vendredi 16 juillet 2010

ENVA d'Alfort, Day 4, a heart tumor


In the refuge of the shade of a plant


Baccarat has a diagnosis. After days of tests and results and more tests and more results that ruled out kidney and liver diseases, infections, deep intravascular coagulation, pulmonary embolisms, and thrombosis, Professeur Chetboul, who I have not met, spoke with the cardiac surgeon who would operate on Baccarat at the Institute Montsouris in Paris and called the veterinary cardiologist who has been following Baccarat with her and the chief of staff, Dr. Gouni, to tell her that according to the cardiac surgeon, if the clot is in the atrium and not moving, it is what they thought it might be, a clot formed over a tumor.

It is nothing else, and the course of treatment they have been pursuing will not be helpful, necessary as it might be to keep her stable until she can have surgery, which is the only option available to save her.

I listened to Dr. Gouni, the resident and student listening alongside, Baccarat on her green cotton tape lead at the student's feet, tired, while she explained that because Baccarat is so young, only having turned 4 last Saturday (she was born the day Zidane was given a red card for his head butt in Materazzi's chest and France lost to Italy, unfairly and undeservedly in 2006), there is a good enough chance that the tumor is benign to justify operating. Because of the size of the clot, they will have to use a cardiopulmonary bypass machine to reroute the flow of blood around the heart during the surgery. The hope had been able to give her the anti-coagulant Fraxiparine to prevent the clot from getting any bigger, while her body's natural process to degrade clots, or fibrinolysis, went to work to possibly make it small enough to operate by clamping a portion of the atrium, but the cardiac surgeon ruled that out owing to the tumor. We cannot know it's size.

Because the lump appears not to be connected to the heart wall, it is possible that it is relatively small still, or some kind of tumor my husband named that I cannot remember, but a tumor it is.

Dr. Gouni went on to explain that if Baccarat were 10 years old, they would not recommend surgery, since there would be as much as a 95% chance of the tumor being malignant.

They will be able to perform the biopsy on the tumor while Baccarat is on the table and have the reply immediately. If it is benign, they remove it and whatever part of the heart muscle they need to and close. She would then have a complete recovery, and little chance of a repeat occurrence.

If it is malignant, they will close.

"Dan ce cas, on peut discuter les options de traitement, chimio --" offered Dr. Gouni, a little reluctantly, it seemed to me, and I shook my head.

"On ne ferait pas ça." The intern smiled sympathetically and nodded her head. Dr. Gouni nodded, too.

"On pourrait lui laisser le temps qu'il lui restera à vivre -- " I nodded.

"Oui. Je lui laisserai le temps de vivre chez elle, et puis, on verra." There would always be time to have her put down if she began to suffer too much. They nodded.

The issue for now is that there is not a doctor specialized in operated the cardiopulmonary bypass machine, or "un pompiste", available until July 27. The surgeon wants to operate as soon as possible because Baccarat's condition is too fragile. They offered me to take her for a little walk outdoors again yesterday, and while she seemed stronger, choosing by herself to get up and move around more from time to time, she had diarrhea and vomited. These are signs that gave pause to Dr. Gouni. It indicates that she has low blood pressure, which they confirmed. Spots also appeared on her shaved belly during the afternoon that indicate internal bleeding. They ran platelet counts to determine whether she should still be on Fraxiparine and adjust the dosage. She will take no more walks. She can walk with me to the cardiology waiting room from her cage and sit there together.

I asked if the cardiac surgeon, who operates on people in a hospital for human beings, is not put-out to operate on animals.

"Oh, non!" said Dr. Gouni. "Il l'aime beaucoup. D'abord, c'est moins stressant que d'opérer sur un enfant" for example, her tone implied, "et puis il aime les chiens, surtout les Labradors. Il en a lui. Aussi, c'est dans le but de la recherche."

Baccarat's surgeon loves Labrador Retrievers. He is a Lab owner himself, and he is doing everything he can to move her surgery date up, and aside from being a surgeon, he is also involved in research. Baccarat's case adds to their bank of knowledge.

"Il donnera son temps," continued Dr. Gouni. "Ils ne factureront pas les chirurgiens, mais tout ce qu'on ne pourra plus utilser sera facturé." In other, words, the doctors will operate for free. We will pay the costs of materials that cannot be reused, and I don't think that amounts to very little in this case. She had guessed 2,000 euros, plus hospitalization and her current costs of diagnosis, treatment and hospitalization. It is somewhat staggering.

