Monday, September 20, 2010
People who get it
I remember my veterinarian giving me the news over the phone while I was at work: Seamus had a form of cancer, "acanthamatous amelioblastoma," to be precise. I learned that it was a cancer that commonly affected older, large-breed dogs. He told me acanthamatous amelioblastoma is not really considered "cancer" as it doesn't metastasize to other parts of the body. Technically, it's not fatal as it won't shut down a major body part. But it likes to grow, and grow quickly. It grows up and out of the mouth, and down and into the bones and teeth. Some dogs that don't have treatment starve to death.
Treatment usually means surgery; removing the tumor itself, along with the bone directly beneath the tumor. They called this a "mandibulectomy." They don't put in a pin or plate to replace the bone, as the dogs tend to bite with an immense force and pop plates before they have been in very long. They told me a surgery like this could be considered a cure, but that it would be expensive, and I should see a specialist. It was implied that I could choose to euthanize him instead.
How could I even contemplate the idea of losing him? Seamus was young, only two years old. It didn’t seem fair that I should have do deal with something so serious in a puppy. And I had big plans for him. I had gotten this dog after a devastating breakup with a long-term boyfriend. Faced with a gaping hole in my life, I filled it with a small, willful, squiggling puppy. I no longer had to worry about how to fill up the long, boyfriend-free weekends, because Seamus needed walks, trips to the store to pick up toys, visits to the veterinarian, play dates at the dog park. Vacations were planned based on places he liked to go. I filled photo frames and albums with his image. No, euthanasia was not an option.
So I drove my little Boston terrier to the surgeon. After reviewing the X-rays, he told me that he would need to take just a little bone from his jaw in order to cure him. Just a sliver. I remember thinking of almonds, something translucent and thin. I left him overnight, for surgery and recovery.
The next morning, they brought him to me. On the operating table, the little sliver had become an entire almond. He'd lost about a ½ inch of jaw, all of his lower front 6 teeth and some gums. He had a lot of swelling, not surprisingly, and looked a lot like my grandmother did whenever she forgot to put in her false teeth: red, swollen, defenseless.
In the early weeks, I watched him shiver and shake from the pain. I held him as he screamed after bouncing the edge of his broken jaw on his food bowl. I cleaned the blood from his face and neck as best I could.
We became a very unified team. I fought to get him more effective pain medication. As he improved, I put pieces of kibble on the floor and tried to teach him to tip his head to the side to pick it up. When that proved too difficult for him to learn, I started cooking his food for him, choosing soft foods like canned pumpkin and cottage cheese and peas. Sometimes, I fed him his food with my hands.
As he healed, the skin around his missing bone tightened and firmed. He ended up with an expression of endless mirth – tongue hanging out of his head, eyes wide, head held at an angle. Oftentimes, other dogs interpreted this expression as one of aggression. As we went on our walks, we were often met with other dogs growling and thrashing on the ends of their leashes, ready to fight this toothless wonder. I bought a harness with a handle on the back, and I learned to pick him up whenever we saw another dog nearby. Eventually, he learned to run and jump into my arms if he saw the other dog before I did.
No one knew that I was working as an ad-hoc occupational therapist for Seamus. I took no photos. I told no one of the work we had been doing or the progress we had made, even though I was immensely proud of my little fighter. I figured no one would understand exactly why I would put my dog through a disfiguring surgery and recovery, especially since I didn’t quite understand it myself.
I found I was more and more comfortable in the veterinarian's office than at work. In the lobby of the vet’s office, I would find myself surrounded by people who were facing these life-and-death choices for their pets, and we formed a community of sorts. We asked one another for updates. “What are you here for?” “Is he better today?” “What are you going to do?” It didn't seem crazy to see people knitting sweaters for their dogs while they waited. Nor did it seem odd to sit next to people who had photos of their dogs embroidered on their jackets. Their dogs were the center of their lives, too. These were the people who drive for 2 hours on a Saturday morning to go to a Boston terrier meetup; people who had bumper stickers on their cars that said, "My Border Collie is smarter than your honor student."
There are lots of Americans who feel this way. Some 95 percent of pet owners bought their animals Christmas presents, according to one study done by Pet Smart. About 67 percent of those owners even admit to wrapping those presents. The American Pet Products Manufacturers Association found that three-quarters of dog owners consider their pets members of the family. Even George W. Bush admitted, on Dateline, that he kisses his dog on the lips. While I didn’t necessarily want to meet the former president, I did want to surround myself with other like-minded, animal-obsessed people. Bumping into them at the vet’s office just didn’t seem like enough. I was looking for a community, both for myself and for Seamus. So I quit my job and started working for veterinarians full-time. Seamus's veterinary care was paid for as part of my benefits (so I saved a lot) and was surrounded by People Who Got It.
