Excerpted from Izzy & Lenore: Two Dogs, An Unexpected Journey, and Me, by Jon Katz, which comes out today from Villard.
The county health department was housed in a small wooden annex in run-down Fort Edward, N.Y., near the county jail. I parked the Blazer and opened the rear door for Izzy, who disembarked, sniffed around, then paused to look at me, awaiting instructions.
"This way, boy," I said, and he trotted along next to me toward the annex, ignoring a dog being walked nearby, a number of trucks and cars in motion, other people walking through the parking lot.
At the door, he walked inside, scanned the half-dozen people in the meeting room, and headed straight for Keith Mann, a muscular, bald man in a polo shirt emblazoned with the Washington County logo. Keith was running the series of hospice volunteer training sessions, held in the annex over several weeks.
Izzy sat down in front of Keith and put his nose in his hand. Keith handed us our name tags, as if it were perfectly ordinary to have trainees with either two legs or four. One said: "Izzy Katz, Volunteer."
This training would test both of us. I had a book coming out, so I was about to start an extended tour. Insanely busy running the farm, I was already harried and drained, struggling to find time to write.
Besides, hospice work was no simple undertaking. The training alone was thorough and demanding, involving considerable role-playing, reading, and memorizing. The volunteer's handbook weighed a good three pounds.
As a former police reporter, I'd seen plenty of bodies, but I'd rarely known anything about the people who died. Here, I would be going into homes and nursing facilities, getting to know people who were failing, getting to know their families, too—and ultimately seeing them die. How would I handle that? Could I do a good job, or would it be one of those projects I sometimes took on obsessively and then, exhausted, had to drop?
I'd gone back and forth about making this commitment. I didn't want to start something I couldn't finish, yet I was learning the hard way how unpredictable and cluttered my life had become.
At first, I'd thought that my busy schedule, complete with book tour, might cause the program to cut me some slack. Could I really drive three nights a week, for several weeks, to Fort Edward?
But it was clear, as Keith explained the volunteer training to me, that there would be no slack, no shortcuts—and that there shouldn't be. The hospice program needed to make quite sure that the people who entered patients' homes, where the psychological and physical issues were often intense, knew what they were doing and could handle what they encountered.
Accordingly, our training involved talks with social workers, doctors, and other volunteers; field trips to the homes of patients; quizzes—and constant monitoring by hospice staff, alert for weaknesses or problems that might arise. I found my motives questioned again and again. I actually had to defend my desire to enlist.
Keith was a skilled instructor, adhering strictly to his orientation and lesson plans—but he also kept a sharp eye on the volunteers to see how we reacted.
From the outset, at least one volunteer paid rapt attention. Izzy sat staring at Keith throughout nearly the entire session. Sometimes, I did look down to see Izzy dozing. But usually he was locked onto Keith, as if listening intently to every word. I half expected him to take notes.
When we took a break, Izzy followed me outside, where he found a bush to mark, then came back in and approached each of the other volunteers, putting his nose in their laps or on their knees. If they responded, he stayed a while. If they didn't, he moved on. Keith always brought a biscuit or two, so Izzy made sure to visit him during the break.
Several things struck me during our early training. Izzy seemed to have an innate sense of appropriateness. He never disrupted the talks or meetings by barking, whining, or even moving much. He understood that the breaks were a time for socializing but the rest of the session was work.
Six other volunteers were going through the training with us, all arrayed around a conference table, listening to lectures, watching slides, talking about our own lives and our abilities to enter other people's. Through it all, Izzy sat by my side or, often, at Keith's feet, taking it all in.
In a sense, hospice training challenges volunteers to go against the grain of what we ordinarily think of as support, concern, and affection. Normally, if I see people in distress, I try to reassure them, to tell them things will get better, that they're doing fine.
Hospice training teaches you to do the very opposite. In hospice, the ending will always be the same: The patient will not recover; there will be no eleventh-hour happy ending.
Reassurances and conventional wisdoms can't really help the dying or those who love them. Each person, family or friend, will experience death in their own intensely personal way, and I have no tonics for them, no words of cheer. I must leave my own experiences, perceptions, and responses at the door and permit them to face and experience death in whatever way they choose. My role is to listen and help only in the ways that I'm asked to. It's an extraordinarily sensitive situation.
