I wear 2 hats in the hospital. First, I am a hematology/ oncology fellow. In this role, I am responsible for seeing consults, primary patients, and patients in clinic. There are hundreds of other heme/onc fellows around the country, all doing the same things that I do. My second hat is my more unusual one; I am also a registered therapy dog handler. 

During my residency, one of our rotations was in a community hospital away from the inner city university where I did most of my training. At this community hospital, I was first introduced to therapy dogs. At the time, I had no experience with therapy dogs and really didn’t know anything about them. These dogs are normal house pets that do extraordinary things. To work as a therapy dog, the animals must be older than 1 year and have exceptional manners and behavior. Their job is simple: to provide joy and smiles. One day, a therapy dog may have an entire nursing unit doting over him; the next may be spent with a very sick patient and her family. Another day, a therapy dog and his handler provided answers to questions about “How is this dog here”…questions from me, a resident near the end of a 30-hour shift.

I have always had a dog in my life. While I was growing up, my family had many different kinds of dogs in our home: Golden Retrievers, Irish Setters, Newfoundlands, and Chow Chows. Once I was in college, then medical school, I had little time to raise and care for a puppy. That didn’t stop me from dreaming, though. I knew that an English bulldog would soon be my pet. I also knew that I could not raise one alone. I was lucky that my future wife Anjaly fell in love with bulldogs as well. Our engagement consisted of her receiving a beautiful diamond, and her present to me was my first dog of my own, an English bulldog puppy we named Princess Danger Curley.

Princess Danger was never intended to be a therapy dog. She came into our home as a pet, a goofball who immediately stole our hearts. The funny thing is that she not only stole our hearts, but that of anyone who met her. She would roll on her back and kiss faces, and was a sweetheart to everyone she met. She left us no choice in the matter—she was clearly born to be a therapy dog! Waiting until she was a year old seemed like overkill, since she was ready at 8 months. Within a month of her first birthday, we scheduled her session to become certified. After 3 sessions, we had our own certified therapy dog.

We didn’t start small. We applied for her to be one of HUP’s Pups at the Hospital of the University of Pennsylvania (HUP). Her certification and vaccine reports were a start, but were not enough for HUP. She underwent a full veterinary examination and passed with flying colors. Her next test was with a veterinary behavioral psychologist, the final test prior to her entering the hospital. We were not surprised that she did not disappoint. She had her ID card picture taken the very next day. She was now a hospital therapy dog with patients to see.The first day we took her to the hospital, my nerves were on edge. I was entering not as a doctor, not as a patient, but as a handler. My sole responsibility was to make sure that my dog was well behaved and appropriate. Her first assignment was the Surgical Intensive Care Unit (SICU) where the head of the therapy dog program walked us through the unit. She gave her love to the nurses’ station and proceeded to see patients. She did this for months, approximately once a week. Her visits lasted between 90 minutes and 2 hours (which is standard for therapy dog visits). Patients laughed, cried, and told me about their dogs. Danger smiled, rolled around, and loved every moment of the scratching and attention she received. She was a rock star at HUP, but we were both leaving to a new city and job at West Virginia University (WVU).I started my hematology/oncology fellowship at WVU and immediately loved what I was doing. Oncology was truly my calling, and each day that passed showed me that I had made the right decision. Therapy dogs were conspicuously absent at WVU and

Princess Danger was the perfect dog to fill that role. She started as a visitor, and soon turned herself into a regular at the cancer center. She first won over the nurses, followed by the staff and patients. She makes both outpatient and inpatient visits at the clinic and hospital, and some of her best work is with those receiving chemotherapy. Chemotherapy visits are typically outpatient (but can sometimes be inpatient) and can last many hours over months, even weeks. These patients love seeing her, as her visit is a bright spot during their time at the cancer center or in the hospital. She has made countless people laugh, smile, and some cry, but there is one experience that I will never forget. Princess was making her rounds on the oncology floor as usual, when a nurse asked if she could come see a dying patient. He had a very aggressive form of leukemia that he had fought valiantly, but he had lost the battle. He was on comfort measures, being given only medications to make his last days of life as comfortable as possible. He was much younger than his sunken eyes showed, as I was able to tell by his young wife and high-school-aged daughter. They were obviously having such a tough time with his imminent death. I thought about how hard it must be for him and his wife. They had spent 18 years raising their daughter, and now he was dying as she was about to become an adult, and her mom would be left alone.

