We take a short diversion in our series on “How We Die” this week to consider another aspect of palliative care: the work done by Therapy Dogs. Guest author Fran Carnerie writes from the heart about a handful of patients whose lives were touched, and their dying eased, by her dog Misty. Please note to protect patient privacy, the names of the patients have all been changed.
by Fran Carnerie
On October 6, 2003, an Angel was born in a little village on the west coast of Prince Edward Island. She had a beautiful face, an intelligent look … and four paws. Nine months later, when a family from Whitby visited the seaside, the Angel insisted on joining them. Forever. The family called the Angel “Misty” to remind them of the ocean where she was born.
From her first day with our family, anyone who came near Misty was met with a wagging tail, Happy Girl face and plenty of kisses — her way of saying she was here to love. Just love. In the next few years, my little Golden Retriever and I partnered through three levels of obedience training and four levels of agility classes — but then came the day she was ready to begin her true life’s work: Misty was evaluated for her fitness as a Therapy Dog with Therapeutic Paws of Canada (TPOC). She easily passed the tests, then the supervised hospital visits and was rewarded with a monogramed red vest to identify her as a certified Therapy Dog when she was on duty. Since I’d had previous work experience with cancer patients, I asked that Misty and I be assigned to palliative care. We were posted to the Supportive Care Unit in Lakeridge Health Oshawa where Misty visited all people: patients who were alert, or those making ready to leave this life. Nurses. Family members. Cleaning staff. Physicians. People who passed in the hall. Anyone needing a listen and a hug. What follows are some life incidents Misty and I shared with fellow travellers on the unit.
“Don’t leave yet.” Albert’s voice came in wisps. His oxygen cannula had fallen slightly more out of one nostril than the other, its dehydrating flow causing his voice to drain away. The inflated neck support had tipped and was at risk of sliding out from under his head. Glasses sat crookedly across his face. All in all, Albert seemed “off kilter”. Still, he managed to stroke his Pet Therapist determinedly — perhaps she was a mooring for him. “Please … don’t leave yet.”
Misty quickly developed a wonderful Therapy Dog skill — on my cue (patting the bed beside the person lying there), she alley-ooped her front end up, so she could tuck in and snuggle the patient while her rear paws remained on the floor. As he patted Misty, I asked Albert if he had a dog at home. He shifted around the styrofoam glasses and can of Ensure on his bedside table, then shook his head.
“My wife never liked animals.” His wife occupied the other bed in that semi-private room. She, too, was perishing from cancer. “When I go home, I’m going to get a dog … but please, don’t leave yet.” Misty and I remained with Albert for some time after which I reluctantly said, “I’m sorry, we have to see other people now, but I’ll bring Misty back same time next week.” Of course, many times people we saw one week were no longer there when we returned, but I said the same thing to everyone. Always.
“I understand,” he said. We left.
Albert was there the next week when Misty and I returned, but the bed beside him was empty. He stared vacantly at the ceiling, with breathing that was rapid and laboured. Lips thin and purplish. I asked if he wanted a visit with the Therapy Dog, but he shook his head, “no”. Gaze remained on the ceiling.
“Really? No? You don’t want to visit with Misty?”
Instantly, Albert lowered his gaze and searched for Misty. His eyes focused. He became alert. “Oh! Yes. Yes! Come here, come here!” He reached out and Misty licked his arm through the bedrails. “She’s staying with me for the night. You’re just going to leave her here.”
I gave Albert dog treats, which he fed Misty awkwardly, through the bedrails. With enormous strain, he pulled himself onto his side so he could lay as close as possible to Misty, while she nuzzled under his arm. That’s when I heard it: not so much a moan; not loud enough to be wailing; more like weeping but without tears. A sound far distant. Remote. Ancient. Was it fear? A quest? Or the shared beating of hearts that has passed between species from the time early human and wolfish ancestors huddled together in darkness. At The Precipice. It was here. Now. I backed away, giving man and dog their space and privacy. Leaving Misty to care for this soul. After a time, Misty backed away from the bed — she’d done all she could for the day.
“See you next week, Albert.”
