Caleb's Archive

When you don’t want to go: Caleb’s passing

Monday, June 16th, 2008

June 16, 2008 – A social worker told me once that Hospice work is the most bounded kind of social work there is. There is only one outcome. This weekend Caleb, who had suffered a series of debilitating strokes, died in his home.
Izzy and Lenore and I had visited him weekly for several months, and I wrote about this patient recently, saying this was the most difficult patient we had visited, the only place we didn’t want to go. We were supposed to see him the day he died.
I did not know him well, or become attached to him. His family did not permit photos.
He loved Izzy, and loved seeing Lenore, yet neither dog reacted to him as intensely as they usually do to the people we visit. I was never comfortable in that house, for all sorts of reasons, and I was reminded by a Hospice official not to drift towards judgment. It didn’t matter what I thought of patients, their families, helpers or environments.
We were there to help people at the edge of life, and if people felt they might be criticized, they might be even more reluctant to seek out help from Hospice or other groups. Besides, when I see what these people are going through, I understand the last thing they need is my sense of what they ought to do or say.
If you don’t want to go, I was told, then that is probably the place you should go. That was good advice. It was always a tough visit, and I rarely felt good about going, yet we cheered Caleb up every time, and seeing his face light up when he saw Izzy and Lenore, and watching him beam as they cuddled  next to him in bed or in his wheelchair proved the point: our job is to bring light into darkness, and the dogs did it well. I could have done better, tried harder. I will next time.
In some ways, Caleb was the most important patient we visited, and I am grateful for that.
I wish him safe passage. It is never easy to lose someone we have been visiting, yet the social worker is right. It is never a surprise.

A powerful day for the Soul Dog

Wednesday, April 16th, 2008

Izzy the lap dog with Barb
Izzy the lap dog with Barb

April 16, 2008 – Today was a powerful day for the Soul Dog.
I’m taking most of April to learn Hospice work, to learn more about the dying process, and train Izzy and Lenore fully, and today, for various scheduling and geographic reasons, we were on the road for hours, from the Adirondacks to Granville to a nursing home near Ft. Edward, making five different Hospice visits. It was a long day, a tiring one, and a test even of Izzy’s skills, and it was a great day, and a real opportunity to see a skilled and generous working dog do a lot of great work for human beings in need in very different circumstances.
Hospice nurses and health aides also got to work with Izzy today and that was helpful as well as instructive. Every time I see these people, I learn more about this work, and how challenging it is.
Everything about Hospice work is unpredictable and different – the people, places, circumstances, emotions. We climbed several flights of stairs in a big old house in the Adirondacks to see Caleb,  almost totally paralyzed by several strokes, and able to only move one hand. Since he couldn’t move, we had to get to him, and he smiled from ear to ear when Izzy came in, and the dog climbed up onto the wheelchair and lay still for nearly an hour while he was petted and held. The room was crowded with medical equipment, warm and cramped. And the patient was unable to communicate in ways dogs expect.
It was one of the most powerful visits we have yet made in Hospice, seeing the emotional transformation in Caleb before and after Izzy’s visits. Caleb is well cared for, yet struggling with his illness, and alone with health care aides most of the time. He was overjoyed to see and hold Izzy, and it lifted him up, and eased his struggle. We sat and talked for an hour, and I told him about the Yankees, who he loves, and about Izzy another dogs.
I left Lenore at home today because I want to continue working with the dogs alone, to train and observe them. And she has a sore leg, garnered plowing into a post after a ball.
We went to another town to see Barb, above, and she has been asking for Izzy for several days, and while Izzy sat in her lap, we worked on a poem together, which I will post tomorrow. “I was worried about him,” she said. “I was afraid something had happened to him.”
Barb is soft-spoken and exhausted, and I love the way she stares at Izzy and says, “good dog, good dog,” softly and with so much love. It is an opportunity for her to be nurturing and to open up emotionally.  Izzy responds in kind.
We then stopped off at Warren and Helen’s to bring some pansies, and Izzy spent some time with Warren. Talk of another poem there.
We went to a nursing home to see two patients, both with Alzheimer’s. Izzy, now tired, was patient, working from the floor by putting his head in the lap’s of both patients, one of whom lashed out at him in confusion. She was in a noisy and crowded hallway, with some extreme dementia patients, and it was confusing for him, a real test of his patience and calm.
I brought him back to the patient who lashed at him, a few minutes later, and both Izzy and she were calm.
Izzy’s day began at 9 a.m., and ended at 9 p.m.
I am somewhat in awe of this dog, and the skills he brings to this work, his gentleness, boundless affection, his confidence and judgment, and his ability to focus on people, as well as his agility at getting himself into tough spots and staying there for long periods. He is almost always watching me for cues, and we communicate on a different level after nearly a year of this work. He enjoys this work, but I feel now that he does this work for me, as dogs often do for humans. As our visits progress, he attaches to patients, and I think, does some of the work for them.
I would not normally work him (or me) this hard, but I had fallen behind a bit on some of these patients, and that is not an acceptable breach, especially when you realize how much it means to them to see Izzy and or Lenore.
Hospice work has to be managed, for me and the dogs, and I am closely monitored by  the Hospice nurses and staff, as are all volunteers,  but I have cleared time for this work, this month and beyond, and want to know more about it, and about how the dogs work in it.
It was a tough day, and a challenging day. It was nothing but a good day, and I am grateful for the blessing of Izzy, who not only has enriched my life, but continues to bring light and comfort to the lives of  people who very much need it.
Izzy is, in fact, a Soul Dog, by which I mean he has the ability to connect with human spirits – human souls – in tangible and meaningful ways. I do not claim to understand what is going on in his mind, but am determined that his gift, and Lenore’s growing skills,  be used whenever possible.
I don’t know if dogs have souls or not, but if they do, Izzy will get to a place with acres of sheep and bones.
He has been asleep since we got home, and I will follow shortly, once I check on the farm and the animals (a goat was running around the backyard when I got home).
Good job, Iz.

