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Canine Cardiology

Deborah Thompson

“Is your cocker spaniel going to be okay?” An elderly woman asks me this as I settle beside her in the waiting room. She’d seen me check in and hand Houdini over to a veterinary student. Houdi, incessant lover of women, had pawed at the student’s thighs and, despite his heart condition, displayed one of his inopportune erections, which the vet student chose not to acknowledge. Then Houdi sat on her feet and offered himself up for adoration, his signature pose.

“It doesn’t look good for my dog,” I answer the elderly woman. Here at Colorado State University’s veterinary teaching hospital, most of the patients have serious conditions requiring specialists. Many will not be okay. “Houdini has congestive heart failure.”

“Oh, no,” she says with seemingly genuine concern. “How old is he?”

“Almost twelve.”

“My dog’s thirteen,” the woman says. “I can’t lose her.”

My face finds its sympathetic waiting room look, long dormant. “What’s she here for?”

“Cancer. They say chemo and radiation can maybe give her another year and a half.”

“I hope so.” That’s the same thing they’d told Rajiv, my life-partner.

“They have to. I can’t live without her. I’m an old woman alone.” She wears a wedding ring on her rumpled hand, so I assume she’s also a widow, but a good 20-30 years older than I am. There’s an unspoken sisterhood among widows, and perhaps an even greater one among those of us with primary attachments to dogs, an attachment much of the world finds pathetic if not downright unhealthy. “They took an inch off my leg with my last surgery,” she adds without pausing for input, the way the hard-of-hearing often do. “Now I can barely walk. Missy gets things for me. She helps steady me when I’m about to fall. I need her.” The woman sounds like she’s pleading with me, as if I have a say in Missy’s longevity.

I understand her need. Just after Rajiv’s first round of chemo and radiation for colon cancer, we adopted the cocker spaniel puppy and named him after the escape artist for his almost prestidigital ability to open cabinet drawers and unlid garbage cans. He soon applied these skills to his overpowering omnivorousness. Shoes were amateur fare; he ate newspapers right through their plastic bags, soup packets through the box, toilet paper rolls in their cubbies, even pencils and pens, spilling ink onto tell-tale paws. Unfortunately, while he was an expert at getting into closed spaces, he lacked the skill of getting out of anything. He was so accident-prone he seemed to have a death wish. He would have eaten himself to death were it not for the $3,000 surgery to remove the synthetic pillow filling obstructing his intestines when he tried to become a stuffed animal. During that episode, the vets detected a heart murmur, and advised me to “watch and wait.” Instead, it was Rajiv, my human life-partner, who died, while Houdini kept living with his murmuring heart for another twelve years.

Despite all the troubles my disaster-prone garbivore caused—or maybe because of them—he became a life-line in my widowhood, filling my existential emptiness with the immediacy of bodily fluids to be cleaned off floors, displacing my nevermore with now, preventing me from thinking too deeply when all thoughts led to death. He helped to steady me when I was about to fall. 

Unlike doctors in human health care, veterinarians, unfettered by HIPAA, come out to the waiting room to deliver the news. Occasionally, though, a veterinarian will invite her patient’s owner to “come in the back” to talk, as was the case for a man near us. 

“That’s when you know it’s bad,” the elderly woman whispers to me. “Good news they give out here, but they don’t want you crying in the waiting room. They brought me back to tell me Missy had cancer.” Her eyes moisten, but she shakes it off. “So now I’m bringing her here every day. I have to drive in to Fort Collins from Denver. I’m an old lady. My hands have arthritis, so it’s hard for me to hold the steering wheel for that long. But you do what you have to do, right?”

I remember my own tears the day I learned that Houdini’s coughing wasn’t from kennel cough but from a regurgitating mitral valve. The vet student said you didn’t even need a stethoscope to detect Houdi’s heart murmur; you need only palpate his chest or put your ear to it. When she did put the steth to my ears, all I heard was the ocean. I hadn’t yet known what a murmur was, so I’d just nodded.

I remember earlier tears, too, thirteen years ago, when Rajiv staggered out of the GI lab into the waiting room after his first sigmoidoscopy, shaking his head. He made a “thumbs down,” but even after his hand dropped back at his side he kept shaking his head. The gastroenterologist came out behind him. That time they didn’t take me back for the bad news. Dr. Compton held a glossy photo of a big pink and red heart that he said was a tumor. I didn’t get it, but when the doctor looked to me for confirmation that I understood, I nodded, knowing that my life was falling apart in that waiting room.  