One week later, Misty and I entered Albert’s room. The oxygen cannula was off his face, lying loosely on his chest. The man who was so anguished during our visit in the previous week now had hooded, unfocussed eyes. He was short of breath, clearly needing the oxygen. A nurse came into the cubicle, attracted initially by Misty. She restored the oxygen delivery then left so she wouldn’t deter Misty from her primary focus: the man struggling for breath. I leaned over to Albert and said, “Misty is back to see you. Do you remember Misty the Therapy Dog?”
Misty pushed her nose into his bluish hand. For a moment, his eyes opened slightly wider and he whispered, “Oh, Misty… Misty… Misty… Misty… Misty…” He slowly moved his head back and forth and for a few moments attempted to pull himself onto his side as he had done in the previous week. Then Albert resigned, letting his body go slack. His eyes closed. Too much exertion now. Too much.
Curiously, Misty backed away. Why was she doing that? What was she sensing? What was she understanding that I did not understand? And so it was in this tender yet profound place. Albert was retreating to somewhere more internal. I cupped my hands around his cool fingers and paused for a few moments to wish him a peaceful journey.
The next week Misty and I were passing by Albert’s room — not steering into it, when Misty paused in the doorway and looked in. I wondered whether anything of the person, any clue, scent, affected cell, any fragment that witnessed the person’s struggle — or passing — remained within those walls. The furniture. The blankets that rose and fell with each laboured respiration. How absent is absence really?
Misty and I went to the bedside of a woman who had requested a visit from the Therapy Dog. “Hi. Did you want to see the Therapy Dog?”
I raised my voice a little, trying to aim the loudness into her ear. “DID YOU WANT TO SEE THE THERAPY DOG?”
“OH! YES! IS THAT THE DOG?”
“YES. HER NAME IS MISTY.”
“OKAY. I’VE SEEN HER. THANKS VERY MUCH.”
An attractive woman sat up on the side of the next bed — Laura was happily excited. Her daughter was getting married the next day at the park beside the hospital — the wedding had been moved up significantly so Laura could attend. She was running through her Mother-of-the-Bride anxieties: will my hair, my dress be okay?
“You could show up in a bathrobe and nobody would care because it’s you they want to see.”
Laura considered this and smiled. “This is my first one to get married.”
The next day, when the weather was gloriously sunny, I thought often of Laura, picturing her natural beauty amid the blooms and fragrances of the community garden. A day for giving thanks.
A week later, Misty and I were back on the unit and looking for Laura. As we approached her room, I saw a sign taped beside the door. It read, “This is Laura’s Room”. Apparently, Laura now needed some help finding “home”. Since the door was pulled almost closed I was concerned that Laura’s condition had plummeted from last week. Well. Concern was not required. Not at all. After knocking on the door, Misty and I entered to find Laura dressed in funky street clothes, certainly not PJs. She sat on the side of the bed, chatting animatedly with her visitors … until she saw Misty. “Oh! Look who’s here!” Misty pranced in and set about licking and wagging and generally adding her own brand of medicine to the medicine of Laura’s visitors. Laura was vibrant and beautiful. Then she announced to her guests, “I’ve known this dog since she was a puppy.” Nobody skipped a beat. The chattering and laughter continued. The talk turned to dogs and Laura never had her hands off Misty. Misty never ceased her happy whimpering and wagging — especially since she was being stuffed with dog treats.
A week later, no sooner had we stepped onto the unit when Misty saw Laura and pulled me in her direction. Laura was in an unfamiliar new pose — sitting in a wheelchair. Clearly, a lot had happened since we’d last visited. Still, Laura needed no prompting about what to do with Misty. “Well hello, Beautiful!” Laura started sitting up straighter but couldn’t seem to respond with her arms. One hand had curled into itself, the other trembled. Misty knew what the circumstances required: she wagged her tail and licked up Laura’s arms. Both seemed delighted.
Before we returned in the week following, Laura, who’d needed a sign on her door to locate her room, did indeed find her way home.
As we emerged from the rotating doors at the hospital entrance, one after another, people about to leave the building changed course, veering over to Misty, drawn as though by some irresistible force, arms outstretched to trail fingers through her fur as they walked past . “What a beautiful dog!” “Can I pat your dog?” “Is this a Therapy Dog?” The unwavering bond of dog and human in this most profound place of birthing, healing, failing, dying, of misery and mystery, was unmistakable. Remarkable. A gift of our shared evolution. Misty gently wagged her tail and offered licks to all who paused to touch her, stroke her, run their hands over her coat, those who looked into her smiling face.
