I met Laurie thirteen years ago. At that time, like many academic surgeons, I was consumed by research, teaching, publications and advancing my career. In retrospect, it was insidious, how with increasing professional demands and success, I was neglecting the personal side of my practice. Laurie was referred to me from an outside hospital where she had presented with blood in her urine and was found to have a high-grade, but apparently non-invasive bladder cancer. She was also a severe, insulin-dependent diabetic. Although in her fifties, Laurie had a shy smile with a subdued giggle. I restaged her and confirmed her diagnosis.
We discussed all the pertinent issues regarding her case-the 30 percent risk of understaging, the 70 percent chance of recurrence and 20 percent rate of progression. As we spoke further about her disease, the subject of her yellow Labrador Retriever, Maggie, came up. As much as she was concerned about her disease, she was as concerned about how her treatments would impact her ability to care for Maggie. When I mentioned that I also had a yellow Labrador Retriever, Tank, our bond began to form.
Laurie wanted to avoid removal of her bladder, if at all possible, and we decided to try intravesical therapy where medicine is instilled into the bladder through a rubber catheter. These weekly installations provided an opportunity for us to meet often and our conversations always turned to the Labrador Retrievers. We shared pictures of our dogs and stories of canine escapades.
Laurie’s disease recurred and we turned to immunotherapy bladder instillations. Again, the frequent treatments gave us the opportunity to know each other even better and to share our mutual love of dogs. When I told Laurie of Tank’s devouring an entire stick of butter on the Thanksgiving table in the midst of the holiday dinner, we laughed together and it helped ease the uncertainty of her prognosis.
Like many patients, Laurie’s bladder therapy ultimately failed and she faced the decision whether to proceed with bladder removal. This is never an easy decision for any patient, but beyond all the usual personal concerns that accompany the prospect of major surgery, again, a significant consideration for Laurie in making her choice was how she would be able to care for Maggie. By this time, I had added a Boxer, Gracie, to my household and that only extended our canine discussions. Laurie was at first incredulous that Gracie had learned how to swim alongside Tank, but a picture convinced her.
Laurie underwent removal of her bladder and construction of a new bladder made from a portion of her bowel. Most surgeons will tell you that complications most often occur in those patients with whom you are close. So, it happened with Laurie who developed a postoperative complication-a fistula from her surgically constructed bladder to her vagina. Probably because of her diabetes, she required two attempts to close her fistula. Throughout her pronged postoperative recovery, Maggie was her main concern, and in many ways, her strength.
After her initial stormy postoperative period, Laurie settled into a routine with regular office visits every three to six months. Things were going very well and then we hit a mutual bump in the road — the deaths of her Maggie and my Tank. We leaned on each other and got through our losses. However, like most dog lovers, we both, with time added other dogs to our lives- her Gizzy and my Finnbar. The stories of canine mischief resumed during her subsequent visits. The latest was during a 4th of July parade last year when the irrepressible Finnbar swallowed, no inhaled, would be a better description, a hot dog and roll from the hands of an unsuspecting eight-year-old.
The bladder cancer and Labrador link came full circle for us several years ago. I was lecturing on the use of urinary markers for bladder cancer at a postgraduate course and mentioned that it had recently been reported that dogs could differentiate, by smell, the urine from normal controls and bladder cancer patients as well as some other types of cancer. It is thought that dogs can detect organic compounds in the cancer urines. To make the point, I showed a picture of my beloved Tank during my lecture. I shared the story with Laurie and her grin said it all- we both had always known that dogs are as least as smart as human beings.
Laurie has become not just a special patient, but a special friend. Without her and the dogs, I don’t know what would have happened. I probably would have continued along a successful career path, but I had already sacrificed something along the way- the reason that most of us become physicians- the doctor-patient relationship. A special patient and some special dogs, a man’s best friend, indeed.
Kevin R. Loughlin MD is a retired urologic surgeon. He has written fiction and non-fiction throughout his career. He has been a dog lover since childhood. His first dog was a Scottish Terrier named Kilts.
