Life continuing

Weeds as high as en elephant's eye

And it looks like they're growing clear up to the sky.

"Mom?" Sam called out, crossing the terrace on this way back in from the shambles we call a garage, which houses discarded and functional bicycles, an assortment of those Razor scooters that found a much smaller following of fidèles than anyone would have supposed from their popularity 10 years ago, the lawnmower, planks for the unfinished petit balcon, two full-size refrigerators, one plugged in and in desperate need of a defrosting, two beat up but valuable leather club chairs we cannot really afford to have recovered, especially since we have learned we prefer to spend our resources trying to save our beloved animaux de compagnie, "pets", but I find that word terribly belittling of what they really are to us, the old Sony Trinitron 17" Dell monitor, all our tools and every bit of used wood removed from somewhere from which my husband cannot separate himself, along with the furnace, the oil tank, the dryer and an old washing machine that serves as a surface on which to pile more stuff.

I waited for what would follow. Were his jeans not in the dryer? Was there no bottle of Coke keeping cold in the real fridge, which is inconveniently far from the kitchen, where my husband finds it perfectly normal to have one the size of what my son will likely enjoy in his monk's (excuse me, student's) lodgings in Paris, either a 9m2 chambre de bonne, now politely and considerately referred to as a "chambre de service" in the annonces, up under the mansard zinc roof of an immeuble de standing in the 17th arrondissement near la Place des Ternes, or a sightly larger but better appointed studette, or very small studio, on the rez de chaussée, the "chaussée" being the pavement, and the "rez de chaussée" being "street level", in a drearier part of town at the edge of their cherished Marais, on a street the shops of which boast exclusively the not exclusive, but cheap garments imported and exported by their hard-working Chinese owners and destined for the Tatis and run-down markets, the better appointments including a real, but small, full bath with shower and toilet, as opposed to a Sanibroyeur in the "chamber", or the nicer option, we have since discovered we believe it to be, of a shared toilet, cleaned by the building's guardian, out on the palier, or corridor, and a separate storage space with shelves, ready to receive a small washing machine for his soiled clothes and bedding that I dream he will wash.

We should know which in about 2 hours, the first being offered, the second being decided.

"You really need to take care of the garden" was what followed. "The weeds are nearly as tall as the gate out by the garage." There was so much truth in what he said. He turned the page, ended the chapter, put the crossing on the final "t" of Baccarat, her too short life, and her death. It was time, he was telling me in his inimitable way, to get back to everything that occupied me before my life became directed toward trying to preserve hers. We lost, but the rest shouldn't go with it.

I realized I am probably depressed, but it was hidden in the business of sitting together, or he in his room and I on my sofa, laptops on our laps, scouring the real estate sites for likely studettes or chambres de service for him and communicating by exchanges of email that were chat before chat existed. The most a son pudique will allow a mother respectueuse de sa pudeur et de son indépendence.

It works.

In two hours, we will know. We criss-crossed Paris on my motorcycle, dodging traffic, cars, trucks and other deux roues. We called for more than 25, visited 5 of the 6 we intended to see, the 6th dropping off the list after we visited the 5th, which is the one for news of the decision we are waiting before accepting the other.

Yesterday, he accompanied me to pick up Baccarat's ashes, intending to go into the city to see friends after. There was hardly time to make it to the train. His plans were indefinite. He telephoned while I waited for the woman who took Baccarat a week before, with one of the vets, to get her ashes. He was by my side when she returned and handed me a bag, containing a white cardboard box. It was bigger than I expected. She placed it in my hands, and it was heavier than I had thought.

"J'espère vous revoir bientôt sous des circonstances plus heureuse," she said, my eyes starting to fill with tears.

You must remain dignified, I instructed myself.

I held her gaze. We neither of us, nor Sam, wanted all the people, suddenly elderly, apart from one young couple, waiting with their cats in travel cages to understand our business. It is the worst of the vets' and their clients' business. Her silence the week before had been from the same source. I suspected that then, and I knew it now.

The vet who had done the sonogram of Baccarat's heart that showed what turned out to be a malignant tumor had called after the weekend. To follow up. To express her sympathy. Her hope that a better outcome could have been possible. I forgave them.

We left. Sam drove, decided abruptly against taking the train into Paris, encountered traffic, and entered a parking lot that can serve as a way to get out of that traffic and onto a quieter way to his old school, or the vet. He pulled even more abruptly into an empty parking space just before the way out, and turned off the car.

"What are you doing?" I asked. I was confused.

"It's just as easy to park here and walk over to return the DVD as it is to drive there," He said. He practically spat the words out. I chose not to argue, nor to reprimand him. "I need your bank card," he commanded. I fished it out of my bag sitting next to the bag with the box containing the urn of Baccarat's ashes, and picked the box up as he strode across the parking lot.

The tape that sealed the box was white like the cardboard, and it was very carefully centered, in each direction. An envelope was taped to one end, as carefully positioned as the tape. I opened the envelope with as much care and removed the papers. It was the certificate of cremation. I returned it to the enveloped, closed it and lifted it, and set about removing the tape as carefully as it had been put there. I would replace it the same way. Inside, there was a ceramic urn, like the sort of inexpensive Delft china you can buy in any market. It was sealed with more tape, with words printed on it that said it was meant only to be removed by the owner "immediately upon receipt".

I lifted it carefully, too, but it twisted on itself, unwilling to come apart again. I tried to lift the top, expecting a seal like a jar of home-made jam or jelly, and a little resistance. I took care to remove it, pulling steadily so as not to let her ashes spill out by jolting it. The resistance was stronger than I thought; it was sealed.

I knew nothing of these things, I realized. I knew it already, but I realized it then.

The top came away with the jolt I feared, and it startled me anyway, but nothing spilled. Her ashes were inside a plastic bag, carefully closed twist-lock tie. Of course, I thought. Of course they would protect the ashes like that. I inspected the top of the urn and the lid. There was the residue of a silicone sealant that I had broken. The bag was translucent, and I could see the contents. I did not open it.

I had heard of it before, in Dave Eggers' novel A Heartbreaking Work of Staggering Genius; they are not ashes like what is left after a barbecue or a cigarette. They are granular, small chips. Small chips of ivory colored bone, Baccarat's bone, from the legs and spine that let her run like a wild thing across the harvested fields when she was not even one, a Christmas ribbon tied around her neck for my holiday card photo undone and trailing on the wind behind her. A shooting black ball of sheer joy. And they were gray grains and other colors like the stones on the beaches in Normandy she loved to play on. The muscles that propelled those bones across the fields and beaches, like I dreamed the other night. The only dream I had in a week of sleep encouraged by light sleeping pills.

Baccarat was running full speed toward me, like she did on those walks, like she did to her mother, running into her full force and getting a nip in return. I was nervous that she'd knock me down, but I let her come, waited for her weight and the fall, but there was none.

The only thing not in that translucent plastic bag is the spirit that moved her and ran right into me and my heart. Our hearts.

"Mom, will you keep some ashes?" Sam asked when he had strode back to the car and got in. He meant would I perhaps not scatter them all in the Moraine forest in Argentière when we go next.

"I could. I think I will find a beautiful wood box for them, if I do. Do you want some? I could divide them," I offered.

"I don't know."

We will figure all that out. My husband prefers not to lift the tape off the box and find the translucent plastic bag. He saw her in the white one, when he already hadn't wanted to. He looked because I did, because I wanted to, and he was there. He touched her, but he prefers to remember the living Baccarat who raced through our lives.

I haven't finished accompanying her in her journey in death, and neither has Sam.
....

Violets

On our last afternoon together
watching a German Shepard play with students

She looks so sad. She knew she couldn't run and chase a stick and make the students laugh, nor run and chase the other dog and make herself laugh. I wondered if she ever would again. She lay down next to me and put her head on my arm, lifting it to look around from time to time. I let my legs rest on her hind quarters. I'll go back to that memory until I can return to happier ones, and I will still go back to it to remember what a moment you want always to remember feels like.

This morning, I wrote an email to a friend.

Today is very hard. I feel sick. Rapide isn't well. She can't move, and she keeps gagging. If I try to lift her, she starts screaming, the way dogs scream. I have to get her an anti-inflammatory, in case it is her lumbar region again, but it is so strange that it came back the evening Baccarat died. Mary, I am just devastated. I know I just have to move through this and eventually it won't ache so badly, but I miss her so much I can hardly stand it. Her body leaves the veterinary clinic soon. I receive her ashes next Friday. I just want to touch her, and I can't anymore. Her fur was so soft, so much softer than her mother's. She always shined, and I loved to stroke her paws, her muzzle, and she let me. I look back at missed walks, my selfishness, thinking she'd be here for years to come, that I would be comforted in her eventual loss by the preparation the work of old age would do in her, but it was so sudden. Now, I recall saying several times that she had become grown-up in the last few months, more subdued and in possession of herself, and all I can think is that what I was seeing was the coincidence of her being 3 going on 4 and her having the earliest stage of her cancer. I thought she was maturing; she was becoming sick. Then, I thought it was the heat that prostrated us all, but it was the cancer grown into an enormous tumor in her heart. Earlier, it slowed her down, just as the heat set in. Then, it hit critical mass, and that's what we couldn't miss: her heart failure was so sudden then.