Marie and Marietta
“No dog! No! No!”
Wife looked at me apologetically as Misty and I backed out into the hall. She followed us out and said, “I don’t understand it. He loves dogs. When he got home after having his surgery, he saw our dog and burst into tears. He was so glad to see her — but, that’s just the way it is with brain involvement, I guess.” She bent over to pat Misty’s head. “You’re so beautiful.”
I asked Wife how she was doing while Misty picked up her cue and cuddled into the woman’s legs.
“You know, it’s strange.” She pointed into the room beside us, Misty’s tail wagging slightly. “Our lives are so similar. We live a few blocks from each other. My name is Marie. Her name is Marietta. We have three boys from six to nine years. They have three boys, the same ages. I’m forty. Marietta’s forty. And our husbands are here. How can that be? How can our lives be so similar… really similar, but we don’t meet until our husbands come to this floor at the same time?” She shook her head, ruffled Misty’s neck and walked back to her husband.
A woman came out of the next room and spoke softly into her cell phone. “Look, all I’m saying is if you want to see him you’d better get down here now.”
Larry and the new guy
Misty and I looked into the next room. It was very dark inside, with the curtain drawn between the beds. A newly admitted man was in the first cubicle, head in hands while his wife rubbed his back. I knocked quietly on the door and Misty stepped in. They both looked so preoccupied that I offered, “We’re just here to see Larry in the next bed.”
The woman spoke up. “He’s just … he’s deceased … just now …” Her husband shook his head, running his hand through his hair. And so it happens here. As Misty and I were coming up to the floor, a human being was breathing for the final time. His heart was slowing to a stop while two people down the hall reminisced about maritime geography. A woman in another room was turning down an offer of milk because her accelerating exhaustion made sitting up to drink from a glass too difficult. As Larry’s brainstem began to shut down, a man in the next room was celebrating his victory for the day: the blood clot that had kept him bedridden the past week was resolving and once again he could sit up in a chair. Opposite him, an empty bed that was occupied in the week previous. A woman across the hall was turning down an injection — her pain was manageable for the time being, thank you. And in the next bed, a man new to the floor, watched.
The woman in bed looked up at me. She had a feeding tube inserted into her nostril.
“They’re poisoning me! It’s rat poison!”
I wondered whether there was this much mental confusion among the patients during the daylight hours … or did the fog swirl about more brazenly in the evening, when shadows crept in from the corners?
Bette was in bed. Uh-oh. Usually she was in a wheelchair “walking” the wheelchair up and down the hall. I never saw her without a smile on her face, including that night. Ever the gentle clown, Bette would pat her bald head as though brushing back luxurious curls, and tell Misty and I how she had to beat back the paparazzi who never gave her peace.
“Misty, where have you been?” Bette took great care to stroke Misty’s face and ears. “I’ve been waiting and waiting for you to show up! Ooooo and I smell your chicken toothpaste! Mmmmmmmm.”
The adoration was mutual. Misty was generous in her smooches planted up and down Bette’s arms and face.
“Wait, Misty…” Bette turned her face to make it easier for Misty to cover the other side of her face with kisses. “You forgot this side.”
Smooch. Smooch. Lick. Lick. Yep. The adoration was quite, quite mutual.
On this evening, Bette was in bed with oxygen flowing through a cannula into her nostrils. She was very pale. Scary pale. But still up for shtick, as we were to discover.
“Bette, do you feel like having a visit with Misty?”
“Oh yes…” she puffed. “Always … I’ve been waiting.”
I pressed the button to elevate the head of the bed. “How are you tonight?”
“Oh, I’ve just got a cold, dear. Don’t worry about me.”
This was more than a cold, of that, I was certain. I wondered if Bette realized that, as well…
“Misty, Misty, Misty…” Bette stroked Misty’s face and spoke with a reedy, breathy voice. “Didn’t your Mummy bring any treats tonight?”
