A Boy, a Dog and Their Neurosurgeon

Dec. 23, 2005 — -- In this season when we hang our memories with the ornaments and celebrate them in stories, this story about a boy and a dog who shared the same neurosurgeon has a new ending every time it's told. It began in 1997, when I first met the three principal participants during a stressful holiday season between Thanksgiving and Christmas.

The boy, Jerry Martin, is a teenager today. He was 5 years old when the story began, had a high-pitched voice, an infectious smile and a head that appeared slightly too big for his body, possibly because he had not grown as quickly as other children his age. He lived in a rural area of Pennsylvania, where his father worked as an independent logger.

The dog, a pug named Tucket, was a natural clown who regularly entertained his affluent family at its home in Philadelphia.

And the doctor, Fred Epstein, was a world-famous pediatric neurosurgeon in New York.

Their lives all changed in profound ways.

It started with Tucket. He was 8 years old in 1997 and lived with Bonnie and Peter McCausland, and two of his fellow pugs, Nannie and Crosby. Bonnie McCausland was the one who chose Tucket from his litter. "He was so cute I couldn't not hold him," she said. "And he had a particularly lively personality."

Tucket began to develop problems in 1997. He had serious trouble walking. His hind legs dragged behind him. "He was losing his balance," said Peter McCausland. "He had difficulty getting up steps. It looked like he had been injured -- hit by a car or something."

The McCauslands could afford good care for Tucket because Peter is president and chief executive officer of a successful industrial gas company. Tucket's veterinarian, Nancy Brown, ordered X-rays and myleograms to try to pinpoint the troubles with his hind legs. "The pattern of disease didn't typify anything we knew of," she said.

So Brown took a chance and consulted a friend of hers on the human side of medicine -- Dr. Fred Epstein, a world-famous pediatric neurosurgeon at the Beth Israel Medical Center in New York. Epstein took care of children, not dogs. But he agreed to look at scans of Tucket's spine and believed he saw an abnormality that could cause the dog to lose the use of his legs. He got a group of other high-priced hospital specialists to take a look at the scans.

Epstein was well-known for an unconventional approach to his work that led to breakthroughs in the treatment of spinal tumors. He had an exuberant personality, a mellow voice and an expressive face with a high forehead topped by an unruly shock of white hair. The nameplate on his office door read, simply, "Fred."

At the time, he recalled that his head nurse stood up at the conference he had called to look at Tucket's scans. "She says, 'Fred, I've got one thing to say to you.' And I said, 'What?' She said, 'This dog is not coming here.' And she sat down."

But the wheels in Epstein's brain were spinning because he knew there was the possibility that the dog could help his favorite cause. Epstein was the founder of the "Save One Child" fund, which brought children from around the world to Beth Israel for spinal and neurosurgery that their families couldn't otherwise afford.

He proposed a bargain: If the McCauslands made a donation that was large enough to pay for a child's surgery, Epstein would perform spinal surgery on their dog.

Peter McCausland was willing. "For [Dr. Epstein] to step forth and say, 'I'll do it if you help me help other people,' made it easy. And that really did make the decision."

Just before Thanksgiving 1997, Tucket went to New York for surgery. He couldn't go to a hospital treating humans, so Epstein took his own surgical instruments to the Animal Medical Center, where a veterinary surgeon assisted him in a life-or-death operation on Tucket's spine.

"The spinal cord in an animal of this size wasn't very different from a baby's, so I was comfortable," said Epstein. "You know what was the hardest thing for me? I wasn't used to [hearing] barking in the next operating room."

What Epstein found was scar tissue, probably from an old infection or injury, that had developed between Tucket's spinal cord and the membrane that covers it. He did his best to fix the problem, but it was still anyone's guess whether Tucket would live or die.

Then, on the very next day, the bargain the McCauslands made to help a child in exchange for Tucket's surgery came due.

The child was Jerry Martin, of Drifting, Pa., then 5 years old. Jerry's severe head and stomach pains had been diagnosed by one HMO doctor as constipation. "We asked for a CAT scan," said Jerry's mother, Betty Martin. "And they said that was their last resort. That's an expensive test."

