On Dogs and Dying: Stories of Hospice Hounds

By Michelle A. Rivera

Dogs know when we are feeling down. They love it when we are happy and seeking friendship and fun, and they understand when we are feeling sad and desperate. This book presents a series of real-life tales of the positive effects dogs have had on people at the end of their lives, chronicling the visits by two therapy dogs, Woody and Katie, to patients in a south Florida hospice facility. Through twenty-one stories, infused with humor amidst the sadness, Michelle Rivera, an experienced animal therapist, explores the many ways in which animals can ease human suffering. Her book begins with the deeply personal story of her own mother Katherine's illness and dying appeal to have the company of a dog, and proceeds to tell the stories of patients young and old who the author was inspired to visit with her "hospice hounds." As well as demonstrating many of the techniques of animal therapy, Rivera argues powerfully that not allowing pets in health care facilities is a counterproductive policy that deprives patients of comfort at the time they need it most. Some of the stories were previously published in Hospice Hounds (2001), but the author has substantially expanded her introduction and added an invaluable final section that gives practical tips on training and certifying your dog to be a therapy animal.

• Language: English
• Publisher: Purdue University Press
• Release date: Feb 15, 2018
• ISBN: 9781612495231

Book preview

Introduction

Michael Berkenblit, D.V.M.

Michael Berkenblit graduated from the University of California in 1986. He is co-owner of Village Animal Clinic, North Palm Beach, Florida with his wife Melissa Degen, DVM ACVIM. He has been actively involved with Delta Society since 1983 when he won a Delta Society scholarship. Dr. Berkenblit also serves on several committees oriented toward educating children about humane animal interactions, especially in bite prevention and avoidance, and he is the Canine Companions for Independence veterinarian in his area. His dogs are the subject matter of this book.

The dogs you will read about in these stories are my kids. I am thankful to and proud of them for being the kind and gentle beings they are, and for being able to translate that kindness and gentleness into an ability to bring comfort to the terminally ill. They are fantastic beings in their ability to adapt to and maintain their calm and confident selves in so many different situations. They go into a television studio every week, they visit rambunctious children at schools, they come to work in our veterinary hospital every day, and, maybe most importantly, they make hospice visits.

I was introduced to pet facilitated therapy while in veterinary school, where I also became involved with the Delta Society. I have been reading the Society’s journal, Anthrozoos, for many years, and have been fascinated with its articles pertaining to the effects of companion animals on people. I have witnessed the profound effects they have on people on a daily basis in my work. I have also seen it at the personal level—the effect our companion animals have on my infant daughter has been a joy. My daughter Emma’s first word was Kelly, the name of our cat. Her first concern every morning in her crib is where her dogs and cats are. One of my most cherished memories is that of my beloved Grandmother Ida, who toward the end of her wonderful life began to fade mentally. It was almost impossible to engage her through the haze of senility. What it took to be able to connect with Ida, to see her lucid once again, was the mere mention of pets. This is a memory my entire family cherishes. The extraordinary rapport between pets, infants, and the aged makes me realize the bond we have with these animals is deep within us. It is a testament to how deeply and basically we are intertwined.

CHAPTER ONE

What is animal-assisted therapy?

When paws touch hands in friendship, mercy follows

It has been said that animals have a sixth sense. In truth, it is probably not actually a sixth sense in the truest meaning of the word; it is probably more like a sixteenth sense, but no matter. The point is, animals can sense things that we mere humans cannot. They can figure things out based on nuance in a way that humans can only envy, if we understand it at all.

When dogs look at other dogs, they know in an instant how that dog is feeling and how that dog will likely react to certain situations and stimuli. For example, a dog who is looking to fight or challenge another will have a certain affect. We may not see or understand it, but another dog will.

So how does that explain why dogs make great therapy partners? Because some dogs know when you are feeling down. They love it when we are happy and seeking friendship and fun, and they understand it when we are feeling sad or desperate. They may not know why we are feeling the way we do, but they get that something is amiss, and they do everything in their power to try to make it better.

