DIAGNOSIS (1)

So this is how it starts.

We drive Duke, our big old hound, up the mountain pass in Colorado to a rural veterinarian for an X-ray, thinking he has torn his ligament and that is why he couldn't easily navigate the stairs at home one weekend. One of our daughters is getting married at a distant bed-and-breakfast, and our neighbor Susan is looking in on Duke and Raven, the smaller female mix we are leaving home with him. Susan notices that Duke is limping when he tries to go upstairs for water. We're surprised. When he doesn't improve, we brace for the possibility that he could have damaged a ligament.

In the vet's office, it is awkward, even with four of us holding him, to get Duke comfortably situated on a cold steel table for the scan, and he bares his teeth to the gums in pain and warning. When the vet examines the X-ray, this respected animal doctor concludes he doesn't need to see any more tests. So sorry, he conveys gravely and sincerely, he's near certain he is viewing osteosarcoma in a distal femoral bone. That means Duke has bone cancer in his left back leg. The vet points out the tumor's shadow, and we nod numbly, not fully comprehending. First there's denial. What? Cancer? Duke? Are you sure?

We're in shock, since we've never associated one big thought, Duke, with the other, Cancer. Yet a longtime acquaintance with veterinary experience in pain management had informed us shortly before this that her family had just lost their dog Yella to a similar condition. We were saddened; Yella had romped a few times with our dogs, and had been a fixture in their children's life almost from the beginning. So, hoping for reprieve, we forward Duke's X-ray. There is silence, and no one suggests our veterinarian is wrong.

After Yella's leg was amputated, we learn, her bone cancer spread rapidly to her lungs. Our friend is not recommending that we put the older and bulkier Duke, almost 12, through that. He is a giant black Lab with a bloodhound face and jowls, so an improbable mixture of two large breeds, one known for distractibility and the other for persistence. When he chases a ball, it's hard to predict which compulsion will prevail.

Cancer, we hear, is happening to a lot of big dogs.

In her caring note to us, I notice that she speaks in terms of weeks, not months, about Duke's prospects. She is a scientist, and a realist to the bone. Even before diagnosis, as a preventative strategy, this lady had been training Yella her whole life to sit still for blood draws and catheters in case she ever needed them.

She recommends that, for Duke, we might want to seek a prescription for oxycodone for his last weeks. (We're still in denial and not hearing the tough odds well. As it happens, Duke lasts not even two months and is gone before Christmas.) Our friend also mentions anxiety drugs. It is very stressful, she notes, for a dog who is struggling with disease symptoms, to not be able to do normal things — maybe for Duke, completing the walking loop at the dog park, whereas for Yella toward the end, it could mean just breathing without strong effort.

On top of all this, she outlines the pros and cons of various discomfort and sedation capsules that may help Duke out. She kindly affirms that she feels our pain and warns that the weeks ahead will not be easy. Between the lines, her highly detailed note is so deeply emotional, I'm surprised; I don't know why. It's a big responsibility caring fulltime for anything, and a dog fallen ill is no different; she talks about making choices for him like we would for a helpless baby. It's so sobering, I gloss over half of what she's saying, in part because I don't know the pharmaceutical references yet, am moved by her distress over the still fresh memory of Yella's demise (and wondering whether we could have offered more comfort), and am starting to realize the trauma we are facing.

And so we drive back down the mountain pass in silence, grappling with the realization that's that — our days with Duke are appreciably numbered. Besides being shocked — cancer is not a frequent house guest — we're tired and glum. I've lost both parents to heart ailments, Mom in New York before I was married myself. When we lost my father-in-law to throat cancer, we had the privilege of participating in at-home hospice care for him; we had embraced this priority by undertaking a prolonged stay in the little white house on a cul-de-sac where Todd had been born and raised in California and where his folks still lived. Other losses weighed heavily as well. Fortunately, despite living in a different state, my husband has been blessed in sharing long visits by telephone with his elderly mother for decades after his own children were grown. And still, for both us, lessons and scars from dealing with loss have been with us for a long while.

So why is there still the sense of being ambushed when it seems now Duke is about to go down? For weeks, I ponder the idea that maybe this is how it goes for pets and people alike: You walk into some antiseptic medical or wellness office full of people in white coats, thinking you'll dodge the odds like the healthiest of your buddies ... and then suddenly you don't ... or it seems you might not. Some cold clinical machinery or document registers your new reality ... as a patient with a pathology report. You've opened some hidden door so wide that cancer has crept in where strength and hope had thrived. You are sentenced over the next weeks, months, or years to be constantly fighting a dread disease, struggling to survive, find a miracle cure, or at least a hopeful remission. The clock stops. You feel despondent. Helpless. Too late. Poor Duke!

