A Kidney for Francis

by

Jaclyn Adomeit

THE AMMONIA REEK OF FRANCIS’S BREATH filled the examination room. Jemma forced herself not to pinch her nose, instead gripping onto the sides of her clipboard. Dogs with kidney disease had breath that could make a litterbox smell pleasant. She winced as Dr. Werner forcibly grabbed the schnauzer’s jaw, checking his teeth.

“Also want to sell the owner on a dental cleaning while he’s under. You can pitch it as eliminating a second round of anesthesia,” said Werner.

Jemma clicked and unclicked her pen, letting the sound stand in for her response. Shifts as Dr. Werner’s vet tech made her question her life choices. Once upon a time, she had thought assisting in veterinary medicine would be a worthwhile career, one where she wouldn’t get paid particularly well but where she could help. She wanted to return animals to health. She wanted to ease suffering. But tasks wore into her wrists and she began to feel less and less helpful as the months were dragged out of her. Francis whimpered as Dr. Werner palpated his belly, prying his fingers into the place where Francis’s fourteen-year-old kidneys were failing him.

“What day did you book in for the transplant?” Dr. Werner let go of Francis, and he backed against the wall. 

Jemma pretended to look for the date, running her finger down the clipboard, like it wasn’t already in her mind. “Two weeks out.” A kidney transplant for a fourteen-year-old dog was insanity. It was a new procedure, one she had only helped with once, and that was for a five-year-old rhodesian ridgeback. For Francis, it was forced suffering. Jemma had hoped that Cheryl, Francis’s owner, wouldn’t agree to the work, that they wouldn’t be able to find a donor match. But after a couple calls, three schnauzer-somethings were found at the local shelters. With a bit of expedited bloodwork and biopsy, one was found to be both a tissue and blood type match. Jemma supposed she shouldn’t be surprised: the entire gene pool for schnauzers was probably only a couple hundred discrete sets of DNA.

“There wasn’t anything sooner?” Werner pulled off his gloves and sling-shotted them into the trash. There was plenty sooner. He knew how open his schedule was, but Jemma wanted to give Cheryl some time to think about the procedure. Jemma couldn’t say anything, but it didn’t mean she wasn’t perfectly aware there were other, more standard methods for treating kidney disease: intravenous fluids, adjusted diet, oral phosphate binders. Other vets, even the others at this large corporate practice, would recommend those things, but Werner knew how to make owners feel guilty. The supposedly best medicine – and the most expensive medicine – was kidney transplants. It was so new there wasn’t clear evidence on how long it extended a dog’s life. Not to mention the procedure cost more than half of Jemma’s annual salary.

“Your schedule for the next month has some openings for surgeries. If we wanted to hold off, perhaps send Mrs. Patterson home with some subcutaneous injections –”

Dr. Werner cut her off with a raised hand. “You go sell the owner on the dental cleaning. I’ll deal with it.”

Jemma tried to ease the clench out of her jaw as her sneakers squeaked down the corridor. Francis lingered on his leash, sniffing the fourth storey windows that overlooked Roncesvalles Avenue. High Park’s proliferation of orange and red glowed in the distance. On some days, Jemma felt lucky to be at the large veterinary hospital in the well-off Toronto neighbourhood. A high-net facility meant interesting treatments, meant profit-share, meant receptionists and janitors and other vet techs who could help. But today didn’t feel lucky.

Jemma gave a cursory knock and slipped into the room where Mrs. Patterson waited.

“My boy.” Cheryl unknotted her fingers from her pashmina and reached for Francis. He licked at her cheeks, and she let him, ammonia stink and all. Jemma smiled. 

“He did great with his exam,” said Jemma. Cheryl pulled a bag of cucumber slices from her purse and held one out. Francis’s tail wagged as he nibbled. Jemma eyed her Hermès bag. Dr. Werner had probably spotted her from across the waiting room.

“No other issues?” asked Cheryl.

Jemma bit into her cheek, considering. “Dr. Werner did mention he could likely use a dental cleaning.”

“He’ll do that at the same time then? Save on anesthesia?”

Jemma wanted to say it didn’t really save on anything. Anesthesia was charged by the quarter hour, and it was harder on older animals to be under for long periods. “That’s Dr. Werner’s plan.”

