They Let You Know

They Let You Know





Lucia looked up sharply from the reception desk where she had been preparing to fax records for a client who had recently moved. Outside, she saw clearly what had caught her eye: a small woman struggling to lift an unresponsive largish dog from the back of a battered Ford pickup. She had its head and front paws out, draped over the side, and was trying to get the rest. Presumably, the tailgate was not working. There was a teenage boy in the cab, eyes focused to the front. Lucia glanced behind her- there was an examination room recently emptied, and only one person in the waiting room. The doctor and Greg were finishing with the other room; and Susan was in back running a stool sample.



Without further hesitation, Lucia ran outside to assist the woman. Together, wordlessly, they carried the dog into the empty exam room, the boy following behind like a reluctant child being dragged by its mother into a clothing store. The animal, a 65 lb mixed breed named Ajax, had no visible injuries, but quietly refused to move, even when placed on the cold steel examination table. Lucia asked the last name- Diettrich- and ran to pull the chart. She mumbled something to the woman with the new kitten in the waiting room-it’s going to be a couple of minutes, there seems to be an emergency- on her way back to the exam room.



She asked a few questions while performing a cursory exam of Ajax. Pale gums, low body temperature. No, he hadn’t eaten anything unusual. Lately, not much at all, in fact. Mass on right side. Hips stiff, close together, cast to the left. Fur matted on belly. Thirteen years old. The boy, thought Lucia, as she filed away the rest of the facts, looks about 16. She returned her attention to the exam. Cataracts. Rabies tag updated by the clinic. Neutered. Yes, he’d had trouble walking. One ear somewhat ragged. Breathing laborious, as if through a leaky straw. It had gotten worse over the past week. She delved deeper, naturally trusting her instinct, and feeling as much as examining. A hand gently run down the spine showed a prominence of vertebrae. Responsive to pinch in front paws, less responsive in back. Holding the calloused paw in her hand, Lucia became lost in reverie as she imagined the terrain it had experienced during its owner’s long life. She was abruptly startled when Susan opened the door, puzzled, and waited for her explanation- Lucia visibly had to shake herself back to earth, “Please tell doc to come in when she gets a chance, and can you get Mrs. O’Grady into the other room with Sierra?” Susan took in the scene, nodded, and left quietly.



Lucia returned to the chart. Ajax’s last visit was last year, with Dr. Jefferson, before Dr. Hale joined the staff, even; brought in for “slowing down”. Diagnosis of arthritis, suspected early stage heart failure. Owners refused Rimadyl and Theophylline, agreed to use baby aspirin and massage to treat the hips. There was no question at all in her mind or heart why the dog was here today. The chart listed the owner as Mr. Sam Diettrich. Lucia wondered if Sam was the husband or son. As if reading her mind, the other woman in the room said sharply, “It’s my husband’s dog, but he was busy today”. Something in her voice told Lucia that Mr. Diettrich was at home sitting on the couch with a beer or puttering outside in the workshop- any excuse to avoid being here. For the first time she really looked at Mrs. Diettrich. Short, graying hair, held back with a practical clip. Flannel shirt, jeans, tired workboots. Keen, intelligent face, bright blue-gray eyes, no-nonsense set to her jaw. A woman who knew what she was about, she sized up in a glance. Not an animal lover, but respectfully minding what needed to be done, tending to business as women have thanklessly tended to unpleasant tasks time immemorial. Lucia recorded the dog’s weight from the table scale, and her findings from the exam. Words like, hypothermia, ataxia, anemia, mild anorexia, nerve damage, scattered across the page; carefully and clinically describing a condition known more coloquially as impending death.



Stroking the dog’s head, Lucia glanced towards the boy, sitting in the corner, and read him, too. She always read her patients. Lanky, black haired. Arms folded across his chest, a look meant to tell the world off but not quite working the way it was intended. Equally worn motorcycle boots as his mom’s, a camo jacket, jeans, and black AC/DC T-shirt. Determinedly keeping his eyes on the floor, in a manner that told Lucia all she needed to know about his relationship with the shepherd mutt on the table. His daddy got him this pup when he was but a pup himself, Lucia knew without knowing. If asked any other day but today, they “growed up together”. Last two years, though, there have been other things- cars, parties, work- and he kind of grew apart. He forgot that puppies grow faster than kids, and didn’t really pay much attention when Ajax didn’t miss the long rambles across the fields to go play in the creek. He might even have forgot he had a dog once, as mom took over its feeding and care. Kids also forget time has a way of catching up with you.



