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.

The Gift of the Magi

When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.”  Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it.  But just in case– the story is about a young couple, poor and deeply in love.  At Christmas, they have no money to buy each other gifts.  She cuts off her long golden hair, her prized possession, to buy him a watch chain for his own treasure, the pocket watch his grandfather left him.  He sells the watch to buy ornamental combs for her beautiful tresses.  In a classic example of cosmic irony, the two are bereft of everything except their enduring love for one another.

Yesterday, an eighty five year old man was crying in my office.  A month ago, he completed a grueling seven weeks of treatment for head and neck cancer. Otherwise healthy, he endured the side effects of treatment with great equanimity—the loss of taste, the sore throat, the dry mouth, the hoarseness, the skin reaction, the fatigue and the weight loss associated with treatment.  His reward is great—he is free of disease and very likely to remain so.  He drove himself to every treatment, clearly motivated to complete his therapy despite his advanced age.  I never had to cajole him into continuing and finishing the treatment—he was clear that he was doing this for his wife of sixty three years, and for his family.  He wanted more time, and more healthy time with them.

When I saw him in follow up, I asked him how his post treatment time had been.  Many times for radiation therapy patients, the week or weeks following treatment are even more difficult than the treatments themselves—the side effects may worsen before they improve.  So I was not surprised when he said, “It’s been TERRIBLE.”  I patted his arm and said, “Tell me about it.”  He replied, “Right after I finished, my wife was hospitalized and now she is in kidney failure.  She started dialysis on Wednesday.”  Somewhat surprised that an eighty five year old woman would choose to go on dialysis, I asked him, “Do they expect her kidney function to improve?”  He said, “No, the doctors said there is no chance of improvement.  The hospital doctor said that under no circumstances would he recommend dialysis for her.  But the kidney doctor said it was her choice—to have dialysis and live, or to be made comfortable and die.  She chose to live, for me.”  And then he wept.

We can all be cynics or pragmatists if we choose.  We can talk about the escalating cost of healthcare, and the wisdom or folly of treating eighty five year olds with intensity modulated radiation therapy and daily image guidance and their wives with hemodialysis.  But what I saw yesterday was an affirmation of enduring love, in two elderly people, who gave one another a gift not unlike “The Gift of the Magi”—the gift of sacrificing self to continue to live.  It’s hard to be cynical about that.

The Adventures of Dad, Continued

If you’ve been following this blog for a while, you’ve probably figured out that my father is one tough old bird.  He was my grandmother’s first born son, and was yanked forcibly from his mother’s womb a month prematurely via a forceps delivery after her water broke.  As a result, his left brachial plexus was damaged, leaving his left arm paralyzed.  By good luck and sheer determination, the paralysis was not permanent and he went on to graduate from high school at 16, attend college and dental school, join the Navy, decide he didn’t like being a dentist, go to medical school, and ultimately become a world renowned plastic surgeon. It’s been a tough act to follow, that’s for sure.  There are two things I remember vividly from my childhood—the first is that wherever we went he was always on the lookout for imperfection in the faces of strangers, and never hesitated to let us kids know how he would fix such imperfections.  The second is that he was an artist, in real life and not just in the operating room.  In this age of computer modeling, it is hard to remember that there was a time when my father would see a new patient in an exam room, study her profile, sketch it on the white exam table paper, and proclaim, “This is how you look now.”  He would then draw an idealized portrait next to the first sketch and state triumphantly, “And THIS is how I will make you look!”  If you think there was a single patient who could resist that kind of sales pitch, think again.

If ever I was going to doubt my father’s resilience, it was this year.  When my mother passed away in January after a long struggle with dementia, he promptly went into congestive heart failure from a stenotic aortic valve.  Ten years after his coronary bypass surgery, he had a second open heart surgery to replace the valve.  When we all realized that he could no longer tolerate the altitude of his retirement home in Snowmass, Colorado, he decided to move to San Diego, living with me while we sorted out his health issues.  After the heart surgery, he began to chafe for his independence, but was also not confident of his ability to meet new people, make new friends and start over at the age of 88.  We urged him to at least try, and so, two weeks ago he moved into the lovely retirement community of La Costa Glen in nearby Carlsbad, California.  The first week was a bit rocky—at one point the community lost electricity, and I had forgotten to supply him with simple safety gear—a flashlight, some candles.  He worried that he could not remember the name of every new person he met, until I reminded him that the reason La Costa asks its residents to wear their name tags is that no one ELSE could remember HIS name, either.  Sometimes I can’t even remember my own, these days.

