AR-News: The New Yorker: THE LAST MEOW; Organ transplants, chemotherapy, root canal-how far would you go for a pet?

Karen Dawn KarenDawn at DawnWatch.com
Tue Sep 9 10:56:01 EDT 2003


The New Yorker
September 8, 2003

 FACT; Annals Of Veterinary Medicine; Pg. 46

 THE LAST MEOW;
Organ transplants, chemotherapy, root canal-how far would you go for a pet?

 BURKHARD BILGER


She arrived in Manhattan looking ravaged and ravishing, like a queen of
silent film with one last swoon left in her. Her sleek ermine coat was
matted and worn, her long neck so weak that it drooped to her chest. For
months she had managed to hide her condition, eating full meals yet still
losing weight. Now she was days away from dying, but her pale-green eyes
didn't show it.

Shawn Levering glanced down at his cat, Lady, then cast a bewildered look
around the waiting room of the Animal Medical Center, on New York's Upper
East Side. He had on scuffed bluejeans and a faded Wheels of Time T-shirt,
silk-screened with a picture of a custom Cadillac. His face was freckled and
ruddy, his forearms thickly cabled. Standing in the middle of the room, his
feet spread wide, he had the specific gravity of a man who knows exactly
where to reach for his tools. Back home, in Wilmington, Delaware, Levering
liked to work on old cars, taking rusted wrecks and transforming them into
street rods. But this cat and her problems, and the city to which he'd been
compelled to take her, were beyond him. "This place is crazy," he said. "The
taxi-drivers are like demolition experts. I just hope we can find our way
out again."

Beside him, the veterinarian, Cathy Langston, nodded, her eyes on Lady. The
cat was in the throes of chronic renal failure, she said. Her kidneys
weren't filtering out the toxins in her blood anymore. "I think she would
definitely benefit from dialysis. It won't make her kidneys better, but it
will buy her time to see if she's a good candidate for a transplant." There
were risks: clotting, internal bleeding, dangerous drops in blood pressure.
More than a quarter of Lady's blood would be taken out of her body each time
and filtered artificially. If the dialysis was done too quickly, it could
cause seizures or even a coma, but the alternative was certain death. "I've
got the whole team on standby," Langston said. "We can whisk her back, put
in a catheter, and take a biopsy today. If she passes all the tests, we
could have her ready for transplant by next week."

Like many of the center's eighty-five veterinarians, Langston is a
specialist. "Everyone has to have a passion, and the kidneys are mine," she
says. But such passions are relatively new in her field. Little more than
twenty years ago, all vets were general practitioners, and neutering and
spaying were among the most elaborate procedures they performed. Now the
American Veterinary Medical Association has more than seven thousand
specialists in thirty-nine fields, including cardiology, radiology,
ophthalmology, and oncology. As the director of the center's
quarter-million-dollar kidney unit, Langston usually has one or two patients
in dialysis at any given time. Some owners have chartered planes for their
animals, then stayed at nearby hotels during the treatment. But not all her
clients are wealthy.

"We're looking at spending a thousand dollars in the next twenty-four hours
and between three and four thousand in the next week," Langston told
Levering. If the dialysis was successful, Lady would have to be transferred
to the University of Pennsylvania, where her condition was first diagnosed.
(The university's veterinary hospital didn't yet have a dialysis unit, but
its vets were more experienced in performing transplants, and Lady was a
high-risk patient.) The total cost would be more than fifteen thousand
dollars.

Levering sighed and shook his head. Lady was already anemic, asthmatic, and
congenitally blind. She had been born on the streets of Wilmington four
years earlier, and dropped at a local animal clinic at the age of six
months. Soon after Levering and his wife adopted her, she became allergic to
her own tooth enamel. "That was a weird thing," Levering said. "Never heard
of that before." But he had willingly paid four hundred dollars to have all
her teeth pulled. In retrospect, it seemed like a bargain.

