How Far Should We Go to Save Our Pets?
Brain surgery, kidney transplants, pacemakers. Thanks to expanding veterinary treatments, end-of-life decisions have never been more wrenching.
ENTERING THE SERENE, SKYLIGHTED ONCOLOGY SUITE, I IMMEDIATELY SEE the goose standing on the tile floor: large, gray, and stately. His bill and legs are orange-hued with subtle gradations to rose, and the slate-colored plumage of his upper body gives way under his tail to bright white. He is elegant for such a full-bodied creature - built like a handsome frigate. Two-year-old Boswell (yes, after Samuel Johnson's biographer) has finished his weekly radiation treatment for the bone cancer in his left leg, and, against the backdrop of computer screens, he is holding court with several lab-coated women. It is a little surreal.
Someone announces that Boswell's "dad,"
The strength of the bond I am witnessing is unexpected, but with this goose, I am reminded of what is at the heart of my quest on this day. I'm here at the Cummings School of Veterinary Medicine at Tufts University in North Grafton trying to understand how we pet owners set about making decisions on how far to go in rescuing our beloved and sick or injured animals. Because I have had Irish wolfhounds all my life - a magnificent breed whose medical problems tend to be as big as its profile - I have wrestled with the issue many times.
This is a country in which 93 percent of we owners describe our pets as members of the family, where 70 percent of us sleep with our dogs and 78 percent with our cats, in which nearly three-quarters of married pet owners report greeting their pet before their spouse when they return home. It is a culture in which, according to one New York study, women report feeling "significantly" more intimacy with the closest pet than the closest person in their lives.
Given this remarkable relationship, how do we approach these life-and-death decisions? Is it as far as our credit cards will stretch? Is it the pet's quality of life? Or our own quality of life? With the super-sophisticated, super-expensive medical diagnostics and treatments now available, especially in Greater Boston, the answers are not always so clear.
THERE ARE KIDNEY TRANSPLANTS FOR CATS, BRAIN SURGERY FOR DOGS. Cancer treatments - including operations, chemotherapy, and radiation - for all creatures, including rabbits, lizards, parakeets, fish, and ferrets. Pacemakers are routine, as are CAT scans, PET scans, and MRIs. Along with the cutting-edge equipment, the level of expertise and specialization among vets has grown, too. As Dr. Dominik Faissler, a veterinary neurologist at Tufts, says, in a nod toward the folksy appeal of the late best-selling author of All Creatures Great and Small, "The days of James Herriot are over - now it's all about the team approach."
And teams aren't cheap. Sure, the cost for all this in the veterinary world is just a fraction of what it would be in human medicine. But with human medicine, presumably there is insurance. We Americans spend $20 billion a year on healthcare for our pets - $1.12 billion of that is spent on vet care here in New England, according to a recent study from the Cummings School. And for most pets, that care comes out of an owner's pocket. A surprisingly small number of owners in the United States carry pet insurance - only 3 percent as of 2004. It made me wonder what we pet owners should dread the most. What's the most expensive thing to deal with?
Dr. Ann Marie Manning, chief of staff at the Massachusetts Society for the Prevention of Cruelty to Animals-Angell Animal Medical Center in Jamaica Plain, says the most expensive medical problems are not necessarily defined ailments like lymphoma or hip dysplasia, but surgeries that can cascade into unanticipated complications - going under the knife because of a "foreign body," like a swallowed sock, in the intestines. Postoperatively, you may be putting out one fire only to have another flare up: infections, heart arrhythmias, blood disorders. Each seems fixable, so you keep going. And the bill quickly climbs to several thousand.
Manning says that rejecting treatment because of money is a weekly, if not daily occurrence at Angell. Though there are assistance funds at both Angell and Tufts, sometimes even getting half the bill underwritten just isn't enough. It's a tragedy for everybody. "I don't know that it gets any easier to deal with over time," Manning says. "In fact, for me, it got harder and harder." And considering the tough economy these days, experts are bracing for an increase in this heartache. At least one grief counselor has already seen an uptick.