Lucia spoke to Mrs. Diettrich, as gently and firmly as she could, the way she knew the woman approached life “I’m sorry”, she stated, “but I guess I know why you’re here?”, then “I’m Lucia; I’ll be taking care of him.”. She waited for the disbelief, the haughty gaze she expected, the look that said, “Why you? You don’t belong here, girl!”



“Carol”- the woman stuck her hand out to her and grimaced. “Yes, they let you know when it’s time, don’t they?” A pause. “I buried my mother last fall, you know. Was quick- doctor said a heart attack. No-one knew. Animals, though- they’re different. They know too much. But I can see you know that.”



Lucia smiled warmly, “Yes, they sure do, Carol, they sure do. I’m always amazed at the way they talk to us. And reveal about us” Shifting directions abruptly, “The doctor will be in any moment. She’ll want to do a brief exam, listen to his heart, run some bloodwork-“



Carol Diettrich shook her head firmly, but without anger. “No needles except one. When my time comes, I don’t want no damned ‘intervention’, either”.



Lucia paused, felt out the words, read the posture, tried to find her footing. “I understand completely”, she finally said, with as much wisdom as she could conjure for her 24 years and tiny frame. “If you’ll excuse me for few- ” Carol waved her out, dismissively. Go, do what you need to, I’ll be here.



Lucia carried the chart out with her, and went to get the consent forms, and to unlock the cabinet safe. Dr. Hale met her in the pharmacy. “Nice work with the dog- Mrs. O’Grady saw you come in. What’s going on?” Lucia shrugged off the compliment, tried to sound nonchalant. “Old dog, wouldn’t get up this morning for breakfast. History of arthritis, heart disease” She gave a brief overview of her observations. “The owner thinks it’s just ‘time’, doesn’t want any more bloodwork.” She fought her mixed feelings, kept her words pointed, directed, clinical.



“Probably right, unfortunately”. Dr. Hale took the chart, read Lucia’s notes, and added her signature to the forms. “It could be old dog vestibular disease, but I’m not sure there’s much to be gained by treatment here. I will trust this owner’s judgment. I’ll take care of Mrs. O’Grady first- can you do the paperwork for this one?” Lucia nodded. “I’ll ask Greg to prepare the beuth. Are you ok to do the assist?” Another nod. And since Dr. hale was new, a final question: “Should I be Dr. Hale or Gretchen?” Lucia smiled, “For Carol? Dr. Hale, absolutely.”



When Lucia re-entered the exam room, Carol was standing with Ajax, a hand resting on his shoulder. The boy had not moved the entire time, it seemed. Lucia glanced in his direction. Carol saw her, and said, “It’s been hard times with him and his daddy”, as if that should explain everything. Perhaps it did.



Lucia asked her to sign the forms. “Will you be taking him with you?”



“Of course”, said Carol. “I’ve have Billy come over from Dale’s Road with his Cub to dig the hole, so’s I don’t have to do it myself”.



Lucia noted a “No” next to crematorium charges, and made the rest of the entries: breed, sex, age, date. “I’m sorry”, she said, “but I’m going to have to ask you to pay before the services are rendered. I can give you a few minutes now…“



“I’d like to stay, if the doctor’s ok with it.”, Carol stated in measured tones. “I can do that, right?”



Lucia was surprised. Not many people asked, and she hadn’t sized up Mrs. Diettrich as one of the ones who would. Dr. Hale was more receptive to the request than Dr. Jefferson, though. “Yes, that should be fine, if that is what you would like.” She stopped, chose her words carefully, “And about the payment…?”