And that is why dogs make great therapy partners. Animal-assisted therapy or animal- assisted activity involves traditional talk therapy with the addition of the presence of a friendly pet. Naturally, the dog himself is not the therapist, he is simply the facilitator. He gets the patient talking to the human therapist. The presence of a dog has been known to do lots of wonderful things for patients, including:

• Decrease blood pressure

• Increase verbosity in patients who are isolating

• Allay anxieties

• De-institutionalize a facility setting

• Provide a buffer for those who are afraid or ashamed to talk to their therapist

• Provide a warm, fuzzy body to hug, thereby releasing endorphins that make us feel better.

Dogs can do all that? Yes! They can! They can do that and so much more. In my travels as a hospice volunteer, helping dogs help people, I found time and again that dogs make things better for people.

But there is a difference between animal-assisted therapy (AAT) and animal-assisted activities (AAA). The former, AAT, is a proscribed therapy that a doctor in a health care setting prescribes for his or her patient. In AAT, there are treatment plans and goals. A doctor may, for example, ask the AAT therapist to visit Patient A BID (twice a day) and ask the patient, who is, let’s say, confined to a wheelchair, to reach and stretch in order to pet the dog. Or the patient who may be aphasic and working on his speech skills, may be asked to address the dog several times a day, asking the dog to perform a simple task, such as sit or shake. The therapists complies with the doctor’s request and then reports back on the session, giving a detailed account of how the session went and if the treatment goals and objectives were met. The sessions are carefully observed and recorded and become part of the medical record.

AAA, however, is a less structured and goal-driven version. During AAA, the animal is still present but pretty much anything goes. AAA encompasses activities such as Reading to Dogs programs that brings together reluctant readers with friendly dogs; or a dog-bite prevention program where a humane educator may come into a classroom and teach students how to behave around dogs, incorporating the dog into the program. AAA could also involve informal visits to residential treatment facilities, such as a hospice, drug-treatment facility, or prison, to bring joy and companionship to the residents without any expectation of treatment outcomes or meeting goals. It is simply a visit by a friendly pet.

While this book chronicles the visits by two therapy dogs to patients in a south Florida hospice facility, therapy animals can be used in a variety of settings. For example, humane educators incorporate them in their presentations for all kinds of educational programs that take place in classrooms, civic groups, scout meetings, and aftercare settings. Some of the topics a humane educator may cover include:

• Careers—working in service to animals

• Dog-bite prevention

• Companion-animal care and basic training

• Issues surrounding animal ethics, such as animals in entertainment, factory farming, animal experimentation, and other animal rights issues

• Animal cruelty and neglect, including dog-fighting, manner-of-keeping, and abuse.

• Environmentalism

Animal programs can also be found in prisons. Several years ago I helped start a program that brought prisoners together with puppies who were being raised to become service dogs. The inmates were under constant strain and pressure, tensions ran high, and morale was always low. As one inmate put it, It’s real easy to have a bad day in here. But the presence of the puppies helped cut down on incidences of violence and fostered an atmosphere of friendly cooperation and quietude; for the sake of the puppies the inmates banded together in a way they had not before. And nursing homes report that resident facility cats and dogs help to de-institutionalize the setting, making the patients more comfortable, the staff less stressed, and giving the visitors a common topic of conversation that turns animal-loving strangers into comrades.

In my book, Canines in the Classroom, I discussed how the presence of a service dog accompanying a child in a wheelchair brought with it a host of benefits unrelated to the actual duties of the dog. In addition to the services performed by an assistance dog, such as picking up dropped items or bringing the telephone to his charge, he also helped the disabled child to make friends. Studies show that when we see a child in a wheelchair in a public place, we instantly divert our eyes. But when that same child is accompanied by a dog, we smile at the child and endeavor to converse with him or her. So a child who felt invisible is suddenly the popular one, the kid with the dog at school and in stores!

So why does AAT/AAA work so well?