Her eyes were the part of her that talked, they and the end of her tail. Her sighs. I just so badly wish that I hadn't had to walk away from her the evening before her surgery. She turned her head away, slightly, but her eyes stayed fixed on me. I wanted to run back and scoop her into my arms, cry in her neck. I forced myself to smile at that old look and tell her she'd be fine. I knew, of course I knew, that I would most likely never feel her warm again, see that look or any other, watch her react to Sam's name or my husband walk into the room. It's so wrong. She was so young, Mary. Just 4, only just turned 4 the first full day she was hospitalized here at our vets' clinic. How could that be? I know that God does not watch over us at all, nor does God protect us. All God does is teach us lessons by placing them in our path. To what end are those lessons intended? How does it make me better to lose someone I love? I understand that sadness and grief are part of life, that we are not immortal, but there should be an order, a real preparation for loss. That's why we diminish and have to go through old age, so that even we are eventually ready, but cancer is terrible. To see your dog seem fine and on the 15th day after you first notice a problem, to go pick her up in white plastic bags, her forepaws crossed even inside there, so beautiful. It is so wrong.

And Rapide is whimpering behind me, in pain. She has finally stopped gagging, at least for now.

The only thing that helps is to keep writing, over and over again. I can't keep doing that. I know I won't need to forever. It will get better.

Yesterday, in the car on the way to get Baccarat at the hospital, where they had brought her back for us, there was traffic. I had a migraine. It was horrible; I felt so sick. When we got there, I got out of the car to go ask the security guard for permission to bring our car in to get her body. I was surprised I could walk. My legs felt like rubber, and I felt weightless, numb. He was kind. His eyes said more than our vet's here, and their nurse/secretary. I am angry with them for that, but he looked so sorry, and nodded, "Of course." The doctor came out to greet us, and she shook my husband's hand and then leaned forward to put her hand on my arm and kiss me on each cheek. My vet here did not shake my hand, did not say, "We are so sorry for your loss." Her eyes are big and blue, and they were wet. They talked to me like Baccarat's, saying all she didn't put into actual words. She showed my husband where to bring the car, to the same door through which I had walked Baccarat out every day I had come to see her, every day they had visiting hours. There was only Bastille Day and a Sunday I couldn't see her. Then, we went to talk in her consultation room. She explained that they knew as soon as they opened her and touched the heart that it was bad. The muscle of the heart wall had become very rigid; a bad sign. It was terrible, she said, very sad for them, because the surgery was going so well, better than they had hoped. The biopsy while she was on the table told them what they already knew, the tumor was malignant and it was a cancer of the worst sort. She said that we made the best decision, not to wake Bacs, saying again that while she would have recovered well, and seemed fine after a few days, since dogs have such a high threshold for pain, but then she'd have failed again very quickly afterwards, and that would have been heartbreaking to see. It's true. Sam and I would have seen her start to be well again, and we would have hoped again, and then it would have been like being cast to the bottom of the canyon floor from the rim.

We made out a smaller check for the surgery, since there were no nights on duty with her, and my husband wrote another for their hospital before we got her body. I appreciated his taking it upon himself to write them. He was showing me that he was assuming this, like he said he would, for us.

Then, he went for the car, and I walked around the side of the building, where the gray door was propped open. A moment later, Dr. Gouni and the resident appeared, struggling to carry her body in the slippery white plastic bag. I asked my husband to hurry out of the car and help them, but they were already there, he opened the back end, and I fumbled to make sure there was the place, nothing lumpy under the blanket under her, as though it would bother her. They asked if I wanted to see her. I did. I told my husband to turn away, if he wanted, since he had not wanted to see her, preferring to remember her alive and well. I had to. I am just that way. They turned down the edge of the bag, and there was her head, in profile, still wet from the surgery. Her. I sobbed, Mary, and reached out for her head. My husband looked over my shoulder and stroked her forehead. Her tongue was sticking out, and gray. I wished it hadn't had to be. She used to lick the inside of my hand with her tongue when I held the end of her muzzle. If I said "bisous", she used to lick my lips; that disgusted my husband. I didn't care. She didn't do that in these last two weeks, but she would lick my hand, gently, and look at me, telling me everything with her eyes for which she had no words. I said goodbye and thank you in English. I told them it is my real voice, but it sounded strange to me. Dr. Gouni reached forward again, and I thought she wanted to hug me, but we kissed each other's cheeks again and she had the courage and the compassion to hold my gaze. I'll miss her. She is a truly good person. Her husband is lucky, the animals are lucky and the hospital at the Ecole Nationale Vétérinaire d'Alfort is lucky to have this young woman, who is older than she looks, and who stays with them despite the low pay and missing her family in Greece.

When we drove away, we took a different route, found the right road, thought we lost it, got aggravated, I asked him to drop it for once, since I really couldn't take it just then; nothing mattered more than just coping, and we didn't need more stress. If we didn't make it back before the vet closed because of the traffic, then we would place her in the spare room and I would take her in the morning. Whatever we had to do. We were on the right road. The traffic lightened, and I noticed that my headache and nausea were almost all gone; all I needed was to have her with us, and I was much better. Perhaps, too, to have seen Dr. Gouni. I asked her to thank the student, Enora, who had cared so kindly for Baccarat. She told me that Enora was sad, too. They had all hoped so much that it would prove to be a myxoma, a benign tumor of the heart. The muscular atrophy had, she confessed, been the biggest indicator for her that it might not be. Baccarat's muscles at her temples were no longer existent. Sam noticed that the first day at our vet, two weeks ago tomorrow. I wondered if I had missed it earlier.

I will send them a letter, and maybe some sort of present for their care.

I might look for a new vet out here. I want a vet who can say, "I am sorry," and shake my hand, at least. If I find one, I will tell them. My husband says that is the difference between public and private. The CHUVA at the ENVA d'Alfort is a public institution for the teaching of veterinary medicine and the vet out here is a private clinic, become more about making money than caring for animals and their families.

They are probably picking her, and any other dogs and cats who have died, up now. I don't like to think of her burning, Mary. I just want her ashes to take to the forest at the base of the peaks of the Mont-Blanc range. I wish there was another way. I wish it didn't have to be this way. I wish.

Mary gave me the idea for a present to send to Dr. Gouni and Enora. Violets. She told me that when they had to have their dog put down last winter, their vet gave them a pot of violets, and it was the same when her son and his wife had to do the same with theirs. Our vet offered no condolences, no support. I thank them for helping us get Baccarat into the cardiologists at the ENVA d'Alfort and their teaching hospital, but I can ill pardon not sharing our grief for an animal for whom they have cared since she was 8 weeks old by at least expressing their regret for so sad an outcome to her short life.

I can offer violets to a young doctor and a student who cared enough to be kind and to let us see that it was so.
....

Rest, Baccarat. Rest, Good Dog

The empty bench

You have to imagine Sam and I sitting here, eating our tortilla wraps (and he his roast beef sandwich on industrial baguette) the other evening. He came after work, taking the RER from Nanterre to the Gare de Lyon, and another to Alfortville, after a long day at work. Dr. Gouni waited for us. She said she had work to do, anyway, but she's like my husband. I know what that means. She thought it was important for Sam to see Baccarat again before the surgery because we cannot know how it will turn out.

Earlier, I told Baccarat that Sam was coming to see her, "Sam! Ton Sam va venir!", and her eyebrows jumped up her forehead, her tail starting to brush the flooring in cardiology with all the enthusiasm her heart can manage. Everyone laughed. She knew exactly what I was talking about. I know you are thinking, "It was the tone of voice she heard, not what you said."

No, you are not thinking that. You know, just like I do, that they understand that much.

It was like the day when my husband came to see her, arriving after Sam and I had. It was the first morning of her hospitalization at our veterinary clinic, and she was collapsed on the floor after a very brief walk, but when she saw him walk around the standing display of flea products and dog pheromones, "for a happy dog", her head shot up and her tail started cleaning that darker gray flooring.

"C'était seulement qu'elle pensait que j'allais la ramener à la maison, puisque vous ne l'avez pas fait," he joked. He knew that she was just happy to see him, too.