“Since the factory shut down, Sam’s been outta work. I’m expecting some money next week. Can I place a down-payment, as it were?” Lucia could see it pained Carol to ask. She understood with perfect clarity why treatment had been refused a year ago. They’d seen many cases like this. Swallowing pride is worst for those for whom it’s all they had, it seemed.



“I think that will be just fine, Mrs. Diettrich. How much will you be putting down today?” She took care of the transaction, and left Carol with Ajax, not trusting the boy to ensure that the dog wouldn’t fall off the table while she tended to the register.



Now it was easier- it was always easier when she had a task to perform. Lucia got the blanket as directed out of the back of the Diettrich truck, and tucked it beneath a black garbage bag she positioned under the dog’s hindquarters. She carefully shaved a small rectangle on the front foreleg, exposing the sluggish radial vein. She was even more meticulous than usual. With Carol evaluating every move, it felt like being watched by God. She tousled Ajax’s golden fur spots, above his eyes, which flickered in gratitude at the light-hearted move. She carefully washed the exposed skin on his foreleg, and prepped with alcohol. She ran her hand intentionally down his side, stroking, reassuring. Lost in her work, Carol’s question, “Where are you from?”, took her by as much surprise as had the request to stay while the doctor performed the euthanasia.



She responded cautiously, “I was born in Nicaraugua”, she said, allowing the full Spanish pronunciation of her home to roll gracefully and challengingly off her tongue. “My family moved to North Carolina when I was three, and came here to find work ten years ago after my dad’s back broke in a construction accident. He knew someone here. There was inside work he could do. My mom’s a receptionist at the hospital in Danville”. Too defensive? She always prickled with the questions. She wanted to add, but couldn’t, “My dad can’t get full-time employment at the factories, either” or, “We’re struggling to make ends meet, too”, because she knew that lay-off’s were happening because new labor, especially immigrant, was cheaper. You could take someone in, have them work just under 35 hours, and let them go after a few weeks to avoid paying benefits. Immigrants often got the jobs first because they accepted lower pay. They had to. She avoided the topic altogether, diverting instead with, “I just love animals. I got my associate’s out of high school. I haven’t been ‘home’ in 12 years. My sister’s a beautician; she’s the ‘normal’ one of the family. I hope to be a vet one day, perhaps after my little boy is out of diapers”. She was aware of the woman’s gaze, trying to size her up, the same way she had done in kind. This was not an easy place to look Hispanic; had it not been for her husband’s family, Lucia would have moved back closer to the city long ago. Mountains, she thought, and decades of hard times, tend to make people suspicious of outsiders. Carol looked like she was going to comment, when the doctor entered the room.



“Hello, Mrs. Diettrich, I’m Dr. Hale”, she said warmly, shaking Carol’s hand, “Lucia filled me in. I just have a few questions for you, before I begin…” She seemed to take it in stride that Carol had opted to stay. Lucia wondered what Carol’s motive was for doing so. To make sure they did a good job, perhaps? She seemed like the type who might say that. She was also glad it was Gretchen, not Rick, on duty today, working with her. Rick was all business, but his manner would have been offsetting. He hated the scrutiny when clients stayed to watch, felt pressured to perform. Hated the tears and the emotion of it. Instinctively, Lucia left to bring back the syringes Greg had prepared. The waiting room had filled up, and Susan was checking in the next patient. Lucia tried not to let herself feel anything as she steeled for the hardest part of her job. Harder, now, because she felt she was once again representing and defending her race in a predominantly white region that, until 10 years ago, was aware only through television that other races existed. The animals were the easy part of this work, for sure. Even in situations like this. They judged you by your heart and ability only.



As she circled Ajax’s head with her left arm, rolling his exposed vein with her right hand, she wondered how many summer days the dog had spent with the boy, romping the way kids now seldom remembered. How many hunting trips? How many games of fetch? Quiet moments spent in repose, around a campfire? She could almost smell the woodsmoke in his fur. He was restful under her slight body as she leaned her weight into him. These people, the Diettrich’s, were kinder than most of their means to their dog. He was an indoor dog, she could tell by the fur. His teeth were worn but in good condition. They had made what efforts and accommodations they were able, even the reluctant mother. Ajax had, for most of his life, been someone’s treasured companion, if not quite a family member. The thought reassured her, if only somewhat, as she prepared for the unescapable agony of watching an animal die under her care.



