The misery dog and the dolphins

Hail,
Don't know if I've mentioned this before, but ...

Florey used to have a dog on the staff.

He (at that time) worked on the palliative ward, ward 1E at Florey, the ward where the dying happens. Just down the corridor from cancer, across the hall from paediatrics, set apart by itself in a small, secluded area.

1E looked different, felt different. You could walk down the corridor, passing from one (relatively large) room to the other. The way I remember it, nothing was white, everything was soft pastel or rich and dark. There were carpets and rugs on the floor, paintings on the walls. Wooden bowls of potpourri, music, rosemary and camomile.

The usual definition of paliiative is negative, a medical practice defined by what it does not do: "relieving or soothing the symptoms of a disease or disorder without effecting a cure". An absence rather than a presence. Medicine goes so far, via surgical steel, precisely calibrated doses of poisons, Xrays and scans that look through you, until it can do no more... and then everything becomes palliative. Palliate is what we do when we can't cure. In a way not part of reductionist "real medicine", a refuge for those who don't have what it takes to cut and cure.

But there is another definition, one that seems to me to accord better with the observation that the palliative wards are full of colour and scent and peace, and ours (emergency, medicine, surgery) are empty and white. In this usage palliative is "moderating pain or sorrow by making it easier to bear": the primary function of medicine. The highest, not the lowest, the principal, not some secondary or tertiary discipline. Before we are anything as doctors we should become specialists in palliative care.

But I digress. Jackson the palliative dog.

As part of the palliative care's approach to the dying, they applied for and were granted permission to have a dog - the only dog on hospital premises (in a similar fashion, the only ward in Shipton that still contains a smoking room, at least until a few years back, was the psychiatric ward). Jackson was a medium sized beagle-brillo pad cross, affectionate to the point of clinical mania, and soon became
the most loved, and the most therapeutic staff members of staff.

Anyway, said dog was loved by all, and comforted a countless number of people in their dying days, and all was well.

For the first six months. And then someone noticed Jackson was off his food. A nurse weighed him and it seemed he had lost weight. He began to slink rather than lollop, to lie by his waterbowl rather than climb onto laps, and eventually people thought they'd better tell Prof Kraepelin, because Jackson was nominally his dog, and if they were going to send him off to the vet, bloods and a CT scan, Dr Kraepelin ought to know.

Prof Kraepelin, by the way, was the reason I went through medical school wanting to be a psychiatrist. He was white-haired, softly spoken, learned... and if it doesn't seem too odd a phrase, he gave the impression of wisdom. He had developed the anorexia nervosa unit where most of us had our first experience with psychiatry, and was a champion of the new approach and research that had bought the mortality rate down from twenty percent in the late sixties to the current "unacceptably high" three percent.

Professor Kraepelin listened to the story with grave face (I still remember the lecture theatre whjere he told us this. The silence, the serried rows of attentive faces, the low, carefully modulated voice), and gave his diagnosis.

Is it not possible, he said, tha Jackson is depressed? Or rather, is it possible that, having seen so many of the people he so demonstrably loves die within a few months, that he is grieving?

Anyway, the upshot of this is the palliative dog became something of a hereditary office, like the King of England, or the Phantom. They get dogs in for three to six month stretches, usually from the pound, and then someone takes them home. Some are affectionate, some relatively withdrawn, some dignified, some shy... but all of them as important and therapeutic as the man who cleans the floors and the woman who runs the pharmacy.

Anyway, here endeth the lesson. But I should point out that recent research indicates that dolphins are a successful treatment for depression*. I have brought this to the attention of the head of the ED, but as yet they are not stocked by our pharmacy.

Thanks for listening,
John