It was just past 7 pm when I went to pick him up on his way up the Avenue Générale de Gaulle on my motorcycle. He had walked enough for the day, and Dr. Gouni was already so kind to wait. She took us up to Baccarat's cage and left us with her.

We were tired and hungry, our heads aching, by the time we thanked Dr. Gouni for letting him come as late as he had to to be able to see her and emerged on the sidewalk.

"There's the Casino over there," I looked up the avenue, past the post office and towards the traffic circle, beyond which the A4 leads to the Péripherique and the A13 home. "We could get something to tide us over until dinner, maybe some sandwiches, and I need some things for dinner. Oh. There's not much room in the top case. I forgot."

"I have my backpack, Mom. We can put some stuff in there," he offered, still standing there on the same spot on the sidewalk. We weren't deciding anything very fast. The sidewalk is where we decompress.

"What do you say? Should we go get something, or just head home? My head is killing me." I had barely eaten anything since my scrambled eggs long ago that day.

"Alright."

"Okay, then, let's go." We stood there another second. He had joined me in my state of suspension.

We got sandwiches from the display at the entrance to the store, looked at the soda. Found a sandwich the color of the salami of which was too gray to be considered consumable and gave it to the guy at the "welcome" desk.

"I know just how he feels," said Sam, "when someone finds a sandwich that's gone off, someone's going to make a complaint. You try to get them before anyone else does." His job this summer has been refilling vending machines for his uncle at one of their biggest clients in Suresnes. He knows about sandwiches and standards of freshness, margins of profit on soda and coffee. "There's a Coke Lite left, Mom," he added.

He stuck his hand in the water vapor over the fresh vegetables.

"What's that?"

"Water to keep them fresh." We looked for the string beans, if there were any, and picked up some organic bananas. "I'd better get a small bunch, for the backpack, but you'll eat one, maybe?"

"Yeah. I'll eat a banana," he said. We still hadn't found any green beans and made another trip around the vegetables.

"My hand doesn't get wet when I put it in the gas," said Sam.

"It's not a gas; it's a vapor," I replied.

"Vapor is a gas, Mom," he said. He was right. We wandered off, looking at the meat, looking for jambon de pays for the melon I had picked up and put back down, thinking of space. I remembered and left the jambon de pays. We walked through cheeses, and Sam picked up a package of prewrapped cheese slices for Croque Monsieur sandwiches.

"Now this is what I am going to need," said Sam, with a new energy we had been lacking.

"But, I buy those already. Usually the cheddar ones for your cheeseburgers," I said. I thought he had seen these a million times, in our fridge, but certainly at my husband's parents' home, where it is staple to feed the army of grandchildren a light supper.

"Oh. It's just the cheese," said Sam, disappointed. "I thought it was the sandwiches."

"Sam, it's really easy to make the sandwiches from the cheese slices."

"I am going to buy lots of pre-made sandwiches, all ready to heat."

"You're going to need much more than that, if you are going to survive law school." He looked back toward the soda and headed off, returning to tell me the last Coke Lite was gone and he had decided against a Coke for himself. He seemed disappointed for me. I rarely drink Coke Lite. It was considerate of him, anyway. "Where are the smoothies," he asked. "I am in one of my healthful foods phases," he added. "The other day, in the Marais, I got an oxygen water. Twice the oxygen of normal water."

"They're right here." I pointed to the juices, just next to where we happened to be standing, still looking toward the display of Coke and Coke Zero, back across the tables of fruits and vegetables, appearing fresh under their streams of gas.

"I want mango and passion fruit."

He compared the Tropicana and the Innocent ones and found the Innocent less expensive. It looked like more, but it was the same size as the Tropicana. A lesson in packaging, but he already knew that. He knows how to look for the price by weight or volume, and read a label.

We headed past frozen foods, and along to the end of the store, scanning the shelves. I didn't know what I wanted. I couldn't concentrate. He was patient, or the same as I was. We had cheese, bananas, dates, sandwiches, fruit smoothie. We negotiated the self-check and headed to sit on the bench, eat our sandwiches and watch the students and residents leave the school and the hospital to enjoy the regular lives on a warm July evening. I watched the vet in her last year of residency who took care of Baccarat last week cross the street, thinking their lives go on; it's normal.

Yesterday, Baccarat and I lay on the ground under a chestnut tree on her last afternoon before surgery. It was cool, and there was wind. It would rain later. I gazed up at the undersides of the chestnut leaves and watched the students walk the dogs who could run and chase sticks. Baccarat watched, too. She knows she can't.

They had found the mass in her heart quite changed, and they were inside meeting about her case, while we rested together outdoors, I on my back on my big cotton scarf, the one I bought in Petit Andelys last summer. The mass had gotten smaller, from a peek of 7 cm in one direction, to 5 cm, and it had moved further into the ventricle from the atrium. Some dark spots in the area where it was thought to be connected to the heart wall had appeared.

"Ce sont des petits endroits de liquide, comme dans son abdomen," said Dr. Gouni. "C'est normal qu'on les trouve là si elle a de la liquide dans le ventre. Mais, on voit que ce n'est attaché que par des filaments, ce que donne l'impression de quelque chose moins tumorale, et plus de thrombose." There were little areas of liquid visible where the mass attached to the heart wall, which is normal, since there is liquid in her belly, and it appeared now that the mass was attached by filaments, and not to a tumor. This, she said, does give the impression that it is a clot, and less a tumor.

"Mais les filaments peuvent être cancereux," I asked. She nodded. They could be cancerous, too.

It was also much darker in appearance, indicating that her body was doing what it is supposed to and working to degrade the clot part by lysis, which confirms it's appearing to be smaller. New clot formation shows as white areas, and when Dr. Gouni showed me the images later, I could see that it was no longer white, only white in small areas.

She pointed to the valve in the right heart, visibly opening and closing with the beats of her heart, but there was no valve visible on the left side. The mass is keeping it open, all the time. She thought she could see a bit of it, and I could see a white bit, similar to those of the valve on the right, held close to the wall of the left heart. She explained that this can damage the valve, and that they have a valve ready for Baccarat, in order to replace hers if it is determined necessary.

"On préfère ne pas le faire," she told me, "si on peut l'éviter. C'est déjà une intevention très --"

"Lourde," I finished, trying to be helpful. She nodded.

"Oui, très lourde. Si on peut éviter de faire plus, on l'évitera pour elle, mais je pense que la valve doit être bien abîmée."

"On peut avoir l'impression d'être chez le garagiste, avec le remplacement des valves," I joked, weakly. She smiled and explained that the valves are given to the research center by the laboratories. They use them to do research. This valve had been given to them; it is worth 6,000 euros, but we would not pay for it, and it was, she explained to me, already prepared for another dog, who was to have been operated on at the beginning of the month. The owner never showed, and never called. They could not reach her. She and her dog disappeared.

"Le chien," she told me, "fut un Labrador." I already knew that.

But, Baccarat will never need that valve. The phone rang some minutes ago, too early. Too early for good news. Baccarat had a hemangiosarcoma, possibly a rhabdomysarcoma (embryonal) and it was bad. They had removed the tumor, and they could wake her, but it would come back, maybe as soon as in only two weeks.

I understood. It was time to make the decision. I knew what my husband thought, and I knew in my heart that he was right. Even if a dog's threshold of pain is much higher than ours, we would put her through recovery only to see another tumor replace this one in less than a month, only to have to let her die later, when she could go now, knowing nothing more than what she has been through already, after our afternoon yesterday, when I had told myself to live each minute, see the colors, feel the warmth of her body against my legs, the weight of her head on my arm, watch her eyes and her expressions to never forget them.

I handed him the phone.

She is gone now. We will pick her up later. They asked if they could keep her heart. It doesn't happen often that 4-year-old dogs are diagnosed with hemangiosarcomas or rhabdomyosarcomas, much less that they are operated on. Her heart will give them information, and perhaps her case will one day help another dog, another family. Perhaps the University of Colorado and the University of Pennsylvania's veterinary clinical studies will yield hope for preventing or curing hemangiosarcoma before anyone else has to watch their beloved animal go so quickly.

We will take her ashes to la Moraine, and leave them under the peaks of l'Aiguille Verte and Les Grandes Jorasses, where we walk under the boughs of the giant firs and feel the sky like a ceiling just above our heads. I am tempted to lie down on the earth there, as though it has a special power to bring peace and safety. It was her favorite place to run and play, in the snow, pushing her head and cheek into it like a snowplow, rolling, running, jumping in the deeper snow until I thought her heart would burst. Let her lay down there to become part of the mountain, the firs.