Yesterday however I knew he had turned the corner.  He spoke excitedly about a dinner party he attended on Friday night, and about the bridge games he was playing, and about the Great Ideas sessions that the community holds where residents who are retired from all walks of life can discuss the nation’s problems, and potential solutions.  But the truth was revealed when he whispered conspiratorially over the phone, “And a lady has already asked me to partner up!”  I said, “Partner up?  What does that mean?”  He said, “You know—each person has their own living space, but you do EVERYTHING together, meals, activities, and ….you know!”  I said, “Dad, you’ve only been there two weeks.  You are going to have to beat those ladies off with a stick!  You need to play the field for a little while before you partner up!”   He laughed.  It’s good to know that life begins at eighty eight!

Adjustments

“Old age is no place for sissies.”  Bette Davis

I am just getting adjusted to the latest adjustments.  When I was in medical school, I heard that word “adjustment” used as medical terminology for the first time, as in “He’s just having an adolescent adjustment reaction.”  Before that, I had experienced the word more frequently applied to inanimate objects—cars in particular, such as “the driver’s seat needs adjusting,” or “please adjust the timing belt.”  As my education progressed, I learned about chiropractors and how they “adjust” the spinal column to relieve back and neck pain, or even foot and ankle misalignment in my friends who were dancers.   But somehow I must have missed the lectures on adjusting to the natural process of aging, since I never gave it much thought until recently when I began to make the rounds of retirement communities here in San Diego.

After my mother passed away in early January, my eighty seven year old father received the news that his heart and lungs were no longer able to tolerate the 8,500 foot elevation of their Snowmass, Colorado home.  Previous bypass surgery and a stenotic aortic valve had taken their toll, and the prospect of wearing oxygen 24 hours a day, seven days a week was not appealing to this man who had been performing cleft lip and cleft palate surgery in Africa and Viet Nam as recently as last fall.  And so a month ago, down from the mountains  he came.  The improvement in his breathing was immediate—so much so, in fact, that he has agreed to come to live here in San Diego.  Although he has been staying with us, and is welcome to do so indefinitely, he longs to reestablish a social life amongst his peers—to play bridge, to discuss great books and current events, and hopefully, to resume his golf and tennis games.  He had been half-heartedly looking at facilities for the past two years of my mother’s dementia—full service facilities that take the elderly from independent living through skilled nursing, and ultimately, if needed, to dementia care.  This time around, he is free from the constraints of her limited options, and we’ve broadened the search a bit.

For the last few weekends, we have dutifully and diligently set off to see the best that Southern California has to offer. We’ve toured low rises and high rises, condominiums and apartments, mansions and villas.  We’ve seen covered heated swimming pools, exercise rooms and movie theaters, casual coffee shops and formal sports coat requiring dining rooms.  We even saw an apartment at Casa Manana, a retirement community in La Jolla, where the floor to ceiling picture window in the all-purpose one room living/bedroom gave up a spectacular ocean view and the sound of waves so close we could almost feel them crashing against the shoreline.  But each time, my father turned away.  Neither of us spoke of the sights that gave a small nagging voice to our fears—the squeak of a walker being lifted and set down again, a palsied hand reaching for a glass of water, the faint smell of mildew in a recently vacated apartment with a silent cane propped in a corner, long ago abandoned for a wheelchair.  My father was pleasant and polite to our tour guides.  I, who will turn sixty years old this year, looked out over the gray heads and stooped shoulders in the dining rooms, and saw my future.

A week ago, after spending most of Saturday and all of Sunday morning looking at potential places for Dad to live, I had had enough.  There was one more visit to be made, to a retirement community very near my workplace.  My husband graciously volunteered while I stayed home to do laundry.  Much to my surprise, when they returned from the excursion, my father was very excited.  The community was new, beautiful, and laid out like a country club, with low slung buildings connected by gardens, grassy areas and well-tended walkways.  There were two dog parks, and folks were out and about on a sunny day.  When I asked my father what he liked so much about the place he exclaimed, “Everybody looked so YOUNG!”

I suspect that my father will adjust to his new life just fine, once his medical conditions are straightened out and the path to that future is clear.  As for me, I am adjusting  to the fact that my pantry and freezer are now stocked full of his favorite foods—oatmeal raisin cookies, bagels with strawberry cream cheese, salty potato chips and Klondike bars.  It looks like my wardrobe is going to need an adjustment soon!