Cutting Room Floor
Not everything an author writes makes it into his books. Here's a section that could have but didn't.
The Contract
Greco was an interesting mixture of canine. Somewhere in his distant past there was certainly beagle blood. That much was clear. Beyond that, breeds and bloodlines blurred. Weighing in at about forty-five pounds, Greco sported the beagle colors, but displayed the body contours of a shepherd. His attitude of braggadocio was clearly independent of his questionable lineage. The set of the tail, the carriage of the proud head, and the careless, almost disdainful persona stated with clarity, "I am who I am. I don’t care who my ancestors weren’t. I am THE Greco." You had to like a dog like that. And Greco was quite confident that you would.
Greco’s owner, Antonio Toumopoulis, seemed equally incongruous. His jet-black hair, heavy eyebrows, dark skin and deep Greek accent were unexpected contrasts from the characteristic upstate New York dialect. Nonetheless, Mr. Toumopoulis bore these Greek characteristics with obvious pride. No apologies were necessary and none were proffered. He more than compensated for his diminutive five-foot-three-inch stature by booming out his staccato accents in unbelievably amplified tones. The pair was indeed an impressive duo.
The visit that morning, though still carried on at rather uncomfortable decibel levels, was relatively suppressed. Greco was sick!
"Greco . . . He no feela good." Mr. Toumopoulis reported, endlessly rolling his R’s in ways that I can not force my tongue to imitate, much less represent in print. "Seence two day ago, He no eeta . . . no dreenka . . . no, how you say, poo." At least half of his meaning was evident from creative use of hand, arm and facial gestures which, in this context, are best not described. "And he . . . (more expressive gesturing) "breenga ohp hees fooda meeny time."
"Do you know of anything he could have gotten into? Any missing toys or things like that?" I queried. It sounded to me like a possible gastrointestinal obstruction.
"Oh no, doctohr. He no playa weeth toys. He theenka squeaky things too seessy. He more like chewa de rocks."
Stoically Greco stood as if planted on my examination table. Too macho to exhibit his discomfort overtly, he simply stared straight ahead, eyes fixed on the wall in front of him. In response to hearing his name, he would give three or four tentative wags of the tail before assuming once again his statuesque pose. There was a barely noticeable catch in his throat as he drew each breath. Otherwise, he masked his discomfort completely.
I carefully felt his stomach with my fingers, gently probing the bladder, the spleen, the liver and the intestines for any abnormalities. Unexpectedly, as I did so, I felt a golf ball sized lump slip through my fingers. When I bumped up against the firm lump, Greco’s pain broke through his stoicism. He turned and snapped at my hand, barely missing, then immediately wagged his tail ingratiatingly as if to say, "Sorry, doc. Didn’t mean anything by that. But man, that hurt!"
I carried Greco to the X-ray room where he bravely submitted to having pictures taken. A stark white object stood out as if in relief at one end of a dark tubular shadow in the abdominal cavity. Greco did indeed like to "chewa de rocks". This one was obstructing his intestines, trapping gas behind it and painfully ballooning the intestines. I knew that surgery would be necessary.
I set Greco back on the examination table. He immediately resumed his painful posture, staring at the wall as if engrossed in must-see television. I turned to Mr. Toumopoulis.
"The X-rays show an intestinal foreign body - probably a rock. It means we should go in surgically and remove it. I don’t think this should wait. I’d like to do the surgery right away." I could see Mr. Toumopoulis’ dark eyes flare with concern for his friend and suspicion of me.
"Ju theenka he need be cut hopen?"
"Yes, I do."
"He be hokay?"
"Not without surgery. And the sooner the better."
He eyed me uncertainly, apparently convinced of neither my diagnosis nor my capabilities. Finally, "Ju do thees . . . cutting before?"
"Yes I have, Mr. Toumopoulis." I tried to be as reassuring as possible while at the same time maintaining a healthy realism. This was a serious condition and the risks were very real. "But you must understand that Greco is seriously ill and, though it’s unlikely, it’s possible we could lose him during surgery. Without it, though, we’ll lose him for sure."
Mr. Toumopoulis studied the floor for a few moments, his dark eyebrows furrowed, almost meeting in the middle over his prominent nose. His hand ran absently over Greco’s head, tracing the forehead and ears. Greco didn’t respond to his touch.
In the end it wasn’t my urging that finally convinced Mr. Toumopoulis. It was Greco’s quiet grunt of discomfort that brought him around. With a conflicted mixture of resignation and conviction, he turned to face me.
"Hokay, doctohr. Ju go do cutting now. I waita for ju to call." He turned to go.
"Mr. Toumopoulis!" I stammered out too quickly. "There’s something else."
More than any other part of practice, I hated to discuss the financial aspects of treating my patients. Human physicians understandably do not have to contend with financial constraints in the treatment of their patients. Veterinarians, on the other hand, are accustomed to these real considerations and are always prepared to include money issues in their discussions about treatment. Orientation for my internship had hammered into my mind the importance of communicating clearly the expected costs of treatment.
"You need to know that surgery could be fairly expensive. For some people that is a consideration. The business office can give you an estimate for the fees and arrange payment options if necessary. So I’ll need you to . . ."
My words were interrupted by a flash of unhappiness in Antonio’s dark eyes. "No . . . No . . . No . . ." Each word was punctuated by the jabbing of a thick finger in my chest. Then the eyes lightened and he addressed me in a rhythmic, almost musical cadence. "I tella ju what. Ju teka de responsibility to fixa de dohg; I teka de responsibility to paya de bill. Coppice?"
And that pretty much settled it. I accepted his terms and began work on my patient. At surgery I removed a man-sized rock which Greco had consumed during his macho play. It had lodged fast in the small intestines, obstructing the passage of all gastrointestinal contents. The section of intestine containing the stone, now stretched and bruised to a dark purple, had sustained irreparable damage. It had to be removed. But surgery went well and I was confident that Greco would recover fully.
No sooner had Greco opened his eyes after surgery than he was trying to stand. Within another ten minutes, he was staggering drunkenly toward the door. His sentiments and intentions were unmistakable. "Thanks doc," he was saying. "You did good. I’ll take it from here. See ya’ later." We literally had to tie him down till he was fully recovered.
Greco went home the next day, much earlier than most patients do after such invasive surgery. Antonio was pleased that his dog had done so well and, as agreed, payed his bill in full with crisp, fresh bills.
I often think of Greco and Antonio. No one before or since has so clearly defined and expressed my role for my clients and patients. It is indeed a sacred responsibility to have in my care the object of someone’s love and devotion. It’s a responsibility that is sometimes easy, sometimes tough, sometimes funny and sometimes full of pathos. Some patients, like Greco, recover fully and never look back. Others never improve, refractory to even our best efforts. Some diagnoses are as stunningly obvious as Greco’s stone. Other diagnoses stubbornly refuse to be made, straining our minds to fit the pieces of the diagnostic puzzle together.
Throughout each case, though, I am aware of the bond between the patient and its person, the owner’s paralyzing fear of loss, the level of trust being placed in me. And I remind myself to "teka de responsibility to fixa de dohg".
BUY THE BOOK from Amazon