Yet the work seems so crucial. Hospice workers often talk about the mistreatment of the dying, by which they mean not cruelty but the natural human tendency to shun death, to avoid the dying and retreat from even thoughts or discussions about it.
Hospice families tell me all the time about the pain of having friends stop calling or visiting, of seeing them turn away from them at the supermarket, simply flee in the face of death's awesome finality.
So we leave them, often quite alone, to their fates, to the struggles with our health care system, to a culture too busy and distracted—or uncomfortable—to pay much attention.
The last thing these people need is some well-meaning volunteer who attempts to cheer them up, offer suggestions on how to die, or tell them how to grieve. All we can do is provide some companionship and comfort along the way. It's a humbling mission.
To bring a dog into these homes seemed an even greater challenge. Patients are often in emotional or physical distress, hooked up to oxygen or IVs, and taking potent medications. Lots of dogs do therapy work, but hospice requires something a dog really can't be trained to do—figure out for himself how to be loving, appropriate, and sensitive to the dying.
To be a hospice dog, Izzy had to be tested by a vet, who issued a certificate attesting to his temperament. I did considerable calming training, praising him for being calm, practicing moving around furniture and other obstacles. We tried him out in several strangers' homes and in a nursing home with a PA system and lots of medical equipment around. And, of course, he attended all our training sessions, where nurses and social workers were watching him carefully.
But the truth was, I had no clear idea how to prepare Izzy. His own instincts and personality, I thought, would prove more critical than any training in determining whether he could do this work. All I could do was bring him along, into patients' homes and lives, and see what he could offer.
All through the spring and summer, we trekked to Fort Edward, with a sandwich and fruit in a paper bag for me and a few biscuits for Izzy. Keith kept a water bowl in the annex kitchen for him. The volunteers were an extraordinarily generous group of people who seemed quite willing to accept us both, and Izzy was happy to see each of them at every session.
I was daunted at first, by the detailed thoroughness of the training, though I would soon enough be grateful for it. We practiced what to say, what to look for, how to listen. We learned to fill out forms and reports. There was a long list of things to avoid saying—like "Buck up! You'll be OK!" The sessions were wearying, but also gratifying. By the time they concluded, I felt ready.
I can't say I know for certain why I wanted to sign up. Perhaps weathering middle age makes one more aware of death, more thoughtful about it. Perhaps, as my work life intensified, I wanted to make sure I had a grounding, a meaningful commitment to help me see life in perspective, to keep my spiritual self alive. Maybe I wanted see if there was a way to share this work with a dog. Maybe all of the above.
While we were learning, it was hard to avoid the sense that Keith and the social workers were watching us pretty carefully. Whatever our reasons for coming, we volunteers had to talk about them. Stan had just lost his dad. Rita had lost her husband a few years earlier, down South. Donna, it emerged—slowly—had also lost someone, though she hadn't said whom.
On the surface, direct experience with grief would seem a perfect qualification for hospice volunteers, but the staff pointed out that it could also be a problem. We had to set our own losses aside, not add to the sorrow the patients and their loved ones already felt.
Donna and I were paired for role-playing during the second week of training. She was a kindly woman, quietly but deeply religious, and eager to help others. "What better way," she asked, "than to help people leave the world comfortably, with dignity?"
In this exercise, one of us played the volunteer; the other pretended to be a person who had lost someone dear. I drew the volunteer role, which meant my job was to listen, to affirm the feelings I was hearing, not challenge them or add my own or try to change anyone's mind.
Donna, playing the family member, sat opposite me and said she had a sick child, a son dying of leukemia. It was horrible, she said softly, to watch her son suffer, wither, and fade. "I'm not doing enough," she lamented. "I feel like I'm not doing enough, no matter what I do."
It was useful practice because under normal circumstances I surely would have reassured her, told her that of course she was doing enough, and urged her not to be so tough on herself. This "character" was, after all, sitting by her son's bedside almost around the clock, reading stories to him, administering medications, making him as comfortable as possible. What more could she possibly do?
"How long have you felt this way, that you're not doing enough?" I asked—a neutral question, meant to allow her to communicate but not to talk her out of what she was feeling or dismiss it by suggesting it wasn't really true.