Plenty of people are mystified by the determination many of us have to save our animals. So much money for just a dog or cat . . . or goose? Personally, I don't think we should ever feel compelled to be accountable to those skeptics. I find that animals are capable of bringing out the best in us - our very humanity. And I'm not sure anyone understands precisely why this is, but science has shown over and over again that pets add real value to our lives - they can lower blood pressure and cholesterol levels, provide higher survival rates after heart attacks, and calm us in stressful situations. Boswell - even though he isn't the most typical species here (that would be, by far, a dog) - is a feathered poster boy for the mysterious emotional tie that is possible between a human and an animal, what it's worth to us, and how we can maneuver the tricky emotional space of love, compassion, care, and the desire of wanting to do anything to buy more time for and with those we love.
But because all that plays out against the harsh reality of simple finances, many of us really do have to put a price on love. Boswell illuminates that aspect, too: Though he was an $8 purchase at the local feed store, his two major bouts with cancer - a tumor in his trachea and now osteosarcoma (a fast-moving and painful bone cancer) in his leg - have added up to perhaps $20,000 worth of surgeries and treatments. Podlaseck, who has no children and lives on a farm in Kent, Connecticut, with Boswell's sister, Woglende, three dogs, two cats, and some chickens, reveals this information right off the bat when I meet him. But later, as we correspond by e-mail and phone, he says he feels a little squeamish about the prospect of seeing the figure in print. I know exactly what he's wrestling with. On the long ride out to the Cummings School the first time I am to meet Boswell, I wonder if I should stop by the records office and find out how much my tally ended up being five years ago for my Irish wolfhound Sage's many orthopedic surgeries. Before Sage went to Tufts, she looked something like an eggbeater in pain when at a full run. After, she is an elegant, happy gazelle (well, mostly). That transformation took three operations, and I must have spent around $10,000, but I've never really wanted to know exactly.
Bo and Susan McFarland, of Northborough, feel the same way. I meet them at the hospital that first day, too. Their beloved 12-year-old mixed-breed, Pegasus, is finishing up radiation treatment after having a brain tumor removed. Yes, brain surgery for a dog. The bills have been paid as they have come in, but the couple would rather stay in the dark about totals. Bo remembers that the initial MRI cost $2,000 and that he stopped counting after that. They say the doggie brain surgeon, Faissler, probably told them how much it would all cost, but "we couldn't hear it," Susan says. "We only cared about whether he could help Pegasus."
CLEARLY MONEY IS ONE HURDLE IN THE ROAD TO HELPING A PET. BUT THE other is just as daunting - and that is the question of what this medical intervention will do to the animal's quality of life.
When I agonized over whether to have my wolfhound Lacey's back leg amputated because of osteosarcoma, I got at least four pieces of important advice. One was that when a dog has a leg amputated, she wakes up from surgery and says, "What?! I only have three legs? . . . So, what's for dinner?" The second was that gaining even one year, to use the old and not totally accurate rule of thumb, was like gaining seven in dog years. Third, from the oncologist himself, was that while everyone reacts with horror to the notion of amputation, he hadn't encountered one owner who later regretted the decision. The fourth piece of advice concerned the way to evaluate the very nature of our companion animals.
Jane Nathanson is a Boston-based counselor who helps confused and grief-stricken pet lovers navigate these waters, both in private practice and as a consultant to animal organizations such as MSPCA-Angell. She works with hundreds of clients each year as they make decisions about treatment options and euthanasia. "Many owners who have long expressed that they will do anything and everything for a pet may ultimately confront a time when this objective is not feasible," she says. "The intervention may be beyond the capacity of the person or the animal to endure."
Carter Luke, president of MSPCA-Angell, sighs repeatedly while tackling this subject. "It's amazing the options we have now," he says. "The hard part is that more options potentially mean more money. The technology raises more questions for us." Luke works at an animal hospital with, as he says, "the finest doctors and most sophisticated technology." Yet, he finds himself returning again and again to the homespun advice that a rural dairy vet in Wisconsin gave him decades ago - and that is to ask yourself, does my pet still have a twinkle in his eye? Still experience joy? "There's no one right way to do it," Luke says.
And that sentiment is echoed by Dr. Deborah Kochevar, dean of the Cummings School. "People often ask the veterinarian, 'What would you do if this were your pet?' And I think that's fair - but it's tough. It just really is something that each family has to decide on their own, with their own perspective. Time, finances, family - all those come into play."
In other words, realistically, what can or can't you do? Does your pet need substantial hands-on care, but you work long hours away from home? That the quality of life for the pet is inextricably linked to the quality of life of the owner or guardian also plays out in a way that we might not think of: It's important through a medical crisis to be a calming, comforting influence. To even leave room for joy.