"I don't know. If it was up to me, I might not go through with it," he said.
He was recovering from a bout of Lyme disease and from carpal tunnel
syndrome, and he had recently had sinus surgery. His wife had been laid up
for three years with back injuries, and was only now going back to work. If
they were willing to go this far for a cat, it was partly out of a sense of
shared misfortune. But mostly it was a matter of love. "My wife is totally
wiped out about this," he said.

A nurse in blue scrubs came over and carefully took the cat from Levering.
As she turned to go, he reached over and laid his hand on Lady's head. Then
he watched as she was borne away in the nurse's arms, through a pair of
swinging doors, and into another world.

The Animal Medical Center and the University of Pennsylvania veterinary
hospital are the Mayo Clinic and the Mass General of their field. One is
perhaps the world's largest private animal hospital; the other is the
world's largest university veterinary center. The A.M.C. occupies an
eight-story concrete tower at the corner of Sixty-second Street and York
Avenue, overlooking the East River, and in an average year admits sixty-five
thousand patients. The center has its own oncology, dentistry, and
dermatology departments, as well as the usual surgery, emergency, and
recovery wards. To insure that there is a steady supply of blood flowing to
surgical patients, it keeps thirteen donor greyhounds, twenty-six donor cats
(some of them inherited from an elderly woman who kept seventy in her
apartment), and three donor ferrets. The ferrets are called Larry, Mo, and
Curly.

New Yorkers, with their dog-averse landlords, have an unusual number and
variety of exotic pets. Throughout the years, the city has been swept by
vogues for potbellied pigs, Day-Glo anole lizards, and sugar gliders-a
nectar-eating Australian marsupial. Most owners don't really know how to
care for these animals (sugar gliders, for instance, are prone to
osteoporosis in captivity), so the A.M.C. sees a steady circus parade of
patients. On a recent day, the exotics unit treated a ferret with a hair
ball, an anorexic bearded dragon, a pigeon with a fracture, two wild Canada
geese that had got tangled in fishing line, a four-year-old guinea pig
awaiting a five-thousand-dollar surgery on a ureteral stone, and a
hummingbird with a broken wing. Two X-rays hung on a light board on a wall
in the corridor. One was of a duck called Nip-Nip, who had swallowed a
metallic object. The other showed a long, elegant spine strung with eight
perfect ovals: a corn snake with a clutch of eggs stuck in her birth canal.

In 1910, when the A.M.C. was founded, animal welfare was a relative term.
Officers with the American Society for the Prevention of Cruelty to Animals
carried guns with which to dispatch horses, several hundred of which
collapsed from heat and exhaustion in the city every summer. It was
considered unladylike to bear firearms, so the women's auxiliary to the
A.S.P.C.A. founded the New York Women's League for Animals, and opened a
clinic. Situated on the Lower East Side, the clinic was devoted to the
city's strays and to the pets of poor immigrants, and funded by charitable
donations. Its first patient, carried across the Brooklyn Bridge by a young
girl, was a cat whose tail had been caught in a door.

In 1962, when the clinic moved to the Upper East Side, veterinarians were
still a utilitarian breed and more than ninety per cent of them were men.
Much of their work was of the kind made famous by James Herriot in "All
Creatures Great and Small": dosing sheep, midwifing cattle. Then, gradually,
women began to enter vet schools. By 1975, they represented half of all
students; by 2000, nearly three-quarters-and most of them wanted to treat
pets. Hospitals sold vets their outdated cat scanners and MRI machines,
making high-tech medicine more affordable. And, as the birth rate dropped,
pets came to take the place of children in some families.

Between 1980 and 2001 alone, the number of dogs and cats in the United
States grew from ninety-eight million to a hundred and thirty million. Two
generations ago, fathers still gave their sons sacks of kittens to drown in
the river. Today, according to a recent survey by the American Animal
Hospital Association, sixty-three per cent of pet owners say "I love you" to
their pets every day. Eighty-three per cent refer to themselves as their
pet's mom or dad.