The majority of Americans love their animals…we really do! Media experts report that stories about animal abuse evoke the most community outrage. The animal-human bond is alive and well in the United States, and we truly love and enjoy our animal friends. We love them because there is not a lot of work involved in loving them. It is very simple. Aside from basic needs, pets do not ask a lot from us in return. They do not care if we are fat or thin, black or white, tall or short, rich or poor, pretty or plain, famous or unknown, smart or.…not so smart. In a world where so many people have their own agendas and reasons for familiarity, animals love us unconditionally. They are also great stress-relievers, and we need that in our lives. Stress can be a by-product of change, and it is tough keeping up with the changes in our world, both personal and public. What with all the politics, fashions, technology, cultural issues, celebrities du jour, the food police, and other factors in our national conversations, keeping up is stressful! Then there are our private challenges, such as changing financial status, health issues, relationships, job issues, and so much more. These things cause stress, and we need to deal with stress in a natural and expedient way to maintain homeostasis (internal equilibrium). Adults who have pets in their home have been found to be happier than those without them. And children who are brought up with pets have been shown repeatedly to have elevated levels of self-esteem, confidence, sense of self-worth, and a general overall feeling of well-being, more so than those without companion animals in the home. These children also exhibit better socialization skills and compassion for others. In families where parents may be breaking up, a companion animal is a constant in a child’s life.

Dr. Randy Lockwood is best known for his work with the First Strike Campaign while with the Humane Society of the United States. Although he has since moved on to the ASPCA, Dr. Lockwood recalls his early work with his wolf-hybrid dog, Fred, in the schools. Working with at-risk kids has taught him that animal-assisted therapy is a valuable, therapeutic intervention tool.

He says, "Pet therapy allows direct connection to take place between the patient and the animal at so many levels. The animal acts as a bridge. They serve as a social lubricant in so many ways. The bridging takes place because the patient who is not quite ready for a human touch will often accept the touch of an animal, or touching an animal. This causes a direct physical connection, and a direct emotional connection. Also, the presence of a pet facilitates conversation…I remember I had a pet and.… And that in turn leads to a deeper insight into the persons’ vulnerabilities and character helping to facilitate the bond. Dr Lockwood went on to explain that …research shows that when we reduce a patient to a disease, i.e.: the liver cancer in room 202; the quality of care drops. So when we get to know the patient through the animal interaction, the quality of care is dramatically elevated. A patient in a hospice facility, especially, is in a time of reflection on the arc of life, and having animals present may help with that reflection."

Sara Roby, an animal-assisted therapist at VITAS, a hospice facility located in Broward County, Florida, agrees with Dr. Lockwood’s assessment that animal-assisted therapy presents a bridge. She began working with her Yorkshire Terrier, Taiko, after the death of two friends in a car accident left her depressed. Sara had owned cats her whole life, but upon experiencing this whole-body depression, something was telling [her] to get a dog. She says it was not a conscious decision, it was just an infusion of certainty that a dog would help her. And that, she says, is what brought her to her present status as an animal-assisted therapist.

It was just like I absolutely knew that [getting a dog] is what I should do. So I started looking for one, and found this little puppy in Virginia Beach. He was so good for me. He helped me out of my depression. I was already working for Hospice at the time, and so I thought, let me get him certified, bring him into the office with me so he can help other people. It’s so amazing, because people who are visiting patients are there for very long days, for hours at a time. And then they see this little dog, he’s very sweet and friendly, and I can see immediately the change in the people. They will play with him for a while and then say, maybe, well, let’s go to lunch or something. They were able to make a cut from sitting in the room, to playing with the dog, and they can break away from the dog easier than they can break away from sitting vigil at a loved one’s side. It shows them that even though they are going through this terrible time, they can still laugh, even have a good time, even while they are experiencing this anticipatory grief. It’s an amazing thing.

Sara acknowledges that having Taiko in the hospice facility is probably more beneficial to the patient’s families than to the patient themselves, who are often so medicated or so sick that they are unable to appreciate visitors in the room. But she did recollect one patient in particular that truly benefited from Taiko’s presence.

He was in terrible pain, she recalled, "because he had no circulation in his leg. And in the end, they had to amputate his leg. Well, he was up in hospice, and for two days before the surgery, the amputation, the doctor’s orders were ‘no medicines for him.’ For two days he was in excruciating pain—it was just crazy…I had never seen a person in such pain. It was just awful. I don’t know why they did it, but maybe because of the surgery or something. This man, he had two or three dogs and cats at home. He liked animals. In the bed, he could not even lie down on the bed. He kind of lay across the bed and