I nod to Missy’s human now.

“My family says I shouldn’t hold on to my dog like I do and spend all my money on her. You need to let her go, they tell me. But where are they when they’re not giving advice? Missy is all I’ve got.”

I nod again. Houdini’s medications alone cost $150 a month.

Across from us a boxer plops belly down onto the cool floor between his sixty-something parents, who each scratch an ear. 

The canine cardiologist comes out to ask me if she can take X-rays; she’s concerned Houdini might have fluid in his lungs.

“I’m sorry,” the elderly woman says after Dr. Bright leaves.

I nod thanks.

We wait. Metal rabies tags clang like tambourines as dogs shake. Nails click on tile. The boxer sneezes nervously.

“I’m waiting for Missy to get radiation,” the woman adds, as if there’d been no break in our conversation. In waiting rooms, normal conventions of speaking and silence, of eye contact and privacy, rupture under the strain. “They’re backed up. They want to keep her overnight. I can’t go overnight without her. But if we don’t go soon we’ll hit rush hour traffic, and I can’t drive in that. Especially not with my new car. The first day I took Missy here my car broke, so I had to buy a new car. Now I’m in debt. So I better die soon. Between car payments and veterinary bills, I can’t afford to outlive Missy.”

I’ve had my share of waiting for radiation, and treating dogs is more complicated than humans, because the dogs have to be anaesthetized. You skim a lot of magazines in the waiting room, trying to find an article you can connect with. Human clinics offer Smithsonian, Good Housekeeping, Sports Illustrated, and People. This waiting room offers National Geographic, but it’s missing a staple of oncology waiting rooms: the jigsaw puzzle. There must have been a published study demonstrating that jigsaw puzzles pacify rattled nerves, because every oncology waiting room I went to had them, and I’ve been to many, from our local Poudre Valley Radiation Oncology to City of Hope in LA and MD Anderson in Houston.  

At one such jigsaw table, Rajiv and I collaborated in collecting edge pieces with a turbaned woman missing eyebrows. Because of her baldness, I guessed she was on chemo for breast cancer. Chemos for colon cancer rarely make their recipients bald, so she looked a lot worse off than Rajiv did. Handing him an edge piece for grass (she was on the sky side), the woman asked Rajiv what stage he was. “Fourth stage,” he answered.

“Yes, that’s right, there are four stages,” she said. “Like, for example, I’m stage II-B with breast cancer. What stage are you?”

“Four,” Rajiv said again.

“Oh,” she said, getting it this time. She seemed to pull back from him in her chair, just a millimeter, maybe just a micrometer even, barely detectable, but I felt it and resented it on Rajiv’s behalf. Up rose the wall between the curatives and the palliatives.  

“Ultimately,” a doctor friend of mine likes to say, “all medicine is merely palliative.” But the people with treatable cancer (what the civilian world would call “curable,” ignoring the trickery of remission) don’t joke about the short-term distinction between cure and palliation.  

I don’t ask this elderly woman now what stage Missy is. I assume it’s bad.

A vet student appears. “Ma’am? Missy’s on the table now. She should be done in about an hour.”

“Oh, bless your heart.” Now the lady is crying, her tears the release of waiting’s clench. “Excuse me.”

As she hobbles to the bathroom I see that she’s completely askew, her spine twisted. She wasn’t exaggerating; one leg really is an inch shorter than the other. She seems on the verge of toppling.

My new friend gone, I settle into the rhythms of the waiting room, which expands and contracts, dogs coming and going, panting and plopping with a sigh. A cat yowls from its carrier. There’s nothing abstract about animal suffering; it’s so much more immediate than its human counterpart. It’s whimpers and hisses and growls and nervous drooling. Dogs with shaved patches of fur on legs and rumps and bellies hobble down hallways, sometimes wearing T-shirts to cover incision scars, sometimes bumping their cones of shame against door-jambs, sometimes in three-legged syncopation. 

I need to prepare for bad news. During Rajiv’s long illness and multi-tiered treatments, including chemo, radiation, surgery, and surgical procedures, I thought I’d gained proficiency in the art of waiting—how to pace myself, how to immunize myself to both hopes and fears. Hope is the bigger danger; fear is merely exhausting. If you must what-if, better to rehearse the worst-case scenario, sometimes already dramatized in the bodies around you. But better yet is to suspend yourself in the waiting room’s eternal limbo, determined to take each new reality as it presents itself.