There was a practiced glide of a steel needle, and a scarlet backflash of blood; then carefully measured pink liquid emptied from the syringe. Lucia was aware somewhere of a set of blue-gray eyes watching her intently, without malice, seeking to understand how she had come from her homeland to this place, this day. Intently watching her startling rapport with the creatures she had chosen to devote her life to. There was no struggle below her, just one involuntary whimper as the solution first hit the vein. It stung a little, Gretchen had once explained to her. The boy lifted his head, stared at her, hard, pitiless, his gaze inscrutable. She felt the sudden surge of blood pressure under her experienced hand. Just as suddenly, Ajax went limp in her arms. The syringe was empty. Lucia gently laid him down, and waited in the uneasy silence of the room for a few minutes. Dr. Hale listened with a stethoscope for a heartbeat. “It’s over”, she affirmed with quiet authority, releasing Lucia to finish her work.



Lucia avoided Carol’s gaze completely as she carefully swabbed the urine from the plastic bag. She cleaned the injection site with peroxide to remove the bloodstain. She lovingly closed the cataract filled eyes, and turned the dog’s muzzle, while the neck was still pliable, resting the dog’s head on its haunches, as if truly asleep. She maneuvered the legs in a relaxed resting position the dog was unable to reach while alive, due to arthritic degeneration of the hips. She smoothed his fur, and glanced at the mother and son. Neither had moved. Taking her cue to finish, she reverently covered the dog’s body with the rest of the blanket, and tucked it into a neat ball. Now, there was only a shape on the table. A round Indian blanket colored shape that a companion once filled.



Carol was still looking at her. Not as one would look at an underling; and not as an immigrant, a threat, an unknown entity, either- but simply as one woman to another. “Thank you for your kindness,” she said, and bent to pick up the shape on the table. Lucia moved to help her, finally understanding the other woman’s motive for staying- Carol had needed to look death in the eye. She was honoring her mother, Lucia realized. Above that, she was performing the rare act of challenging her own, and perhaps her mother’s beliefs- about the luxury of veterinarians for companion animal medicine perhaps, the same as Lucia had had to face upon entering the field in the first place. The ridiculous extravagence and bother of pet ownership, complete with the frivolity of needless emotions perhaps. Or maybe, her feelings about immigrants, for another. But not even Lucia’s acutely honed perception prepared her for the real lesson being taught in that exam room, for the unnamed player.



For the boy now rose steadily, wiping a sleeve across his eye, and strode to his mother. “I’ll take that”, he said simply, as he cradled his pet into his arms and left the room.



Lucia pretended not to see the significance in the act. “It was nice to meet you”, she said firmly and genuinely to Carol. “I only wish the circumstances were different.” Carol nodded, and shook Lucia’s hand. “You too. Best of luck to you, young lady.” She hesitated, as if surprising herself with her next thought, "I really mean that, you know?" There was no apology for the unabashed scrutiny of earlier. Carol was all business. Yet, she seemed hardly surprised at her son’s reaction, merely nodding to herself and relaxing her shoulders slightly, her breath held a moment, as the boy walked out. Lucia had to give the woman credit for her insight here, and the courage it took to drag him here today. One misstep would have ruined the lesson, she realized. Oh boy is there ever going to be Hell to pay between that boy and his father, she thought to herself. His mother knew that perfectly, and was purposely setting him on a course that would take his life in a completely different direction. Away, out, into the realm of the unknown and uncomfortable, as Lucia’s own parents had taught her when they left their small towns and smaller educations behind to come here. Sometimes, the unknown is worth the risk. Intuition, she thought, was reading the signals, and knowing when the time was right to act. Lucia had the feeling that the boy’s journey was going to start today, this very afternoon even, as surely as she knew that Billy wasn’t digging the hole for the grave tonight.



She smiled and sang an old marching tune under her breath as she prepped the exam room for the next client.