She told me more about her son and his diagnosis, his weakness and decline, about the fact that he might die at any moment while she was right there watching, and how helpless she felt to prevent it.
As she spoke, Donna's eyes welled and her face contorted with grief. I was surprised to see Izzy appear out of nowhere, put his head on her knee, and stare up into her eyes.
Suddenly, I saw what he, perhaps, saw. I understood that Donna was no longer playing a role; she had lived this. She wasn't simply a volunteer portraying a stricken mother. We had moved into the realm of real loss.
I don't know what dogs can see or sense, but I know they can discern things that I can't. Rose sees things invisible to me when she is working with sheep. Izzy had some sort of insight about people.
"I'm sorry, Donna," I said. "How long ago did your son die?"
She put her face in her hands and sobbed. "Five years. Five years." And we were done.
The social workers were pleased; they said I'd handled things well, had been perceptive in seeing that Donna was still actively working through her grief, something important for them—and her—to understand as she ventured into hospice work. And Izzy had been a model of empathic restraint.
We all bonded over those weeks, eating cookies and sharing stories of loss from our own lives. I talked about the deaths I'd seen as a reporter, the two pregnancies we had lost before our daughter, Emma's, birth. I talked, too, about my fear of losing a sense of spirituality in my too-busy life.
We played hospice quiz games and watched hospice movies and talked to a stream of social workers, a warm, funny, intensely dedicated group who reported high rates of burnout and stress among their ranks.
The staff talked a lot about volunteer burnout, too, about the need to prepare for this curious truth: Everybody you are visiting will die, and your job is not to save them but to help them leave with as much comfort and dignity as possible. It will be wrenching, surprising, different every time. It isn't for everybody. There are support groups for us, too, numbers to call, help available.
We were briefed by lawyers and nurses and bereavement counselors. We were taught how to spot trouble—filthy conditions, spilled medicines, rising pain, family members breaking down—and to notify the hospice staff immediately.
We all had fears, doubts, and many questions. Could we bring food or books or other gifts? Pass out our phone numbers? What if we saw family members fighting or patients being mistreated? Could you sense death before it came? What was it like? What were the signs? What if somebody died while we were there? How did people grieve, and for how long? What was helpful and sensitive? What wasn't?
But training convinced me that I wanted to do this. Besides, it seemed no longer purely my decision. Izzy had enrolled. At the end of the summer, we completed our training, passed our background security checks, got fingerprinted (well, one of us). Izzy and I received our certificates and photo IDs at a ceremony complete with cake. We would be notified of our first assignment in a few weeks.
Soon enough, we were on the job. Keith mailed me a hospice assignment sheet, telling me the patient's name and address and condition.
On a muggy, late-summer afternoon, we drove to a small bungalow next to a church on a tree-lined street. I was anxious, going over the training in my mind. This looked like any other house, I thought—then chided myself for such foolishness. Why wouldn't it look ordinary? How easy it was to stigmatize death, to the point of expecting a dying person's house to visibly proclaim its status.
The patient, named Jamie, was 86 and in the final stages of Alzheimer's disease. No longer willing to be touched, terrified of even her own family, she was deemed difficult to handle. The social workers were concerned about her daughter, who'd exhausted herself and her savings caring for her mother. Hospice hoped a dog might help settle her; she'd been a dog-lover all her life.
The protocol was rigid. Izzy and I both had to wear our photo IDs, and I had to wash my hands, going in and coming out. We were not permitted to drive patients, to have anything to do with medicines or medical equipment, to perform any kinds of hands-on care. Technically, we weren't even supposed to touch the people we were visiting, although most of us trafficked in illicit hugs.
A former schoolteacher, Jamie had been moved into a first-floor bedroom in her daughter's house. Carol had been caring for her faithfully for several years, but it was growing steadily harder. Jamie slept much of the time, but often yelled or cried out when she was awake. It had become increasingly problematic for the nurses, or even her daughter, to bathe her or change her clothes; she seemed terrified of physical contact and struggled, sometimes to the point of bruising her fragile skin. Carol was worn and weary from the effort. Yet any suggestion of a nursing home was anathema.