The mountains offer another form of peace, the rest of eternity. While I walk through the forest at their feet and feel the urge to lie down on that cold earth that beckons kindly, watched over and protected by the eternal peeks and soaring trees, promising to cradle me gently under the night sky, others climb the rock faces and the glaciers and find their rest and safety below the cold ground and snow.
-- "Rest", The Sisyphus Journals, February 24, 2009,

She will always be there, waiting for us, Sam and I.
....

The other patient

The koi in its Nifurpirinol bath, Day 13

It could really use a name now, couldn't it? I am nearly certain it's a female, but not enough to commit to a name. Maybe I should call it George, as in George Eliot.

No. That stinks. I'll just refer to it has "he" and "him" until I have a better idea.

I need to put together a series of photos, from the first day I put him in quarantine and began salt and anti-bacterial/antibiotic treatments to the present, to see if he really has improved as we think he has. His eyes seem to be less protuberant, and there is a less marked difference between the scales of his body from those of his tail, which is also to say that the scales of his tale now seem to stick out a little, too, but the rest perhaps less.

I pour over pictures of different varieties of koi, looking to see if his scales appear normal now by some variety standards, and one very encouraging thing is that the enlarged blood vessels around his right eye that appeared just after I began treatment disappeared within a couple of days of treatment, and they have not returned. Another is that he appears no worse, if not necessarily certainly all better. He is lonely in his quarantine tub, but that is better than dead. Sometimes he comes out when I come to visit him. He also seems to accept my removing him when it is time to change his water, to which I add a Nifurpirinol tablet, in addition to the salt, to his water, and I am no longer doing the concentrated, brief Nifurpirinol baths.

I am not sure he is eating anything, but that's probably just as well for his system, and besides, hiding all day behind his rock and plants doesn't require a large amount of calories. If he continues to do as well, I will return him to the "bassin" in a week or two and see how it goes, but don't say anything to him; I haven't told him yet, and I don't want to get his hopes up.

It's time to leave to go see Baccarat for the afternoon. It's her last afternoon before open heart surgery, and I am doing things I don't recognize that I am to stay calm. I don't know what you call it, but it's a lot like that afternoon when I knew Audouin would come home with the lab results for my melanoma. I remember thinking, up on my ladder painting the Orange Room, "Soon, you could get news that will change your life forever. You could learn that you won't live much longer," and I looked out the window at the sunshine in the flowers, the dogs and Shadow sleeping on the lawn, and myself spoke to me, Just enjoy this afternoon, this moment. It's what you have, and I felt peaceful, happy.

Sometimes, that's enough.

This evening, Sam will call me when he finishes work, and we will meet up on the Champs-Elysées to go see Toy Story 3. Like he was just the right age for Harry Potter when it came, and made a reader of him, he was the right age for Toy Story, so that 11 years later, when Andy is going to college and leaving his childhood room, so is Sam. We'll spend time together and enjoy that, and tomorrow will bring what it will. Each moment until they have the result of the biopsy is a moment of the present, when Baccarat is still alive and there is hope.

Everyone knows that it is already almost a miracle that she is still alive with this mass taking up nearly all the space inside her right heart, reducing the blood flow to a trickle, her circulation to a a stream in the desert. Her heart could fail at any moment, her brain be destroyed, but say the name of one of her beloved people, and the head darts up, the tail starts.

"Baccarat! Guess who's coming to see you! Sam! Sam's coming to see you!" and the tail is going. Everyone laughs because I could tell her in the same tone of voice that we were going to force feed her some more of that protein-rich food, and she'd stare out past the legs of the chairs and people and sigh heavily. She is still there.

"C'est un bon signe," they tell me, "qu'elle se bat. Elle aurait pu se laisser aller, mais elle reste avec nous et elle s'intéresse; elle se bat." It's true. She could let herself go; she could let herself die, but she is interested in what is happening around her, and she is hanging on.

"L'hôpital va lui manquer," I laughed, "Parce qu'ici, l'où elle va, elle est accompagnée par tous ses amis, un petit groupe d'étudiants, d'internes et de résidents! C'est très agréable!"

And, this is true, too. She will miss the hospital and all her friends there because wherever she goes, she is accompanied by a small troupe of friends, students, interns and residents. It is very nice to be so cared for.

Tomorrow, the car will take her and two vets, including Dr. Gouni, to Montsouris. At noon, the perfusionist will attach her to the cardiopulmonary pump, and they will begin open heart surgery. She is one of the very few dogs ever to undergo this surgery, which would be out of the question in the United States. Even here, where the surgeons are donating their time in the interest of trying to save her and to learn more, it is going to cost more than my son's lycée, as much as one year of his school in Paris during collège.

"There is no price that can be put on her life, Mom," he tells me again and again.

"There is, Sam. For everyone, there is a limit, a moment when they cannot spend any more. They just can't. For us, we are willing to make this sacrifice because she is so young, and because we love her, you love her so much, but for others, for most people, it would be out of the question." It is hard for him to accept this.

"Il faut être un peu psychologue dans notre travail," said Dr. Gouni yesterday, as I filled out the papers and wrote a check to IMM Recherche. My fingers spelled the sum out easily. I didn't need to make a list of all the things I could live without to make it possible. Like my friend said, we can eat potatoes for a couple months. "La plupart des gens ne pourrait pas se permettre de payer une chirurgie et les soins. On le sait et on leur n'en parle pas." One must, she said, be a bit of a psychologist in our work because most people could not pay for this surgery and the medical bills. We know it, she said, and we don't even suggest it to them.

"Je pense au chien," I answered. "Il n'a que son amour à offrir à son maître. Il n'a pas d'argent pour payer quoique ce soit. Si son maître est en train de mourir d'un cancer, on ne lui demanderait jamais de payer ses soins, de lui sauver la vie, alors, pour lui, c'est normal qu'on lui offre ce qu'on a, l'amour et de l'accompagner dans le temps qu'il lui reste. C'est bien à ses yeux.""

I think, I told her, of the dog. He has no money to pay for his master's medical bills were he dying of cancer. He only has his love to offer, and he will give it until the last. So, for him, it is normal that we only offer him the same if it is all we have. It is good in his eyes.

I need to go now. I am late.
....

Off to Alfort

My gardening hat and the Texas scarf

I have watered the flowers, parched from the return of the summer heat, and put the hose away, tried to feed the neighbors' cats, but someone had gotten there before I did, and I am preparing to leave for Maisons-Alfort to spend the afternoon with Baccarat. My friend will join me there, and Sam will come later, after work. Her surgery is the day after tomorrow, but this is one way we would never have asked Baccarat to open her heart if it weren't the only way to save her life. We need to be with her as much as we can so that she knows her hanging on is worthwhile, and because we can't imagine being anywhere else right now.

I have learned some things this year. The garden taught me before I ever needed to know it that sunlight is beautiful from the shade; it is the thing that makes green and every other color what it is meant to be. My own cancer taught me that to sit in the shade and look at the sunlight where I love it most, even more than on my skin (although I will confess to permitting myself to stand in it for a few moments while I water, or do something else -- I am not a saint), on my flowers, or shimmering and leaping on the waves of the ocean, is its own joy. Baccarat's illness has taught me not to miss a second of life's joy or love, although I will fail this lesson finally because we all do, caught in our hurts and our grievances.

Maybe, though, the appreciation for the love she offered, the joy of her running and selfishness (her only selfishness, aside from wanting all the pets destined for her mother) with a soccer ball, jumping up to rest her paws on the gate to greet the schoolchildren and delight them through the grill with her being there for them while they wait for the bus or get off and join their mothers, her ignorance of our lines drawn between ourselves, drawing none herself, will be stronger than our own reluctances to love and to take interest without condition and without measure.



Non, c'est pas facile d'avoir le ballon quand Baccarat joue, and we didn't even know these people.

Allez, Bacs, encore un effort et une bonne nouvelle jeudi et on ira jouer!
....

ENVA d'Alfort, Day 8, Thursday

Resting

The surgical team at the Institute Montsouris, or IMM Recherche - CERA, has been able to move Baccarat's surgery up to Thursday. Five days sooner.

The studies undertaken here are large animal veterinary, as I understand it, but it is part of the Institut Mutualiste Montsouris, which is a human medical center in Paris. We are assured that they have state of the art technology and techniques, that the team operating on Baccarat operates on human beings in cardiovascular surgery, and that medically, we have the best possible care available.

This, I do not doubt. I knew that the moment we were referred to the Ecole National Vétérinaire d'Alfort.