She walked Cheryl through the paperwork for the procedure. Surgery for Francis and for the donor dog. Two weeks of aftercare for them both. Take-home meds, and check-up bloodwork, and the dental cleaning. And there was the adoption paperwork. Cheryl would have two dogs, if everything went as planned. A donor dog would give a kidney in exchange for a home.

Jemma pulled the credit card machine out from a drawer and punched in her pin. “So the total for all of that comes to $32,400.”

“Dr. Werner said you could help set me up with a payment plan.”

Jemma looked up from the machine. Her eyes flicked to Cheryl’s handbag.

“Oh, I know.” She patted her purse. “My sister likes to give flashy gifts. People are always asking me why I’m on the bus.”

Jemma began to ask if Dr. Werner knew this but stopped herself. She needed to say something. This woman did not need to pay thirty-two grand to give a geriatric dog a kidney.

“It’s a tight budget, but I can make it work. My husband passed away a couple years ago, and it was before he was up for pension.” Cheryl gave Francis a squeeze, holding him close.

Jemma put the machine back in the drawer. “I know Dr. Werner has spoken a lot about the transplant. But it isn’t the only care option. There are dogs in Francis’s condition who can live for years on modified diets and at home fluid injections. A more reasonable plan might mean – you don’t need to do this.”

Cheryl cradled Francis’s chin in the crook of her elbow. “I want to make sure he gets the best he can get.”

Jemma swallowed, trying to find a professional way to suggest that most-expensive did not always correspond with best.

Dr. Werner pushed into the room without knocking. “Paperwork done?”

“Yes we just –”

He ignored Jemma and turned to Cheryl. “I’ve reviewed my schedule, and I’ve booked Francis in for surgery tomorrow.”

“Is it an emergency?” asked Cheryl. Werner’s smile accentuated the crevices of his cheeks. In the fluorescent light he looked fifty, though Jemma knew he wasn’t past thirty-five. She wondered if the long hours, the lack of sunlight and proper meals, had taken hold of her own thirty-year-old face and worn it down.

“We’re extremely lucky to have found a match,” said Werner. “And if we don’t finalize papers on the other animal, someone else might adopt –” He flipped through his clipboard, looking for a name. “– Daisy.”

“I don’t want that,” said Cheryl.

“Excellent. And we’ll hold him overnight this evening. Make sure all his bloodwork and prep are squared away, the donor too, so everything is ready.”

Jemma nearly raised her foot to kick him in the back of the knee. Bloodwork could be done in the morning. He wanted to eliminate the chance that Cheryl could change her mind and not show up.

Werner checked his watch. “The humane society is driving the donor over. Should be here in twenty.” He pushed open the door and held it wide, swinging his chin to indicate Jemma should get on with it.

JEMMA PACED THE LOADING DOCK. Nothing about this was good. Francis didn’t need a transplant. The donor, Daisy, didn’t need to lose part of her body. Cheryl didn’t need to go five figures into debt. She knew what Werner’s justification would be: Daisy was getting a home. But she was also risking anesthesia, infection, complications, increased likelihood of kidney disease. With the money, Cheryl could adopt five rescue dogs. A breeze pulled the dumpster’s stink in her direction. A transport van rolled up and backed into the dock’s concrete barrier with a thunk.

“You’re signing?” The driver held out a clipboard. She considered saying no, but the driver wasn’t the problem. He was another man doing his job, a job rooted in animal welfare. And yet, here he was, delivering a living creature that had grown a commercial product. Jemma flipped through Daisy’s notes. Brought in from a puppy mill. At two years old she’d already carried and birthed multiple litters. Complication free spay. No known allergies. And here she was in her carrier. Jemma leaned down to see a scrubby grey and white girl, the fur around her mouth gummed up and brown, her legs trembling. Jemma held her fingers up to the kennel’s bars, and Daisy sniffed. Jemma pulled out a chunk of freeze-dried liver. Daisy licked then happily chewed, her tail whacking the plastic.

“I need the carrier back.”