QUALITY OF LIFE IS MUCH ON THE MIND OF MARK PODLASECK WHEN HE e-mails me just days after our first meeting; it had been Boswell's fifth radiation treatment. Since then, Boswell has had trouble standing. Podlaseck writes: "stuffing him with baby arugula and reading him the iliad, which he seems to love." Then, "(meanwhile, lots of bourbon and neil young for me.)" Podlaseck can mask his emotion to a relative stranger with wit, but has to admit that he is "fretting."
Podlaseck has already told me that with Boswell "you can tell when he's happy and when he's sad." And Podlaseck's not liking what he's seeing. After a few phone calls between owner and doctors, the goose's appointment for the following Thursday is reclassified. Instead of receiving his last dose of radiation, as previously scheduled, Boswell will be in for an evaluation. Another communication: "we're getting close to that 'quality of life' issue you raised," Podlaseck e-mails me. Then: "so he may not be coming home with me. but he's surprised me before."
When Thursday arrives, I meet Podlaseck outside the animal hospital at Tufts. Though the pair are famous for walking side by side through the waiting room, today Podlaseck is carrying Boswell. I ask Podlaseck, whose navy sweater is by now dotted with fine white feathers, what makes Boswell special. He tells me that Boswell is amazingly gregarious - right from the start, the goose liked going on errands into town with him. "He's everything you'd hope a goose would be," Podlaseck says. Reflecting on it all, he says something all of us animal lovers feel deeply: "I really, really needed him in my life."
In a small examining room today, Podlaseck reports to Dr. Joerg Mayer and intern Dr. Candace Hersey-Benner that he's not sure it's right to continue treatment for Boswell. In white lab coat and round horn-rimmed glasses and speaking in German-accented English, Mayer can often display a robust and warm humor, but in this moment, he's all serious scientist. "This is the million-dollar question. The really tough decision," Mayer says. "Without a crystal ball, we have to ask, is this worth continuing?"
I feel my own stomach tightening at the question.
But Mayer then pulls a trick out of his vet's bag: chemotherapy. He advises that they try one injection today, adjust Boswell's other meds, and determine within one week if there has been improvement. "If this were my own animal," Mayer says, "I would not feel happy to give up right now."
Podlaseck kisses the top of Boswell's head and says, "What do you think?"
Within minutes, Boswell is having an X-ray, and then, under sedation, he receives radiation and an injection of a chemo drug. Nancy Thompson, an oncology chemotherapy tech, even administers a little free reiki, a Japanese healing therapy, to Boswell while he's unconscious and lying on his back on an examining table. She smiles and says, "When people ask how what I do is different than in human medicine, I say, I don't get sued if I kiss my patients."
An hour or so later, Boswell is tucked into the Volvo for the ride home. If he does well enough, there will be another chemo appointment in three weeks.
"We're killing the most aggressive cells and significantly slowing down the growth," Mayer says to me. But the disease will eventually kill Boswell. This isn't a cure. Podlaseck knows this and is just looking to keep Boswell alive as long as the bird can enjoy life. Six months? A year? No one knows.
A few days after the treatment, I hear from Podlaseck via e-mail: "boswell is doing ok. able to take a few steps from one water bowl to another." A week later, even happier news: "he's actually made a pretty dramatic recovery," Podlaseck reports - "chased the dogs out of his barn yesterday." There is joy in the goose's life again: "we got to an exciting battle in the iliad and he was honking and flapping his wings. he loves the insults." Unless Boswell has a real affinity for ancient Greek literature, I think his "enjoyment" of the great epic is really his enjoyment of Mark Podlaseck. And I think the goose is so exquisitely tuned in to Podlaseck's emotions that he really does get worked up in key sections.
Who can say what this bond between Podlaseck and Boswell - or between any of us and our animals - is all about. We don't need to try, and we don't have any explaining to do. As counselor Jane Nathanson points out, "It's nice if other people understand, but what's far more important is that we, ourselves, understand."
Vicki Constantine Croke's latest book, written with Sarah Wilson - Dogology: What Your Relationship With Your Dog Reveals About You - hits stores this fall. She's currently developing an animal show for NECN. Send comments to magazine@globe.com.
