John Fredrick looked at the X-ray for several seconds. He then turned to Jennifer Adams and looked briefly over his glasses
at a yellow Lab named Ben lying on the floor. John folded his glasses and laid them on the exam table. He was a robust man
in his late 40s, and his normally jolly manner was now noticeably muted.
"Mrs. Adams, Jake has a mass growing in the femur — the long upper bone in the back leg."
He leaned over the table and tried to smile.
"The limp and consequently his pain seems to originate from this mass," John offered.
He waited a moment for all of this to sink in. Jennifer sat frozen to her seat and said nothing. John cleared his throat and
"I have a good friend in Memphis, Dr. Sarah Jeffers, who is a boarded orthopedic surgeon. She also has an oncologist working
with her. I would like to refer you there as soon as possible."
Jennifer slowly emerged from her glacial trance.
"Dr. Fredrick, we have always come to you all these years and trust you in every way. Is this something that you can do here?
Could this be cancer?"
John had to bite his tongue. Ten years ago he would have either done the complete workup in his office or sent it on to the
university. He quickly thought about the many legs he had removed in his career. He had to be careful.
"Mrs. Adams, I want only the best for Jake. In recent years, specialists have moved closer to a lot of the practitioners in
the country and have brought state-of-the-art veterinary practice closer to our patients. Although cancer is a possibility,
I cannot know for sure. The specialists are definitely in a position to give you more options than I can."
Jennifer nodded and took the referral brochure from John's hand. After they had talked for several more minutes, John emerged
from the exam room and entered his office.
He always took a little time at mid morning to open his mail and make some callbacks. He went through the pile slowly and
finally came upon a letter from the university. It was a referral letter from one of the clinical faculty at the veterinary
school. The letter was well written, but the case in question had been sent to the university many months ago, and he would
need to pull the chart and review the particulars.
John got up and closed his door.
The letter noted that Fuzzy Abrahamson, a blonde Pekinese, had been referred through the emergency room to an intern and subsequently
to various doctors and then to this particular doctor — a Dr. Frances Simon on the medical rotation. Fuzzy had died after
an exhaustive investigation and apparently several trips to the veterinary school for evaluation. There was a necropsy performed.
The letter noted that the teaching hospital had not, as of yet, received the results of the necropsy from pathology.
John frowned. This was the first communication that he had received after the referral. Why was he getting this letter so
late? He looked at the date of the letter. It had been written a few weeks ago.
John looked down the list of veterinarians that had seen Fuzzy. He did not know a single soul. He squirmed at bit because
he knew Mrs. Abrahamson and hoped that the staff had treated her well there. She was nice but very particular.
John picked up the telephone and called the university. He asked for Dr. Simon. After a few minutes, another voice came on
"I am sorry Dr. Frederick, but Dr. Simon has just left the university for a position in private practice."
Dr. Frederick quickly fumbled with the letter and looked at the list of practitioners that had seen Fuzzy. After a few false
starts, he was able to talk to one of the residents that had seen Fuzzy and was given a vague idea of what had happened. The
resident was very pleasant and helpful but only could give part of the story due to the nature of the receiving situation
at the university. He did say that pathology was backlogged, and a lot of cases were still in the tube. John thanked him and
As he hung up the phone, Judy walked in.