In the middle of December I sat in the exam room with Madeline, waiting for the vet. Visiting the vet’s office with Madeline was an opportunity to see what single mindedness looked like. She loves going for walks, especially in new neighborhoods, and is always curious about doorways. So she’ll happily walk from the car, down the block, veering left and right to smell everything she can, until we reach the door.Tail wagging,she’s excited that this time I’m actually taking her into a strange door. Once inside, though, she’ll realize where we are, and start pulling on her lead back toward the door. Or she’ll try to fake you out: “See how calm I am, wagging my tail and just standing her? OK, time to go!”
That day had been a drop-off appointment: we brought her in in the morning, and they kept her for the day for more tests that required sedation. It was the end of the day, and we were waiting for the report from Dr. Morris. Madeline wasn’t particularly interested in the report: she was ready to go. She alternated between pacing around the room and sitting underneath my legs, whining almost inaudibly.
It was amazing to me, after so many x-rays, that she’d never had one when her pleural cavity was empty. Earlier in the day, Dr. Morris sedated her, drained 300mL of liquid from her chest, and took the x-ray, undoubtedly grateful she was asleep, still, and not trying to bite him. The x-ray didn’t show anything that might be causing the cough: no masses, no foreign objects, no fluid around her heart. He also did a tracheal wash while she was sedated. None of the medicines were working, and Dr. Morris wanted a look at what she was trying to cough up.
As I’d feared, the sample didn’t show anything interesting, either. Dr. Morris patiently explained that the cells looked normal, but that he was going to send them to the lab for analysis, just in case there was something he’d missed. I sat there, asking questions, feeling panic rising in me: “You can’t send us away empty handed! We need help! We have to sleep! There must be something!” I didn’t realize how desperate I was for help until that moment.
I managed to get the words out without sounding like a complete mess, and Dr. Morris prescribed hydrocodone as a cough suppressant, a stop gap until we could see the specialist.
We had an appointment with an internal medicine veterinarian, Dr. Maretski, for December 29, just over a week later. It had been almost four years since we’d seen Dr. Maretski,and it seemed somehow fitting that we were back in his office. We gave him her recent history, describing her symptoms and what we’d tried. He hefted her chart in his hand, almost an inch thick with a bright orange “WILL BITE” sticker on the outside.
“You guys have been through so much already. I mean, just… Well, you probably know what I’m going to suggest, and we probably know how it’s going to turn out. I think it’d be worthwhile to do a CT of her chest, since it’s been a few years, just to make sure there’s not another lung issue or something going on an x-ray wouldn’t see. And as you guys undoubtedly know, it probably isn’t going to show anything, but at least then we’ll know for sure. Other than that, I’m not sure. I mean, gosh, if you didn’t know her history, she presents as a totally healthy dog. She looks great for her age.” Dr. Morris had said almost the exact same thing in October when the coughing began.
He was right, of course. On the CT, everything appeared normal. No apparent reason for her cough or her pleural effusion. “Idiopathic”, he called it. It felt like the end of the testing, the final thing to investigate. Talking to Dr. Maretski on the phone a week later about the radiologists report, I voiced the assumptions in my head. “I’m operating under the assumption that there aren’t any more tests to do, procedures to try, or anything else, and that we’re talking about palliative care, right?” I was right.
I usually feel pretty calm about that, maybe even accepting. Richard and I keep talking about our desire to keep her comfortable while her quality of life is good.And this isn’t the first time we’ve thought we were at this point, but it feels more final than it did before.