I’ve come to think of the oncology waiting room as what anthropologists call a “liminal space,” a threshold between two states of being. It provides a transition between the civilian world outside the front door and the medicalized world “in the back.” The significant others wait here, suspended between health and illness. If you sit in enough waiting rooms while your beloved disintegrates in increments, you begin, too, to occupy the realm between life and death. In this limbo you get used to seeing people in all stages of dismemberment and decay; they’re no longer “the other.” It’s here, in the waiting room, that the idea of death congeals into reality. As your beloved declines, you may begin to identify more with the dying than with the living. In the unreality of this liminal space, you may try to offer the universe your own life in exchange for your beloved’s, wishing you could die so that he may live.  

Then, after his death, you find yourself shocked when the universe doesn’t listen and you keep living. You want to linger in that liminal space where he still lives, suspended in that waiting room of eternal deferral and palliation—but your dog doesn’t know you’re half-dead and he doesn’t care. Having no respect for this fragile threshold, he keeps eating and pissing and shitting and vomiting, and there you are cleaning up the mess. Before you know it, he’s pulled you back into the world of the living, until eventually you find yourself yet again waiting, this time for your dog of life.  Houdini. 

His namesake, Harry Houdini, could chain himself in a suitcase underwater and escape drowning. We’d thought our Houdini was misnamed, but maybe his moniker would prove prescient after all…

But no. I know better than to hope. I need to put an abrupt stop to that kind of thinking. Worst case scenario? I can handle it. I can. I take an inventory of all the things I’ll be able to do after Houdini dies: I’ll put toilet paper rolls back in their cubbies. I’ll put out throw pillows on the sofa. I’ll leave pens and pencils astray on the table, or, hell, even the floor. I’ll wake up in the morning without having to listen for the rasping breath proving Houdini hasn’t died overnight.  

Yes, I can live without my dog. I can. I’ll be just fine. Relieved, even. I’ve survived losing my human life-partner, haven’t I? Houdini’s just a dumb, silly, ridiculously affectionate dog, unlike Missy, a therapy dog, whose owner pleads with me and with her doctors and with her fate. The old woman needs Missy more than I need Houdi. She is me a few years ago, in an earlier stage of mourning. I’m past that now.

And so, amid the panting and clicking and mewling and whimpering, I enter the perverse logic of waiting, and find myself in a zero-sum game. I begin to bargain with fate: you can take Houdini if you must, but only in exchange for Missy. At least let Missy live.

Even as I make this deal, I begin to feel twinges in my own heart. Probably just the usual chest wall muscle spasms I sometimes get. Does Houdini’s heart feel like this, I wonder?

Often when stressed I imagine myself petting Houdini. I picture him climbing into my lap and butting his head under my armpit while I smooth his Meg Ryan hairdo. That almost always calms me. But this time my heartbeat seems to get even more irregular. What if I have a heart attack in the middle of the veterinary waiting room? Will they take me in the back and treat me alongside Houdini?

Now Missy’s owner hobbles back from the bathroom. I say nothing to her about my bargain with fate.

Finally, finally, my vet comes out for me. “Let’s go in the back so we can talk,” she says. I glance at the elderly woman. Her spine seems to twist two degrees more.

“I’m sorry,” she says, and squeezes my hand.

At the last appointment Rajiv had with his oncologist—though we didn’t know going in that it would be the last—Rajiv complained of migraine. He’d been struggling the day before, but still dragged himself to his lab to supervise his grad students. By evening, though, when we went to see Monsoon Wedding, he had trouble walking. That night he woke up shivering violently as I piled on blanket after blanket. And now in the doctor’s office, this migraine. “He’s not doing very well,” I added, since Rajiv always understated his illness.

“No, I don’t think he is,” Dr. Tweedy said. “I don’t think it’s a migraine. These are the blood test results from yesterday. It looks like he’s gone into liver failure, and the bilirubin level is affecting his brain stem.”

I think I said something like, “So this is it?”

“I’m afraid so,” I remember Dr. Tweedy replying. “I’m sorry.”

He helped set us up with home hospice. We walked out through the waiting room—after paying the cashier for the death sentence—knowing we’d never be waiting in that room again. Knowing that the worst waiting, the real waiting, was about to begin.