This evening, after Dr. Gouni came to find Baccarat and I and give me the estimate for surgery, I was sitting at the edge of Baccarat's cage and listening to the older couple who had come to see the dog in the cage next to hers, a dog that lies there on its inflatable pad and twitches. She has neurological problems, among other things, they told me. Her chart said that she is sweet, but you must get her attention before touching her. Baccarat's chart said, under temperament, "Gentille", but today it read "Très gentille". Their dog had been operated on and was still recovering. They were older than I am. Well dressed. They bent into the cage, rather than sitting on the edge, as I did. She was worried. He seemed pragmatic, concerned, self-possessed. He exuded knowledge and confidence.

"Vous êtes médecin?" I asked. I already knew the answer.

"Oui," he nodded. Of course.

"En quoi?"

"Rhumatologie," he replied. I noted his suit without tie, shoes. The red thread at the lapel button hole indicating his membership in the Légion d'honneur. Something my husband, who wears jeans and long-sleeved cotton t-shirts to the hospital, to protect his arms from the polyester mix of the "blouse blanche", would refuse. I wondered how he had earned it, thinking he was probably a professor of medicine. I noted his well-coiffed, somewhat long gray hair and nodded.

"Mon mari aussi. Il est obstétricien-gynécologue." He nodded and looked from me to Baccarat.

"Elle va être opérée," said his wife, looking over from her dog. "Elle a une tumeur dans le coeur."

Her husband knew. I had told him while she talked to her dog. 18 years old, they had found her in a forest when she was 2, 16 years ago. I thought of Wisp, also found in the woods, and who is becoming mentally unstable since Baccarat has been hospitalized. This morning, walking up the stairs to clean Sam's room -- I know, don't tell me; I am hoping to install better habits before he gets his own place --, I smelled a smell. It was only when I got in the bathtub to take my shower before leaving for Maisons-Alfort that I noticed the smell again, particularly strong in the bathroom, and saw the pile of cat poop deposited in the corner between the tub and the window.

Damn it, said myself. Now what are we going to do?

"Clean it up and hope Baccarat makes it, because if she doesn't, we've got a serious problem developing."

"Elle a beaucoup de personalité," said the rhumatologist, "ça se voit dans ses yeux." His wife looked around again into Baccarat's cage.

"Elle est si belle," she said. "Elle a des yeux si communicatifs."

"C'est exactement ça," I said, nodding, and looking back at Baccarat.

It was only after they left and the student who has been caring for her since she arrived came and knelt next to me, after having asked with a big smile if I had been told, Baccarat would be operated on on Thursday, reaching in to caress her head, and said, before getting up to leave, "Vous pouvez rester le temps que vous voulez," that I broke down again. I stroked her head, while she lie there, resting, her eyes closed. She glanced at me. I reached for the scarf in my bag from the motorcycle and buried my face in it, wiping my tears.

The veterinarian on rotation in medical hospitalization came in. She had come to find me outdoors earlier and introduce herself, and now she stood there smiling at me. They hold us up, too. They encourage us, and they tell us to bring our families; we have to prepare ourselves, see our beloved animal before the surgery because, if it is very bad, it will be kinder not to wake her up only to suffer the pain of recovery for nothing.

I knew what she was going to say; my husband had anticipated it, and Dr. Gouni had said it. I said it before she had to. She smiled at me, and I looked at her eyelashes. The length of them. Their color. The spacing between them and their curve. Her eyes. I looked at her lips as she spoke and smiled. I wondered if I would be able to recognize her again, seeing all of her face at once. I could only see pieces of her. Could she tell how I was seeing her? I could hear her.

"Si," Dr. Gouni had said, "c'est très, très méchant, il serait peut-être mieux de ne pas --"

"La réveiller," I finished. "Je sais. Mon mari me l'a dit. Je fais confiance à l'équipe médicale et chirurgicale." She nodded.

If it is a not so very bad, but malignant, they will remove it, close and let her live out the time she has.

We know it is decided already. Prayers no longer serve any purpose. They never did. It is what it is, benign or malignant. Love and support are what we need. Caring eyes and compassion.

Hope will help until the phone rings sometime around 4 pm Thursday, but we are told that we must prepare ourselves. The new vet and I looked at Baccarat, and my eyes filled with tears again.

"On se demande seulement comment, comment cette chienne si pleine de vie et si jeune aurait pu avoir cette tumeur."

"Elle est déjà une chienne spéciale. Ca se voit dans ses yeux si expressifs. Elle va vers les gens. C'est clair qu'elle est bien avec les gens, et elle se bat. Elle ne se laisse pas aller, et cest très important," she said. She is right. Baccarat is fighting to stay with us. She is not giving up, lying down to let herself go.

"Je vais la laisser dormir, se reposer," I said.

"Oui, et nous allons bientôt faire ses soins du soir," she said, smiling again.

"Je serai là demain, et après demain, et mon fils aussi," I told her, "Mon mari est de garde à l'hôpital mercredi. C'est bête. Peut-être il va pouvoir me joindre demain soir." She nodded, and left me to say good-bye to Baccarat.

I had to stand and shut the glass door on her cage. She watched me, her eyes never leaving mine. I smiled. I wanted her to know that it was alright. That I believed it was alright.

"Je reviens demain, ma Bacs. Je t'aime."

I walked down the corridor, and on down the stairs, out to my motorcycle, waiting in the sun on the wide sidewalk along the avenue.
....

ENVA d'Alfort, Day 6, An education I don't want

Sam joins me

Today was harder. Baccarat seemed a little sadder, but maybe that is only because I might be. Perhaps she was the same. They always ask me how I find her each time I visit with her; some days (I can say that now; it has been a week that she has been hospitalized), she seems more perky; some days, she seems deflated, resigned, sad.

Or, that is I who feels that way.

It's the wait now that is hard. I can see that now. In the early part of the week, we were busy. We were busy with the first echocardiograms and sonograms, blood tests and x-rays. Then, I was busy calling pharmacies looking for Fraxiparine (a form of Heparin) and going to get it. Then, I was busy getting Rapide's blood drawn and taking it to the lab out here for the D-dimer test. And, finally, I was busy waiting for the results of all the tests, busy being with Baccarat when I could, or driving to and from the CHUVA at the Ecole Nationale Vétérinaire d'Alfort (l'ENVA d'Alfort).

Yesterday, we learned that there is certainly a tumor under the 5 cm blood clot clearly visible in the right atrium, or l'oreillette droite, of her heart.


At its size, it fills the chamber, and it protrudes through the tricuspid valve into the right ventricle, as well as nearly covering the valve of the vena cava, from which blood returns to the heart to be pumped to the lungs for oxygenation before being returned to the left heart to be pumped into the body. Watching the images on the echocardiogram machine, you can see that there is still blood flow, but it is severely restricted through the tricuspid valve, with some blood backing into the vena cava when the tumor shifts toward the valve. Baccarat is fatigued from a lack of oxygenation, and this is why she cannot walk very far at any time, and shouldn't. Calm and rest are the best thing for her, as well as staying cool, so that the demands on her heart are kept to a minimum. It looks like depression.

Now I think of all those days before she stopped eating, when I called to my husband or Sam to come see how cute she was, appearing to deal with the terrible heat with grace, when she was actually suffering from a tumor of the heart. It wasn't cute at all. It was the earliest signs of what could be a hemangiosarcoma, the least cute thing imaginable for a dog. Since there is no question that there is a tumor, the best we can hope for is a hemangioma, the non-malignant form. If it is an hemangiosarcoma, they will close without removing the tumor because it is an highly aggressive, high-grade soft tissue sarcoma that metastasizes very rapidly throughout the body, attacking the blood vessels. According to the Canine Cancer Awareness Organization:

Hemangiosarcoma is insidious, as it attempts to build it's own blood vessel network, making blood blister like formations which disrupts normal organ function. It is commonly in the advanced stage before detection, making it virtually a silent killer.

It's once you know your dog has a heart tumor that you know the signs that would have helped you help your dog much sooner had you known them, but you must forgive yourself because it is rare. It is especially rare in 4-year-old Labrador Retrievers, although their cousins the Golden Retrievers and German Shepherds are the two breeds most likely to develop this kind of cancer.

I asked before Sam and I left today if I had understood correctly that if the biopsy shows the tumor to be malignant that they simply close, leaving it in place. The young student, who is usually as quiet as Sam can be, spoke. He told me that it is the case because it metastasizes so rapidly and is not considered treatable. They can try chemotherapy, but in most cases, it will not save the dog.

"Et, ça, cette forme de cancer, elle s'appelle comment encore?" He answered me, but I couldn't retain the word. I was embarrassed. It happens when I don't actually want to be having to hear something. A friend who is a breast cancer specialist tells me this is typical; they know that as soon as they say "cancer", the patient can hear only 1 of 5 words. She modulates the way she speaks to help the patient hear and retain more. I had to ask again and force myself to pay attention to the reply, begging my brain to remember.