The current director of the A.M.C., Guy Pidgeon, has lived through both
halves of this history. He was born on a farm in western Nebraska in
1947-though you'd never guess it from the stout, Friar Tuck-ish figure he
now is-and went to the Colorado State University veterinary school, intent
on becoming a country vet. "Then, at some point, I began to see an
incredible dichotomy between agricultural and veterinary medicine," he told
me. "One was driven by economics, the other by emotion." A sick cow could
merit only a few shots before it was sent to the slaughterhouse; a sick
hamster could motivate a six-hour surgery. To a veterinarian interested in
cutting-edge medicine, the future lay with pets.

"My staff likes to tease me about the time my father came here for a visit,"
Pidgeon said. "He's eighty-six now and still lives on the farm. He tries to
maintain a sense of humor about what I do, but he doesn't really understand
it." The poodles getting root canals, the rabbits in radiation wards, were
strange enough; but the crowning absurdity was the sight of two prairie dogs
in the intensive-care unit. Members of the latest exotic pet craze, they had
contracted pneumonia and were having trouble breathing. "If you're a farmer
in Nebraska, you've been waging holy war against prairie dogs all your
life," Pidgeon said. "And here I was giving them oxygen therapy."

Before I visited the A.M.C., I had a certain cartoonish image of its
clientele: the dragon lady from Carnegie Hill kissing her lapdogs on the
lips; the Wall Street power broker sending his wolfhounds to have their
teeth cleaned. I thought of the German countess Carlotta Liebenstein, who in
1991 bequeathed her eighty-million-dollar estate to her dog Gunther. Of J.
Paul Getty, who refused to return from Europe when his twelve-year-old son
died of a brain tumor but had a vet flown in when his dog developed cancer.
When the disease proved fatal, he spent three days weeping in the dog's
room.

Lady's owners were different. Like many of the rumpled, red-eyed people I
sat with in the A.M.C. waiting room, they could scarcely afford their
sympathies. Shawn Levering works with mentally disabled adults, finding them
jobs and visiting them weekly at their workplaces. He recently turned forty
and makes twenty-seven thousand dollars a year. His wife, Karen, who is
thirty-four, is the caregiver for a disabled teen-ager and is earning a
degree in child psychology. They live in a three-room apartment in a plain
brick building on the outskirts of Wilmington. At night, trains rumble in
and out of the nearby Saturn car factory, delivering parts, and you can hear
the thrum of Interstate 95 half a mile away.

When I visited them at home, on a Wednesday evening, Lady was scheduled for
a transplant the next morning. She had made it through the dialysis
treatment at the A.M.C. and had been transferred to the University of
Pennsylvania. Karen had been to Philadelphia that morning to see the kidney
donor. The hospital maintains a pool of cats for the purpose, often taken
from local shelters and research labs. The surgery seems to have no ill
effect on the donor cats' health, and it solves the problem of having to put
them to sleep: the owners of the transplantee have to agree to adopt the
donor. In the Leverings' case, the new cat would bring their feline
population to four.

As we talked, Jimmy, a fat brown tabby with a cream belly, slinked warily
past Bogart, a scruffy white tom lounging on the couch. Karen had found
Bogart starving in front of a 7-Eleven one night and brought him home, only
to find that the cat was stone deaf and deeply irritable. The first time Sha
wn tried to pull Bogart and Jimmy apart, he was bitten so deeply that he had
to go to the emergency room. The second time, he had to take a round of
antibiotics and get a tetanus shot. Karen's asthma flared up so badly, with
all the dander in the air, that she had to use her albuterol inhaler
repeatedly. "But I really think my system has adjusted to them," she said.

