Good News

I received some amazing news last week. After a year of targeted treatment for melanoma, my PET scan came back with the report “No Evidence of Disease.” When I told my friends and family, they wanted to know “What does that mean?” “Are you cancer-free now?” So, just in case you ask, here’s what I tell them. These days doctors rarely tell their patients that they are cancer-free, because having cancer, like being an alcoholic, is a permanent condition. Instead, they are more likely to use the terms “remission,” or “NED.”

In 2021 Medical Oncologist Dr. Phat Le explained these three terms in an article written by Cynthia DeMarco for the University of Texas MD Anderson Cancer Center newsletter, Cancerwise.

“A lot of people use these terms synonymously, but “remission” and “no evidence of disease” (also known as NEOD or NED) are probably the closest by definition. Officially, both mean that no cancer is currently detectable in the body. That may be based on scans, bloodwork or some other kind of test, such as a [biopsy].

“Cancer-free” is a little more complicated, because it’s not based on something we can measure. Instead, it implies that not only is there nothing detectable in your body as cancer, but we also believe no residual cancer is left anywhere, so there’s no chance of the cancer ever coming back. And that’s a lot trickier to say because there’s always at least a very slight risk of recurrence if you’ve ever had cancer before.” (italics my own)

So “no evidence of disease” is about as good as it gets.  I’ll take it.

During this year of diagnosis, surgery, treatment, and side effects, there have been many lessons. Those of you who know me also know that I like to be in control, don’t do well with change, and tend to work long hours, drawing on apparently unending energy. (Thanks, Dad. Most of those traits I inherited from you.)

And none of them are compatible with having cancer.

As I accustomed myself to not being in charge, facing continual change — of how I felt, of treatment decisions, and of having little if any energy to actually do anything — I had the benefits of an amazing medical team and friends and family who stepped in to drive me to appointments, empty my dishwasher, walk my 15-year-old Border Collie, Kismet.

Kismet.  Here’s where the narrative changes.

Because Kismet died yesterday, less than a week after I received the good news that I was “NED.”

Losing Kismet

Those of you who have lost a pet won’t be surprised to know that I’m feeling very bereaved at the moment, every bit as sad and alone as I did when my mother and father passed. It seems disloyal or weird to write that, but it’s true.  For over fifteen years Kismet and I shared every day, barring brief periods when I paid lots of money to people to care for her while I traveled. She accompanied me on several 1000-mile road trips to visit my parents in Canada, bravely took on challenges like herding sheep and running agility courses, and sat beside me as I wrote, read, watched movies, or lay on the couch feeling rotten. She even accompanied me last month as I bounced from one hotel to another after being evacuated from the threat of Los Angeles wildfires.

This past year was difficult for us both.  As my body fought the cancer cooties, Kismet developed kidney disease and arthritis in her hips. She could no longer jump up on my bed or the couch, gradually lost her appetite, and slept more and more each day.

As I rejoiced over my NED diagnosis, Kismet struggled with stairs, uneven ground, and getting up and down from her long naps. She had lost interest in her canned kidney diet months earlier, so I began feeding her homemade meals made from cooked chicken, rice, and vegetables.  That helped for a while, but about a week ago she simply stopped. She stopped eating, asking for walks, dragging her bed out from the corner to her favorite place by the fire, and sleeping beside me as I worked. Instead, she lay in her crate all day and all night.  And then she stopped eating and drinking and refused the pills her vet prescribed for pain, for nausea, for her latest UTI. Her kidneys failed, and she gradually fell into a deep sleep from which it was clear she would never return.

Yesterday I called an end-of-life veterinarian who came to my home and gently administered euthanasia. She was understanding and kind as she explained that she would first administer a sedative to reduce Kismet’s anxiety, and then insert an IV carrying fluid that would stop her heart.  I was able to sit beside my friend, scratch that sweet spot beside her ear, and say goodbye as she went to sleep for the last time.

Last evening I tearfully sat in my empty house and sought to understand my overwhelming grief. Kismet was just a dog, right? So why was I so terribly sad? I slowly collected artifacts that reminded me of Kismet — her bed, collar and leash, toys, hairbrush, and jar of treats — and put them in the garage. It didn’t help. Eventually, I did what I always do when I’m confused or at a loss – I searched for answers.

Trying to Understand

First I turned to the internet to research the relationship between dogs and humans. For my readers who follow the PBS drama, All Creatures Great and Small, it will be no surprise that the psychologist who best explains this is John Archer, of the University of South Lancashire, UK. Dog ownership is high in the north of England, my birthplace, and my experience visiting there is that many people seem to derive more satisfaction from their relationships with dogs than those with humans. Archer says that’s because “dogs supply a type of unconditional relationship that is usually absent from those with other human beings.”

In the journal Evolution and Human Behavior Archer wrote that “for most people, the loss of a dog is, in almost every way, comparable to the loss of a human loved one. Unfortunately, there’s little in our cultural playbook – no grief rituals, no obituary in the local newspaper, no religious service – to help us get through the loss of a pet, which can make us feel more than a bit embarrassed to show too much public grief over our dead dogs.

“Perhaps if people realized just how strong and intense the bond is between people and their dogs, such grief would become more widely accepted. This would greatly help dog owners to integrate their pet’s death into their lives and help them move forward.”

Coming to Terms

So here I am, processing my grief with you, my friends, and spending Presidents’ Day going through old pictures of Kismet and me. Especially during the past year, when her presence was so very comforting. This sadness will eventually lift, I know, and my life and times with Kismet will recede into that place where I keep precious memories.

To those who suggest I get a puppy, I will say no, Kismet was my last canine companion. I’m too old to take on a 15 or 20-year commitment. It wouldn’t be fair to the animal.

Perhaps when the sadness recedes I might consider fostering a dog for the Humane Society, or perhaps I’ll get a cat.  But for the moment, I will hold my grief close and be grateful for the many years Kismet and I had together.

And for being NED.

Marlene