mercredi 21 juillet 2010

The other patient

The koi in its Nifurpirinol bath, Day 13


It could really use a name now, couldn't it? I am nearly certain it's a female, but not enough to commit to a name. Maybe I should call it George, as in George Eliot.

No. That stinks. I'll just refer to it has "he" and "him" until I have a better idea.

I need to put together a series of photos, from the first day I put him in quarantine and began salt and anti-bacterial/antibiotic treatments to the present, to see if he really has improved as we think he has. His eyes seem to be less protuberant, and there is a less marked difference between the scales of his body from those of his tail, which is also to say that the scales of his tale now seem to stick out a little, too, but the rest perhaps less.

I pour over pictures of different varieties of koi, looking to see if his scales appear normal now by some variety standards, and one very encouraging thing is that the enlarged blood vessels around his right eye that appeared just after I began treatment disappeared within a couple of days of treatment, and they have not returned. Another is that he appears no worse, if not necessarily certainly all better. He is lonely in his quarantine tub, but that is better than dead. Sometimes he comes out when I come to visit him. He also seems to accept my removing him when it is time to change his water, to which I add a Nifurpirinol tablet, in addition to the salt, to his water, and I am no longer doing the concentrated, brief Nifurpirinol baths.

I am not sure he is eating anything, but that's probably just as well for his system, and besides, hiding all day behind his rock and plants doesn't require a large amount of calories. If he continues to do as well, I will return him to the "bassin" in a week or two and see how it goes, but don't say anything to him; I haven't told him yet, and I don't want to get his hopes up.

It's time to leave to go see Baccarat for the afternoon. It's her last afternoon before open heart surgery, and I am doing things I don't recognize that I am to stay calm. I don't know what you call it, but it's a lot like that afternoon when I knew Audouin would come home with the lab results for my melanoma. I remember thinking, up on my ladder painting the Orange Room, "Soon, you could get news that will change your life forever. You could learn that you won't live much longer," and I looked out the window at the sunshine in the flowers, the dogs and Shadow sleeping on the lawn, and myself spoke to me, Just enjoy this afternoon, this moment. It's what you have, and I felt peaceful, happy.

Sometimes, that's enough.

This evening, Sam will call me when he finishes work, and we will meet up on the Champs-Elysées to go see Toy Story 3. Like he was just the right age for Harry Potter when it came, and made a reader of him, he was the right age for Toy Story, so that 11 years later, when Andy is going to college and leaving his childhood room, so is Sam. We'll spend time together and enjoy that, and tomorrow will bring what it will. Each moment until they have the result of the biopsy is a moment of the present, when Baccarat is still alive and there is hope.

Everyone knows that it is already almost a miracle that she is still alive with this mass taking up nearly all the space inside her right heart, reducing the blood flow to a trickle, her circulation to a a stream in the desert. Her heart could fail at any moment, her brain be destroyed, but say the name of one of her beloved people, and the head darts up, the tail starts.

"Baccarat! Guess who's coming to see you! Sam! Sam's coming to see you!" and the tail is going. Everyone laughs because I could tell her in the same tone of voice that we were going to force feed her some more of that protein-rich food, and she'd stare out past the legs of the chairs and people and sigh heavily. She is still there.

"C'est un bon signe," they tell me, "qu'elle se bat. Elle aurait pu se laisser aller, mais elle reste avec nous et elle s'intéresse; elle se bat." It's true. She could let herself go; she could let herself die, but she is interested in what is happening around her, and she is hanging on.

"L'hôpital va lui manquer," I laughed, "Parce qu'ici, l'où elle va, elle est accompagnée par tous ses amis, un petit groupe d'étudiants, d'internes et de résidents! C'est très agréable!"

And, this is true, too. She will miss the hospital and all her friends there because wherever she goes, she is accompanied by a small troupe of friends, students, interns and residents. It is very nice to be so cared for.

Tomorrow, the car will take her and two vets, including Dr. Gouni, to Montsouris. At noon, the perfusionist will attach her to the cardiopulmonary pump, and they will begin open heart surgery. She is one of the very few dogs ever to undergo this surgery, which would be out of the question in the United States. Even here, where the surgeons are donating their time in the interest of trying to save her and to learn more, it is going to cost more than my son's lycée, as much as one year of his school in Paris during collège.

"There is no price that can be put on her life, Mom," he tells me again and again.

"There is, Sam. For everyone, there is a limit, a moment when they cannot spend any more. They just can't. For us, we are willing to make this sacrifice because she is so young, and because we love her, you love her so much, but for others, for most people, it would be out of the question." It is hard for him to accept this.

"Il faut être un peu psychologue dans notre travail," said Dr. Gouni yesterday, as I filled out the papers and wrote a check to IMM Recherche. My fingers spelled the sum out easily. I didn't need to make a list of all the things I could live without to make it possible. Like my friend said, we can eat potatoes for a couple months. "La plupart des gens ne pourrait pas se permettre de payer une chirurgie et les soins. On le sait et on leur n'en parle pas." One must, she said, be a bit of a psychologist in our work because most people could not pay for this surgery and the medical bills. We know it, she said, and we don't even suggest it to them.

"Je pense au chien," I answered. "Il n'a que son amour à offrir à son maître. Il n'a pas d'argent pour payer quoique ce soit. Si son maître est en train de mourir d'un cancer, on ne lui demanderait jamais de payer ses soins, de lui sauver la vie, alors, pour lui, c'est normal qu'on lui offre ce qu'on a, l'amour et de l'accompagner dans le temps qu'il lui reste. C'est bien à ses yeux.""

I think, I told her, of the dog. He has no money to pay for his master's medical bills were he dying of cancer. He only has his love to offer, and he will give it until the last. So, for him, it is normal that we only offer him the same if it is all we have. It is good in his eyes.

I need to go now. I am late.
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