Daisy crawled into Jemma’s lap, licking at her chin, as Jemma secured a collar. Jemma led Daisy inside, passing the diagnostic room, the cat kennel room. Daisy stayed close to Jemma’s ankles. A male vet stepped out of one of the operation theatres, his smock covered in blood. Daisy leapt to the end of her leash, catching Jemma’s leg. Her foot slipped, and she slammed to the floor, cursing. Daisy pulled, barking.  

“You okay?” The vet skirted around Jemma, hands up in surrender. “You want me to get a muzzle?” He was already on his way to where he needed to go. Heads poked out from the many doors that lined the hallway.

“We’re fine.” Jemma pulled herself up. Daisy whimpered, tucking herself behind Jemma’s legs. “Okay, girl. It’s okay.” Daisy licked at her hand. Her inky eyes looked up, asking what horrible thing was going to happen next. Jemma crouched, scratching her beneath her collar, down her back, until the doors all closed and they made their way down the hall, unwatched. Jemma stepped into the exam room where Francis and Cheryl waited, easing Daisy inside.

“Just one more signature for the bank here,” Werner held out a clipboard, and Cheryl dashed a pen across the page. “And we have our new arrival.” Werner held out his hand. Daisy skirted behind Jemma, growling. Cheryl pulled Francis onto her lap. “Looks like the Humane Society sent us a girl with a Patient Paw classification. Shouldn’t be a problem, right? You’re an experienced owner.” He scratched Francis’s head, and Francis burrowed into Cheryl’s pashmina. Seeming to decide he had displayed enough bedside manner, Werner handed Jemma the adoption checklist, excused himself to submit the credit application, and left. With the doctor gone, Daisy focused on Francis, tugging to the end of her leash, whimpering and straining her neck.

“She sure has a lot of energy,” said Cheryl.

“She’ll definitely require some socialization.” Jemma held Daisy tight.

“My husband took care of all the puppy stuff.”

Daisy nosed at the handle of Cheryl’s Hermès bag. She opened her mouth and chomped.

“Off! Off!” Cheryl shooed Daisy away. Jemma grabbed a chew toy from one of the drawers. Daisy began to gnaw, her eyes intent on Francis. Jemma half regretted bringing Daisy into the room, but Cheryl needed to meet the dog she was adopting. It didn’t feel fair to go through the adoption checklist with Daisy locked away in a kennel.

“So, if we go forward with the surgery –” Jemma paused, waiting to see if Cheryl would protest. She didn’t. “Daisy would come home with you after four days of monitoring, while we keep Francis for an additional ten.” Cheryl nodded. The chew toy clattered to the floor, and Daisy began to tug. Jemma picked up the toy, wiggled it, making it a game. She flipped a page on her clipboard, pulling out a second copy of the form. They ran through the checkboxes. Would Cheryl agree to provide proper food? Check. Water? Check. Shelter, enrichment, kind treatment, and veterinary care? Check. The adopted animal would not be used for food, experimental purposes, or subjected to unlawful activities?

“Do people really do those things?” Cheryl eyed Daisy, who was scratching the floor, fighting against Jemma’s hold on her collar. 

“It’s a legal precaution.”

Check.

A separate page of special caveats waited on a second page, since she was an organ donor. Check-ins every six months for the first four years from the Humane Society’s welfare team, for which Cheryl would need to cover the cost. Legislation that applied to animal welfare and animal organ use that Cheryl could be charged with if Daisy was not cared for after the procedure.

“And the final point: the Humane Society outlines that you’re adopting the animal as is. The adoption and all points above are still binding if the transplant procedure fails and Francis does not make it.”

“Francis could die?”

Jemma clenched her teeth. Of course Werner didn’t go over the liability paperwork in detail. “It’s major surgery. At Francis’s age, there are risks with anesthesia and potential complications with the transplant. We’ll do all we can, but there are no guarantees.”

She held Francis to her chest. It felt like an intrusion to see the sheen in her eyes. Jemma turned to Daisy, scratching her ears. Daisy’s wet nose nudged, asking for more.

“This isn’t the only potential treatment for Francis. We could go over all of your options again if you’d –”

Werner opened the door. Jemma jumped. Daisy stood, fur spiked and growling.

“We’ve got everything all set up in a comfy kennel for Francis’s sleepover.”