Much of the time, the two women were alone in this small frame house, Carol sitting by her mother's bedside, reading or talking to her. Most of the neighbors didn't even know that Jamie was terminally ill, Carol said. They had few visitors. Once her mother had lost her ability to recognize them, friends had drifted away, and family members came by infrequently. She encountered growing problems talking to them anyway, Carol confessed; they seemed to inhabit some other planet.
When Izzy and I came into the house, Keith was waiting for us, as was customary when volunteers paid their first visit to new patients.
Carol, a slight, round-faced woman wearing a lavender sweatsuit, was pleased to see us, welcomed us, and knelt down to pat Izzy. I'd been warned that she was bone-tired and increasingly anxious about her mother, who might sleep all day and then cry out in the middle of the night.
In a tiny, meticulously clean powder room, I washed my hands, carefully and thoroughly, as instructed; Izzy waited outside the bathroom door.
I could see a bedroom at the end of the hall, decorated with family photos and fresh-cut flowers. As we drew closer to the room, I could hear a TV; Carol explained she kept it on most of the time, so her mother could hear voices and feel less lonely.
A beautiful older woman was lying in bed, beneath a summer quilt. Someone had carefully arranged her silvery hair, polished her fingernails, even daubed on a touch of lipstick. She was mouthing barely audible words and moving a bit restlessly.
"This is so great, the dog coming. She loved her dogs so much," whispered Carol as we entered the room.
Carol introduced us loudly and slowly. "This is Izzy," she said. "And Jon. They've come to see you. Izzy is just like Flash. You remember Flash, Mama, don't you?"
Jamie stared at the ceiling and began mumbling. I came to the foot of the bed, looked at Izzy, and gestured to the foot of the bed; he hopped up. "Stay," I whispered, and he sat stock-still.
Jamie seemed unaware of his presence. I waited. Carol was quiet, too. Keith, watching from the doorway, might have been nervous about what would happen with Washington County Hospice's first canine volunteer.
Izzy seemed a bit uncertain, not sure what was happening, looking first at me, then at Jamie. He'd never been in the company before of someone so debilitated, so close to the end; clearly, it was strange to him. Was it smart, I found myself wondering, to bring along this dog, who'd spent most of the first four years of his life alone outdoors? But he looked all right, his ears and tail up, no signs of stress or anxiety. In fact, he seemed to be studying the room, looking carefully at me, at Jamie and Carol, seeking cues.
He cocked his head at me. "It's OK, Iz," I said. "Say hello."
He seemed to get it then, some invisible trigger or instinct kicking in. I hovered nearby, ready to move in quickly if there was trouble. This was a dying woman who didn't want to be touched. Would she be frightened or perhaps frighten Izzy? How would he respond to a situation he'd never been in, couldn't really be trained in advance to handle?
He lay down and very slowly began inching up the side of the bed. He didn't step on Jamie, or even graze her frail body, just crept slowly alongside her. When he got close to her hand, he burrowed his head beneath it and lay still.
Jamie stopped muttering. Her face looked alarmed at first; then she broke into a slight smile. She didn't look at Izzy, but moved her hand slightly, feeling his forehead and his ears.
"Oh," she said. "Oh." And then, smiling, "Oh, how pretty ... pretty."
"This is the first time she's said real words in weeks," Carol whispered, astonished.
Izzy kept quite still as Jamie stroked him and talked in disjointed sentences, still smiling. After a while, she drifted off. A few minutes later, her hand still resting on Izzy's head, she awakened and stared at the ceiling, and smiled again. She seemed calmer than when we'd come in.
After 15 minutes, without instruction, Izzy extricated himself and skipped down from the bed, circling around to Carol, offering her a friendly paw. She kneeled on the floor, weeping, and held Izzy for a long moment. Then our visit was over, the hospice canine volunteer program launched.
"I can't explain how much this means," Carol told me as we left. "For a minute I had my mother back."
We agreed to return the following week. Later, we learned that Jamie allowed Carol to bathe and change her without fear or resistance. Why this would be true was nothing any of us could explain, but something was different.
Outside, Keith shook my hand and leaned over to praise Izzy. "This works," he said. "This is awesome. Izzy is a natural. You aren't so bad yourself."