There’s a lot going on in this story. At the risk of confounding you more, I’ll dive in a little deeper. It’s now Aug. 25, a week after I wrote the first post about Duke.
First, an update. Duke still lacks the energy he used to have. He can trot out the door and across the street, but if he doesn’t get farther than a house or two away before he gives up and comes home, seeking the refuge of our air conditioning and the cool wood floors. But he’s been playful lately. Last night he lay on his back and wriggled with his feet in the air like he was wrestling and imaginary friend. Last week he patiently let Ella dress him in an old pair of her underpants and a t-shirt, necklaces and pink ribbons around his feet.
But I’m not finished with the vets. Our local vets were both evasive and defensive about Duke’s diagnosis. One wanted to assure me that she had examined him on Monday and didn’t see any problems, so this cancer came on quickly. But on Thursday, when I asked her to run his bloodwork (she still had a blood sample), it was clear that he was declining then. She either hadn’t examined him — hadn’t read his pale gums — or she completely missed what was obvious to the Wednesday vet. The Wednesday vet tried to sugar-coat a diagnosis. His blood count’s a little low, he’s a little sick, you need to take him to a critical care clinic where there are bigger brains. The Monday vet wasn’t much better. “One thing we start to think about is cancer.”
Please. It took the recent vet school graduates 10 minutes to tell me my dog has cancer.
Let me talk about those young doctors.
I wanted to go to the vet school. I knew they had more resources than anyone else in the area, including more brain power among the faculty. And, I thought they would be less expensive.
The internist came into the waiting room to get me and led me back to the exam room. She had kind, empathetic eyes. She explained what was happening with Duke and listened to my questions. She spoke calmly and quietly. I sat in a chair and she squatted on the floor against the wall opposite me and said we would be informal. A student trailed her into the room and sat on the floor. And, she brought the oncologist into the room, who explained a course of chemo that might extend his life. Media life expectancy — she patiently explained the word “median” — was nine weeks, and with chemo, an 11-week course, Duke might live 18 weeks. Together they explained what diagnostic procedures they could offer — bone marrow aspiration, ultrasound, CT, more blood work, careful observation in the ICU. They could perform radiation therapy in conjunction with the chemo. Then they left the room to let me think things over.
After 20 minutes or more I asked for the internist to come back into the room. Again, she was calm and listened, until I said that I did not want Duke to go through chemotherapy. I wanted him home, and I wanted him to die on our terms.
He demeanor changed from understanding to mild disbelief. She excused herself and returned a few minutes later with the oncologist, and when the two re-entered the room I felt double-teamed, like I was about to get the good-cop, bad-cop treatment. The room became a holding cell — bright lights, cold hard floor, stainless steel furniture, windowless. They were there to rescue me from my bad decisions, and my dog’s care would be better left to them.
The oncologist was in some ways the antithesis of the internist. The internist was in scrubs and sneakers, her hair in a pony tail. She looked like a doc who planned to be awake at 2 a.m. caring for patients. What she lacked in physical poise she made up for in apparent dedication.
The oncologist, however, was smartly dressed in black pants and the cuffs of her black turtle neck peeked out from the sleeves of her white coat –sure, it was August in North Carolina, but I thought she probably dressed to ward off the frigid AC. Maybe she was cold-natured. Before, when she ran through the rote response about leukemia, she stood erect, her head held back. Confident. That’s good. She was smart. This time, she came into the room and sat in the chair next to me, leaned back and put both hands on her knees. She started, “I became on oncologist because I wanted to offer …” I could tell she was preaching from her experience, but I stopped hearing her. You’re not an oncologist, I wanted to say. You’re a resident, an oncologist in training, and you’ve just crossed the line from healer to harper.