DIAGNOSIS (1)

So this is how it starts.

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

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

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

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

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

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

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

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

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

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

HERE AND GONE (2)

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

Since I hadn't moved out of state, I was able to visit home frequently enough to keep up with her changes. They could happen almost without warning. Once between visits, her silvery gray bobby-pinned curls turned white, which shocked me upon arrival. Trips to the hairdresser remained a pleasure, and helped me learn what she knew about her condition by hearing what she shared with the women in the shop. As...