Monday, July 2, 2007

A Quality-of-Life Issue

This evening I took my 11-year-old golden retriever (a golden-years golden) to the vet for his “old man checkup.” The vet, Dr. Olsen, came in. After greeting both Tucker and me, she got down to business. While she was checking him over, I mentioned Tucker’s numerous lumps and bumps and asked her if she’d take a look at them for me.

She ran her hand over each area of Tucker’s body quickly and expertly. When I mentioned the lump on Tucker’s right shoulder blade in particular, her hand covered and probed the lump, then stopped, resting lightly on the gray-flecked fur.

“I’d like to aspirate this,” she said. “I think that it’s another fatty tumor under some muscle, but I’d like to check to be sure.”

As she looked at me, I drew in a breath. As I let it out, I told her that if the lump was not a harmless tumor but one of the other kind, that there would be no surgery. Tucker has had three abdominal surgeries and two tooth extractions. Our family didn’t think twice about the expense and heartache of leaving him at the vet’s because we knew that the quality of his life would be improved when all was said and done. But to start subjecting him to surgery to remove the tumor and then chemotherapy and/or radiation at this stage in his life, well, that would pretty much be like torture. We might be able to squeeze out more time with him, but at what cost?

We once had a dog, Sadie, who had “seizures of unknown origin.” (She's the one in the picture in the sweater. Despite what certain individuals believe, she loved wearing that sweater.) We loved her and cared for her as best we could. The vet ran tests and tried out different medicines. But slowly, almost inexorably, her seizures became more frequent and closer together.

The day came when Sadie had one seizure after another. When I took her to the vet during one of the brief respites between seizures, they immediately sedated her, giving both her and me some relief.

The vet on duty, a tired-looking young guy, described our options. One option was to get an MRI of her brain to see if a tumor was the cause of her seizures. I declined because it would just be an exercise in futility and an expense that we could ill afford. Even if the image showed a tumor or an “x marks the spot,” we still wouldn’t have been able to afford the expense of the surgery or follow-up treatment.

“Well,” he said, “we could try significantly increasing the amount of medication she’s taking now.”

“What will the side effects be?” I asked.

“She’ll pretty much be a walking zombie, but hopefully the seizures will be controlled,” he said.

Our one and only option was to turn our lively, funny Sadie into a zombie in the hope that her seizures might—just might—be controlled. As with Tucker and his mystery lump, this was another instance where the quality of life was the overriding factor.

These issues exist in the human world, too. A good friend of my mother’s had terminal bowel cancer, but during her final three years, underwent procedures, chemotherapy, and what the medical profession describes as “significant discomfort.” Being a legal adult and in her right mind, my mother’s friend was well within her rights to do whatever she chose. However, whenever my mother described this poor woman’s agony, I was struck again and again by the tradeoff. Is it worth having quantity of life if you don’t have quality of life?

“Terminal” means you’re going to die, that you’re in the process of dying. We all have to make our own choices, but for me it all boils down to quality of life. Enduring daily torment in the desperate hope that the doctors were wrong or that medical science would discover a miracle cure in time just seems like so much needless suffering.

Back at the vet’s office, Dr. Olsen stuck a needle into the tumor and aspirated a sample, which she then deposited on a slide. After a moment looking at the slide, she turned to me and told me to take a look. There, on the slide, were lovely tiny globules of fat and a small smear of blood. The diagnosis “fatty tumor” never sounded so beautiful to me.

So the quality of Tucker’s life will continue to be good, and we will love him and take the best care of him we can. And if the quality of his life is good, then the quality of my life and those of my family members are good, too

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