Musings

So today I’m feeling a bit sad and reflective. I have to do something I am NOT looking forward to for a number of reasons. But it does give me the opportunity to look back and realize that I am reaching a milestone in my career as a “Family Practitioner” Veterinarian. It’s almost as if my career is reaching real maturity.

Eleven years ago I graduated from Vet school, feeling proud, hopeful, excited, and yes, even a little relieved that I’d managed to get through it. I had an incredible stroke of luck and found an amazing family in a small town who took me and the Hubs in as one of their own immediately. They were looking for an associate Veterinarian for their small-town practice. The practice and the family hiring were such a perfect fit we flew back to VBB College Town, loaded up our meager possessions into a Ryder truck and drove across the country on the biggest adventure of our lives.

I was getting settled into being a Vet quite nicely the day about 10 years ago when I met the Andersons. They are a great couple, about my age. Joe is probably the biggest guy I’ve ever met….the size of a redwood practically. But he’s gentle, quiet, reserved, and when he speaks he has something to say. His questions are probing and thoughtful. He listens carefully to my answer, mulls it over, and GETS it. Rita is sweet and caring, the family worrier, but also keenly intelligent. She’s funny and friendly and dramatic at times (in a good way). I love to see them on my schedule; it makes my day knowing I get to see them.

That first appointment was to see the new addition to the couples’ lives, Ike and Ivan. They were brothers, Labrador mixes- with what, who knows? But they both have pensive, wrinkly, adorable hound dog faces and long, droopy ears. At the time they were about 6-7 weeks old, and there was NO predicting they’d each top 100 pounds when fully-grown. They were each small enough to fit in one hand! Ike was nearly white-blonde, and Ivan black with white on his feet. New puppies have always been my favorite type of appointment. I take my time- nearly an hour usually to meet the family and puppy, do a physical exam, and talk about all the things it takes to raise a healthy, happy, social, well-behaved family member. Our puppies visit every week or two as they grow up so we can love on them and bond- I’d say 95% of my canine patients drag their owners into the clinic from the parking lot. Ike and Ivan are no exception. Ivan has always been a bit more shy than his brother…he comes in, hides a bit behind Mom, and peeks around her legs.  Ike is the brave one….in my face schnuffling on me the moment I enter the room. Then Ivan sidles up and says hi while he thinks my attention is on Ike. Funny boys. They ALWAYS visit together, even if only one of them needs to see me.

Over the years, I’ve seen the brothers welcome two baby boys into the family (the two-legged kind). Brendan is the baby- a bit young for me to really get to know yet, but Joey is about 7-8 years old now. He’s a perfect mix of his parents. He’s friendly and funny like Rita, and he asks great questions and listens like Joe. He’s got a round cherub face and a mass of mahogany colored curls. I think he’d be a great Vet. One time he brought in a plastic dinosaur (he was about 5) and explained to me some medical problem it had and his treatment plan for it. I don't usually enjoy kids…..THIS is a kid I LIKE. I could hang out with him and have fun.

Ivan and Ike are like all dogs with the best families- medical disasters! I don’t think there is a problem common to labs that at least ONE of them hasn’t had in the last 10 years. They’ve both been to see specialists multiple times. Ivan has had both knees re-built. Ike once ate an ENTIRE tin of popcorn on Christmas Eve morning (you know, those HUGE tins with the Christmas scenes on the outside and three flavors of popcorn inside?) I usually see appointments until noon on December 24th, but somehow I’d gotten REALLY lucky and nobody needed to come in. I was planning to stay home, but I got a call from the office- Rita had called in a panic, thinking Ike would rupture his gut from the popcorn! I went in to examine him, he was stable, happy, tail wagging, face grinning, belly HUGE! He belched NOT so softly as I palpated his belly…..he felt like a plastic trash bag STUFFED full of popcorn! Rita felt so bad about calling me in on Christmas Eve she brought coffee AND Starbuck’s gift cards.

