Down through the years I’ve had my share of educational moments. As I got older I got better at being the sort of person who takes his beatings cheerfully, registering the lesson, and moving on.
Today I had another. I have no such lofty response to this one. It will take awhile, I suppose, and eventually it will fade.
Where do I start? My experience today reminded me of so much that is sad about this country we live in and the values it finds itself mired in. It reminded me that there are good people caught in the ways and means of the American profit machine, following its patterns for their own livelihood and sustenance in the absence of an alternative.
I’ll start at the beginning.
Our Labrador Retriever Charlie, a beloved family member – and that phrase does little to describe the depth of love and respect we have for him – developed a lip tumor earlier this year. We took him to the vet and he had surgery to have it removed. The post-surgical histopathology report characterized the tumor as a malignant plasmacytoma. Six weeks after the surgery it came back.
When the tumor reappeared I undertook to educate myself about Charlie’s condition. Up until then my wife Lenore and I had relied on the expertise of the vet, who was quite good, and we still have a high regard for the expertise she brings to all of us.
When the tumor came back our next option was a more aggressive, disfiguring surgery which would remove an area of his lip about 2-1/2” long and an inch and a half high. It would have left Charlie’s canine tooth and gum in that area exposed.
We decided not to do that. The vet then referred us to an oncology clinic where the specialists there could inform us as to chemotherapy and radiation therapy treatment options available to treat and/or shrink the tumor.
During that time we began to treat Charlie’s condition ourselves, using the knowledge gained from our own research. The tumor continued to grow, but soon after we started our own treatments it started to show some signs of breaking down.
Last night the tumor began to bleed profusely, and the corn starch treatment we were using to stop bleeding wasn’t working very well. Combined with pressure it did help us stop the bleeding then, and again early this morning. Realizing we needed something better than the corn starch I located a Chinese Herbal store in Portland that carried Yunnan Baiyao, an extremely effective agent to counter bleeding, and planned to go get some.
Then the damn thing started bleeding again, profusely, and only pressure held it back.
So we called the oncology clinic – one of two in the Portland-Vancouver area – for an emergency appointment, citing the referral of our primary vet and letting them know who to contact for Charlie’s records so they could have them when we arrived. They were about 45 minutes away from where we lived
I asked if an oncologist would be involved in the emergency visit and was told that the triage vet would review the records with a staff oncologist and that a list of optional treatments and their costs would be given to us at the end of the visit. I asked if they by any chance carried Yunnan Baiyo, and they did, and the cost of the emergency visit would be $99. It all sounded good to me. We’d even be able to pick up the Yunnan Baiyao there, too.
It was a big clinic. The parking lot was full, and it was a big parking lot. As a provider of emergency services as well as being one of only two commonly referred local providers of pet oncology services in the area, the place was a hive of activity. The front desk was in a common entrance area for all services, and the staff there ran the desk fast and efficiently. Calls for “the next available triage vet” came often, folks with appointments were handled quickly and well. All in all it was a well-oiled machine running at peak efficiency.
I might have thought it all a bit too well-oiled had I been in better shape, but Lenore and I were both short on sleep, nearly exhausted, worried about Charlie.
A vet tech appeared promptly and took Charlie back to be assessed by a triage vet. Less than ten minutes later another tech reappeared, told us they had stopped the bleeding – with two caps of Yunnan Baiyao – and we were conducted to an exam room. Shortly after that our triage vet appeared.
He was about twelve, I’d guess. Well, not that young, but obviously new to the trade. He was earnest and informed and obviously well educated in veterinary science and told us Charlie’s bleeding had been stopped. After he briefed us on that it looked like we were going to be ushered out to pay our bill.
I had a few questions. Was an oncologist consulted? No. I told him we were told on the phone that a staff oncologist would be involved during our visit, and that we would be given a list of our options and the costs for further treatment. He said he could talk to an oncologist before he prepared his final report, and would since I asked. That sounded good, so I gave him some background on the tumor to pass along to the oncologist. He was aware of plasmacytomas, but it became obvious as I spoke to him that his knowledge was only general knowledge, and I was glad he’d agreed to talk to an oncologist. It was jclear that although he had Charlie’s records in hand from our vet, he had not looked at them at all, and so I gave him a brief description of Charlie’s history.
A cutaneous plasmacytoma in lip tissue like Charlie has, even with a high mitotic index characterizing it as malignant, is not necessarily or even probably a tumor that will metastasize to other parts of the body. It’s also not typically a metastasized extension of another deeper tumor. It’s a skin cancer that grows fast in the area it appears in. I’d learned that one oncology protocol involved a prednisone and melphalan treatment which might help shrink the tumor without the disfiguring surgery, and I wanted to know more about that and the costs involved. The young vet took it all in and said he’d talk to the oncologist about what I’d said.
I asked about an antibiotic then, citing the apparent break down and degradation of the tumor which produced the bleeding. I thought there might be a chance of bacterial infection present. He agreed with that assessment and prescribed an antibiotic. And I had to remind him that we wanted to get the Yunnan Baiyao while we were there, and he made a note of that as well.
We were then taken back to the waiting area to get Charlie and the vet’s report, and about 20 minutes later had both in hand and I went to pay our bill.
Suffice it to say that the bill was large, much larger than I expected. I was tired, worn down emotionally, sleep-deprived, worried. I was exhausted, and sad, and troubled by the interaction I’d had with the vet and the concentration it had taken to call his attention to things I’d expected him to know. I could feel the well-oiled machine running all around me, pushing me through it.
I thought about questioning the amount for just a moment. Any other time I would have been able to discuss it. In that moment I couldn’t. I just paid it. But I didn’t just pay it. I gave up, and then I paid it. In that moment the hammer came down and my spirit truly broke. I didn’t care about the damn bill. I just wanted to get the hell out of there with Lenore and Charlie and go home. And that’s what we did.
There’s an iceberg beneath the tip of that moment. I’ve been plumbing the depths of it ever since.
More to come.