie.

“Sure,” I say, positioning Clint so she’s sitting upright as I gently open the corner of her lip, creating a pouch near the back of her mouth in which to squirt my chalky medicine.

Barium tastes bitter, and Clint squirms and gags, zombie drool dripping from her lips, but most of it goes down the hatch. Amy and I set up for another X-ray, take the picture, and four minutes later I have the two latest images side by side for comparison, before barium and after barium.

I stand back, but I don’t need to deliberate and I don’t need to work my imagination. The answer is right there, in front of my eyes, and with it comes a bigger, far more cogent question, one that eclipses any thoughts of celebrating a diagnosis. It begs me to ask whether or not it was there all along, before Clint got so sick, before she began to suffer, before it was too late.

“Well?”

Did I underread the original films? Did I fail to take in the big picture? Is Clint another milestone in a life being defined by an endless series of mistakes?

“Dr. Mills?”

This time it’s Harry, and I want to tell him but I also want to be sure.

“Amy, you bring home a meal for Harry most nights, right?”

“What’s that got to do with … ?”

“Yes, she does,” says Harry.

“Bear with me a moment,” I plead. “And, Harry, you told me you ‘sometimes’ feed Clint table scraps, yes, though I think you meant to say ‘always,’ right?”

Harry nods, though he looks lost. I turn to Amy. “What do you bring him from the diner?”

“What ever’s on special.”

“And does that vary?”

“On a daily basis, sure, but it’s pretty much the same week to week.”

“So what was it today?”

“Spaghetti and meatballs.”

“And yesterday?”

“Chicken parmesan.”

“And the day before?”

“Lasagna.”

I gesture for her to keep going.

“Chicken marsala. Pork.”

Pork. “What sort of pork?”

“Pork chops. Why?”

I take a deep inhalation, but it’s one of pain, not relief. Taking a step closer to the X-rays, I tap what was once a white fluff y cloud, that now, stripped of its cloak of invisibility thanks to a thin layer of barium, has been unmasked as a half-chewed piece of bone.

“Clint has a piece of pork chop lodged at the bottom of her esophagus. It’s stuck just in front of the opening to her stomach. Maybe it’s mainly gristle or cartilage, because I don’t see it properly on the plain X-ray, but the barium doesn’t lie. That’s why she has pain behind her shoulders. That’s why she was having a hard time eating and drinking.”

Harry’s moving beyond the diagnosis, tuning in to the fact that I’m not pleased with what I’ve discovered. “Is this bad?”

“Potentially, yes.”

“Potentially?” snaps Amy. “What does
potentially
mean?”

Harry pats her arm, like he’s used to reining her in. I try to swallow. My mouth is dry gulch.

“If the bone or cartilage or whatever has been stuck in the same spot for the past few days, it could have caused pressure necrosis on the mucosa of the …” I stop myself and start over. “A rotting piece of wedged pork chop could have worn a hole in the esophagus, the tube from the mouth to the stomach, allowing saliva and ingested food and bacteria free access to the inside of Clint’s chest.”

Harry and Amy stare at the X-rays, as though they might discover the answer for themselves.

“Can you see a leak?” asks Amy.

“No, but it still might be there. We didn’t use enough barium to know for sure.”

“What can we do?” asks Harry, brushing past me to hug Clint around her neck, to put his face in hers, to whisper in her ear. I don’t want to eavesdrop but I can’t help but hear the strangled words “I’m so sorry. I’m so sorry.”

Amy and I glance at one another, powerless to stem Harry’s tears.

Not so long ago, I would have dismissed Harry’s connection to Clint as irrelevant to my diagnosis and superfluous to my cure. But here and now, embedded in this crisis, I can’t ignore the tremor in Harry’s grip and the insistent rhythm of Clint’s beating tail. If this is the end, then this must be a dog with no regrets, no wish for anything different in her life. And as these two best friends look into each other’s eyes, I am convinced that Harry and Clint know more about giving than most.

Is this what Lewis meant? Is this what I left behind? Empathy?

“You didn’t answer me,” says Harry, ignoring the tears and mucus and fur plastered across his face.

“What?”

“I asked about what we could do.”

“Right. Well, it’s not coming out through her mouth,” I say. “Way too risky trying to grab it and yank it backward. Something’s going to rip or tear. I can call around and try to find a surgeon who’s prepared to open her chest, take it out that way, but I’m guessing it will have to wait until tomorrow.”

“She won’t last until tomorrow. She’s ready to leave me. I can see it in her eyes.”

“Then, I’m sorry to say, there’s not much else I can do.”

Amy steps closer to me. “That’s it. You’re giving up.”

