After her visit to the ER on Wednesday, when they bandaged the wound on her arm that was started by the IV she had in during her overnight stay in the ICU 13 days ago, Roo had to return to the hospital on Thursday for her third round of chemotherapy. She was upset at being brought back, but, eventually walked in voluntarily. She pleaded with me to go in back with her when the tech led her away, but I’m not allowed to. Some hospitals let you, but not these guys.
Roo had her bloodwork done and then given orally this week’s chemo drug, cyclophosphamide. When she was brought back out, the bandage was off her arm, because it is preferable for the wound to be in open air to heal properly, and she went right back into the cone.
The vet said that the bloodwork was much improved, that everything the course of treatment could be hoped to accomplish this early on was on track. It was good news. Roo, though exhausted and obviously feeling bad, is responding to the chemo.
This creates some difficulty with the decision I realized by the next day might be necessary to make. The vet seems to be entirely competent, assuming that what she reports about the efficacy of the treatment is correct. But that hospital is clearly geared to being a multi-million dollar business above everything. Patients are run through in a hurry and the vet is always in too much of a hurry to spend more than three or four minutes discussing the patient afterward and tried to clock out in less than that. This is not enough. There are all sorts of questions that come up, and though I write down the ones that occur to me before the visit, there is always more news and information to deal with. I’ve always believed that what prevents some excellent veterinarians from joining the ranks of the best ones is the effectiveness of their communication with the pet parents. There are questions of diet, of what to expect during the recovery, of the trajectory of the disease, of a million things. Roo’s IV infection is an example, and that happened on her first visit. The best vets are interested in more than the sheer science of the lab reports and medical technologies. They listen to the caretakers of sick animals. Vets who don’t do that don’t think it’s important. They are too firmly convinced that their administration of medicine is sufficient. I disagree. I’ve taken dogs with varying degrees of disease or illness to veterinarians in at least a dozen countries on three continents. The best of them, whether country vets like Dr. Stokes or university specialists in Switzerland (Orville, a white Lab, turned rust red and wasn’t diagnosed by French, German or Italian vets; it took an insightful Swiss one to figure out what the trouble was.
The stress of the hospital always knocks Roo out, now even more so, and as soon as she got back in the car she slept. She’s been panting since she got sick more than two weeks ago, and by late that night, Thursday, she seemed to be panting harder yet. Not with her mouth open and tongue out. Just sharp, short breaths as she lay on her side looking miserable.
On Friday, Roo was lethargic. Her panting was hard. The wound on her arm had finally stopped oozing and showed the first signs of granulating, but maybe it was hurting her so much that she didn’t want to get up. Maybe it was the chemo, even though the vet had told me that this drug was well-tolerated and if any bad side effects appeared they wouldn’t for three to five days.
I called the hospital and was told by the tech who is the oncologist’s liaison — their description — that because the doctor only works three days a week, Friday not being one of them, she would call me back on Monday.
“Roo is sick now,” I said. “You can’t possibly expect me to wait for a call on Monday.”
The tech said she would ask one of the ER vets what they thought. No, i said. Roo is in the earliest stages of cancer treatment. The oncologist is her doctor. She’s the one who knows the protocol and the drugs and their effects.
“Then you should bring her to the ER,” she said.
“She was in the ER the day before yesterday. She had chemo and bloodwork and was examined by Dr. Gill yesterday. I need to speak to the actual doctor before stressing Roo out with another 80 miles of driving and being checked back in there if it’s just to spend another $300 on being listened to with a stethoscope for something that a phone consultation might clear up.”
The tech reminded me that the doctor wouldn’t be in until Monday.
“All right. Then I need to find another oncologist. Nothing personal. you’ve all been great over there and I appreciate it, but you must realize how absurd it is to be told that a critically ill dog’s vet won’t return a phone call for three days,” I said.
“I’ll tell the doctor about your concerns,” she said, and I thanked her and got off the phone. The truth is I was choking up.
Five minutes later the vet called. It was all I could do to control my voice. Not from any anger. I was worn out and sad, the way one gets when watching a dog suffer. Roo had been so sick, I had spent most of the night with her on the floor, I was starting to feel like a poison was flowing in my veins and now, being faced with the question of whether to put Roo through transferring to another hospital just when she was just getting used to this one.
I told the doctor what was going on and she said there had been nothing the day before to suggest anything to worry about. That prednisone often causes panting. She told me to reduce the dosage. She said that the first few weeks were always the worst, that Roo’s body is dealing with a lot of stuff. No need to bring her in unless she got worse. She also gave me ways to contact her without going through the hospital and the sort of deflection with the tech that had just happened. So, we’ll see.