“He’s kind of slipped into end stage,” the cardiologist says in the exam room, Houdini sitting on her feet. The X-rays show Houdini’s heart at twice the size it should be, pressing all the way against his left ribcage. Dr. Bright makes a fist to demonstrate. “I wouldn’t have believed how close it was to the chest wall if I hadn’t seen the X-ray,” she adds, speculating that his damaged mitral valve only gets about 20% of the blood through. He probably has less than 30 days to live. His lungs will most likely get wetter, until slowly he drowns in his own blood. Or his heart could burst at any time, and he could exsanguinate. Another scenario, of course, is euthanasia, which “would not be inappropriate at this point,” though I’ll probably elect to wait another two to three weeks. I’ll know when it’s time.

So now the real waiting begins again.

At least with Houdini’s death, I won’t have to wait until the very end, wait through bouts of unconsciousness and agitation, through the death throes and the rattle, never knowing which breath will be the last, holding my own breath until it comes. I’ll have Houdini euthanized before the real suffering begins.  

In retrospect, I could have euthanized Rajiv. I’ve never had any moral problem with euthanasia for humans who choose it. I’ve always believed it to be a humane option, and still do. As it was I kept Rajiv comfortable with morphine. I could easily have overdosed him; I was alone for much of the time, plus there was no autopsy. Of course, his mother would not have approved. But even more, while it was happening, I felt a kind of reverence for the death process. Because it was a process. Slowly, organ by organ, sense by sense, his body shed itself. It seemed almost ritualistic, this dying ceremony. The waiting felt unbearable but necessary. Medical parlance offers the phrase “actively dying,” which sounds like an oxymoron, but embodies an almost sublime paradox. I never knew before how active dying could be, or how much labor it demanded, or how important the work of letting go that transpires in this ultimate liminal space between life and death.  

I’ve heard my story repeated by other widowed people: you comfort yourself that at least the unbearable waiting is finally over. That’s the moment you realize you’d give anything to go back to waiting. There are worse things than the grueling limbo of waiting after all. At the same time, your waiting doesn’t really end with your loved one’s death. Now you wait for a sign from him, for something to attach meaning to, for an afterlife communication that you might not even believe in. You wait for meaning itself, for something to redeem this otherwise cosmically unjust and senseless death. Night after night you have dreams of his return: he wasn’t really dead after all, in spite of what you saw. You realize you’re waiting for magic, for Houdini’s last-minute death-defying escape after all seemed to be lost.

Then with each new loss, the old one returns, and you wait again. Wait harder.

Now, in front of the cardiologist, I try to ignore the electric line of referred pain down my left arm. “Houdini is just a dog,” I tell my body, but the psychosomatic pain doesn’t listen.

Houdini, sensing a need, relocates to my feet and paws at my bare calf until I pat his pouffy head. He seems full of life as he swallows up my anxiety and steadies my heart rate. But I know that Houdini the dog is no Houdini the magician. He can get into things but not out of them. There will be no death-defying escape after all.

Leaving the exam room and heading for the cashier, I see Missy’s human, walking toward the front door of freedom, hunched over and unsteady like a two-legged spider. At her side is her little Schipperke, brightly solicitous, her eyes never leaving her human’s face, which, in turn, looks rejuvenated.  

At least Missy gets to live in exchange for Houdini. I take some comfort in that bit of ridiculous magical thinking that of course I don’t believe in.

When the woman finally sees me I shake my head, like Rajiv did in the GI waiting room so many years ago.

“I’m sorry,” she says. Then she pulls Missy’s leash in, as if to restrain her dog from Houdini’s death aura.

It’s a small, unconscious micro-gesture, but it breaks our bond, and for a moment I resent her. Is it too late to re-bargain with fate? To say no, I changed my mind, I was wrong, I can’t live without my dog either, my dog who’s just as deserving as Missy, and who, dumb though he is, is just as needed…

Houdini moves to the old woman’s feet, too close to Missy for her comfort, so that the woman can better adore him, and sprouts another inappropriate erection, oblivious to his death sentence and my betrayal, and to the realization that he’s the last living creature to remember, in his animal way, what Rajiv smelled like, the taste of his skin.

After I pay, Houdini trots his ear-swinging trot beside me to our car. Once inside, his metronomic tail stump set to allegro, I “palpate” the left side of his ribs. I understand now what Dr. Bright meant about the distended organ pressing against the chest wall. It feels as if I’m holding the bulging heart itself in my hand. It murmurs into my palm.