I look over at Harry. His eyes are pinched shut, but they’re still leaking tears. I lower my voice. “First do no harm, you know?”

Her heterochromic eyes come into some kind of focus on mine, penetrating and resolute. “ ‘Strong reasons make strong actions.’ ”

She pauses, maybe for effect. Truth is she didn’t need to say a word. What lies behind her stare says it all. It’s the push I need.

“Shakespeare?”

She nods. “
King John
.”

No time to comment on her impressive knowledge of the more obscure works of the Bard. “It might be possible to push the bone into the stomach.”

Her eyes narrow, chin tilting up and to the right.

“But it’ll still be stuck inside her,” she says. “How long before it gets hung up on another part of her guts?”

I shrug. “Stomach acid and digestive enzymes should be able to break it down. I’m more worried about what will happen if I try to make it move.”

“A tear?” Amy whispers.

I nod.

“Fatal?”

“If untreated, yes.”

She straightens up, looks over at Harry and Clint. “Give me a moment.”

I watch her go to Harry, fishing for tissues in her coat pocket, easing him away from his dog, enough to wipe down his raw cheeks and silver-stubbled chin. They talk quietly for a few minutes, fear and trust and pain and love bouncing back and forth between them until they embrace in a hug that has Harry crying again.

“We want you to try,” Amy says. She strokes a finger below her right eyelid, the brown one, before I can say for sure that a single tear got away from her.

I come over to Harry, and do something rash, something I would never ordinarily do. I reach out, place my hands on both his shoulders, and squeeze. When Lewis held me at my mother’s graveside, he couldn’t stop the pain, but what he could do was make a physical contact that let me know his intent to try. After what happened today, it’s dangerous for me to look too long into the old man’s milky blues, so I’m quick to pull back.

“I need something long enough to get down there.”

“What are we talking?” Amy asks.

I come around to the front of the table, touch the tip of Clint’s dry nose with one index finger and, like a tailor measuring for a suit, stretch my other index finger down to the back of her rib cage.

“Couple of feet. And I need something perfectly smooth, no rough edges, something round, tubular but not too big in diameter.”

“What about a length of garden hose?” Harry asks.

“Probably not stiff enough. I need something more rigid.”

“What about a broom handle?” Amy asks.

And for some reason, the cogs interdigitate, the wheels turn, and something inside my head falls into place. “Hang on a minute.” I disappear through the waiting room, the unused storage room, and go down to the basement. I need the roof rake, or should I say, I need one of the individual tubular aluminum segments that make up the roof rake.

Lewis has put it back where he found it. I grab a segment, a hacksaw hanging over the workbench ( just in case it’s too long) and yes, I glance over at that empty space where the collage of photos used to hang. It’s enough to imagine the only smile my father left behind, the one I get to keep, the one with his eyes half closed, the one that makes me think to ask,
what would you do, Dad?

I make a silent promise to hang it someplace where I can seek his advice on a regular basis. Force him to be there for the tough calls, the difficult cases. What would he make of Clint? I’ve got nothing, but for today I’m going to believe that he’d want me to have a go.

“I think this might work,” I say, handing a segment to Amy for her inspection. “Light, strong, nice diameter. Put some strips of white tape over the cut end and make sure there’s no sharp edges.”

I realize too late that I’ve given an order, as if I’m her boss and Amy’s a fully trained veterinary technician. I’m relieved when she goes along with it. “Harry, I need your help placing a catheter. Okay?”

Harry nods, and it strikes me that I should have done this sooner, started Clint on fluids, got Harry involved and distracted and doing something physical to help his best friend. It’s also better to be working with him and not Amy, so I don’t have to feel her scrutiny as my hands shake, blowing a vein in Clint’s right foreleg before I manage to get it in on the left.

“This do?”

Amy hands me the tube and I check her work, the way she’s cushioned the end that must coax the bone into Clint’s stomach. “Feels good. Here, hold this bag as high as you can and squeeze it as hard as you can.”

I pass her a liter bag of warm fluids that’s hooked up and running into Clint’s vein. I want to get it into Clint’s circulation as fast as possible. “Okay. She’s pretty out of it, but I’m sure she’s going to fight this tube going down. I’m going to give her a little something to keep her calm.”

I find the drawer containing the anesthetic agents—what little we have left—and pull out a small bottle of what looks like milk. I read the drug dosage information written on the label, guesstimate Clint’s weight, and draw up the appropriate volume in a syringe.

“What’s that?” asks Amy.

“Propofol.”

Nothing registers on Harry’s face, but Amy’s eyebrows are up like hackles. “Propofol. Isn’t that the stuff that killed Michael Jackson?”