Ivan and Ike survived the popcorn and various similar disasters over the past decade…and there was NEVER any question from Joe & Rita that they were going to choose the best recommended tests and treatment every time. But they are also 10 year old BIG dogs. They’ve really started to show their age the past couple of years.

Ivan has always had some lameness issues from his bad knees, but then Ike started having trouble with arthritis in one of his shoulders. We’ve tried a number of therapies, all of which are either ineffective or they make him ill. He can barely get up and down the stairs now, and the loss of the muscle tone of that leg is obvious from yards away. He simply can’t use the leg any more.

Then about a week and a half ago Ivan was on my appointment schedule. He wasn’t eating, seemed really lethargic. Rita brought in Ivan (Ike waiting in the truck this time) and Joey. As I bent over to say hello to Ivan my heart sank. I stroked him under the chin, only to find the lymph nodes there were the size of large eggs. Moving down along his neck I found more enlarged lymph nodes in front of his shoulderblades, and again in his calf muscles in his rear legs. “Rita,” I said…”You guys fish a lot, right? Could he have possibly eaten any raw salmon or trout?” (I knew the answer was no…Joe and Rita have learned over the years NOT to let the dogs have anything out of the ordinary because Ike has a particularly sensitive stomach). She confirmed that, though they’d been fishing, there was no way the dogs had eaten any fish… Damn. Not salmon poisoning.

I looked up at her, "All his lymph nodes are enlarged. This worries me. I am NOT happy to find this.” I could see her start to mist. She’d known. She sent Joey out of the room to sit in the lobby. He protested- he’s always well-behaved and has NEVER had to leave the room before. But she asked him again quietly, and he nodded, and left the room. I think he knew, too…even at 8. I told her my fear was that this was lymphoma. I needed to take some samples to send to the lab to confirm it…then we talked about cancer. If I HAD to pick a kind of cancer for my dog, it would probably be lymphoma- chemotherapy protocols these days can do amazing things…remission is common and many times you can get good quality of life for years. Then she dropped the bombshell. She asked if it would be wrong, and could I do it if she asked, to put the boys to sleep together. Ike hasn’t been doing well, and now Ivan is really uncomfortable and not eating. They’ve NEVER been apart. There was crying. And talking. Lots of talking. We decided to wait for lab results, then we’d take it from there.

Unfortunately (as I’m sure all the DVM readers have already guessed) the lab confirmed small cell lymphosarcoma. Ivan did ok during the weekend while we awaited the results, but his appetite was down again Monday. I spoke with Joe and Rita probably four or five times on the phone last week…deciding whether to go see the internist for a consultation, then deciding whether to give prednisone a try, then deciding when it’s time….

It’s time. Today. This afternoon. Ivan is not doing well- won’t eat, won’t play. Ike is plugging along but in constant pain from his shoulder. I imagine the whole family will be there. There will be tears. There will be hugs. They want the boys cremated together, their ashes mingled in a single container. It will be hard. But I will do it, because I love them and they are my friends and I have the privilege of sparing them from a horrible end. So is the life of a family Vet.

There’s a poem called “The Rainbow Bridge” we send to clients at the loss of a pet. It’s quite lovely, a nice sentiment….Heaven for animals, essentially. I’m glad it gives people solace. At times I wish I could believe in those things. But I am a naturalist, realist, scientist, atheist. I believe that the end is, well…the end. Now, before you go feeling all sorry for me, or disappointed, take a moment to think about what that can mean:

We have this life, and ONLY this life. Enjoy it. Make the world better for yourself and the others around you. Heaven is not some mystical reward to be given to you in the afterlife. It’s an ideal, a dream, a goal. It’s something we all need to work together to MAKE for OURSELVES. Love well, love deeply, love many. Find humor. Find beauty. Find joy. SHARE it. Share your defeats and tragedies as well, for without sorrow there is no joy, and pain shared is pain halved. Smile, laugh, cry, dance. Live.