Izzy and Lenore, Barb and Caleb

Monday, March 24th, 2008

March 24, 2008 -  We started the day in Granville, spend several hours in the Adirondacks seeing Hospice patients. Long days for the dogs.
Izzy and Lenore continue to develop very different styles in Hospice work. Izzy approaches the patient head on, eyes-on-eyes, Lenore loves physical contact, sits still in  laps, lies down on people’s feet. Both elicit different responses. Izzy soothes, Lenore draws smiles.
Izzy’s demeanor suggests he wants to get to know you, and Lenore wants affection. The combination is effective. The dogs cheer up the families as well as the patients, and I notice they do become tired if they work too often, or stay too long. Monday was a long day for them, in the car for hours, into homes, schools, nursing homes, office buildings.
They are calm and quiet in the car, and seem to have boundless energy and affection.
Barb is a dog lover, who beams when the dogs come into the room. Izzy shook hands, above, and then Lenore lay down near Barb and Izzy went into a corner and watched.
I enjoy many things about Hospice work, one being the stories people tell me about their lives. Barb was a nurse for some years, and her husband was a fireman and she talked quietly and evocatively about “My Bill” and their life together. I think this may also become a poem. She is an avid animal lover, so I brought her the National Geographic story on animal intelligence, which we discussed on this blog. Also a picture of Rose. It’s a funny thing about pictures of Rose, but women, especially women that have worked, love seeing her, and pick up her ferocious work ethic in those eyes.
Rose knit and quilted before it became tough for her fingers. She said she would love to hear some poems and stories, and I have plenty of those. She has a dry sense of humor, and misses little. Times with her are quiet, soothing. She likes having both dogs around.
I want to work the dogs continuously, so they both become polished. Izzy is, Lenore is getting there. Barb clearly enjoys both dogs, so I will bring both to see her.
Both dogs also work for Caleb, below, a difficult challenge for Izzy and Lenore, as he is confined to a wheelchair and can only move one hand. Izzy stays near the hand, so Caleb can stroke his head, and Lenore lies still in his lab. He smiles when he sees the dogs, and nods vigorously when asked if they want to come back.
Lenore forages carefully around every inch of a room before she settles in to work. She is almost unfailingly appropriate now, approaching people gently, and doesn’t mouth anymore, as young Labs tend to do. I definitely see growing intuition in Lenore. She is clearly learning to be calm and focus around the Hospice patients.

