Opinion
A PIECE OF MY MIND Anna Reisman, MD Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Corresponding Author: Anna Reisman, MD (anna.reisman @yale.edu). Section Editor: Roxanne K. Young, Associate Senior Editor.
Hounded The two reasons why I dreaded my monthly house call to a tiny old man with big round glasses were loud and furry. The angry barking and frantic scraping of claws began even before I’d pressed the doorbell. Once, the larger dog—a scruffy, overgrown terrier—snapped his jaws at my legs. I panicked, shoved my doctor’s bag between us, and slammed the door. After that, my patient’s daughter herded the dogs—the yappers, I called them—to another room where a sliding glass door muffled their braying, and I could listen to the old man’s raspy breaths and trim his rough toenails in peace. I am not a dog person. But in my line of work—I’m a primary care physician who sometimes makes house calls—dogs are everywhere. To me, they’re nothing more than jumping, growling, barking barriers to good care. They’re messy, shedding clumps of fur and dander and doggy drool everywhere, and they’re intrusive, the way they poke their snoots in embarrassing places. At best, the dogs I’ve met on house calls are useless: one aged white dog watched me through a rain-splattered window as I rang and rang the doorbell. I tapped on the glass, expecting the beast to bark my arrival; instead, he raised a hind leg, peed on the couch, and limped away. Some dogs are downright scary. I cowered in one living room where a vicious-sounding dog hurled itself over and over at the locked door between us so intently that I thought the door would come off the hinges. Another patient reassured me and the dog-fearing medical resident (sometimes trainees came along to learn about house calls) that his pooch would just sniff her a bit before settling down. A moment later, the beast lunged, frightening both of us half to death. While visiting a patient in his backyard—his wife didn’t want me and the resident, a different one, in the house—a mean-looking pair of lion-sized Dobermans chained to a pulley paced, their squinty eyes riveted on us. They growled when the resident wrapped their owner’s arm in a blood pressure cuff. I can’t help but wonder if they imagined he was wearing a leash now too. For older people who can still get around, I understand that dogs can provide companionship, of course, and with their dependency on a human for a feeding and walking schedule, structure. But for the oldest and most infirm? Even sleeping dogs pose risks. One white-haired octogenarian tripped over a snoring Fido and broke her hip (the patient’s, not Fido’s). At another house, nobody noticed that the dog, curled up by his sleeping master on his electronic hospital bed, was lying right on top of the bed control device. The next
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the
morning, the man’s daughter was horrified to find her frail father propelled to unsafe heights. I’d heard a couple of do-gooder dog tales, like the one about a stone-deaf man whose dog became his ears. The only way his nurse could get into his house, she told me, was to yell for the dog through the mail slot. The dog would gallop to its owner, and the ancient man would totter in to unlock the door. Another nurse described a patient whose lower legs were so loaded with fluid that they oozed. You guessed it: his long-tongued floppyeared best friend happily kept them clean, all the livelong day. But dogs like this, in my experience, were clearly the exception. And then one day, I paid a visit to a man in his 80s with advanced dementia who, a few weeks earlier, had fallen out of bed and fractured his hip. I leaned over the bars of his bed and gently tapped his thin shoulder. Ever since the fall, he’d lost the mischievous twinkle in his eye, his readiness to laugh. “Hello, there,” I said brightly. My patient’s skin was sallow and his mouth drooped open. He stared at the ceiling. A pale purple vein pulsed weakly at his temple. The screen door creaked open behind me and something small and warm bumped into my leg. It was his niece’s dog, a Chihuahua, the size, make, and model of a rat. Before I could protest, she placed the squirming creature, leash jangling, on the old man’s pillow. I cringed, expecting an awful spasm or, worse, none. Instead, the old man came alive. He cooed and snuggled. He smiled. The pup’s simple wriggly warmth had triggered something deep inside his dementiaaddled brain, perhaps a memory of a beloved dog, or maybe it was just the dog’s eagerness, the tickle of the nuzzling moist nose, the panting that warmed his cheeks, the happy thumping of the pointy tail on his bony chest. All right, I remember thinking, begrudgingly. Maybe there is some primitive reflex to animal love. Maybe the pet therapy people are onto something. But I still shuddered thinking about the yappers. One night, a few hours after midnight, my tiny bespectacled patient awoke, his bladder full. He heaved himself up from the recliner where he slept, felt around for his walker, and lost his balance. Face down on the hardwood floor, unable to get up, he called and called for his daughter, fast asleep on the other side of the house. He could have been there all night. He could have died. But the dogs ran to him, and then, those wonderful and responsible animals—no, caregivers—ran to her. Those yappers saved his life. And made a convert out of me.
Disclosure of Potential Conflicts of Interest and none were reported.
jama.com
Acknowledgment: Thanks to John Schumann, MD, for helpful comments.
