Duke is dying.
But he’s dying a good death, best as I can tell. He eats well, and he’s perky, even happy. He wags his tail and wolfs down dinner.
But inside his body leukemia is choking out healthy red blood cells, pushing platelets out of production. According to the vet he might have six weeks left. It’s hard to tell, though. Her estimate was based on her few years as a student and oncology resident. She also figured a course of chemotherapy that would last 11 weeks.
My estimate, however, of a “good death” is based on experience with a very poor death, one that was lonely, painful, confused and sad. And, preventable. Paco, my dog before Duke, was gripped by a sudden illness that left his esophagus slack, unable to swallow. An inexperienced vet puzzled over him. I remember seeing her one day walking out of a church service, and she said she was going to go home and read her text books to see if she could find the answer. By the time she had an inkling, Paco was declining fast, and by the time I got him to Auburn University’s vet school, he had bacterial pneumonia. I had planned to bring him home to be put to sleep, but he died before I could.
I can’t say my experience with Duke’s vets was better than with Paco’s.
One Sunday afternoon Duke came up to me outside and his eyes were swollen; the right eye was completely shut, the left one was open a sliver, but this third eyelid, that milky-white membrane that looks like a Venetian blind that pulls up from the bottom, covered it. I instinctively yelled for my wife, a nurse of 25 years. Neither one of us knew what could have been wrong with Duke, but we knew it wasn’t good.
Monday, the vet said Duke’s eyes were too swollen to examine. She prescribed steroid drops and a follow-up in a few days.
Wednesday morning I showed up, hoping to get answers. A different vet would be in that day. I left Duke and took our daughter to pre-school. Later that day the second vet, the Wednesday vet, called. She still didn’t know what was wrong with Duke’s eyes, but she was more concerned that his blood counts were low. How low, I asked. Pretty low. How low is that? Around 18 percent. And what’s normal? Normally around 40.
This was the first sign that something was wrong not only with Duke, but with our experience with vets. The Wednesday vet was very experienced, skilled, knowledgeable and well liked by her customers. But she hemmed and hawed. Eighteen percent is pretty low. I said, he’s pretty sick. Yeah, well he’s not doing too good. And his gums are pale.
The Monday vet said nothing about pale gums or poor blood results, although she had drawn blood, and, the Wednesday vet assured me, his gums had looked fine on Monday.
The Wednesday vet said we should try to get Duke into the North Carolina State University vet school hospital, where they have “bigger brains” and more resources to know what’s wrong.
All this from swollen eyes. After reflecting on it a while I thought Duke got sand in his eye from lying in Ella’s sandbox. Trish thought he might have scratched his cornea among the tomato plants. Maybe it was a bee sting. But none of those instances were likely to result in both eyes being swollen. Now Duke had low blood — which, Wednesday vet and Trish explained meant that he wasn’t getting oxygen.
The NC State vet hospital was full — no room in the kennel for a very sick dog. They suggested I try a couple of private animal hospitals, staffed by intensivists. That sounded fine, but it also seemed expensive. NC State, I thought, would be more reasonably priced. And I like the concept of academic medicine. So I decided to wait. I was instructed to return to my primary vet the next morning for more blood work.
The Monday vet was back at work on Thursday. She drew more blood; his counts were still low. That morning he had bled a little, and had apparently shaken his head and splattered drops across the floor of Ella’s bathroom. I mentioned this off-handed to the vet. She called me later, sounding anxious, and told me they knew where Duke was bleeding, from his nose. Swollen eyes, bloody nose, low blood count. I couldn’t add it all up. But the vet could, and probably did, she just hadn’t told me yet.
I adopted Duke from a shelter a little over a year after Paco died, and about four months after my divorce from my first wife (how many marriages end after a pet dies?). I was writing a story for the newspaper about the kennel late one Friday afternoon, and decided to take a look at the pups. I thought the timing might be right. I was living alone, lonely, and needed something to do in my free time. About four or five columns of cages with lack-luster pups, here was one with a bright black-and-white coat, sparkling eyes and cockeyed ears — one down, one up, his very own flag. He was about six weeks old and had a thick coat of medium-length hair, and a curly fluffy tail, so he was listed as a border collie-huskey mix. His name was Falco. I have a friend whose last name is Falco, but at the time I thought it was the worst name for a dog I’d ever heard.
I decided to sleep on the decision. It was late Friday, and the shelter was closing. But by Saturday morning I had already scheduled the vet visit and was the first one through the shelter’s doors, there to claim my new pup. I read books about dog training, and I walked Duke three times a day. He was the model dog and a quick study. That first day home he went right to the door and pawed it, telling me he needed to go outside. He never needed housebreaking, he was training me!
Thursday’s vet still seemed puzzled. She assured me that Duke’s gums were not pale on Monday. Yet I wondered how long his blood levels had been low. They drew blood on Monday, did they test it then? No. So could she test it now? Sure, and a few minutes later came back to say his levels were already at 18 on Monday. His gums had to have been pale. I knew the vet was starting to feel guilty, and I didn’t press her. Finally she told me that his bloodwork and symptoms were pointing to a diagnosis of cancer. If I still wanted, she could make some calls and get me into the vet school.
It was 5 o’clock before I got Duke to the hospital, and by then the attending vets were leaving.
A vet called me back to an exam room so we could talk — I noticed we didn’t stop in the corridor as some of the other families had. She was joined by an oncologist and they spelled it out for me. Duke had leukemia. The oncologist explained the disease’s course, and my dog’s prognosis. She offered ultrasound, bone marrow aspiration, radiation therapy, eleven weeks of chemo … to extend his life by a few weeks at best. If he responded to the drugs. If the treatments didn’t kill him first.
The young vets seemed surprised, and a little disappointed, in my decision not to pursue chemo. The oncologist left, but when I pressed the internist about not wanting chemo, she left and returned with the young cancer specialist, who began by telling me she had become an oncologist so she could save animals. She was sure I wanted my dog to spend quality time with my family. She offered to give him one dose of a drug that would carry him through the night.