Into the Wild – What my dogs teach each other (and me)

Wednesday, March 19th, 2008

March 18, 2008 – Monday, Izzy and Lenore had their longest, and in some ways, most difficult time as Hospice dogs. We saw Barb, above, in her home, and also Caleb, who has suffered from multiple strokes and who lives in the mountains also. These were alien environments for the dogs, filled with small spaces, medical equipment, and people who behaved differently, in some ways, than the dogs are used to seeing. Strange dogs were running loose everywhere. The rooms were warm, crowded, filled with different odors, humming machines.
Izzy showed his remarkable intuition and physical grace, honing in on the patients, stepping over and around tubes, cables, beds, other equipment.
Lenore is growing in confidence and calm by the visit, as shown below.  Izzy and Lenore are becoming inseparable, this work clearly drawing them closer to one another, as well as to the people they see.

And I saw this happen, which I wanted to recount:

We saw Caleb, sitting in a wheelchair, and Barb, who was sitting up in a kitchen chair.
When we saw Caleb, who can only move one hand, Izzy and Lenore were both uncertain. Izzy put his head in Caleb’s hand and left it there.
I saw changes in both dogs. Lenore, clearly, is learning from Izzy, something behaviorists had alerted me to watch for, but I was not seeing myself. Monday, I was watching for it. And I saw it.
Lenore tends to forage when she enters a room, something Labs do. Izzy goes right to work. After Izzy had spent a few minutes with Caleb, Lenore came over to see what was doing on, her tail wagging. Izzy pulled his nose out of Caleb’s hand, and then touched noses with Lenore. I would have thought this was a gesture of curiousity or affection, but alerted by the behaviorists, I realized Izzy was teaching her. He got her attention, then put his nose back under Caleb’s outstretched hand, then withdrew it.
After they touched noses, Lenore put her head in Caleb’s hand, and then licked it. She doesn’t show affection the way Izzy does – he stares into people’s eyes. Lenore licks, cuddles and snuggles.
Izzy seemed to have guided her to Caleb’s hand. And she kept returning to it, grasping the idea that we are in these places to see people, and she lets Izzy guide her, it seems to me, as to how.
Later, at Barb’s, Izzy put his head in her hand, and then Lenore did the same, and then she lay at Barb’s feet while Barb leaned over to pet her, something Izzy did twice that day, just before Lenore did. As the day wore on, Lenore did it more and more. Barb was sitting upright and I didn’t want her to have to lean over, so Izzy did his patented nose in the head approach, and Lenore nosed Barb’s hand and lay at her feet.
I now have no doubt that Izzy grasps the nature of the work we are doing, zoning in on the patients and responding to their attention and need. If they are tired, in pain, or not interested, he simply moves away. Lenore is still less certain initially, but becoming more confident with each visit, and is remarkably calm and focused.
In a remarkable scene, shown below, one of the most powerful yet in our Hospice visits, I was trying to figure out how to give Caleb a chance to feel the dog against him, and it was awkward, the room filled with furniture, and he lying back in a wheelchair, not able to move. Each visit is different, and presents its own challenges, and requires a distinct and different approach, one that is sensitive and responsive to the person we are visiting. These are powerful and intimate moments, and they deserve thoughtfulness and care.  Each visit is completely different from the other, as the circumstances of each patient – home, illness, state of mind, health – is so different. You have to clear your head each time, and approach the task with a fresh approach. Everyone wants and need something different. I felt Caleb needed affection, Barb was looking more for a personal connection. I was not sure at first how to help Caleb.
So I reluctantly – I was concerned about an anxious Lab puppy squirming, clawing or jumping – had an idea and lifted Lenore up and lay her on Caleb’s lab.
She sensed instantly what I was doing, lay down and still for almost 10 minutes, while Caleb stroked her back and smiled. I would not have imagined before that visit that I could put Lenore, a seven-month old puppy, down in that space, and have her lay so still for so long. She certainly won’t do that at home. My sense was that Caleb responded particularly to the more sensory affection of Lenore, and Barb to Izzy, to whom she kept whispering, “Good, goodl dog.”
The nurse in the room said Caleb didn’t want to get out of bed that morning, until told that Izzy and Lenore were coming, and then he eagerly nodded that he wanted to get up. I’ve decided not to show Caleb’s face in these photos, but I am sorry all of the people reading this could not see his quite enormous smile.
Dogs do teach one another, as I have been told, and have now seen clearly with my own eyes. And sometimes we have to get out of the way and let them do it.
This is one of the many reasons Hospice work is neither depressing nor discouraging, but quite uplifting. We will be back in the Adirondacks as soon as we can, and we will find at least two people eagerly awaiting us.