Karen has strawberry-blond hair and a moon-shaped face unmarked by her
relentless bad luck. When she met Shawn, in 1997, through a dating service
on the local radio station, she was a teacher at a Christian school. A month
before their wedding, her car was rear-ended when she stopped at a yield
sign. Her injuries were serious enough to warrant visits to a chiropractor
during her honeymoon, and they were compounded, three months later, when she
was rear-ended again. With a fractured vertebra and several torn disks in
her spine, she couldn't stand in front of a classroom anymore, so she stayed
home, on constant medication. When she tried to start a family, she couldn't
get pregnant.

"I don't know what I would have done without the cats," she said. "Shawn was
working long hours, and the pain was so extreme sometimes that I would just
go to the bathroom and cry." Lady seemed to sense her moods. She would leap
onto the bed at night and nestle on her chest. Karen had studied enough
psychology to suspect that her feelings for Lady were partly misplaced
mothering instincts, but she also knew that relationships like theirs could
have a particular intensity. In the early nineteen-seventies, for instance,
the biologist Erika Friedmann, of Brooklyn College, studied how heart-attack
patients respond to social support. Patients who had a dog or cat, she
found, were more than four times as likely to survive a year after a heart
attack than those who didn't have a pet.

Research like Friedmann's has since spawned its own scholarly journal,
Anthrozoos, and a "prescribe-a-pet" movement has sprung up among some
therapists. Three years ago, Karen Allen, a psychologist at the State
University of New York at Buffalo, studied two groups of hypertensive
stockbrokers from Wall Street. One group was given drugs and a pet, while
the other received only drugs. Six months later, the brokers took a stress
test. They were asked to appease a client who pretended to have just lost
eighty-six thousand dollars, thanks to their advice. Everyone's blood
pressure rose, but for those with pets it rose half as much. Allen later ran
another series of tests on pet owners. This time, she had them perform
stressful activities alone, in the presence of their pets, and in the
presence of their spouses. The results were unequivocal: pets made people's
blood pressure drop; spouses made it shoot up.

Sitting side by side on the love seat in their living room, Karen and Shawn
could have passed for two of the pet lovers in Allen's study. Karen argued
that her cats deserve "the respect of life." She described the prayer group
that she belonged to at a Methodist church and said that the other members
would be sending their blessings to Lady the next morning. Shawn reminded
her that they were already in debt-"We've gone from getting by to barely
scraping." He said the first time she mentioned a transplant he was tempted
to have her sanity checked. The cats wound their way between them, filling
the silences with their purring.

Late that night, Shawn and I took a drive through the deserted streets of
Wilmington, past strip malls and sandwich shops to the garage where he works
on his street rods. Inside, a 1940 Ford truck lay on blocks, its body sanded
and primed, waiting for parts from the crippled car beside it. Shawn and his
friend Eddie had bolted the truck's body to a Chevy S-10 frame. They had
chopped five inches from the frame, dropped in a burly 305, and laid in a
steering column and brakes from a 1987 Monte Carlo. Then the money ran out.

"Before Karen and I got married, I was hoping to have this car done in two
years," Shawn said. He glanced around the garage and chuckled. No, he said,
he wasn't imagining what fifteen thousand dollars could buy. He, too, had
come to depend on Lady's company. "I can't say I haven't compared this
transplant to a down payment on a house," he said. "But you can't go too far
down that road. If Lady comes through this thing alive, I won't think about
it twice."

I was reminded of the two trucks the next morning, in the operating room at
the University of Pennsylvania. The donor cat, Jasper, was lying on one
table, his kidney stripped out and strung from its blood vessels like an old
transmission. Beside him, Lady, covered with surgical drapes, was awaiting
her replacement part. An oxygenation monitor had been clipped to her tongue,
an anesthesia tube was pumping Isoflurane gas down her throat, and nylon
cords anchored her limbs to the corners of the table. As soon as one team of
surgeons cut her open and located her renal blood vessels, aorta, and vena
cava, another team would cut Jasper's kidney free. Then the transplant would
begin.