HERE AND GONE (2)

Grappling with death and loss, and handling end-of-life care compassionately, have been on my mind for decades. When Mom died shortly after her sixty-seventh birthday-collapsing in my arms-I was devastated. Really I had not contemplated the possibility until a year or two before, when her heart disease became apparent. At the time I was climbing the career ladder at my first newspaper job after college, and it was difficult to know with any certainty the best measured response to her declining health with age. Plenty of people live with heart ailments, and we were hoping she would be one of them. We were close growing up, and I shared her interest in the psychological dimensions of life, including connection, displacement, grief and loss.

Since I hadn't moved out of state, I was able to visit home frequently enough to keep up with her changes. They could happen almost without warning. Once between visits, her silvery gray bobby-pinned curls turned white, which shocked me upon arrival. Trips to the hairdresser remained a pleasure, and helped me learn what she knew about her condition by hearing what she shared with the women in the shop. As she weakened, medication changes played games with her thinking. It was harder to say good-bye or to know, when driving more than three hours back home to resume work, that I was doing right by her. Bereavement's uncertainties rode with me, inspiring noisy internal debate.

Our mother had a cardiomyopathy — an enlarged, less efficient heart muscle. Diabetes and hypertension likely were factors. Up to her last year, she cooked, cleaned, and shopped much as she had done before. But during her illness, her blood pressure was lowered to decrease the workload on her heart; subsequently her brain was not well supplied.

After Mom died, I briefly volunteered at Elisabeth Kubler Ross' facility at Head Waters in the Blue Ridge Mountains of West Virginia. The renowned bereavement philosopher wasn't there at the time, but it was arranged for me to stay with a bustling mountain family whose children had hardly ever met a woman in her thirties who hadn't yet married. While I was already an accomplished enough journalist, for that aspect of my self-development I was something of a novelty in these hills, the same way my sister Louise, a trauma doctor, was during her years after college serving with the Indian Health Service in Ganado, Arizona.

As a busy young reporter, I could not have cared less about doing things socially by the book, and was ambivalent about the prospect of early marriage. I wasn't alone. Louise, whom we called "Weez," recalls viewing marriage as the end of a woman's life of her own. More than once, Mom urged her to claim and have her own life. The moment for that kind of thing was ripe outside the doors of our, by then, middle-class home, and the borders of our small town. Times were a changin' in the late 1960s, when I graduated from high school and studied writing in college, and we welcomed the wave of new options lifting women out of their stuck places. Life was exciting enough. One thing I did fear was office boredom; in those times, many workers were, arguably not unlike their spouses at home, lifers in factory or desk jobs, resigned to trading curiosity and adventure for the security of routine, the known ... stuck in desperate tracks, or so I speculated from the lush fields of youth. Often I turned to look back at passing strangers with lined faces and hunched shoulders and thought they looked whipped by adult life. No cabin by Walden Pond for them, and maybe no quickening vision.

The main career fields for those of us called "the distaff" side back then were nursing, teaching and secretarial typing. Inexplicably, given their tight financial circumstances, neither of our parents pushed academic achievement — nor parenting. But Mom, with her Irish bloodline, stuck up for us finding our purpose in life, and that was that. With Dad's support as well, our older sister Barb changed family history when she was the first of us to enter and finish college, and also to marry and bear children. Mom seemed certain that our middle sister's purpose involved medicine and caretaking, and that mine included adventure. She didn't drive a car, nor often work outside our home, and her own quest for adventure by mid-life seemed destined to be lived vicariously through us. But all too soon, her illness hinted time could be running out for her. Surgery to implant a pacemaker in her chest, we hoped, would help slow that march.

So her early death took us by surprise, not unlike painful whiplash. What passions and adventures could come to her now? Her youthful exploits in San Francisco may have been capped with marrying Dad, a soldier stationed near her home there during World War II, and bravely moving out east to raise a family where he had grown up. Inequities of the 1950s assured it was a flawed plan to start with. She rarely ventured further from home than downtown on the city bus that she caught on a nearby street corner. Since she lacked the means and pitch of an avid consumer, she must have just enjoyed getting out of the house. She rarely saw her own family again, and then — just like that — we three flew the nest.

Thinking of this, and how fast it happened, grieves me to this day. Since I had moved away to accept my first post-college job in journalism, and had partnered in meaningful relationships, I barely had two chances, before she was gone, to eat lunch out with her like I did with office colleagues. Occasionally she volunteered at the hospital, on the serving side of the counter. I imagined we would laugh and share freely as women when I wasn't a preoccupied kid anymore and she, too, could begin to step out in this way. Even though the calendar pages were fast flipping over, there was supposed to be more time.