Caleb, Izzy, Lenore

Monday, March 10th, 2008

Ready to work Ready to work

March 10, 2008 – Izzy, Lenore and I ventured far out into the countryside today, to see Caleb, a 90-year-old who entered the Hospice program last week. Caleb can’t speak, and can only move one hand. He is a lifelong dog lover and the broad smile that erupted on his face lit up the room when he saw Izzy, and then Lenore.
Izzy is by now a Hospice supervisor, the Hospice staff jokes. He came into the house, found the stairs, rushed up to Caleb’s room, found him sitting in a wheelchair, and by the time I got up there, he had his head under Caleb’s hand.
Lenore did beautifully. She gently climbed up on the chair so Caleb could pet her, and he seemed, after awhile, to want to see Lenore, who is, after all, the Light. Izzy backed up and watched, and he seemed almost bemused by Lenore’s spotlight-stealing.
This was, in many respects, one of our tougher Hospice visits. Caleb can’t speak, so we had to pay close attention to his reactions. These are difficult behaviors for most dogs, including mine, to read. Izzy is experienced at this now, but it was new to Lenore, who seemed tentative at first (quite naturally.)
Izzy put his head in Caleb’s hand, Lenore seemed initially confused, then seemed to figure it out. At seven months, and only two weeks into Hospice work, she has not yet developed Izzy’s confidence at entering a new space, and going to work. He always has done this, but has gotten more focused, even businesslike, with experience. Izzy has changed after nearly a year in Hospice.
After a few minutes, Lenore lay at Caleb’s feet and waited to be petted.  We helped him reach his hand over and stroke her back.
He smiled repeatedly, and nodded enthusiastically when asked if he enjoyed the dogs.
Then we got Lenore to climb up and cuddle with him, which he clearly enjoyed.
We will see him again in a few days. This is a challenge for us. It was a valuable experience for Lenore, who seemed clearly to pick up on the idea that she was there to pay attention to someone in particular. I can’t be sure, and am loathe to guess about a dog’s mind, but she seemed to be watching Izzy closely, and after a few minutes, it seemed to me that she was following his lead. We will be back in a few days. This is the second time I’ve used both dogs, and it worked well, one lying down, getting out of the way, while the other worked. Good visit, by which I mean we clearly brought pleasure and comfort under circumstances that were challenging for the dogs, and for me.
Every Hospice visit is different, and asks and requires something different from the dogs, and from me. It is a powerful experience all around. The dogs seem to grasp that this matters, and they work hard. I take it seriously, and expect a lot of them, and I’m sure they sense this purpose in me.  These are important times for the people we visit, and I feel very strongly that they not be alarmed, or made uncomfortable in any way. No mistakes are appropriate here, and I suppose that is a lot of pressure on the dogs.
In addition to nursing and home care, Hospice musicians are coming in to bring Caleb some music
Both dogs collapsed when we got home and have barely moved. I’ve noticed this repeatedly in the Hospice work with dogs – they are quite drained afterwards. Lenore is always animated in the evenings, but she is lying at my feet and hasn’t moved since we got home.

By the time I got upstairs, Izzy was at work. Izzy has the touch.

Lenore calmed down quickly, kept an eye on Izzy, stayed out of the way when it was his turn.
She’s got it.