The large plastic e-collar is impossible for Roo to wear inside the camper, unless she lies in the middle of the one open area of the floor, and that’s only about four feet by four. She can barely move or switch positions with the cone on. She didn’t feel up to moving, but I couldn’t leave her alone and she managed to get in the car and we went to the store and bought her an inflatable soft collar. It makes it easier on her, though she still can’t squeeze into the corner where she likes to sleep at night. We both got a little sleep Friday night, and on Saturday, Roo’s wound was finally dry and had what looked like the solid start of a scab on it. Later in the day, she even chased a squirrel and took some interest in a few minutes of wandering in the woods behind the house.
Maybe it was the reduced prednisone dose, maybe it was that the wound on her arm was not hurting as much, but by early Saturday evening, Roo’s breathing was back to normal for the first time in two weeks. Finally she began to get some real rest, and I kept the camper silent.
Until the fireworks started when some asshole began blowing off big bombs nearby, sending Roo into a panic. It was her first exposure to loud noise since the last of the thunderstorms we were in down south. The whole reason for bringing her north was a quieter, cooler climate. She began to tremble and tried to hide, an impossibility in the camper to begin with, but entirely out of the question with her e-collar on, even the soft one that doesn’t catch on corners. There was nowhere for her to hide. I took her e-collar off and held her and tried to soothe her a little while I hoped the jerk setting off the explosions would blow his hands off, better yet his whole arms, or blind himself permanently or lobotomize himself with shrapnel and set his house on fire and have generations of his spawn haunted by malicious spirits. If you’re a fireworks aficionado, sorry. I hope the same things happen to anyone who blows off fireworks in populated areas and places their mindless pleasure above the pain they inflict on half the animals in earshot. Maybe we got lucky and he did blow himself to molecules. Maybe he’s in the morgue or burn unit where he deserves to be today. Or maybe he only stopped in 20 minutes or so because he ran out of ordnance.
The damage was done. Roo was a mess. Her panting ramped up again and never slowed back down. I stayed with her on the floor until about four in the morning when I couldn’t take it any more. I’ve had too many bones surgically removed from my spine and fused vertebra that cracked once and a couple of bum shoulders I had to lean on the whole time and I had to get off the floor and try to get some sleep. Roo was in a sort of daze and desperate to sleep.
A couple of hours later — this morning — I leaned over the side of the bed to check on Roo and put my hand on her arm to see how the wound felt. It was wet. I opened the blinds and the door to let in the dawn sunlight so I could see the wound. Roo had managed to get her tongue all the way around the edge of the soft e-collar and lick her wound open again. It didn’t make sense. The collar extends beyond her nose and it would take at least another six-inches of tongue stretch after that for her to get at the wound. It would take a tongue like one of those Amazonian salamanders that can snatch a fly out of the air a foot away. I had watched her try and it had seemed impossible, way out of reach. Yet, in those few overnight hours, she managed it. She destroyed the scab and excavated the wound. It’s as bad as it was days ago when she went to the ER. It hit me hard and I broke down and felt tears coming on the way they did when I was a little kid, all at once.
“Oh, Roo, bear,” I said to her, “what have you done? What have you done? You licked the arm.” She just wanted to try to get some sleep. I cleaned it up and put a bandage on it. A couple fo hours later I had to pick her head up off the floor when it was time to give her her three antibiotic pills and two prednisone pills. Her head was dead weight. She was too tired to hold it up the way she always has. I gave her a piece of the Dogswell jerky she loves to wash the sticky capsules down, fitted her bigger plastic e-collar and tried to get some sleep — the exhaustion by then was overwhelming, even though I’m always exhausted — but it was pointless. I lay there and checked my email, but it was just the usual notices from credit card companies and Craigslist scammers. I’d responded to half a dozen rental listings from Maine to New Hampshire. Without exception, every one turned out to be a scammer suggesting I immediately wire a deposit. I shut the iPad off lay there listening to Roo’s panting.
This afternoon Roo is breathing a little better, but the deep wound must be painful. The slit in the skin where the skin seemed to rot after the IV is wide and it opens onto a deep, empty area below. She managed to scour out the whole inside of the wound, the same way she injured herself with lick granuloma when she was a puppy. She stayed on the floor and didn’t want to go out for more than the absolute minimum. When she saw Virginia in the driveway that made her happy enough to go out to say hi, but she came right back in. Or it could be that she’s feeling bad from the chemo, now that we’re in the three-to-five-day window. Most likely, it’s all of the above. She’s got lymphoma, she’s on chemo, prednisone and antibiotics. Who wouldn’t be run down.
That’s where we are on this sunny Sunday in Maine.