"Hémangiosarcome, si c'est malign. Hémangiosarcome. C'est rare."

I only remembered that it began with "h" and ended in "sarcome" by the time we were out on the street. It was alright. I had understood enough, I have a doctor at home to ask, and Google. I could find it again, now that I knew what to look for, and it turned out to be an education I wish I never needed.

According to the information on the Canine Cancer Awareness Organization's site, which cites current clinical studies at The Animal Cancer Center at Colorado State University and The University of Pennsylvania, Department of Clinical Studies, there are three types of hemangiosarcomas, dermal, hypodermal and visceral, with the type where tumors form in the heart or on the spleen being visceral, or the most lethal form of hemangiosarcoma. Again, from the CCAO site:

Visceral Hemangiosarcoma accounts for 2% of all reported malignancies and up to 5% of all noncutaneous tumors in dogs. Although these numbers seem small, they have a significant impact on dogs, since this form of cancer kills. The spleen and the right atrium of the heart are the most common sites of occurrence of visceral Hemangiosarcoma. Dogs may have nonspecific signs such as lethargy, loss of appetite, weight loss or more specific signs such as difficulty breathing, pallor, or abdominal fluid. Regardless of the site of origin, visceral Hemangiosarcoma is locally invasive and highly metastatic. Up to 25% of dogs with splenic Hemangiosarcoma have cardiac Hemangiosarcoma and up to 63% of dogs with atrial Hemangiosarcoma have metastatic disease. Metastases commonly affect the lower mesentery, lungs, and brain.

This was terrifying to read. Baccarat's tumor is in the right atrium, although the spleen, or la rate, is normal without any sign of metastases at present. She had all of the nonspecific signs of a hemangiosarcoma except the pallor. When she was first seen at our nearby clinic, the vet found her pale, but by Monday, the vets at the CHUVA did not, and they still do not, although they check her gums regularly. Her lungs also do not show signs of metastases. Her brain has not been scanned. She could, nonetheless, not yet have developed metastatic disease. I turned to my husband, who was stretched out on the sofa, his back in an analgesic position, watching the Tour de France.

"C'est difficile à penser que la tumeur ne soit pas maligne quand tu lis sur le hémangiosarcome," I said.

"Ca n'a pas l'aire bon," he replied. I nodded and looked back at the computer screen, scanning the words for something that said "bénign". There was nothing. I Googled benign heart tumors, and I found information on myocardial tumors on PetMD.com:

Myocardial tumors refer to tumors that specifically affect the heart. These types of tumors are rare, and when they do occur, they tend to occur in older dogs. Benign tumors are masses of tissue that do not metastasize, whereas malignant tumors metastasize throughout the body. Abnormal tissue growth arising from the blood vessels in the heart can be malignant, as with hemangiosarcomas — rare, rapidly reproducing tissue growths; or they may be benign, as is the case with hemangiomas — harmless growths consisting mainly of newly formed blood or lymph vessels.

"Il y a aussi des hémangiomes," I said to my husband. "C'est la forme bénign, et ce sont des masses faites des vaisseaux sanguins ou lymphatiques récemment formés, mais dans l'atrium, c'est peut-être plutôt un myxome à ce moment-là. Ca existe aussi, et les symptoms sont pareils."

"Même l'amaigrissement?"

"Oui, car il y a aussi un manque d'apétit." I returned to reading the first site. "En plus, il y a plusieurs signes qu'elle n'en a pas. Avec un hémangiosarcome, l'ascite à la même apparence que le sang, et la liquide dans son ventre c'est du sérum, plutôt taché du sang. En suite, c'est souvent accompagné par un coagulation dissimulée intravasculaire, ou CDI, ce qu'on vient d'apprendre qu'elle n'a pas avec le D-dimer. Aussi, son sang coagule normalement tandis que le sang dans le cas d'un hémangiosarcome ne coagule pas. Elle ne sagne pas visiblement non plus, comme du nez, par exemple. C'est peut-être bénign après tout, et elle est si jeune," I added, hopefully.

"Peut-être," he said, before drifting off to sleep, while I continued to read, trying to convince myself that her chances were as good that it was benign as that it was malignant from all the things she doesn't have, such as liquid in her abdomen that looks like blood, a blood disorder called disseminated intravascular coagulation (DIC), which did not show up from her D-dimer results, blood that does not coagulate (they found her coagulation rate normal last evening), and no visible bleeding, such as nosebleeds. And she is young for a malignant cancer, they say.

Before I left her with the two students, who were preparing to take blood again, the young woman told me again that they are doing everything they can to move up her surgery date from the 27th to next week. It all depends on being able to get the person who runs the cardiopulmonary bypass machine, which are "pumps are operated by allied health professionals known as perfusionists in association with surgeons who connect the pump to the patient's body." See Wikipedia, http://en.wikipedia.org/wiki/Cardiopulmonary_bypass. Here in France, a perfusionist is called a "pompiste", and there are few of them to begin with, but particularly few available in the vacation months of July and August, with the first availability being July 27th.

I suppose the only way they can move the date up is to beg someone to make him or herself available when they are already fully booked, which I hope the surgeon and the veterinary cardiologists can succeed at doing. It is especially hard when they cannot charge for their time. They are doing this for the glory of clinical science and from their humanity.

Baccarat needs them now, but she will wait patiently, if she must. But, she is getting depressed, as kind as and attentive as everyone treating her is, and as much as we go to spend visiting hours with her every day they have them. It's hard to be in the hospital, away from everything and everyone you know.

Hang in there Baccarat. Nous t'aimons si fort.

When we left, Sam was hungry. I was, too. If Baccarat didn't want her "very appetizing pâté", we wanted something.

"I think there are some brasseries that way," I said to Sam, pointing across the avenue Générale de Gaulle, towards the grocery store, where I had done my shopping the other evening. Sam looked off down the avenue.

"There's one there," he said. "But, there are probably nicer places in Paris." I thought about getting back on the bike and heading into the city for lunch, which would be nice, and then I thought about Audouin, waiting for us at home. "Wait, we're where? On the southeast side of Paris?" He shook his head. "There's not really anything there."

We crossed the avenue and passed an animal supply store and the post office, turning in to where the grocery store is.

"There's the Casino."

"Do you want sandwiches or something there?" I asked, not trying to sound enthusiastic and glancing around for signs of the village center and a place to sit down for lunch.

"Not really."

I turned left onto a road that branches off the traffic circle at the entry to Maisons-Alfort, and we walked along, past a fruit and vegetable stall, a boulangerie all in pink, with tables on the sidewalk, and on under the train overpass, past some sort of restaurant, Japanese I think, closing for renovations, and on a bit farther, scanning the storefronts and awnings, the street signs, looking for signs of something promising.

"Mom," said Sam, interrupting my search. "Where are we going?"

"I don't know, Sam. We're looking for where the shops and cafés are. There must be some." I looked across the street, and there was a wine bar ahead, and some tables set up on the sidewalk, the storefronts set back from the sidewalk. "Like that, there's something there. What is it?"

We saw the word "bagels" at the same time, and Sam grinned.

"We'll go there?"

He was already crossing the street, toward bagel, ham and cream cheese sandwiches, Vitamin Water, milk shakes and cousins of Frappucinos.

"Who'd have thought a place like this would be here, in Alfortville?" he mused, reading the chalkboard menu on the wall.

"See, Sam," I said, "sometimes you don't know where you are going, and then you find what you would have been looking for, I mean, if you knew it were there."

"What's pastrami?" he asked. I realized we'd been away from New York for a long time and explained. He listened and decided on the ham and cream cheese.

We sat, alone, up in the mezzanine at the rear of the shop, Sam still feeling chilled from the ride in, and probably the emotion, the unseasonable temperatures in the 70s, a breeze, and maybe from being hungry.

"I haven't had cream cheese since we went to London," he said, chewing his sandwich.

London. That was a little more than 2 years ago. I nodded, trying to remember where he'd had cream cheese, but he interrupted my effort to remember, saying, "Maybe I'll go to New York after my license, Mom. I can eat food like this, get to know the art world there, and work on my photography full-time, get a job at Element. If it doesn't work out, I'll do my law degree."

"Don't you eat that stuff when you go to that American restaurant -- what's it called? And aren't there bagel and cream cheese places all over near your old school?" Of course there are, but they aren't on every street corner, everywhere you look, whenever you happen to want one. "And, you know, they have bagels in the Marais, the authentic Jewish bagels."

"Yeah, but they're braided and have poppy seeds." His attention was back from NYC.

"They probably have plain ones, too. Or at least just with sesame seeds."

Bagels.

