Hospice care: The best man for the job is a dog

He looks at me with his big brown eyes, lays his warm blonde head in my lap and I am besotted.

It's not every day that I fall head over heels in love with the subject of an article, but then again Rian, the therapy dog on the palliative care ward at Our Lady's Hospice and Care Services in Harold's Cross, Dublin, is no ordinary interviewee.

The golden retriever came to the hospice when he was 12 weeks old and, apart from a few incidents – including a missing slipper or two and the day he inadvertently ate the baby Jesus from the crib – he quickly became everybody’s favourite colleague.

At just two years old, Rian has some pretty big paws to fill. His predecessor Cashel, a beautiful golden Labrador, lived and worked in the hospice for 10 years from 1995 to 2005.

Cashel was the hospice’s first dog and one of the first resident therapy dogs in the county. Remembered with great fondness by all who had the privilege to meet him, this writer included, Cashel sadly passed away in 2006 after a decade of loyal service to the hospice’s patients, staff and visitors.

One staff member who remembers Cashel well is Noreen Holland, assistant director of nursing and palliative care.

Cashel came to the hospice as a fully trained guide dog who had failed his final assessment over problems negotiating traffic lights. The guide dogs’ loss was the hospice’s gain however, as Cashel quickly settled in to become a much loved member of staff.

Innate sense

“I was the staff nurse here on the ward. I worked days and nights and Cashel accompanied us. He just seemed to sense when patients were feeling sad. When a patient’s condition was changing he seemed to sense that and he would walk towards that bed and sit by that patient. He just had an innate sense of knowing where to be, and when to be there, we weren’t able to explain it. He just had very special intuition,” Holland recalls.

It might be a new patient who was anxious about being in the hospice, a distressed patient, or one nearing the end of life. Whatever it was, Holland says, Cashel sensed the anxiety and would quietly pad a bit closer, perhaps lay his big golden head on the bed in an effort to ease the patient’s distress.

“He would just be there, and his presence seemed to dispel the anxiety for people.”

Cashel also prevented patients from falling on several occasions.

“When people come into a hospice they are weaker sometimes than they realise . . . they forget sometimes that their legs aren’t strong enough to hold them, so they get out of bed and fall. But Cashel was always there. When a nurse or care assistant saw Cashel move towards a bed they knew to go after him because there was a need. So we are convinced, particularly at night, that he prevented falls.”

Cashel became particularly attached to one of the consultants who worked at the hospice and used to meet him at the entrance to the ward every day and accompany him on his rounds.

“He would actually do the medical rounds with the team. He would go from bed to bed . . . it worked well because a lot of members of the team bought into the idea of a therapy dog on the ward.”

Unlike Rian, Cashel lived on site in the hospice and, towards the end of his time there, Holland says they felt he was getting a little depressed. Despite having a lot of holidays offsite and long daily walks in the park or the beach, the burden of being there all the time was becoming too much.

Cashel officially retired in 2005. His ashes are interred under a Japanese Maple tree in a pot on the grounds and there is a bench dedicated to his memory in the hospice garden. A photo of Cashel also takes pride of place in the hospice where he can keep a watchful eye on his young successor.

New kid on the block

The decision to get another dog wasn’t easy for the hospice as Cashel was so special, however in November 2014 when staff were presented with 12-week-old Rian any reluctance quickly melted away.

Rian is owned by the hospice but has three foster “mums”.

He lives most of the time with Carol Lynam and her family. His other main carers are Linda Tobin and Leona Butterly; all staff members at the hospice.

Holland explains that Rian works the same shift as a nurse at the hospice, 39 hours a week, and he starts work every day at 7.45am on St Catherine’s palliative care ward.

Like his predecessor Cashel, Rian is beginning to tune into people’s needs. Holland recounts a story told to her by the relative of a patient who recently passed away at the hospice.

“There was a man very close to dying and his wife and daughter decided they would go to the day room for a break, and Rian stood in their way. He wasn’t aggressive or anything, he just stood there. When they went to go around him he moved and stood in front of them again, so they somehow changed their minds and decided to remain in the room. A few minutes later that man died. So that lady is absolutely convinced that Rian instructed her to go back in the room. She will be saying that for the rest of her life, that he steered them back into the room.”

According to Holland the presence of a dog “distracts people from the reality” of what is going on in their lives.

She says Rian’s presence is particularly beneficial for people who are nervous about coming to the hospice. Therapy dogs also offer wonderful companionship. “I think it’s the same feeling people get from their pets . . . they are therapeutic for people regardless whether they are a trained therapy dog or not. I think it is something that is innate in dogs to show love and companionship when people are in need.”

Holistic approach

Audrey Houlihan, chief executive of Our Lady's Hospice, says therapy animals are a great addition to any healthcare environment as they "create an environment of home".

“I think it really ties in with our whole holistic approach to care, the home from home environment that we are trying to create.”

The hospice also facilitates visits from patients’ own pets. Some of the more unusual “visitors” included a horse and some fish.

“We have had strange requests but we try to facilitate them all. We had a horse come to visit a lady. She was very much part of the lady’s life and she actually came to the window and got the opportunity to greet her . . . it’s very uplifting”.

Houlihan says Rian’s presence on the wards benefits patients, visitors and staff alike.

“You can feel quite vulnerable both as a patient and as a visitor and . . . to see Rian come up to you, and have your attention taken in a different direction, can really help at a difficult time.”

One of Rian's biggest fans at the hospice is Penny Butler who has been a patient there for a number of months.

“He is wonderful. He will come and sit with you and put his head on your lap. He just takes your mind off other things and he will woof at you if you don’t pay attention to him, which is good,” she says.

Butler, who has three dogs of her own, says Rian is “a reminder of home”.

“I think it is a great idea having him in here . . . seeing a dog wandering around, it is a lovely thing.”

Linda Tobin, care assistant at the hospice and one of Rian’s foster mums, explains that when on duty Rian wears a special coat and potters around the ward. “Rian has a spot at the top of the ward and he sits there. Most of the patients know that if you give him a nod he will come straight over . . . often if a patient is having a bad day we will bring Rian down and the patient could sit with Rian for hours and just rub his head. It is very therapeutic and very comforting for the patient.”

Rian gets regular walks throughout the day and goes on a number of “puppy play-dates” to get used to other dogs. His carers also have dogs at home so he is well used to socialising with other animals and come clocking off time he gets to play and be a regular dog at home.

While Rian is undoubtedly a wonderful addition to the hospice team, Tobin says having a therapy dog is “a huge commitment”.

“There has been a lot of work put in with Rian . . . every few hours he needs to be brought outside; the training is ongoing. We have to stick to the commands and give tough love a lot of the time. It was a big commitment and hard work, but very much worth it.” She smiles.