Etta's * room was at the back of the nursing home, "all the way to the end, on the left," said the manager coolly. Nursing-home administrators, like some doctors and even family members, aren't always happy to see hospice volunteers, whom they sometimes see as harbingers of surrender.
I unleashed Izzy, my golden-eyed, 5-year-old border collie, rescued from an upstate New York farm. He now lives on my upstate farm, where he's my resident soul mate and shadow. He's what I call a spirit dog—he takes you places you don't necessarily know you're going.
Izzy and I became volunteers together last summer, after weeks of rigorous training by Washington County Hospice. Volunteers are an integral part of the hospice philosophy, but they have to be taught to behave differently than they might normally—to listen rather than give advice, to accept the reality of death rather than cheer everybody up, to be comfortable with the fact that patients will not recover. To never, for example, tell a patient or family to buck up, move on, or cheer up. Generally, things do not get better.
While the hospice workers at the Washington County Hospice and Palliative Care Program are always looking for ways to make patients more comfortable, they weren't immediately certain that a canine would make an appropriate hospice volunteer—they had to ponder the insurance and health implications, and the particular sensitivities of hospice work. What, for instance, would be the consequences if a dog bit a patient or ate his medication? Final moments matter. My vet had to testify to Izzy's temperament, attesting to his gentleness and responsiveness.
As it turned out, he is a natural. I was the one who needed all of the training.
We headed down the corridor, Izzy walking beside me, watching for cues. Etta's room was a large one with a hospital bed, a dresser topped with old photos. She was 86, the last surviving member of a family that had farmed Hartford for 150 years. She'd had dogs on her farm for years and loved them. Now, the hospice report said she was suffering from advanced colon cancer and dementia.
She had outlived all of her friends and had no visitors, apart from the hospice social workers and nurses—and now, Izzy and me. In private homes, I've seen, the dying are often comforted and surrounded by their families. In nursing homes, they are often alone.
Etta sat in a wheelchair, clutching her side, moaning occasionally, saying she was going to the hospital. She barely seemed to notice when I came to her door.
She was nearly phobic about being touched, the nurses reported, making it difficult for the home staff to clean and care for her. She sometimes struck them. Now she was "actively" dying, a term used to warn volunteers she wasn't expected to live long.
I announced cheerfully that we were there, that I had a dog with me. As is often the case in short-staffed nursing homes, there was no one around. The staff didn't have time for social visits, and so I found myself alone with this still-handsome, elderly woman who appeared anxious, uncomfortable, and confused.
In the three months since we started doing hospice work, Izzy has learned to spot and to head for wheelchairs and hospital beds. His gifts as a volunteer are multiple: gentleness, appropriateness, patience. He never pesters anybody or goes where he's not wanted. He can remain still for many minutes. When he's not wanted, he finds a corner to curl up and vanishes.
He approaches people in pain, people in comas, with dementia and paralysis, disfigured and frightened, always softly, carefully, and lovingly. He threads his way around IVs and oxygen tanks. I've never had a dog that could do this kind of work, nor could I begin to imagine how to train a dog to do it.
This time, though, as Izzy came to Etta's right knee, she cried out in alarm. Her hand jerked forward and she swatted him sharply across the nose.
Izzy was surprised. He backed up quietly, looked at me, and sat down. I rushed over, concerned about how he might react, but he seemed composed, calm. I talked to Etta, trying to reassure her, though she probably didn't understand. I remembered my training. Speak to people as if they do understand, even if you don't think they can. Because they might.
"Sit down, sit down," Etta kept pleading, as if she were, on some level, trying to be hospitable.
Izzy inched forward again, and again her hand lashed out—but this time, he was ready, and he was quick and backed away.
I kept talking to Etta, as I'd been trained, asking her how she was, as she clutched her stomach.
Izzy was watching carefully. When she put her right hand on her knee, he made his move, slithering toward her and placing his nose beneath her hand.
She froze, as if shocked, and her eyes widened. Her mouth opened, but no words came out. I saw her hand close over Izzy's slender nose as he sat stock-still. A slight smile came over her worried face, and she calmed, visibly. "Oh," she said, softly, with pleasure. "Oh. It's a dog."
Izzy didn't move for at least 10 minutes. Neither did Etta. She moaned still, but more softly.
One of the aides came in on her rounds and looked shocked. "My God," she said, "that's the first time I've ever seen her smile." She called for help from another aide. While Izzy and I stepped out into the hall, they got Etta up, changed and bathed her, got her into bed. By the time we came back in, she had fallen asleep.
So, we went back down that long hallway.
"What a beautiful dog. I wish he could be here, but he's better off where he is," one of the women told me. "Don't let him stay here."
Izzy and I have visited a number of patients by now, and the hospice people are right: It's sad to see somebody die. But it doesn't have to be depressing. Sometimes it can be beautiful, quite powerful, especially when the people are comfortable and cared for, and have a sense of control.
Izzy has his rounds, patients who wait for his visits. There's a 6-year-old boy with a brain tumor; Izzy puts his head on the boy's chest, and the two lie together for long moments while the boy strokes Izzy's coat. A man with bone cancer asked to see Izzy just before he died. When Maria, an 80-year-old Alzheimer's patient who was one of Izzy's favorites, died, Maria's daughter asked if Izzy could come pay a final visit to the home. He hopped into Maria's bed and lay still on her pillow. Maria's daughter burst into tears.
I don't really know why Izzy brings peace and pleasure to people in their final days and hours. There is little research about this kind of interaction, and I prefer to keep it a mystery. Maybe the people are remembering the dogs they loved as children. Perhaps the gentle touch is what matters, what gets through.
Whatever the reason, I see the same thing over and over. People startle, then smile, and the tension drains. They grow more peaceful, feel safer. There are some things experts and studies can't explain, even in our sound-bite-obsessed culture.
When I think of my work with Izzy, I often think of Sam, a middle-aged man dying of cancer who was pale and weak but alert, even cheerful. When we entered his house, Izzy would trot toward Sam, purposefully, making strong eye contact, tail swishing.
The last time we saw him, Sam laughed softly as he saw Izzy coming, and he put his hand over Izzy's head, scratching it softly. As Izzy sat by him, he closed his eyes, leaned back in his chair. Everyone in the room was mesmerized by the palpable connection between these two.
After a few minutes, we said our goodbyes. When Izzy paused, turning as if he forgot something, he returned to Sam for a final pat. "Izzy, thanks," he said. "See you on the other side." We didn't see him again.