“Of course!” On cue, I passed four or five little carroty dog bits into those white-blue hands.
“Here, Girl. One for you…” she placed a treat in Misty’s eager mouth. “And… one for me.” With surprising swiftness, shocking even, Bette flicked a dog treat into her cracked, dry mouth and laughed.
I think my mouth dropped.
A nurse appeared beside me. “Did… did she… ”
I nodded mutely. Bette did her best to crunch the desiccated treat, but she and Misty were smiling.
We spent a long time with Bette that evening … the longest time we had ever spent visiting her. Bette just kept stroking and patting and loving Misty and Misty stayed half on the bed, the two of them sharing carrot breath and The Joke. When finally Bette was fatigued, she bid Misty and I goodnight.
As we left the room, I turned and waved to Bette, wondering if Misty and I would see her again. The next week I learned we would not see Bette again in this life.
It was an unusual note. I was asked to be very quiet, to move slowly and explain everything Misty and I would be doing with a new patient in the private room. Oh yes, and be prepared to leave quickly.
Misty and I stood outside a closed door. The woman who was the subject of the mysterious note was in this room. I used the pads of my fingers on the door to signal our arrival, more patting the door than knocking, like Dylan Thomas’ line in Under Milk Wood, “a mouse with gloves”.
Ever so slowly, I eased the door open and saw a beautiful young woman in the bed. Her husband walked around the bed to greet us, so I whispered, “You wanted a visit with Misty?”
As Therapy Dog Handlers, we are given only enough information about patients to help us understand how to approach the person, for example: “hears better from left ear”, “pain in both legs”, “confused”, “daughter afraid of dogs so knock before entering”. With Carey, the information provided was “startles easily.” She breathed through a tracheostomy tube, evident at the base of her neck. Her pupils were of unequal size and so large they swallowed her irises. Carey’s eyes were opened so widely she had the appearance of alarm. Both her arms were in splints to prevent contractures and she appeared to be paralyzed from the neck down. Carey’s husband, David, smiled, even if sadly, as he stroked long blonde hair back from her forehead.
As David waved us in, Misty walked carefully beside me, clearly taking cues from us that “Hush” was the operative word. Carey was on her side facing us, making small jerky movements. By contrast, I was moving like a tortoise when I bent down and whispered, “My dog is here to see you.”
Carey’s mouth opened. She swallowed repeatedly, lips moving over perfect teeth. I looked to David who explained that Carey was trying to talk. He continued stroking her hair as he spoke.
I asked quietly, “Do you think it would it be okay to uncover her arm so she can touch Misty’s fur?”
“Yeah, let’s try it.”
Speaking softly, I explained, “I’m going to uncover your arm so you can feel my dog.”
Lip smacking and swallowing continued, then Carey’s whole body jerked for an instant. I looked up to David.
“It’s okay, she does that occasionally.” He nodded for me to continue.
Very slowly, I uncovered her arm and Misty put her nose on Carey’s skin and, I guess I should’ve expected it, Misty gave Carey’s arm one lick.
I sucked in my breath, concerned there would be more jerkiness from the woman. The only reaction: “Ahhhh. That was so sweet.” David approved. Carey continued swallowing and lip smacking. I slowly rewrapped her arm and whispered, “See you later.”
A few weeks and few visits with Carey later, Misty and I had come to the hospital on Christmas Day to spread some cheer. As we walked by the food court I heard, “Hey look, it’s Misty!”
David came over, arm around one of their daughters, who appeared to be eleven(ish). “This is the dog who visits Mom upstairs.” He looked at us and said, “Carey’s over here.” David gestured broadly to the eating area where several family members had gathered around the young woman propped in a large chair with a tray across the front. Her tracheostomy was emphasized by the angle at which her head was thrown back. David tenderly stroked his wife’s hair back from her forehead as I’d witnessed on each visit.
I asked Misty to stand up on her rear legs while I positioned her front paws across the tray. As I uncurled Carey’s hand from its grip around a rolled towel, I tried to draw the hand across Misty’s outstretched forepaw — very difficult given the clench of Carey’s spasms.