He's still a New Yorker somewhere in his soul, and bagels are always in NYC, where they are everywhere, anytime you want one, with whatever you want on it, where they were when he was a child. Anywhere else, well, they're a reminder, a symbol for what they are: part of an unretrievable past. And when we understand that the past is unretrievable, we may chose to understand that the only thing left it to greet the future and live today.

....

ENVA d'Alfort, Day 4, a heart tumor

In the refuge of the shade of a plant

Baccarat has a diagnosis. After days of tests and results and more tests and more results that ruled out kidney and liver diseases, infections, deep intravascular coagulation, pulmonary embolisms, and thrombosis, Professeur Chetboul, who I have not met, spoke with the cardiac surgeon who would operate on Baccarat at the Institute Montsouris in Paris and called the veterinary cardiologist who has been following Baccarat with her and the chief of staff, Dr. Gouni, to tell her that according to the cardiac surgeon, if the clot is in the atrium and not moving, it is what they thought it might be, a clot formed over a tumor.

It is nothing else, and the course of treatment they have been pursuing will not be helpful, necessary as it might be to keep her stable until she can have surgery, which is the only option available to save her.

I listened to Dr. Gouni, the resident and student listening alongside, Baccarat on her green cotton tape lead at the student's feet, tired, while she explained that because Baccarat is so young, only having turned 4 last Saturday (she was born the day Zidane was given a red card for his head butt in Materazzi's chest and France lost to Italy, unfairly and undeservedly in 2006), there is a good enough chance that the tumor is benign to justify operating. Because of the size of the clot, they will have to use a cardiopulmonary bypass machine to reroute the flow of blood around the heart during the surgery. The hope had been able to give her the anti-coagulant Fraxiparine to prevent the clot from getting any bigger, while her body's natural process to degrade clots, or fibrinolysis, went to work to possibly make it small enough to operate by clamping a portion of the atrium, but the cardiac surgeon ruled that out owing to the tumor. We cannot know it's size.

Because the lump appears not to be connected to the heart wall, it is possible that it is relatively small still, or some kind of tumor my husband named that I cannot remember, but a tumor it is.

Dr. Gouni went on to explain that if Baccarat were 10 years old, they would not recommend surgery, since there would be as much as a 95% chance of the tumor being malignant.

They will be able to perform the biopsy on the tumor while Baccarat is on the table and have the reply immediately. If it is benign, they remove it and whatever part of the heart muscle they need to and close. She would then have a complete recovery, and little chance of a repeat occurrence.

If it is malignant, they will close.

"Dan ce cas, on peut discuter les options de traitement, chimio --" offered Dr. Gouni, a little reluctantly, it seemed to me, and I shook my head.

"On ne ferait pas ça." The intern smiled sympathetically and nodded her head. Dr. Gouni nodded, too.

"On pourrait lui laisser le temps qu'il lui restera à vivre -- " I nodded.

"Oui. Je lui laisserai le temps de vivre chez elle, et puis, on verra." There would always be time to have her put down if she began to suffer too much. They nodded.

The issue for now is that there is not a doctor specialized in operated the cardiopulmonary bypass machine, or "un pompiste", available until July 27. The surgeon wants to operate as soon as possible because Baccarat's condition is too fragile. They offered me to take her for a little walk outdoors again yesterday, and while she seemed stronger, choosing by herself to get up and move around more from time to time, she had diarrhea and vomited. These are signs that gave pause to Dr. Gouni. It indicates that she has low blood pressure, which they confirmed. Spots also appeared on her shaved belly during the afternoon that indicate internal bleeding. They ran platelet counts to determine whether she should still be on Fraxiparine and adjust the dosage. She will take no more walks. She can walk with me to the cardiology waiting room from her cage and sit there together.

I asked if the cardiac surgeon, who operates on people in a hospital for human beings, is not put-out to operate on animals.

"Oh, non!" said Dr. Gouni. "Il l'aime beaucoup. D'abord, c'est moins stressant que d'opérer sur un enfant" for example, her tone implied, "et puis il aime les chiens, surtout les Labradors. Il en a lui. Aussi, c'est dans le but de la recherche."

Baccarat's surgeon loves Labrador Retrievers. He is a Lab owner himself, and he is doing everything he can to move her surgery date up, and aside from being a surgeon, he is also involved in research. Baccarat's case adds to their bank of knowledge.

"Il donnera son temps," continued Dr. Gouni. "Ils ne factureront pas les chirurgiens, mais tout ce qu'on ne pourra plus utilser sera facturé." In other, words, the doctors will operate for free. We will pay the costs of materials that cannot be reused, and I don't think that amounts to very little in this case. She had guessed 2,000 euros, plus hospitalization and her current costs of diagnosis, treatment and hospitalization. It is somewhat staggering.

"You cannot," said Sam again last evening, when he called me, "put a price on life, Mom. We have to pay whatever it costs to save her."

I was getting on my motorcycle, getting ready to leave, when I happened to see rather than hear a call coming in on my cell phone, sitting on the bike. It said it was from Sam. I answered.

He was calling to tell me that he would not be going to Nanterre in the fall for law. He said it in a voice that sounded flat, possibly just an instant from being catastrophic.

But it's not possible not to be able to go to even Nanterre, myself said, our thoughts racing. They have to accept him!

"Hold on," I said to myself, "maybe it only means that he got into one of his other choices." I turned my attention back to Sam, "Sam, does that mean you are going to the Sorbonne?"

"No. I am not going to the Sorbonne."

"Oh, I'm sorry," I said, and I really was. That was his first choice, and he thought that with his English and his American culture, he'd have a chance, but these things can be somewhat haphazard, too.

Then what? asked myself, sounding panicky. Where can he be going? What's left? Can it be that he can't go anywhere?

"Descartes, Mom," interrupted Sam. "Paris 5. I got in."

I had to round up my stray thoughts, balanced there on my bike, feeling hot and vulnerable for a melanoma victim in the sun. It was lovely for a moment on an afternoon that had been sunny, then cloudy, windy. He seemed to sense that I was in need to being assisted in gathering my mind.

"I'll be in Malakoff, Mom, at Descartes."

"Are you happy? I mean, is that what you want?"

"It was my third choice, over Nanterre," he reminded me, sounding more patient with my slowness and failure to get into his head than usual. He has been feeling a little sorry for me, since he knows what it feels like to care about Bacs.

"Wait, third choice? What were your others, then?"

"The Sorbonne, Assas, and Descartes."

I had forgotten Assas. Or, rather, I had forgotten that he hadn't removed it from his choices, not that he'd need to; he had decided he didn't want to go there owing to its reputation for being cut-throat and competitive, not Sam's best learning environment, but he'd never get in, anyway. While all the public law schools, like all the public medical schools -- both of which are the best, anyway --, are supposed to be equal, Assas has a reputation for cronyism that cannot be denied in the professional world. Sam's got enough brains and personality to make up for that missed point of assistance. I am not worried about that.

"Are you sure you want to go there?"

"I can change later, if I want, and if I do well, maybe I can transfer to the Sorbonne, if I want. There is less information on Descartes' law program than on the others, but it is smaller, and I think that is better for me, and it was my first intuition to put it over Nanterre, so, here I go, I am about to click on "oui définitif". I'm clicking. There. It's done."

Can I possibly tell you how proud I am of him? He did this all by and for himself. Hours of research and reflection on himself and his options, and he made all his own choices, for the better or for the worse, but I can only believe that they will be for the better. He has this under control.

I only need to keep the currents warm under his wings.

"Do you want to come see Baccarat with me on Saturday morning?"

"What time?"

"Early, 9:30 am until noon."

"Alright." That's early for him, but he wants to see her. "Are they doing things for her to help the pain?" he asked.

"She isn't in pain, Sam. She is tired, and they are giving her all the attention, care and kindness we could hope for; they are making her comfortable and keeping her stable with everything they can do."

"There cannot be any question of money, Mom. This isn't about money. We have to help her."

I thought again of him saying that her life is far more worthwhile than all the "conneries" he could spend his money on, including the new used scooter he wants. I think now of a friend writing:

I'm with you--on every front. As a mother. The fact that Sam is moved by love for Baccarat to take a position: "Love, life--has more value than money" is both beautiful and a signal that your son has depth. What a fine man he will grow to be when this very special facet of his nature is nurtured.

And another saying:

[your husband] will pay for this for you and for Sam as you said, so don't question it. You do things for him, he does things for you, that's marriage. Have more faith!

And, finally, my sister weighing in:

I think if there is any type of decent chance that it might not be malignant and you can scrape together the money that you should do it. I know [my husband] is squarely in [your husband's] corner. He thinks it is unfair to the animal to put them through all that. I guess I would say the most humane thing is to do what is in Bac's best interest.