Lillian Aronson, the head surgeon, strode in with her forearms scrubbed and
dripping, her face set in an uneasy grin. She'd begun the day in good
spirits, joining the nurses in the kidney chant they had made up:
"K-I-D-N-E-Y, You can do it if you try! Kidney! Kidney! Kidney!" Then things
began to go wrong. Every cat has two kidneys, though it needs only one to
survive, but not every kidney is fit for a transplant. Jasper was Lady's
second donor. The first donor, Jack, seemed to have an ideal kidney: a CT
scan showed that it was neither too big nor too small, and that there was a
single artery and vein servicing it. But when Aronson opened the cat up, she
found a second artery tucked behind the first. This artery would have to be
sacrificed in a transplant, depriving part of the organ of blood. Luckily,
Jasper-Jack's littermate-was available for surgery, and his blood type was a
match for Lady's.

"It's all very scary," Aronson said, putting on her surgical gloves. "I
ought to just open up a bed-and-breakfast and hang a 'No Vacancy' sign."
Aronson, who is thirty-six, has been transplanting kidneys for ten years.
Though her success rate is high-ninety-four per cent of her patients leave
the hospital, and more than half are alive after four years-the procedure
still fills her with a pleasurable dread. The night before, I'd watched her
practice in this room, sewing stitches into a sliced rubber glove. A cat's
renal artery is only about two millimetres thick. To stitch it to another
artery of the same size, Aronson has to use an enormous surgical microscope
suspended above the patient's open belly, with dual eyepieces for the
surgeon and for her assistant. That brings the sutures into view but throws
her eye-hand coordination out of synch. Seen through the eyepiece, the most
delicate forceps loom like pliers.

As Aronson took a scalpel and placed the tip on Lady's belly, I could see
her bracing for the start as if for a pistol shot at a racetrack. Animal
lovers are often accused of anthropomorphism, but after you've spent a few
weeks in a veterinary hospital it's hard to resist the opposite urge: the
doctors all begin to look like their patients. Aronson is unmistakably a
greyhound: lean and tightly wound, with dark, downturned eyes and a
disarmingly sweet nature for someone who is so single-minded. She runs
marathons regularly with her husband, and has wanted to be a vet almost from
the time she could talk. When her oldest brother, a physicist, first heard
about her transplanting a cat's kidneys, his only comment was "Why not just
perform a collar transplant instead?"

Aronson needed only a few minutes to open Lady's belly, clamp the aorta and
the vena cava, and bring over Jasper's kidney. "This cat has issues," she
had warned me before the surgery. "With that asthma, I'm not sure how she'll
hold up under anesthesia." So far, though, Lady's breathing was deep and
even, her blood pressure steady. Using a foot pedal, Aronson steered the
motorized microscope into position. She grasped the cut end of Jasper's
renal artery with forceps and pressed it against a tiny hole that she had
cut in Lady's aorta, like a T-joint in a pipe. For the next ten minutes, she
sutured the joint together. Then, just as she was putting in the final
stitch, her needle caught the back wall of the artery. As she drew in the
thread, it pinched the vessel partially shut. Blood could still flow through
it, but there was the possibility of a blood clot.

Aronson glanced up at her assistants, her features thrown into shadow by the
overhead lamp. "Can anything else go wrong today?" she said. She had no
choice but to take out the thread and restitch the joint, but that could
irritate the arterial wall, again increasing the chance of a clot. "Her
potassium level is going up," a technician called out beside her. Aronson
shook her head. "I'm worried about that artery," she said. "Very worried.
I'm telling you right now this may not work."

The dire choices that define a veterinarian's day aren't particularly well
compensated. The average American vet makes around sixty thousand dollars a
year-a hundred thousand less than the average physician, though veterinary
training can be just as rigorous and costly as medical school. If vet
schools still have to turn applicants away, it's partly because people love
to work with animals and partly because they're put off by the tortured
ethics of human medicine. Whatever dramas veterinarians have to face, they
know that malpractice suits are rare and relatively inexpensive, and that
euthanasia is always an option.

