mercredi 14 juillet 2010

ENVA d'Alfort, Day 2

Look at that face -
Just look at it,
Look at that fabulous face of yours.
I knew first look I took at it,
This was the face that the world adores.

Look at those eyes -
As wise and as deep as the sea.
Look at that nose -
It shows what a nose should be.

As for your smile, it's lyrical -
Friendly and warm as a summer's day -
That face is just a miracle.
Where could I ever find words to say

The way that it makes me happy
Whatever the time or place?
I'll find in no book
What I find when I look
At that face.

Look at that face -
Just look at it.
Look at that funny old face of yours.
I knew first look I took at it
You've got a face like a kitchen door's.

Look at those eyes -
As close as the closest of friends.
Look at that nose -
It starts where a good nose ends.

As for your smile - spectacular!
One grin would frighten the birds away.
You've got a face like Dracula!
And I mean that in the nicest way!

To say that there's no one like you
Would not even state the case.
No wonder I shook
When I first took a look
At that face.

Today, they asked me if would like to take her for a walk when I arrived for visiting hours shortly after 2 pm, regretting the 20 minutes I had missed owing to a late start and a long drive. She was in her impeccably clean cage, with a bowl of water, another of food, sort of touched, and a length of green cotton tape tied around her neck. A makeshift hospital leash. They told me that she had already been out for a little walk and had peed. We were so proud of her!

Really, I am not being sarcastic. Even the smallest of things doesn't seem so small when someone is so very sick.

We took the elevator down to the ground floor, Baccarat stopping to relieve herself just outside the waiting room, which no one minded in the least, and down a corridor that seemed as long as the QE II at Baccarat's new pace. Just past the door was a little wood, with a path along which some interns and students hurried with small dogs in their arms, or others strolled in small groups, with a dog on its green tape. We past a bench, rounded a corner and came upon a red plastic bowl filled with water and drowned insects.

"Bacs, tu veux boire un peu?"

She answered by way of making a slow bee-line for the bowl, lowering her muzzle to drink and then letting her forelegs splay and her body sink slowly to the ground, like a mechanic's lift leaking hydraulic fluid. Her forepaws remained on either side of the bowl, her head just above it, for convenience. I got out Daniel Deronda and read, but mostly watched her watch the strong summer breeze in the leaves of the trees around us where we sat in our patch of shadow beneath an Acer campestre, so named by Linné, or Lineaus, the tag told me. A Field Maple. I thought about how the trees were planted with scientific discovery and learning in mind and contemplated making a garden for them.

Too much work for them, said myself, who had been fairly quiet of late.

That's what being preoccupied with real worries will do.

And then I noticed that some of the people walking near us were walking right up to me. It was Dr. Begue, a young vet in her last two years of specialty training in internal medicine, and Dr. Gouni, the cardiologist. I felt as though I should apologize for making them have to come find me, but they were smiling. They knew where I was, and it was alright. They do this. They had come to tell me about Baccarat's progress and what they knew. I had seen Dr. Begue already when I arrived, but not Dr. Gouni.

What they knew for now, with some pieces of lab work not yet available, is that Baccarat's liver is fine, that she is not in kidney failure, that her kidneys seem to be alright, but they still do not know why she lost so much blood protein. That loss of albumin and the protein that is responsible for anti-coagulation probably explain the formation of the clot.

They asked if I could find a lab for human blood work that would be willing to test dog blood because they need to perform a test usually done on humans to see if there is thrombosis, in other words, a thrombus somewhere in her body (in addition to the clot in the right atrium) that they haven't seen; a lot of Baccarat's diagnostic work and care involves people medicine, and will possibly involve people cardiac surgeons. We are going to have to take blood from Rapide, too, so that the lab has a comparison with a healthy dog, since the indicators for humans don't necessarily correspond to dogs. This thrills my husband, since Rapide, after nearly 4 years of cohabitation, still hasn't come around to him.

It's looking like I will have to ask our vet out here to draw the blood or never get it done. Sigh.

This brought us up to what they had in mind. The thinking is that if her physical condition improves, and if the cause of the clot can be identified and is not chronic in nature, and if we feel we can afford the cost, they will organize surgery for Baccarat in a hospital in Paris in an OR for humans.

I haven't told my husband about this. Not yet.

They hope that with the return of blood proteins to a normal level, which seems to be the case, and the anti-coagulating drug Fraxiparine (at 16 euros a day) that the clot will not continue to increase in size and her body can do its natural work to dissolve the clot. Another echocardiogram today seemed to show it ever so slightly, possibly smaller. If it decreases in size, then they can consider operating on the heart without a bypass. It it doesn't, at its monstrous 5 cm proportions, then they would have to do bypass surgery to open the atrium and remove the clot. It is unlikely, given its size, that it can go completely away, and they cannot give dogs the drugs they give people to shrink a clot. They are almost always lethal for dogs.

