We all have a group of friends who adore the work of Nicholas Sparks. Perhaps his most popular story was captured in a film in 2004 entitled The Notebook. In this tale, an elderly woman is played by Geena Rowlands, is at the end of her life and is plagued by dementia. She is taken care of by her husband. This husband, James Garner, is a dashing and unusual caregiver to his frail spouse. We see the backdrop of their lives as young lovers, followed by their later years. At the end of the film, the couple is found intertwined in one single bed, both dead simultaneously.
If we can translate this seemingly unreasonable tale into today’s standards, a couple can die together. I do not know if Nicholas Sparks himself felt this to be plausible, but it happens. It typically does not happen in one evening, but when two souls have spent their waking lives together, one often dies shortly after the other one is gone. This actually makes sense, and as a person who has worked with the dying, I have to give Mr. Sparks a little bit of credit here. (Even if the romanticism of The Notebook is a bit effusive for my taste, this author writes about what we all ultimately crave. Few of us would want to outlive our best friends).
I once owned two dogs. They had always known each other. Their names are Mitzy and Ruben. About three months ago, I had the sense that Mitzy was dying and recognized her diagnosis of Congestive Heart Failure. Having witnessed the course of this disease in the humans that I treat in the world of healthcare, I decided against the use of heart medication to prolong her life. I knew that my dog would be prescribed diuretics and urinate all of over the house. I also knew that it would not buy Mitzy a lot of extra time with me and did not want to be one of those people who prolong the lives of others to ease my own conscience.
Yet on the three days leading up to the death of my female dog Mitzy, my male dog became listless. Ruben drooled uncontrollably, he draped his body upon his sister to console her. I wondered what would happen next. I knew one of my dogs had to be put down, but could I afford to lose the other? What if these dogs were the best friends that I knew them to be? What if they needed to die together?
After euthanizing Mitzy, which equaled the identical heartbreak of anyone who has ever put down an animal, I took her brother to the veterinarian. The vet told me that Ruben, the one dog I had left, was in Stage IV heart failure. I wrestled with my next decision. During the next 24 hours after Ruben’s visit to the vet, I watched Ruben like a mother hawk. I took his pulse. I tried to estimate his water intake. So that Ruben would not feel alone without his sister, with whom he shared a doggie bed for years, I carried him up to my room and placed him in my bed. My sole remaining dog looked at me oddly, as if to say, Where did she go? Where is my sister?
I drove back to the vet later that day. I asked her what I could do to help Ruben live. He needed a cardiac workup. After a cardiac ultrasound, for the low, low price of $700, Ruben was prescribed three heart medications for his Congestive Heart Failure. The very same diagnosis that I refused to treat in his sister Mitzy. I was given the medication that very day. I placed the three pills on the countertop, mixed them with a dollop of peanut butter, and reached down to feed them to Ruben. He wagged his tail and licked his chops.
Only two weeks later, Ruben was bounding about like a teenager. This reminded me of the earlier part of the movie The Notebook. Before the senile dementia of the elderly heroine, she was a tempestuous and shockingly beautiful woman, played by the actress Rachel McAdams. She was in love with a man from across town, a man of disparate upbringing and social standing. Ryan Gosling was the ideal rugged counterpart for a woman with white gloves, and as much as this movie might tip towards a cliché of Disney’s Lady and the Tramp, one cannot help but feel a little ping at the pericardium while watching these two actors face all odds and fall in love.
I have always liked the ending of The Notebook. Soulmates who die together are fortunate in that there is no grieving widow/widower, nobody is left to reconcile the debts/wealth/estate, and as much as the surviving friends and family are grieving doubly, there is a sense of finality that the two souls are at rest together.
I do not think Ruben has forgotten his sister. Rather, I think he delights in all of the attention focused on him, in the succulent duck meat that has become his breakfast, and in the energy of the living. For it is now that I watch the buds awaken, young lovers grasp hands in the park and the chest of my dog rise and fall, as we await another day. We have this. That is why Ruben is still around. We keep on going. He has taught me everything I need to know about losing something and getting it all back somehow.