But that may be changing. The law has long treated pets as property, no
different from a Teddy bear or a windup toy. If an owner sues for the
wrongful death of his cat, the most he can demand is the cost of replacing
the animal. Recently, though, lawyers have begun to demand more. Two years
ago in Oregon, a retired football player named Stan Brock filed a lawsuit
against a man who had shot his two Labrador retrievers with arrows. (The man
claimed that the dogs had been threatening stray cats near his house.)
Replacing the dogs would have cost, at most, a few hundred dollars, but
Brock sued for three hundred thousand dollars. "Pets don't depreciate; they
appreciate," his attorney, Geordie Duckler, argued in court. "That's very
different from what you can say about a purse or a car." The trial judge
agreed.

Brock eventually settled out of court for an undisclosed sum, but Duckler
expects a number of similar cases in coming years. In Tennessee, he says, a
law that was recently passed allows owners to sue for up to four thousand
dollars in emotional damages if their pet is killed by a negligent pet
owner's dog, and several other states have comparable bills on the docket.
In New York, in 1999, a housing court forced a landlord to let a woman keep
a puppy in her Queens apartment when she cited research on the health
benefits of pets. Elsewhere, a group called In Defense of Animals has
lobbied communities to define people as "guardians" rather than owners of
their pets. Seven cities and the state of Rhode Island have adopted at least
a variation of the ordinance.

"The more people spend on their pets, the more that cost is going to be
reflected in the law," Duckler says, which means that veterinarians could
face million-dollar malpractice suits in the future. Each time they
introduce an expensive new procedure-radiation therapy in the
nineteen-eighties, MRIs in the nineteen-nineties, experimental cancer
vaccines in the new millennium-they implicitly raise the value of their
patients. Many vets, like doctors, are now on call at night and on weekends.
When they sit at kitchen tables at four in the morning, listening patiently
to owners describing their dogs' stool consistency, they suggest that a pet
is worth almost any effort, any cost.

Vets say that rising malpractice awards will hurt both sides. "They'll just
bring the insanity of the human side of the business into my profession,"
Guy Pidgeon told me at the A.M.C. "And all those costs will be passed on to
the client." But pet owners have already begun to prepare for those costs.
Nearly four hundred thousand pets are now covered by medical insurance
policies in the United States, and that number is expected to grow to two
and a half million in the next five years.

Not long ago, at an all-day symposium at Harvard Law School, Jane Goodall,
Alan Dershowitz, and others tried to sort out the legal and ethical
principles behind these issues. Should courts grant animals some human
rights? If so, which animals and which rights? There was much talk of I.Q.
and the theory of mind, of gorillas that can communicate in sign language
and parrots that can do arithmetic. Steven Wise, an animal-rights attorney
and the author of the book "Drawing the Line," divided the animal world into
four categories, based on ascending levels of intelligence. At the bottom
were earthworms, bacteria, and other creatures that are notably lacking in
self-knowledge or the power of deductive reasoning. At the top were the
great apes, dolphins, and a few clever birds. Only this last group, Wise
argued, could claim "legal personhood." Dogs, cats, and most other pets
hovered somewhere in category three: just a little too dim-or poorly
understood-to earn our highest regard.

Wise knows that his categories won't convince most people. An adult
chimpanzee may be smarter than most two-year-old boys, but that won't get it
into day care. The rights we grant animals are, first and foremost, a
function of empathy-and, on that count, no ape can compete with a pet. "The
chimp is amazingly similar to us in brain structure, DNA, and behavior,"
Jane Goodall told me during an intermission. "But a dog can be a better
friend to you than anyone else." Goodall has spent most of her life living
with chimpanzees, but it was her childhood dog, Rusty, who first taught her
that animals have personalities, intelligence, and feelings. If one research
facility was being cruel to dogs and another was abusing primates, she said,
she knew which one she would shut down first: "I'd choose the dogs."