Seamus came to work with me nearly every day. We had a large, enclosed reception area that tended to remind people of a bull pen or a boxing ring, and he would cuddle on his bed and sleep through my shift. When people were deciding what to do with their pets, they would look at him and his prominent tongue, hanging out of that broken mouth, and then they would look back at me, either with recognition or with horror (or sometimes both). Some clients recognized that I was one of them. One gave me a book of poems to read to her dog during the day. One gave me a tape-recorder loaded with lullabies to play to her dog. Another gave me printed prayer cards to put in her dog's kennel. I did all of these things, of course. Even though it may not have helped the dog, it helped the people deal with this situation -- to feel like they were contributing and part of the team. Looking at Seamus, they knew that I would understand.
Not everyone I met felt this way, of course. Some people who had animals with minor injuries that theoretically could have been saved with treatments, such as bad abscesses, diabetes, or minor leg fractures, simply chose euthanasia right off the bat. I never did try to persuade them otherwise. After awhile, I even stopped trying to connect and empathize. I held Seamus on my lap, as my visible reminder of what camp I was in, and I said nothing. And if I felt particularly puckish, I'd bring him in the exam room with me when I brought the owners the forms to fill out before the doctor would perform the euthanasia. I tried to train him to carry the forms in his mouth, but he never did quite pick it up.
Seamus had always been very attached to me, very needy, and I saw him start to change, grow and blossom. He began trusting people again. Some clients asked to sit with Seamus in the lobby, while they were waiting for their animals to come out of surgery. He was always grateful for the added attention, and showered them with drool and black and white hairs before settling down in their laps, falling asleep, and deafening them with his snores.
The clinic tended to be on the chilly side, which made Seamus uncomfortable. Bostons have extremely short coats to begin with, and his open mouth made it harder for him to regulate his own temperature. Co-workers started bringing him blankets, fresh from the clinic’s dryer, for him to cuddle up in.
Regular clients discovered that Seamus would sit in rapt attention at the slightest suggestion of food. He would sit stone still, right in front of the person with food, and drool would drip from his tongue in puddles on the floor. Long-time clients brought cookies and cheese in their jacket pockets, just for him.
We went to a local dog-friendly bar on Monday nights, and he started to command a hero's welcome. The regulars would set up a wooden high-chair for him to sit in, so he could see what we were doing (and cadge food, if possible). Dogs who chose to pick on him were quickly removed from the area, and owners were told not to come back.
It was incredibly rewarding for me to see him grow his own fan club. He was branching out and connecting with people, separate from me. I think all the added attention is what kept him healthy, as he knew he was protected and adored. And I found I could let go of some of the overwhelming responsibility I felt for his health and well-being, as I finally had the community and support I had been looking for.
At age 7, Seamus started to slow down a little. Walks were shorter, and he needed more breaks. I would sit on the curb and watch the cars go by while he rested in the grass. At home, he tended to curl in his blanket and sleep most of the time. At first, I figured these were normal age-related changes. But then we were hit with more severe symptoms. He started stumbling and falling. He had nightmares and would scream, unable to awaken. He would follow me into the bathroom, and then be unable to find his way out.
His blood panels were normal on all counts. But he couldn’t stay awake for the physical exam. The veterinarian gently told me that this time we were likely dealing with a brain tumor: This would account for the poor gait and the personality changes and dreams, as well as the loss of energy. I’ll never really know for sure. Definitively diagnosing a brain tumor means sedated and expensive tests (such as an MRI), and I felt like Seamus had been through enough at this point. I declined further testing and took the sleeping dog home.
While I never told anyone of my decision, his fans knew something had gone terribly wrong. His buddies at the bar started bringing him homemade cookies that were soft and aromatic, hoping he would eat them. Clients at work gave him tearful goodbyes after their visits, as they knew he wouldn't be staying.
One evening in March, I came home and found Seamus in his bed, shaking and crying and covered with drool. He didn’t seem to be able to walk. So I picked him up, bed and all, and took him to the office one last time. He was silent and shivering in the car, but when we got to the clinic, he seemed happy to be there, looking around and widening his eyes. I was in tears, of course, as was our doctor. He licked all of us in our faces, in turn. I think he wanted us to know that he was ready to go.
I stroked and petted him as they gave him the injection that ended his life. I told him he was a good, good boy. At the very last moment, he put his muzzle right by my ear and exhaled, and gave me one last lick on the cheek. I often wonder what that meant, what he was trying to tell me, other than simply "Goodbye and I love you."
I had known, of course, that his death was coming. I had been waiting for this day since the first cancer diagnosis call came through. But I credit his 7-year survival, and my relative mental health, to the fact that we didn't go through this journey alone. I had friends. He had friends. Sometimes they were the same people. Sometimes they were not. We spread the burdens and joys of his illness, his recovery, his life and his death among many, which made all of it more sweet and sad by turns, but always more bearable. I wouldn't change a thing.