And, here is another piece of information. A clot tends, I am told by Dr. Gouni, to form on an area that is "moche", or "ugly", meaning "not smooth", but "bumpy", "irregular". It can be from the formation of a tumor that attracts clotting around it, or it could be from an irregularity on the inside surface, in this case, of the heart muscle. What they remove would be biopsied. If it is a tumor, it is certain to be malignant. If is it merely an irregularity in the surface of the muscle, then it is corrected. Sam has offered his earnings. He says it is more worthwhile than any other "connerie" on which he would otherwise have spent them, like a new used, higher cylinder scooter for the fall, on which he had his heart set.

My husband will want to know that this offers her a longterm positive outcome and quality of life. They have the same objective and say it is too early to tell, but they wanted just to know if we would want to do this if they felt it could be worthwhile because many people would not be able to, owing to the cost.

"Si j'avais un chien qui en avait besoin," she said to me, "je sais que je ne pourrais pas le faire."

I looked at the sunlight in the trees and the blue sky and down at Baccarat at our feet. I thought of all the things I don't want as much as I want her to live. I thought about Sam and how much he has come to love this dog he didn't want. I thought about what it means to be part of one another and about from where the money would come. I felt happy thinking about it.

Happy? That meant one thing: I wanted to do it for her, if it would mean that she could run in the Moraine again in the snow.

I was happy later, when with Mappy maps in hand showing the locations of some 16 pharmacies in Créteil, I sat down on a parking barrier in the courtyard to call as many pharmacies as it took to get a week's worth of Fraxiparine. I picked the cluster the closest to the boulevard to the veterinary hospital and started calling, rounding up doses of Fraxiparine and noting it on the maps. After 5 calls, I had what I needed. I jumped into the car and headed off to collect it all. It took three pharmacies for a week's supply at about 120 euros.

I was doing something to help her. I was happy to be the gopher, to get anything they needed, to give them the name of a lab that would help, to make their work possible and easier.

"Vous faites un beau métier," I told Dr. Gouni yesterday.

"Mais, savez, ce n'est pas toujours beau," she replied.

"Non, que le résultat ne soit pas bien n'enlève rien de la beauté du métier." She nodded, accepting that.

It was going on 7 pm when I returned to the hospital, emptied down to the bare bones staff and emergencies, and rang the bell. A young intern came to let me in, and took the little plastic bag full of other smaller plastic bags of Fraxiparine. She told me everyone was gone, but she would deliver them to the service for me. I turned to leave, and remembered I had left something for me in the bags and took the stairs up to ask if it could be retrieved. There were two students, or interns, at the emergency desk. Embarrassed, I explained.

"Elle était petite, en vert, les cheveux bruns?" the young woman asked.

"Oui, c'est bien elle."

"Attendez, je vais aller la trouver," she said, without looking put upon in the least.

"Si vous mettez plus que deux minutes," I told her, "laissez tomber. Ce n'est rien d'important --"

She was already gone and back with the petite young woman in green with brown hair, who went off with a smile to get my sunscreen and returned to tell me that if I could possibly wait, Dr. Begue hoped to speak with me. Glancing at my watch and thinking I was going to miss any chance to get groceries before the stores possibly closed tomorrow for Bastille Day, I nodded.

"Bien sur je peux la voir." After all, these people were practically dedicating themselves to caring for my dog and trying to save her.

Dr. Begue appeared, hoping that I could wait for the blood to take to the lab and the syringes and tubes for Rapide's, and as soon as she was gone to do that, Dr. Gouni rounded the corner, practically straight into me, smiled, and took another chunk of her day to bring me up to date.

When we had said good-bye, Dr. Begue returned and talked about the hospital, about dog food, about anything. They work hard, but with so many hands to make light work of it, they have time for what Dr. Gouni said is also part of their work: the people who bring their sick animals to them, because, as Dr. Begue said, if we bring them there, then we are truly dedicated pet owners.

"Une dernière chose, si je peux m'abuser encore de votre temps," I said. She smiled, waiting. "Aurait-il un supermarché dans le coin?" She nodded. There was a Casino. She gave me detailed directions, as helpful as she had been with the Mappy maps of Créteil with the pharmacy locations circled in red pen and a print-out of their names and telephone numbers.

"Il est encore ouvert à cette heure-ci?" I asked, a little worried. Out here, everything closes by 8 pm.

"Oui, ça ferme à 21 h. N'oubliez pas de mettre l'échantillon de sang au congelateur," she reminded me with another smile as we parted, and I headed off to do my grocery shopping, Baccarat in her clean glass-fronted cage with her green cotton tape around her neck, perhaps sleeping, only several doors away.

It was alright. Dr. Begue and the students would be with her. I'll be back Thursday.


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