The mystery of a significant person or presence in your life being here, then gone is what loss through death is all about. What does it all mean, and how do we mean to process it for ourselves and our future, including the idea it will happen to us as it happened to pets and loved ones? Maybe not as fast, but still so finally.

This hit Weez hard even as a little girl, when she was shocked to discover the dead body of our kitten Frisky in dried leaves by the curb of our red brick street.

Apparently the kitty had been hit and killed by a car, and now all animation was gone from this living, breathing jellybean who had made us roll with laughter. For a future doctor, this was a key moment, understanding the arrival of death as the end of life as we know it.

Another feline, Midnight, used to limp home and retire to the musty cellar to recover from shrill cat fights we trembled under our cool sheets to hear rage outside our bedroom walls. Besides the backyard game and movie nights shared in our neighborhood, we held more than a few pet funerals with our friends. So Weez also took note when our puppy Cinders died of distemper, curious why that wasn't prevented when she understood it to be preventable. Barb also was inconsolable over this first memorable loss of life. While we didn't have many dogs around the house growing up, Dad was disgusted by adults who tied beagles to doghouses and left them to fend for themselves; he often said they shouldn't be allowed to own dogs if they weren't going to fully care for them. Watching tales of Lassie on TV at 7 Sunday nights, before Ed Sullivan, was sacred family time, enjoyed with home-made pizza. Besides this collie's heroic deeds, we were raised on sweet tales of Mom's German Shepherd Jack. She had to give him away as a child and yearned to see him again. I already had begun to understand that pets, like us, had emotionally complicated lives. After becoming acquainted with The Yearling story, I took nothing for granted when it came to practical survival and the love of a child for another innocent in nature.

From the start I had heart for animals, and I'm sure I indentified with them in many ways. Very early on I collected money around the block, and in thin white plates or soiled tins fed stray dogs and cats canned food and evaporated milk. These were purchased, perhaps at a discount — I don't recall — from the corner grocer. After the can was open, I'd pry loose the sharp-edged tin circle and dispense just a little of the thick whiteness, conserving the rest for the hungriest of the hungry. "Nick" always kept a running tab for our family at Nichols five-and-dime. "Cat got your tongue?" clerks would ask when I showed up on a mission with my nickels and dimes. Typically I just wanted to be left alone to do this, my thing, in peace, and it did keep me out of bigger trouble. Being a child meant being subject to endless limits, so discretion came with me to the corner store.

A few times I've heard death described as someone passing from one car to another. That image of half-shrouded transition fits dogs almost more than people, since their lives appear to many of us to be so much less complicated than ours — and maybe also because they are so often drawn to riding in the car, no matter what! Also, as the many "missing" signs on the dog park bulletin board suggest, these sudden twists of fate or outright trafficking happen frequently to their domesticated species.

Yes, the loss of a beloved pet is more than a dress rehearsal for real loss. It is painfully authentic loss seeping into our pores before we are ready to let go of our markers and touchstones. We've been conditioned to think losing an animal from our family is not as awful as losing a person, and yet the reality can be that the shorter relationship was deliciously intertwined, less contentious, and much less conditional than most human ones. So the pain easily can run deeper than the number of years woven into the bond might suggest; the unconditional quotient deepens the impact of loss.

Looking back over all of the dogs and cats we've loved and lost, along with the ferocious ferret Bandit, various birds, mice and other small animals we've sheltered, we may be forgiven for occasionally mixing one or two of them up, whether by name, looks or personality. That's especially so in regard to remembering several dogs who shared similar traits over time; Reebok, Nina and Raven, our black and white "upside down" lineup, who all used to recline on their backs with their legs up and their undersides exposed in silly happy postures.

Despite even a few pernicious quirks and some engaging commonalities, we are much less likely to mix up relatives who are in our family lives for decades, half a century, or even a century. House pets, if never quite replaced in our hearts, are constantly being followed by adorable successors, it would seem — more so than spurned or lost human partners. Going 10 years or 20 years without getting a new dog is not normal for dog-friendly people.

BARGAINING (3)

The hard reality of the moment seems to be that a terminal illness has hold of our Duke. Could that mean a window (or dog door?) has been opened for disease to move brazenly into our home? I'm not proud of it, as a spiritual counselor pledged to uphold faith and wholeness, but more than once I've speculated silently that a cancer diagnosis could easily be received by a strong and impatient person like me as an involuntary, imposed sentence of sort — to eat, breathe and study how to survive the high costs of this illness in every element of here-and-now life. That's a tall order, and not how most here-and-now advice about coping with illness goes. If Duke does have cancer, it is happening in our home now, healthy cells going wacky within our four walls, under our roof. But why? How did this insidious danger gain entry?