JEMMA MANAGED TO GET BOTH DOGS into their separate kennels by tucking one under each arm and swinging open the doors with her feet. Head buzzing, she went to go find Werner. He’d nearly shoved Cheryl out of the clinic, ignoring her last-minute questions and repeating over and over that everything would be fine. Jemma needed to do something. He needed to give the woman a call and at least give her a chance to speak.

Werner sat at his desk. Jemma gave a courtesy knock on the door, stopping herself from punching a hole right through.

“Oh good.” He smiled, waving her in. “I’ve switched out your schedule.”

Jemma paused, confusion abating rage. “What?”

“You’re familiar with the dog’s case. You’ll get all the tests prepped and sent off, make sure everything is ready for the morning.”

Jemma blinked, the truth bubbling in. “You booked me for a double?” A back to back. A day and a night. Twenty-four fucking hours. “What if I had plans?”

“You don’t. And it’s all overtime – that’ll be nice, won’t it?”

Jemma dug her nails into her palms. She supposed they should both celebrate: she got cash and he got to steal a dog’s kidney. “You could have held off. Sent them home with some injections.” He could have let Cheryl leave with her dog. Given her time to think.

The mask of friendliness fell from his face. His lip curled into something worse than a grin. “Can you remind me what your job is?”

Jemma interlaced her fingers, held them at her navel, and squeezed her frustration. “I’m a vet tech.”

“A technician. Do technicians have the ability to diagnose? Do they have the ability to recommend treatment?”

She wanted to tell him that ability and accreditation were two very different things. She understood that the hospital had been purchased by a conglomerate a year ago, and that his compensation was now based on production. She had seen him go from recommending fluids and antibiotics to recommending exploratory surgery and scans using the 64-slice CT unit, a piece of equipment the clinic had purchased off Toronto General. She knew he was only a couple years into being a vet, and his student debt must be in the six-figures. Like everyone else in the city, he was trying to get into the increasingly expensive real estate market. But she also imagined that once, maybe not so long ago, he must have chosen this life for a love of animals.

Jemma shifted her weight to the heels of her sneakers, deflating. If she was angry with him, she also needed to be angry with herself. What had she done to change anything? She turned it all into one firm syllable. “No.”

“Good. Then get yourself a cup of coffee and finish that bloodwork.”

JEMMA SAT ON THE FLOOR OF THE KENNEL ROOM, empty for the night except for Francis and Daisy. Neither had eaten out of their bowls, so she opened their doors, one at a time, and held kibbles in her hand, willing them both to please eat something before the 10 p.m. cut off time for their pre-surgery fast.

Daisy crunched a few bites, but the kibble fell from her mouth, dropping to the floor in wet clumps. She backed into the corner of the kennel, glaring at Jemma with wet eyes. Jemma closed the door and moved over to Francis, holding out a hand. He licked, getting more of her palm than the food. The stink of his breath stuck to her skin. He didn’t need to be here. He could be at home, eating, having a less stressful night. If she could have just had an opportunity to talk to Cheryl, an opportunity to explain, maybe he wouldn’t be here at all.

Jemma glanced at the chart holder hanging from the wall. Maybe there was a way. She pulled Francis’s file from the slot. A ten-digit number, and Cheryl would be right there. She really should use a hospital phone, but the receptionist at the front desk couldn’t hear this, and Werner’s office would be locked, now that he’d gone home. She slipped her cell from her pocket, ignoring the few vapid social media notifications, and typed in Cheryl’s number. She paused. She was not supposed to personally contact clients. It was most definitely in her contract. Francis slumped over in his kennel, his chest undulating with heavy breath. Daisy whimpered.

Jemma hit call. Ringing seemed to fill the small concrete room.

“Hello?”

“Hi, Mrs. Patterson. It’s Jemma. The vet tech from the clinic.”

“Is everything okay?” she asked.

Maybe Jemma was doing the wrong thing. Maybe it was better that Daisy got a home, when the other option was going back to the Humane Society.

“I –” Jemma steadied herself. Maybe it was also better to let a grown woman be fully informed and decide for herself. “I think you should get another opinion on Francis.” The phone went so silent, Jemma was almost sure Cheryl had hung up, but a sigh rattled down the line.