By the time a neurosurgeon found the spinal tumor that was causing the pain, Jerry's parents were advised to make his last days as happy as possible.

"They give us basically no hope," said the boy's father, Jerry Martin Sr.

By coincidence, however, Betty Martin's sister-in-law had read an article about Epstein. Out of the blue, in desperation, she called Epstein's office and got him on the phone. It was the day after Tucket's surgery. Epstein told the Martins to come to New York immediately.

Within a week, the Martins had packed young Jerry into their car and set out on the five-and-a-half-hour drive to New York. The family had expected to accumulate medical bills they would pay for life. Instead, they were told that the costs of Jerry's spinal surgery would be covered by the donation made by the McCauslands on Tucket's behalf.

Jerry Martin's operation was performed a week to the day after Tucket's surgery. In a state-of-the-art facility, a monitoring team kept close watch on Jerry's responses as Epstein opened the boy's spinal cord to begin to remove as much of the tumor as possible without causing neurological damage or paralysis.

In the waiting room later, Epstein told the Martins that Jerry would need future treatment to eliminate what was left of the unusual cancer. "But from a surgical point of view," said Epstein, "everything that we can do is done."

In the meantime, Tucket was getting rehabilitation and therapy treatments at his veterinarian's office. For days, he couldn't use his hind legs at all. Then he stood again, and finally, he walked again. He legs still dragged a bit, but he grew stronger and was allowed back out into the fresh air.

Jerry Martin rebounded with his typical energy as well. After staying at the Beth Israel Medical Center for the first several days of his rehabilitation, he was allowed to go back home to Drifting. Friends and neighbors strung together colorful balloons to welcome him.

Both Jerry and Tucket had made it home for Christmas.

Just after New Year's in 1998, when Jerry went back to New York for a checkup, Tucket, strolling on all four paws, came from Philadelphia with the McCauslands to meet the Martins.

It was an extraordinary scene -- a boy and a dog who shared a second chance at life, thanks to the extraordinary confluence of luck, skill and generosity that spanned that holiday season.

Today -- eight years later -- there is much more to tell. First, there's Tucket: He lived another five years, to the ripe old age of 13, after his operation. The McCausland family still has four pugs, including two of Tucket's relatives. The McCauslands stay in touch with the Martins.

Epstein's life changed even more profoundly than those of his patients. On Sunday, Sept. 30, 2001, he was riding his bicycle near his Connecticut home when he struck a depression in the road and tumbled over the handlebars onto his head. Even though he was wearing a helmet, the injury to his brain was critical. Epstein became a patient of the very people he had helped train at Beth Israel.

His rehabilitation was long, difficult and painful. The accident severely affected his speech. Although his words came out slurred after extensive therapy, his speech was clearly understandable; he was determined to return, somehow, to medicine.

Jerry Martin is now 13 years old. His face has filled out and his voice has deepened. "I feel lucky that I'm here almost every day," he said.

Jerry has undergone complicated treatments since his surgery, including intensive radiation at Johns Hopkins to stop any further growth of the cancer that remained, and back surgery to correct the effects of the radiation.

But his family believes he is with them this Christmas because of the process that began with Tucket and the McCauslands and Epstein.

"He gave us our son's life back," Betty Martin said of Epstein. "They gave Jerry three months to live. He gave us hope and he gave us our son."

"I'm happy that I get to be with my family -- and that's the true meaning of Christmas, anyway," said Jerry. "Everything that happened to me, I feel it's made me have a very strong faith."

In December, at the Miami Children's Hospital, a 67-year-old doctor visited young patients to encourage them. "You may not feel it," he told one, smiling, "but you're going to do very, very well."

The doctor was Fred Epstein. He was accompanying the hospital's director of neurosurgery, John Ragheb, one of many doctors who had trained in fellowships under Epstein.

Epstein will never perform surgery again, but he is hoping to be credentialed to at least consult on children's cases. Around him were the decorations of a season that -- like his story and Tucket's and Jerry's -- is enhanced by memory and defined by transition.