JAMA May 28, 2014 Volume 311, Number 20
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 06/04/2015
2069
A PIECE OF MY MIND Anna Reisman, MD Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Corresponding Author: Anna Reisman, MD (anna.reisman @yale.edu). Section Editor: Roxanne K. Young, Associate Senior Editor.
Hounded The two reasons why I dreaded my monthly house call to a tiny old man with big round glasses were loud and furry. The angry barking and frantic scraping of claws began even before I’d pressed the doorbell. Once, the larger dog—a scruffy, overgrown terrier—snapped his jaws at my legs. I panicked, shoved my doctor’s bag between us, and slammed the door. After that, my patient’s daughter herded the dogs—the yappers, I called them—to another room where a sliding glass door muffled their braying, and I could listen to the old man’s raspy breaths and trim his rough toenails in peace. I am not a dog person. But in my line of work—I’m a primary care physician who sometimes makes house calls—dogs are everywhere. To me, they’re nothing more than jumping, growling, barking barriers to good care. They’re messy, shedding clumps of fur and dander and doggy drool everywhere, and they’re intrusive, the way they poke their snoots in embarrassing places. At best, the dogs I’ve met on house calls are useless: one aged white dog watched me through a rain-splattered window as I rang and rang the doorbell. I tapped on the glass, expecting the beast to bark my arrival; instead, he raised a hind leg, peed on the couch, and limped away. Some dogs are downright scary. I cowered in one living room where a vicious-sounding dog hurled itself over and over at the locked door between us so intently that I thought the door would come off the hinges. Another patient reassured me and the dog-fearing medical resident (sometimes trainees came along to learn about house calls) that his pooch would just sniff her a bit before settling down. A moment later, the beast lunged, frightening both of us half to death. While visiting a patient in his backyard—his wife didn’t want me and the resident, a different one, in the house—a mean-looking pair of lion-sized Dobermans chained to a pulley paced, their squinty eyes riveted on us. They growled when the resident wrapped their owner’s arm in a blood pressure cuff. I can’t help but wonder if they imagined he was wearing a leash now too. For older people who can still get around, I understand that dogs can provide companionship, of course, and with their dependency on a human for a feeding and walking schedule, structure. But for the oldest and most infirm? Even sleeping dogs pose risks. One white-haired octogenarian tripped over a snoring Fido and broke her hip (the patient’s, not Fido’s). At another house, nobody noticed that the dog, curled up by his sleeping master on his electronic hospital bed, was lying right on top of the bed control device. The next
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the
morning, the man’s daughter was horrified to find her frail father propelled to unsafe heights. I’d heard a couple of do-gooder dog tales, like the one about a stone-deaf man whose dog became his ears. The only way his nurse could get into his house, she told me, was to yell for the dog through the mail slot. The dog would gallop to its owner, and the ancient man would totter in to unlock the door. Another nurse described a patient whose lower legs were so loaded with fluid that they oozed. You guessed it: his long-tongued floppyeared best friend happily kept them clean, all the livelong day. But dogs like this, in my experience, were clearly the exception. And then one day, I paid a visit to a man in his 80s with advanced dementia who, a few weeks earlier, had fallen out of bed and fractured his hip. I leaned over the bars of his bed and gently tapped his thin shoulder. Ever since the fall, he’d lost the mischievous twinkle in his eye, his readiness to laugh. “Hello, there,” I said brightly. My patient’s skin was sallow and his mouth drooped open. He stared at the ceiling. A pale purple vein pulsed weakly at his temple. The screen door creaked open behind me and something small and warm bumped into my leg. It was his niece’s dog, a Chihuahua, the size, make, and model of a rat. Before I could protest, she placed the squirming creature, leash jangling, on the old man’s pillow. I cringed, expecting an awful spasm or, worse, none. Instead, the old man came alive. He cooed and snuggled. He smiled. The pup’s simple wriggly warmth had triggered something deep inside his dementiaaddled brain, perhaps a memory of a beloved dog, or maybe it was just the dog’s eagerness, the tickle of the nuzzling moist nose, the panting that warmed his cheeks, the happy thumping of the pointy tail on his bony chest. All right, I remember thinking, begrudgingly. Maybe there is some primitive reflex to animal love. Maybe the pet therapy people are onto something. But I still shuddered thinking about the yappers. One night, a few hours after midnight, my tiny bespectacled patient awoke, his bladder full. He heaved himself up from the recliner where he slept, felt around for his walker, and lost his balance. Face down on the hardwood floor, unable to get up, he called and called for his daughter, fast asleep on the other side of the house. He could have been there all night. He could have died. But the dogs ran to him, and then, those wonderful and responsible animals—no, caregivers—ran to her. Those yappers saved his life. And made a convert out of me.
Disclosure of Potential Conflicts of Interest and none were reported.
jama.com
Acknowledgment: Thanks to John Schumann, MD, for helpful comments.
JAMA May 28, 2014 Volume 311, Number 20
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Western Oregon University User on 06/04/2015
2069
