And Death Shall Have No Dominion

“Though lovers be lost, love shall not;

And death shall have no dominion.”

Dylan Thomas, 1933

The Pasatiempo magazine comes every Friday with the local newspaper’s end of the week edition—the New Mexican’s “Weekly Magazine of Arts, Entertainment and Culture.”  Needless to say, with two yearling giant sized puppies hell bent on destroying my house, I don’t get out much.  But I do like to browse the magazine.  What caught my attention today was not the local events profiled inside, but rather the advertisement on the back cover:  “An Open Letter to the Citizens of New Mexico.”  The full page ad detailed a place called Orion’s Peace Camp and Learning Center.  As it turns out, Orion Strong was a boy who attended the Peace Camp in 2005 as a seven year old.  In 2013, at his eighth grade graduation, Orion received an award presented to the student who best exemplified the concept of selfless service and for his commitment to being drug and alcohol free.  On November 10th, 2014, the ad stated that “Orion earned his angel wings after a 17 month battle with leukemia. Before he transitioned, Orion asked those who want to honor and remember him to do something to uplift the community.”  Earned his angel wings?  Transitioned?  Why can’t we just say “He died.”?   Because, as the poet Rilke said, “Der Tod ist gross.”   Death is huge.  And when it happens to a child, it is unthinkable and unmentionable.

Tuesday, October 25th would have been my nephew’s 21st birthday.  He died on August 30th while away at college, about to begin his junior year.   He was articulate, intelligent, handsome and beloved by his classmates.  To celebrate his birthday, his friends and peers gathered at a harvested wheat field near the college in eastern Washington state.  In the photographs, the wheat chaff is yellowed and lifeless against the ground and there is a roiling gray sky.  There is a storm coming—one can feel it.  His friends hold balloons, each emblazoned with a message for their lost friend. The barometric pressure rises, creating an intense feeling of suffocation. And then the balloons are gone, risen to the ether while his friends remain behind to grieve.  There is a strange light in the horizon.  It is dusk, but it seems like dawn.  And death shall have no dominion.

I am sure that two years later, Orion Strong’s family is still grieving.  And I am certain that we will be grieving the death of my nephew in every year to come as summer gives way to fall, as the leaves turn blazing colors and the nights grow cold.  There is no making lemonade out of lemons when it comes to the death of a child, a brother, a grandchild, a nephew.  We each have to do what we can—my sister will establish a scholarship in her son’s name at his college; I will go back to work to fight cancer and I will make a donation to Orion’s Peace Camp.  And I hope that my nephew’s friends and classmates will remember him and seek help if they are struggling, and lend a hand to their peers that need guidance, and that each and every one of us will resolve to be a little kinder and a little more understanding.  Death is real; death is huge, death is not a euphemism.  But let us all strive so that in the end, no matter how or when it comes: “Death shall have no dominion.”

Do Dogs Know They are Dying?

Labor Day, 2006, is a day I will never forget.  It was a gorgeous day here in San Diego—bright, sunny and nearly 90 degrees.  I decided it was a perfect day to give the dogs an outdoor bath.  At the time, we had Valentine, the matriarch at nearly twelve years old, Izzy who was four, and the two young  ones Magic and Angelina who were two years old.  We started with Valentine—at her age she’d had a little problem with urinary incontinence, and she needed her bath the most.  We knew that the coiled up hose sitting in the sun on that hot afternoon had enough warm water to bathe her in, so my daughter and I mixed shampoo in a bucket of hot water from the kitchen sink, and just outside the garage, we soaped her up.  She seemed to be enjoying herself, a nice soapy massage on a beautiful day, and then a quick rinse.  As I turned to get the towel to dry her, I heard my daughter say loudly and in a panic, “VAL, DON’T FALL DOWN!”  I turned back around and she was gone, down on the wet pavement, eyes blank.  She never felt a thing.   I spent the rest of the afternoon sitting on the driveway with my dead dog, brushing her hair until it dried and the crematorium people came to take her away.  Needless to say, no one else got a bath that day.