“Carey, Misty’s here to see you.” David turned to me and said, “It would be good if she could feel the different texture.” I nodded and continued my efforts but the involuntary strength of Carey’s muscles to clamp her arm back to her body meant it didn’t go all that well. Carey responded as she always did: by smacking her lips, opening her mouth slightly as though she was trying to speak. I looked up to David who, unseen to his wife, shrugged. He didn’t know either. Was Carey able to understand our efforts to communicate with her?
“Carey,” I said, “I’m returning Misty’s paws to the ground.” Carey seemed unable to follow visual cues because she continued staring ahead with widely opened eyes. Irrespective of what Carey’s sensory perceptions may have been, she was surrounded by love, concern, warmth, caring … a compassionate energy that cocooned her entirely. As Misty and I moved away, the family gathered to thank us, stroke Misty and liberally shower us with Christmas Spirit.
The week after Christmas Misty and I walked into Carey’s room and I broke into goosebumps. Carey was gone. The nurses reassured me that she had been transferred temporarily to another institution for some rehab. Then, a few months later, just as abruptly, Carey returned.
“Hey! It’s Misty!” David strode up to us smiling hugely. “Look! We’ve got a new way to communicate — flash cards!” Above Carey’s head was a metal rack with plasticized, highly colourful cards, each about two inches square and bearing images. “Honey, Misty’s here. Remember Misty the Therapy Dog?” He walked to the top of Carey’s bed so he stood behind her head, then reached up to the cards and selected two. “This one with the big red ‘X’ on it means ‘No’ and this one with the green flower on it means ‘Yes’. I hold both of them up to her and she moves her right eye to the answer.” He positioned the cards about six inches away from Carey’s face. “Honey, do you want Misty to visit with you tonight?”
Carey’s right eye rotated over to the green flower.
“Well, that looks pretty definite!” He was elated. Months earlier I’d had the feeling that Carey was a prisoner captured by her own body because she seemed alert and aware of what was happening to her. The nurses told me that when her children left, she cried. But now, with two by two cards, the world, external Life, could ask her questions and she could make her will known. A triumph!
I carefully placed Misty’s front paws beside her, noticing that Carey was less twitchy than previously. “Carey, we’re going to move your arm so you can feel Misty’s fur.”
David nodded then gently rotated one of Carey’s splinted arms so the skin exposed between the Velcro straps could be touched by Misty’s fur… And then Misty licked the arm. Carey shivered. David smiled. The visit was over.
Misty and I were at the nurses’ station, where she was engulfed in hugs. “No, I saw her first!”
“She obviously likes me better.” Misty licked the nurse’s face. “See, I told you.”
“Hey, Misty, I know where the dog cookies are kept.” A finger placed conspiratorially over lips, long past their glossiness. “Is it okay if I give her a cookie?”
“I think she would insist.”
Misty was happily crunching on the biscuit when a man approached. We had stopped in to see the man’s family a short time earlier but his wife was much too uncomfortable for a visit with the Pet Therapist. He crouched down to stroke Misty’s sweet face while he told us of the cancer’s determined march through his wife’s body. Misty licked his hands. Then he stood up and said, “This is great work that you’re doing.”
I looked at him. “It’s not work.”
In March of 2014 Misty was diagnosed with osteosarcoma — the same kind of bone cancer that struck Terry Fox. Like Terry Fox, Misty’s leg (the right rear leg) was amputated, she underwent several courses of chemotherapy, was outfitted with a custom-built wheelchair, called a “dog cart”, and we returned to visiting palliative care patients.
As with Terry Fox, however, the cancer recurred in her lung. On May 29, 2015, the day Misty went into the next life, she was in terrible pain but still greeted her veterinary specialists with happy whimperings, kisses and a wagging tail. Our Angel was a Therapy Dog to the end of her days.
About the author
A life-long owner and respecter of dogs, Fran Carnerie, has marvelled at the gifts and compassion animals bring to help humans. In her previous career as a nurse practitioner, Fran worked with cancer patients, so a palliative care unit was the obvious place to visit with Misty, her certified Therapy Dog. Fran also has a thoroughbred mare who provides equine therapy to children and adults at a local Therapeutic Riding Facility. If you are interested in reading more about Misty’s work with people on a palliative care unit, and the work of therapy dogs generally, see their blog: www.mistysjourney.org.