The missing voice in this debate, of course, is that of the animals. Is the
agony of chemotherapy worth an extra six months of life to a dachshund? Does
a parrot really want legal autonomy? Veterinarians like to talk about a
pet's quality of life, but no one really knows what they mean. Injured
animals no doubt experience fear and pain: the parts of their brains that
process those feelings (the amygdala, the thalamus, and the hypothalamus)
are similar to ours, and animals often have keener senses. Do they also feel
enough pleasure-enough joy in the sheer fact of existence-to make surviving
worthwhile?

Two weeks before Lady's transplant, I saw a mastiff named Taberia in the
intensive-care unit at the A.M.C. The dog was eleven years old-ancient for
her breed-and barely able to stand. Her eyes were rimmed with red, and her
skin draped over her bones like an old rug. She had a grapefruit-size growth
hanging from her belly and a bleeding tumor on her spleen that seemed to
have spread to her liver. "Surgery will probably just prolong the
inevitable," a resident said. "Dogs with this kind of cancer don't respond
well to chemo." The doctor gently suggested putting the dog to sleep, but
the owner seemed not to have heard him. She was a bartender at Red Rock
West, in Manhattan, with a pale, defiant face and a voice gone smoky from
years of screaming above crowds. She crouched inside the mastiff's cage and
cradled its head. "Taberia used to love hanging out at the bar," she said.
"I've always thought she must have been a drunken ballerina in her last
life."

Euthanasia is one of the last dividing lines between human and animal
medicine, but it has been blurred in recent years. Although Oregon legalized
assisted suicide in 1997, and Jack Kevorkian and others have championed the
practice for the terminally ill, veterinarians have grown more wary of the
procedure. Less than twenty years ago, a pet owner could still have a
healthy animal put down. Now most vets will euthanize only the very sick,
and their standards continue to rise as their medicine improves. "Sometimes,
in all the hoopla over what we can do, we lose sight of the fact that there
are people who don't want to go that far," Pidgeon said. "And sometimes we
think the pet is being forced to endure more than it should." Owners can
still weigh the costs and benefits of saving a pet's life. But the more pets
are treated like surrogate children, the more complicated the equation
becomes.

In Taberia's case, under the surgical lights the doctors found exactly what
they had expected: the abdomen full of blood, the spleen and the liver so
engorged with purplish cancer cells that they had burst open. Even then, the
owner wanted the dog sewn back up and sent home. If Taberia could just live
for a few more weeks, she thought, she might be able to cure her
holistically.

The surgeons eventually persuaded Taberia's owner to let them put the
mastiff to sleep. When I asked her what she planned for the body, she said
that she was going to buy Taberia a plot in Hartsdale, New York, in the
country's oldest and most prestigious pet cemetery. "When someone buries a
dog there, you know they must have loved it to death," she said.

It had been six hours since Lady's first donor was cut open. For the past
twenty minutes, a brittle silence had fallen over the room. Aronson shuttled
from one side of the surgical table to the other, getting the best angle on
her final stitches. The replacement kidney had been without blood for about
forty-five minutes. Most organs can survive that long and still function,
but Aronson could never be sure. She gave her assistants a weak smile. "Pray
to the urine gods," she said.

When the clamps came off, the renal artery and vein hung limply at first,
like guy wires from a deflating zeppelin. Then, little by little, they began
to stiffen. Their pale white walls stretched and expanded, until a delicate
tremor ran down their length: the beating of Lady's heart. "Unbelievable,"
Aronson said. The sutures were holding, and the weakened artery showed no
signs of collapse. Now she just had to attach the ureter: the vessel, even
thinner than the artery, that carried urine from the kidney to the bladder.

Aronson sliced open the bladder, flipped it inside out, and cut a small hole
in the side. She threaded the ureter through the hole and was preparing to
attach it with a crown stitch when her hand suddenly froze. "Will you look
at that?" she said. Her assistants crowded around, craning their necks. A
thin stream of clear fluid was trickling from the ureter's open end. "A new
kidney making urine," Aronson said, as everyone whooped and cheered around
her. "There's nothing better than that."