"You cannot," said Sam again last evening, when he called me, "put a price on life, Mom. We have to pay whatever it costs to save her."

I was getting on my motorcycle, getting ready to leave, when I happened to see rather than hear a call coming in on my cell phone, sitting on the bike. It said it was from Sam. I answered.

He was calling to tell me that he would not be going to Nanterre in the fall for law. He said it in a voice that sounded flat, possibly just an instant from being catastrophic.

But it's not possible not to be able to go to even Nanterre, myself said, our thoughts racing. They have to accept him!

"Hold on," I said to myself, "maybe it only means that he got into one of his other choices." I turned my attention back to Sam, "Sam, does that mean you are going to the Sorbonne?"

"No. I am not going to the Sorbonne."

"Oh, I'm sorry," I said, and I really was. That was his first choice, and he thought that with his English and his American culture, he'd have a chance, but these things can be somewhat haphazard, too.

Then what? asked myself, sounding panicky. Where can he be going? What's left? Can it be that he can't go anywhere?

"Descartes, Mom," interrupted Sam. "Paris 5. I got in."

I had to round up my stray thoughts, balanced there on my bike, feeling hot and vulnerable for a melanoma victim in the sun. It was lovely for a moment on an afternoon that had been sunny, then cloudy, windy. He seemed to sense that I was in need to being assisted in gathering my mind.

"I'll be in Malakoff, Mom, at Descartes."

"Are you happy? I mean, is that what you want?"

"It was my third choice, over Nanterre," he reminded me, sounding more patient with my slowness and failure to get into his head than usual. He has been feeling a little sorry for me, since he knows what it feels like to care about Bacs.

"Wait, third choice? What were your others, then?"

"The Sorbonne, Assas, and Descartes."

I had forgotten Assas. Or, rather, I had forgotten that he hadn't removed it from his choices, not that he'd need to; he had decided he didn't want to go there owing to its reputation for being cut-throat and competitive, not Sam's best learning environment, but he'd never get in, anyway. While all the public law schools, like all the public medical schools -- both of which are the best, anyway --, are supposed to be equal, Assas has a reputation for cronyism that cannot be denied in the professional world. Sam's got enough brains and personality to make up for that missed point of assistance. I am not worried about that.

"Are you sure you want to go there?"

"I can change later, if I want, and if I do well, maybe I can transfer to the Sorbonne, if I want. There is less information on Descartes' law program than on the others, but it is smaller, and I think that is better for me, and it was my first intuition to put it over Nanterre, so, here I go, I am about to click on "oui définitif". I'm clicking. There. It's done."

Can I possibly tell you how proud I am of him? He did this all by and for himself. Hours of research and reflection on himself and his options, and he made all his own choices, for the better or for the worse, but I can only believe that they will be for the better. He has this under control.

I only need to keep the currents warm under his wings.

"Do you want to come see Baccarat with me on Saturday morning?"

"What time?"

"Early, 9:30 am until noon."

"Alright." That's early for him, but he wants to see her. "Are they doing things for her to help the pain?" he asked.

"She isn't in pain, Sam. She is tired, and they are giving her all the attention, care and kindness we could hope for; they are making her comfortable and keeping her stable with everything they can do."

"There cannot be any question of money, Mom. This isn't about money. We have to help her."

I thought again of him saying that her life is far more worthwhile than all the "conneries" he could spend his money on, including the new used scooter he wants. I think now of a friend writing:
I'm with you--on every front. As a mother. The fact that Sam is moved by love for Baccarat to take a position: "Love, life--has more value than money" is both beautiful and a signal that your son has depth. What a fine man he will grow to be when this very special facet of his nature is nurtured.

And another saying:
[your husband] will pay for this for you and for Sam as you said, so don't question it. You do things for him, he does things for you, that's marriage. Have more faith!

And, finally, my sister weighing in:
I think if there is any type of decent chance that it might not be malignant and you can scrape together the money that you should do it. I know [my husband] is squarely in [your husband's] corner. He thinks it is unfair to the animal to put them through all that. I guess I would say the most humane thing is to do what is in Bac's best interest.

This morning, I told him that it is about money for many people, for nearly everyone. It unfortunately has to be because money is never unlimited, and it depends on each person or family's resources where they have to draw the line. We would have to draw a line somewhere, too. It's hard to know when, but it isn't now for us.

Baccarat will go to Montsouris, if nothing happens between now and then, whenever that will be, and she will have cardiopulmonary bypass surgery to remove a tumor, if it is benign.

I have to hope.


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