I once read an essay by an oncologist who said that she hoped that she would die of cancer.   I was baffled by this, because my personal preference would be to go suddenly, of a heart attack or a massive stroke, preferably while doing something I enjoy.  But her reasoning was quite clear:  she said that with cancer, when you know that your days on earth are numbered, you still have time—time to do the things you always wanted to do, time to say good bye, time to make amends.  This has actually been true for most of my patients—when they know that they are diagnosed with a life threatening illness, their priorities change.  If they have the means, they live the lives they always wanted to live, for as long as they are able.  They remember, they forgive and they forget.  The trivialities of daily life become unimportant, except insofar as they struggle to get through them.   Many become the person they always wanted to be, and I hope that if this is my fate, I have the grace to do the same.

Today we took old Magic to the veterinary cardiologist.  Magic is my eldest deerhound—a big male at 120 pounds, and nearly ten years old.  The last two weeks have been hard for him—we’ve had thunderstorms and he has always been afraid of thunder.  In desperation over his anxiety last week I called his vet for a prescription for a tranquilizer.  It worked temporarily, but on Tuesday we had strangers in the house and he was panting, salivating, and his heart was beating far too rapidly.  I laid a hand on his chest and I knew instantly that his big old heart was failing.  Today the diagnostic echocardiogram confirmed what I already knew—that my big guy has dilated cardiomyopathy, and that he is in congestive heart failure.  We started medication immediately, and I am hoping for a few more weeks, or a few more months with this grand old man who is, as my husband says, “the dog who never did anything wrong.”

Do dogs, like humans, know when they are dying?  I don’t think so.  And in fact, for their sake, I hope not.  Unlike us, they have nothing to apologize for, and perhaps their next meal, or a walk in the park, or in a dream a wild chase after a highland stag, followed by a soft bed and the touch of a human hand is all that they hope for and dream about.  As Magic slowly made his way out of the van today onto solid ground, he was greeted warmly by Queen, Quicksilver and little Yoda.  I can no longer promise him a life beyond his years, but I promised him today that every day from now on will be the best day I can give him—lots of treats, a comfortable place to rest, and with all certainty, no more baths.

Love and Loyalty From the Souls of Dogs

“Such sadness and endearing and abiding love…”  Fran

I am by nature a “right brain” person—despite my training in science and medicine, I prefer paintings and photographs to words and mathematical constructs.  Over the past two years of writing this blog, I have resisted on many occasions the urge to add pictures to this website, despite the fact that I possess wonderful photographs of the things that I write about—my family, my dogs, my horses and my patients.  I am constantly taking pictures—I have chronicled my entire life in photographs from my first Kodak Brownie and I will continue to do so.  But I started writing again, thirty eight years after graduating from college with an English degree, to see if I could “describe” rather than “illustrate” the events in my life which have had an impact.  I want to write stories that leave a little bit to the imagination, to my readers’ right brains—stories that can be read out loud.

For the past few months I have been following the saga of Roo on Facebook.  Roo is an Ibizan hound owned by the artist Nan Kilgore Little. Affectionately known by their owners as “beezers”, this breed’s history dates back 5,000 years to the times of the Egyptian pharaohs.  The erect ears and tall lean bodies of these hounds are depicted in hieroglyphs in the tombs of Ptolemy, Nefermat, Mereku and Tutankhamen.  Think of the god Anubis, Protector of the Dead, and you will have a good visual image of the head of this hound.  Brought to the Balearic Islands off the coast of Spain by the Phoenicians in 800 B.C., these dogs have hunted to put food on the table of their masters for centuries.