This morning, I told him that it is about money for many people, for nearly everyone. It unfortunately has to be because money is never unlimited, and it depends on each person or family's resources where they have to draw the line. We would have to draw a line somewhere, too. It's hard to know when, but it isn't now for us.

Baccarat will go to Montsouris, if nothing happens between now and then, whenever that will be, and she will have cardiopulmonary bypass surgery to remove a tumor, if it is benign.

I have to hope.


....

Any port

Wisp, in Rapide's neck

This is where she normally seeks comfort, only in Baccarat's neck. Any port, as they say, in a storm. Her dog has disappeared, and Rapide is wondering when it will be her turn to suddenly leave and not come home again. She is as nervous and jumpy as a cat on a hot tin roof. All I have to do is touch her when she can't see my hand coming, and she tenses and leaps into the air. I have to remember to announce my intention to reach out, from where she can see my hand, and then touch her.

What a lot of anxiety and loneliness one dog's illness and being hospitalized can create.

This morning, my husband tried to draw the vial of Rapide's blood necessary to serve as a control for Baccarat's D-dimer results. We are in the "jamais vu" in veterinary medicine. A D-dimer blood test is used to rule out a pulmonary embolism, deep venous thrombosis or disseminated intravascular coagulation (DIC), or, in other words, the presence of other blood clots (thrombi) in the vascular system. Basically, they are looking to see how much D-dimer is in the bloodstream.

This is not a veterinary blood test, as the incidence is non-existent in dogs, being more common in cats, but possibly still statistically small, and so the test has had to be done in a lab for human blood testing. Happily, the lab with which my husband works the most does test animal blood for our local veterinary clinic, and they agreed to perform the D-dimer, charging us for one test, instead of the two needed. However, the results indicate normal and elevated levels for human beings, and we cannot be certain of normal in canines.

This rather amazed my husband, but you also have to consider that the D-dimer test was first described, according to Wikipedia, in the 1970s and its clinical application discovered only in the 1990s. That it hasn't been established for non-existent cases in veterinary medicine is not, then, wondrous. Rapide and Baccarat would offer some information to veterinary cardiovascular science should Baccarat's levels differ significantly from Rapide's, and their comparison to human D-dimer levels would be interesting.

D-dimer is a fibrin degradation product, or a small protein, that is present in the blood after a blood clot is degraded by fibrinolysis. If there is a lot of D-dimer, chances are good that the body has been busy degrading blood clots, meaning that there is the possibility of a thrombosis, or an illness tending to produce blood clots. If Baccarat's blood sample indicates a higher than supposed normal level of D-dimer, we can suppose that there is another clot, or more, elsewhere in her body, that she has suffered a pulmonary embolism, or that she is suffering from DIC. It is nearly certain that if she is, it is not a severe case yet because there is not the bleeding that accompanies severe DIC. If it is mild DIC, the possible causes are several, with only some being likely or possible in Baccarat's case:

• Cancers of lung, pancreas, prostate and stomach, as well as acute myeloid leukemia (particularly APML)
• Obstetric: abruptio placentae, pre-eclampsia, amniotic fluid embolism
• Massive tissue injury: Trauma, burns, extensive surgery
• Infections: Gram-negative sepsis, Neisseria meningitidis, Streptococcus pneumoniae, malaria, histoplasmosis, aspergillosis, Rocky mountain spotted fever
• Miscellaneous: Liver disease, snake bite, giant hemangioma, shock, heat stroke, vasculitis, aortic aneurysm, Serotonin syndrome^[9]
• Viral: Arenaviruses causing Argentine hemorrhagic fever or Bolivian Hemorrhagic Fever

A cancer has been ruled out, at present, and Baccarat has been spayed, so obstetric causes are not in consideration; nor has there been any trauma. There are no indications of infection, either, and the hepatic results show a normal liver. There are no lesions to indicate vasculitis, which is common in dogs and horses, and Serotonin syndrome can be ruled out, as well, because it is an adverse drug reaction, and Baccarat has not been on any medications. An aortic aneurysm has not been mentioned, since there does not appear to be anything abnormal with the thoracic aorta, and I believe they have looked at the abdominal aorta in the abdominal sonograms performed. As far as snake bite is concerned, we cannot be certain that there was no poisonous snake bite, but she has demonstrated no pain, we have seen no swelling or oozing blood-like liquid from a snake bite site, and there have been no neurological indications.

This tends toward what the veterinary cardiologist has been suspecting, should the D-dimer level indicate DIC, which is that Baccarat possibly suffered heat stroke.

We are obviously hoping that the D-dimer level matches Rapide's and tends to correspond to normal levels in humans.

Last evening, after the finish of the 10th stage of the Tour de France, which we watched collapsed on our respective sofas, the healthy animals draped over furniture, cushions and each other in similar repose, we took Rapide for our old walk, down on the path along the edge of the fields where they end at the bank of the Seine. We went as far as the little stone-covered beach under the willows and other trees I cannot identify, or haven't bothered to, and Rapide waded in the cool water, while my husband sat up on a bench and rested his back. It has been hurting again. I watched Rapide, and I remembered all the walks we took there, moments spent watching them play in the shimmering river, back before Baccarat tried to bring back one too many stinky, foul dead things she'd scarcely fail to find, or, worse, to roll in, like her mother.

I thought about how precious moments are, and how even if we know it at the time just how precious they are, one day they will be unrecoverable, memories only, and they will sear the throat and heart, and the greater the joy and beauty, the greater the pain.

I thought about taking Baccarat and Rapide to walk along the Seine from the vet's, past Sam's lycée, and on a little farther toward the bridge to Limay Monday morning, and how I could see the Ile aux Dames, where the tennis club where Sam used to play is, and how I used to bring the dogs to walk in the park and wait for Sam's lesson to be finished. I had wanted to get there, to sit with them in that park again, but Baccarat could go no farther than halfway up the stair to the bridge, and then she found a damp spot in the shade and let her front legs slide until her belly touched the stone and she did not get up until I had to try to get her back to the vet for care.

We sat there and I looked at where the club would be, on the other side of the bridge, and I thought about how those moments are unretrievable, part of another part of my life as a mother, and how Sam has joined me as an adult, ready to care for our dog with all the love he has learned he has for her. I wanted to run to that parking lot and sit there again in my car, see him walk up the gravel path between the courts, his racket over his shoulder, his curling hair long over his brow and down his neck, a can of coke in his hand, won because he beat everyone, ready to tell me again how they are lousy, anyway, but he started too late to be one of the chosen players. I looked at Baccarat, and I thought about how that Sam is gone, just like she might soon be gone, a memory, photos, the stories we can tell, and I felt almost desperate against the nostalgia you have to fight.

Go on, only on. Love and let the future take care of the past and the pain.

Rapide came to my side and looked at me. It was time to join my husband up on the bench. I told him, my voice so tight the words could barely come out. I looked at the opposite bank, the water flowing by. He touched a tear that hung from my lower lashes and threatened to betray me by being followed by another, running down my cheek.

"Je pense," I told him, "que ce n'est pas pareil pour toi qui passes ta vie à l'hôpital, où les jours sont les mêmes sur toutes ces années qui filent, mais nous, les mères qui peuvent, qui sont avec leurs enfants, même si on travaille, qui les amènent à leurs activités, qui s'en occupent tous les jours, on vie ces périodes, ces phases, on doit les laisser passer pour vivre la prochaine et un jour la voir passer aussi. On a tant de petits deuils à faire, et on doit se battre contre la nostaglie tout le temps ou couler."

He considered a moment. I glanced at him and saw him looking out over the Seine, as well. Once, my husband told me that he couldn't imagine not living by water. Twice this week, I had sat and watched the river flow by along with my memories and thoughts.

"Tu as peut-être raison," he finally said, "mais je vie des moments de nostalgie aussi, seulement, je les repousse."

"Moi non plus, je ne me laisse pas rester dans la nostalgie. Je serais trop malheureuse pour rien faire. Ce n'est juste que la coincidence entre ce moment quand on risque de perdre Baccarat et je vois Sam devient un adult, son enfance dans le passé, c'est trop fort, mais je n'y reste pas." He put his arm around my waist, and we headed back to the path along the Seine and home, to our bottom gate.

The coincidence, the terrible synchronicity in perhaps losing Baccarat at the very moment that Sam's childhood ends, is too much, but I won't let myself get lost in that. Baccarat needs me to do what I can for her, and Sam will need me in different ways, with new things to live. Ends are never so neat as that, thank heavens. They just seem that way when we are fragile.

It's time to leave for Maisons-Alfort. I'll take my motorcycle today, since Baccarat won't be coming home yet.
....