“I know you see so many pets. It must seem crazy that I’d spend all that money on –”

“It’s $1700 a month.”

“What?”

“If Francis gets a year and a half – and he might not even get that – it’s $1700 per month.”

“And I’m willing to pay that for more time with him,” said Cheryl. Jemma could hear the annoyance in her voice: the tone of a woman who had made up her mind.

“But he could live just as long with injections and a diet change. And then you’re not putting him through the risk of surgery.” Jemma could feel Cheryl’s patience waning. She rattled off the names of two other veterinary clinics, smaller, private practices. The desperation of her voice reverberated in the small room.  

“All right, all right. I’ll give one of them a call in the morning.”

“Really?”

“A second consultation might not be a bad idea.”

Jemma didn’t know if she said it just to end the call, but thanked her amidst Cheryl’s hurried goodbyes. The line clicked, and Jemma slumped to sit on the floor, her back against the kennels. Daisy nudged at her elbow. Jemma busied herself, trying to shrug off her embarrassment. She took a blood sample from each dog, sent them off for analysis. She took Daisy outside to the dog run in the alley, padded astroturf surrounded by chain link, and then brought her back to the room.

“Your turn now, c’mon bud.” She eased Francis from his carrier. He didn’t want to walk, so she picked him up. “A pee and then we tuck you in to sleep.” Francis nudged at her cheek with his wet nose. He lurched around the dog run, panting. Jemma shivered in the cold, rubbing her arms. She was such an idiot on the phone. She should have said something sooner, chased Cheryl out to the parking lot, had the conversation in person.

Francis began to whine, and Jemma turned and crouched. He gagged, his back heaving as he retched. A couple kibbles and bile dribbled from his grey beard.

“You’re okay, buddy. What’s gotten –”

Francis’s front legs buckled. He collapsed to the turf.

“No. No.” Jemma knelt, putting her ear to his chest. A murmuring beat whispered back. “Shit. No. No.” Jemma scooped him up and rushed inside, trying to remember who was on call. “I’ve got a code blue!” She shouted down the hallway. A vet, one of the good ones, Dr. Amy Chao, and two other techs rushed out of the staff room. “He vomited in the dog run. Then he collapsed.” They stepped into a surgical room. Dr. Chao nodded, pulling out a breathing tube and bag from a drawer.

“He’s not on a DNR?” she asked. Jemma shook her head. Dr. Amy didn’t need to say it. It was all too common in dogs Francis’s age: a heart attack. “Get an IV catheter and the dobutamine. Go!” Dr. Amy pressed a stethoscope to Francis’s chest. She opened his mouth, pulled out his tongue, and inserted the breathing tube with a smooth glide. One tech started chest compressions while the other inflated and deflated the breathing bag. Jemma couldn’t untangle the IV tubing. She couldn’t get her fingers to pick up the syringe of dobutamine.

“I’ll take that,” said Dr. Amy, easing it all from her hands. “You make the call to the owner.”

Jemma stared up at her wide eyed. Calling Cheryl back. She had just called Cheryl, just had such a stupid call.

“Jemma? Hello? What the hell has gotten into you?”

“I can’t.”

The line of Dr. Amy’s jaw hardened. “You take over for Kendra.”

Jemma took the breathing bag, a steady three one-thousands in and another three out, while the other tech set the IV. Dr. Amy turned, pulled up Francis’s file and picked up the phone.

“Hello? This is Dr. Chao calling from the Roncesvalles Hospital.”

Jemma wanted to drop the bag, wanted to press her hands to her ears. She focused on the rise and fall of Francis’s chest, not on Dr. Amy’s words.

“If you can get here immediately, we’ll keep him with us for as long as possible.”

Jemma leaned in close, not caring about Francis’s breath, focusing on the flutter of his grey eyelashes. “You should have been home. I’m so sorry you’re not home.” She could feel the other techs’ stares, feel tears running down her cheeks and into her scrubs. She kept at the bag, even though Francis’s gums began to turn a pale blue. One one-thousand. Two one-thousand. Three one-thousand.

Dr. Amy shooed the other tech away, pressing her stethoscope to Francis’s chest, and shook her head.