Roo turned sixteen years old a few weeks ago, an extraordinary old age for a large sighthound. You can see it in the pictures—the eyes, once keen are now cloudy and the strongly muscled hindquarters have wasted.  The bone structure appears more prominent, and yet more delicate at the same time. The ears are nearly transparent, and beautifully veined.  Nan started to post pictures of him on his daily walks, interacting with the other dogs in the household, and resting on his favorite pillow—pictures which have inspired a legion of Facebook followers who clearly feel privileged to watch the “old man” in his waning days and to take that last journey with him and his loving family.

The last forty-eight hours have been tough. Old Roo, with his brightly colored bandanna and his watchful countenance has stopped eating and has taken to his bed, his head resting on his favorite pillow.  He is not in pain, but he is very tired.  No more walking in the Wild Yard and no more jumping over the Big Tree.  His best friend, an Australian cattle dog named Barkool, has taken up watch and rarely leaves his side.  Barkool is neither elegant, nor particularly beautiful and his squat body is a contrast to the lean and classical Ibizan.  He is Sancho Panza to Roo’s Don Quixote.  He is the friend we wish we all had.

My Facebook friends love dogs as do Nan’s and as a result, we frequently feel compelled to put up photographs of abused, starving and abandoned canines in need of rescue, or dogs beaten and bloodied in the service of man’s cruelest whims.  But rarely, in these hastily posted pictures, we see a glimpse of life as it can and should be.  Yesterday Nan posted a photograph of Roo and Barkool.  Roo is wearing his blue bandana and is wrapped the cocoon of his softest blanket, one covered by multicolored hearts.  Barkool’s head is tucked under Roo’s chin as a pillow and his stocky body is still as can be.  His eyes show apprehension, and resignation at the same time.  He is, above all, present for his buddy.

Sometimes friends and families of my patients are uncomfortable visiting their loved ones after a diagnosis of cancer, or even more so at the end of life.  They ask me, “What should I say?” or “What can I do?” The answer is revealed in Nan’s picture of Roo and Barkool:  without fanfare, without words, without tears, just be there.

So It Goes

It was only natural that in a large urban radiation therapy department, such as the one where I did my residency, the residents often turned to black humor in order to escape from the realities of death and dying that we were witnessing.  Despite one of my attending’s iron clad rules—“Never treat a patient on his last day of life”—occasionally a patient would indeed expire right in the department.  Once the relatives were consoled, and the gurney and body departed, inevitably one of the students or residents would feel compelled to add a new euphemism to the secret list we kept hidden in our cubicles.  And so the list grew over the years we trained there.

There were always the “good old boy” standbys—he “bought the farm”, “kicked the bucket”, “cashed in his chips”, “bit the dust”, “gave up the ghost”—and of course the simple but expressive “he croaked.”  And then there were a few with more sensitive connotations—she is “pushing up daisies”, “took a little slumber”, went “six feet under”, “played harps with the angels” and “shed the mortal coil.”  Not to mention the vaguely piscine morsels, such as he “went to Davy Jones’ locker”, and is now “sleeping with the fishes”.  Depending upon occupation, cowboys always “went to the last round up” and hunters to that “happy hunting ground.”  Little did we know that we had already been trumped long before when Monty Python did the “Dead Parrot Sketch”, introducing the inimitable “pining for the fjords”, and “rung down the curtain and joined the invisible choir.”

By the time I got to California, I thought that I had heard them all.  In my new department I had a licensed vocational nurse who was responsible for taking vital signs and putting the patients in rooms on our on treatment visit days.  Every couple of weeks, I’d come in on a Monday and a patient would be missing from the schedule. I’d ask our nurse, “Where is Mrs. So and So?”  And she would say, “She went to Texas.” After the first couple of months at my new job, and the third or fourth time our nurse said, “He went to Texas”, I finally got exasperated.  I said, “PLEASE tell me why all of these patients are moving to Texas!”  The room was silent, all eyes on me.

Apparently there are significant regional differences as to how one expresses that a patient has “passed on”.  What do they say in your neck of the woods?