Afterward, when the bladder had been stitched shut and injected with salt
water to insure that it was watertight, and the kidney had been sewn to the
side wall of her belly to prevent it from drifting, Aronson closed up Lady's
belly and rolled her to the intensive-care unit. She gave the nurse on duty
the rundown: "She's blind, she's toothless, she has renal disease, and she's
really sweet." Then she went out to get a Diet Coke-her first meal in more
than twenty hours. Lady lay on the table, immobile. After a few minutes, she
opened a single eye.

Americans now spend nineteen billion dollars a year on veterinary care, up
from eleven billion just seven years ago. Add to that the cost of pet food
and other supplies and the number rises to forty-seven billion, nearly three
times as much as the federal government spends on welfare grants. The
figures fill even some pet owners with dismay. If society could give up on
goldfish alone, the sentiment suggests, it could fund a few dozen more Head
Start programs. Cure the addiction to dogs and cats, and millions of
families might be lifted out of poverty. Pets, as George Bernard Shaw wrote,
"bear more than their natural burden of human love."

But, of course, it's not that simple. Our feelings for animals aren't easily
transferred, a fact best illustrated by our treatment of the pets we don't
own. When Lady was recovering from her transplant, a kitten was being
treated next door. His mother had died after giving birth, and his
littermates, hungry for milk, had mistaken their brother's penis for a
nipple, eventually giving him a bladder infection. The kitten's owners had
driven in from western Pennsylvania and were paying hundreds of dollars for
his treatment. Yet they could have got another kitten for free in any
shelter. Every year, while pets like theirs are saved by the most elaborate
means, some six million strays are put to sleep.

Americans are no more inconstant than other nationalities. The Chinese
pamper their Pekingese and stir-fry other breeds. Polynesians used to
slaughter some puppies and breastfeed others. The Inca kept hairy dogs as
hunters, and hairless ones as bed warmers, shielding the latter from sunburn
in rooms filled with orchids. Modern veterinary medicine is either the
natural culmination of these ancient relationships or their crowning folly.
Spending fifteen thousand dollars on a cat is an outrage, some say, yet they
gladly spend four times more on a BMW.

The last time I saw the Leverings, Lady had been back from the hospital for
a week and had a bedroom to herself. The first days of recovery are a
dangerous time, Aronson says. One of her other clients tried to keep her cat
from jumping down from the couch not long after its transplant. The cat
shook itself free, ran downstairs, and fell over dead-its renal artery
having torn free in the tussle. Even if Lady avoids such mishaps, she will
have to take steroids and immunosuppressants for the rest of her life to
keep her body from rejecting the new kidney. The drugs will cost about five
hundred dollars a year, not counting veterinary fees for trimonthly visits,
and will leave Lady prone to infections, cancers, and diabetes.

Karen showed me how she prepared the doses twice a day, injecting amber
cyclosporine into clear-gel capsules. Two days earlier, she said, she had
locked herself out of the house when it was time for the afternoon dose and
had to use a rock to break in through the kitchen window. Otherwise, it had
been a smooth transition. Jack, the failed kidney donor, was being adopted
by a vet at the hospital. Jasper had developed a toe infection and an
allergy to his plastic food bowl, but he had taken to the other cats
immediately.

Halfway through the conversation, Shawn came back from church, propping up
an elderly man with an enormous, lopsided grin. His name was Don and he
worked at an auto-parts factory, and sometimes helped out in the garage on
weekends. He and Shawn settled on the couch across from Karen and talked
about street rods for a while. Lady padded in from her room, picking her way
around the furniture by memory, and joined Bogart and Jasper on the carpet.
They were an oddly harmonious trio-one blind, one deaf, one allergic to
plastic and missing a kidney-not unlike the people around them. Gathered
there in the living room, they kept an eye on one another, the cats and the
people. "It would have been hard not to have Lady around," Shawn said. The
cats, as always, didn't say a word.




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