Man’s – and woman’s – best therapy

As is so often the case, Theresa Brown’s latest blog post has me nodding my head and saying, “Been there, done that.” If you haven’t read her effort from this past Friday, titled Bringing Home to the Hospital, do so and be prepared to marvel at the extraordinary place that a beloved dog holds for a seriously ill young woman. As Brown relates, the biggest barrier to pet visitation therapy is often the rigid hospital environment. Her story caused me to reflect on a similar experience I encountered while working in a coronary care unit (CCU) nearly 20 years ago. I was moved enough at the time to write a brief essay, which I include here. Note that I haven’t changed anything to speak of. I no longer work at the center in question, nor do I have any idea how long a life my patient was able to live with Benji, but however long it was, it was well worth it.

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“I know you probably won’t approve of it, but I would like to ask one favor of you…. “

R.R.’s wife came to me with these words about midway through my twelve-hour shift in the CCU. And at this point, I was ready to grant her just about any favor.

R.R., who had undergone coronary artery bypass graft surgery only a month before, seemed very close to death. After returning home from his surgery, his mitral valve decided to go on strike and R.R., in his seventies but otherwise in good health, went into severe heart failure.

For ten days we had worked to get him off the ventilator and normalize his cardiac output, but we had been unsuccessful. The previous day, his attending physician discontinued his medications, ordered comfort measures only, and set up a meeting with the hospital’s ethicist and attorneys to discuss disconnecting the ventilator.

On this day, while mentally preparing myself to assist in terminal weaning, I observed that R.R. appeared slightly more alert, and that his vital signs were fairly stable even without being pumped full of inotropes and diuretics. Even so, I knew his prognosis, and my goal for the day was to provide whatever solace I could to him and his family.

Although I had only worked in the CCU for five months, I was feeling more comfortable about my critical care skills. Before taking this position, which allowed me to “flex” between the cardiac ICU and stepdown units, I had worked on a medical-surgical intermediate care unit for more than two years. Clients’ acuities were high, and so was the nurse’s workload — but it was a wonderful place to learn nursing. Even though I had been an orderly and nursing assistant in hospitals for six years before graduating from nursing school, that was important to me. So on this day in late March, I was getting better at keeping the high technology, tubes, and wires from overshadowing what my clients and their families really needed.

“We have Benji out in the car. I wondered if you could let us bring him in to see Dad one last time.”

At once I realized not only that it could be done, but it had to be done. The hospital had recently implemented a pet visitation policy, despite some initial objections from infectious disease doctors and others. And I was aware that if there was ever a right time for a pet visit, this was it.

Of course, the policy had to be followed to the letter. But I had no idea what kinds of hoops I would have to jump through to make Benji’s visit happen. I had to obtain a veterinarian’s OK, a clean bill of health for the dog. And though R.R.’s wife had vaccination papers with her, I needed to phone the vet and confirm that Benji was disease-free.

I called security, to let them know there would be an animal entering the lobby, and to have them reserve us a service elevator. And when the patient representative got wind of what was happening, he questioned me to make sure that a visit was appropriate. Fortunately, with all private rooms on the unit, there would be no roommate to object.

With all the arrangements I was making, I felt more like a politician’s press secretary than a nurse. But I had a suspicion that the work would not be in vain.

Almost three hours after R.R.’s wife approached me with her request, I met her and Benji in the lobby. I examined the overweight but otherwise healthy-looking Cairn Terrier for fleas, wrapped him in a sheet, and escorted him to the CCU.

As soon as we entered the room, I sensed something therapeutic was happening. R.R. instantly recognized the twenty-pound dust mop I placed on his lap, and vice versa. Benji’s only problem was that the endotracheal tube hindered easy access to his master’s face; and it scared him when the extra abdominal pressure caused R.R. to cough, and the ventilator responded by alarming in disapproval.

The visit itself was a total, unqualified success, and what followed was even more remarkable. Pleasantly surprised at R.R.’s mental status half an hour after Benji’s visit, the pulmonologist decided to try weaning him once more, this time without cardiac drugs. And, incredibly enough, we succeeded; he was extubated less than 48 hours later. His DNR status was reviewed, medications were resumed, and within a few days he was transferred to the stepdown unit. And most significantly, R.R. was able to return home and reunite with Benji and the rest of his family.

Of course, skeptics will say that pet visitation, and my role in facilitating it, had nothing to do with this man’s recovery. While that is possible, I do not believe it. The literature is starting to show examples of the therapeutic benefits of pet therapy, and I am convinced that it played a role in R.R.’s healing process. Even if he had not survived, a visit from his beloved dog would have helped to brighten his last days and raise his family’s spirits.

This incident earned me a certain amount of notoriety, especially after we re-enacted it later in the week, for a feature story on a local television station’s evening news. And it seems that if any of my colleagues in the Heart Center has a question about pet therapy or visitation, they come to me first as a resource person. But the most important feeling I retain from this experience is that I helped make a difference, that I went the extra mile, and that perhaps as a result, Benji is perched on R.R.’s lap right now as I remember them from not so long ago. And as for my own dogs at home, I hope that, if I am ever critically ill, my nurses will allow my best friends to visit me as well.