After caring for some hardy goldfish in medical school and deciding that I needed something more in my life, I adopted my first cat Mina who was unintentionally (I think) a sort of cat version of myself: brown and black, wide eyes, petite, a bit shy with some mischief bubbling under the surface. It was instantly clear that I was a cat person. I understood her need for both love and space, I could read the curve of her tail and the carriage of her body. I was told that some days when I left for work during residency- those were long days- she would yowl for a time before settling. When I returned home after a 30 hour shift she would come under the covers and sleep with me. And mysteriously, when my girls were about a year old she began obsessively licking the fur off her belly. We assumed it coincided with their increasing mobility which terrified her, but we didn’t see that it actually started around the time of my own illness. The vet prescribed Prozac which she spit out no matter how we tried to hide it. It only became clear why she was so anxious once I felt a little better; she did too and the fur grew back. Mina and I, we had a relationship.
After Mina was gone- a loss I felt more deeply than I could have imagined- we acquired two more cats, Annie, a toothless, neurotic old lady from a hoarding home who sucked us in with her big green eyes and her clearance price of $39, and Cookie, who was a kitten and is now something like a perpetually surprised, lovable panther. She can sense an upset person from across the house and has become a great arbitrator of disputes, somehow knowing who is right and making sure that she is on duty, purring at the affronted person’s side.
But with all of these cats it became increasingly clear what Andy and the girls were missing: a dog. The reason was mainly me. See, I’ve always been an observer, even as a child watching from the background. In band I enjoyed the solos and melodies, but I loved playing the harmony lines more than most. Staying behind the scenes let me understand the big picture- the interplay of the musical parts, or dynamics between people thus making me comfortable with being a part of it. But somehow I’ve never managed to do that with dogs. While they lick out of love I am squeamish of their slobber. A dog zooming, careening, mouth open, tongue out is a total mystery to me. And never mind their inelegant poses- my cats turn into perfect circles when they sleep, for example, something a dog body isn’t designed to do. Dogs are all out there in the foreground, and I am not.
It was a surprise for everyone, then, that after years of looking at adoptable dogs that were too big or too small, too furry or not furry enough, too young or too old (I actually like mellow geriatric dogs, but that’s not what we were looking for), not good with cats or kids, I saw Coretta and said I think this is the dog for us. She was in Alabama and would be delivered to New England, loved kids, and tolerated cats. Coretta was gentle, floppy eared and had thick feathery spotted fur. Stepping off the doggy transport truck on a typical northeast February morning- bitterly cold, gray, crispy snow on the ground- she became our family.
During all of this I happened to be designing a curriculum to teach my fellow doctors about empathy in medicine. In medical school, perhaps because I’m an observer, empathy and communication came naturally to me. For the most part I can read people and tailor my conversations accordingly. I’ve had plenty of missteps nonetheless- talking to the wrong woman with dementia for minutes before I realized I was in the wrong room, for example. There have been conversations with an angry family where I didn’t take a deep breath to prevent it from escalating, and moments when I left the room in tears after being insulted by a patient. But most of the time I can see hear what a patient is really saying; I get them.
So I looked for something when Coretta arrived but her face was blank to me. That first day she did her doggy things, exploring this thing called snow, sniffing the northern earth. I couldn’t read her though, and used to patting cats, I was unsure how to soothe her with touch (this handy diagram helped). Did she trust us? Did she have any recollection of the warm southern air in her former home? As the days passed I grew more puzzled. Why did this highly athletic creature not climb our wooden staircase? Fear? Where were her goofy grins? Why was she content to sleep apart from us at night when we were beyond the slippery staircase but also during the day when we were downstairs? How would we untrain the bit of her mutt genetics that caused her to herd chickens and children? And the stubbornness! When she would get distracted by a squirrel, or bored of trotting along with me I had to stand there with her trying to make her budge, pretty well convinced that I was doing it – everything- wrong. My inability to understand this living being was scary, uncharted territory for me.
There’s a lot in the empathy curriculum about observing the other person, and understanding their perspective. What I learned from Coretta is that this can be really hard to do. Like some patients, she can’t tell us much so I’ve spent a lot of time trying to take a history as we do in medicine, hoping to unlock her mystery and phrase it in language I can understand. So far I know that Coretta is a gentle soul who wants to be friends with all people, everywhere; when she pulls me across the sidewalk as someone walks by us it is because she wants to say hi to her new friend, not because she’s being naughty. Knowing that, I can prepare for it. When she starts to herd*, or when she rolls around the grass with a crazed look in her eyes- behavior that terrified me at first- it is because she is overstimulated, not unlike a sleep-deprived toddler. Getting her to focus by redirecting her brain (“Coretta, sit!”) helps as long as there are treats involved. My instinct to deep breathe with her so far has been unsuccessful to calm her, but it certainly helps me just as it does when I talk to a patient.
I’m learning how to be with Coretta when she’s acting like a young dog in training, which to me is like the angry patient no one wants to talk to, scary but you can do it and you can do it well if you try. It seems so obvious but I’ve found that she will listen to me only if I listen to her. For example when we’re running along together, me thinking happily that the scene we have here is a girl and her dog, like we’re a curated Instagram post, and then Coretta comes to a screeching halt snuffling out something in the dirt that she must uncover right there, right now, I try not to get frustrated that I cannot tow a 60 pound obstinate beast. Instead, I inhale-exhale, rattle my treat bag, show her that I have something yummy that’s better than a vole in a hole and get started again, slowly at first then building up speed. And soon enough we’re running again, her tail and my hair streaming behind us, in step until the next rodent sighting. Coretta is my guide and I am hers. So too with patients. Doctors and patients must guide each other in conversation because no matter how many catch phrases we learn in medical school, empathy isn’t a one size fits all solution and there are going to be distractions along the way.
It isn’t perfect yet with Coretta but I’m building an understanding of dogs, mostly by observing and listening to her and paying attention to my response. When I look back at the first day photos I can see that her face looks reserved and definitely sad. But, guess what? She smiles now. She just needed some time, I think.
*herding children sounds cute and funny, but herding dogs mean business. After all the dogs are bred to corral animals that weigh a couple hundred pounds. Here’s a great video that demonstrates it- you can get a sense in the first few minutes.
Loved this insight into the parallels everyday life has with patient care! And sometimes, it all just takes some time and perspective!
Loved this! And the treat bag is key to any situation!!
I had no idea- but it is so necessary!