Princess entered the room with her normal amount of energy. The patient could barely move, and each breath caused him pain. His daughter and wife were at his bedside, and the true therapy began. My 40-pound love bug hopped in their laps and cuddled up like she hadn’t done before. She knew they needed it, and they truly latched onto her. We stayed for almost 2 hours. They talked about their loved one, but were mainly distracted by Princess Danger. She showered them with love and affection, and moved them both to tears. I knew she truly made a difference, but I didn’t yet know how much she had done to change their lives.

I started taking care of the unfortunate gentlemen as a patient the next day, caring for him and his family. His wife never left his side. His daughter was gone for the day, but I didn’t ask where she was. I can’t really imagine the level of emotion she was going through, losing her father at only 18. The next day I was in the physician workroom when a nurse asked me urgently to come to the unit. Usually this means that someone is gravely ill and needs immediate attention. That day, that was not why I was called. In the hallway, I found a bouncing, happy, 12-week-old English bulldog puppy, freshly picked out by the patient’s daughter the day she was not in the hospital. She was so happy to have her own little bundle of love, and that puppy picked up the staff’s morale that day. I spoke with the patient’s wife; she couldn’t say no to a puppy at that point. She told me that the dog was helping them get through the hardest days of their lives.

The patient died the day after the puppy joined their family. He passed peacefully, surrounded by his family. I was at his bedside and let them know that he had died, and their emotions came pouring out. The family left that day broken, their husband and father taken from them prematurely and unfairly. Cancer is not a fair disease, especially when it relentlessly attacks the young and innocent. We did everything we could to save his life, and in the end we could not succeed. However, Princess Danger had changed their lives forever. I am sure that when they look in the eyes of their dog, they will not only see their lost loved one, but will always remember the day my therapy dog changed their lives.

Brendan Curley, DO, MPH, is a hematology/oncology fellow at the West Virginia University School of Medicine, Mary Babb Randolph Cancer Center, Morgantown, WV.

Articles

Princess Danger was never intended to be a therapy dog. She came into our home as a pet, a goofball who immediately stole our hearts. The funny thing is that she not only stole our hearts, but that of anyone who met her.

Canine Caring: A Therapy Dog for Cancer Patients

“Don’t quit.” These are words of wisdom passed down from one oncologist to one in training. Two months into my fellowship, I had the opportunity to listen to Dr Siddhartha Mukherjee, Pulitzer Prize—winning author of “The Emperor of All Maladies,” speak at my home institution. This was his simple answer to a very complex question: I had asked him what advice he had for a first-year fellow. The message behind that simple statement speaks volumes abut how difficult and taxing an oncology fellowship can be. It is amazing that after 4 years of medical school, 3 years of internal medicine residency, and countless interviews that quitting would even be an option. We work so hard to become a fellow, to become an oncologist, but when we get there, sometimes we wonder what we got ourselves into.

As an internal medicine resident, you essentially have an idea of what your day will entail when you wake up. You arrive for work, see your patients, go to morning report, round, attend conference, rinse, wash, and repeat. There are days when things are different; a transfer to the intensive care unit, a difficult family talk is all par for the course. Things change when you become an oncology fellow, though. It is difficult to label them as good or bad, but perhaps it’s best summarized that the unexpected is now a routine. The average day as an oncology fellow is best described as riding a rollercoaster in the dark, without sound. There is no clicking in anticipation of the big fall, no ledge in front of you to warn of the impending drop lurking ahead.

As the consult fellow, when the pager goes off, anything can be waiting at the other end of the phone. If it’s a benign hematologic issue, a thrombocytopenic patient is intellectually stimulating and patients rarely fear seeing the hematologist. However, when the oncologist comes into the room, the intensity and attention are heightened. Patients truly listen to every word, hanging on what is being said. You don’t notice this on day 1, nor does it take until the end of your fellowship; but at some point it clicks in your head. This is the worst day of this patient’s life, and I am playing an integral role in it. Cancer is now a stigma that they carry, a survivor is something they long to become.

Words that had different meanings to patients become routine; cycles, palliation, neutropenia are all terms that oncology patients understand but were likely foreign to them prior to their diagnosis. We introduce this metamorphosis to them, changing their vocabulary and views on their mortality. We are there for the worst day of their life, more times than not. It is difficult, it is draining, and it can become very emotional. Remember to lend a shoulder to cry on, a hand to touch, and silence to let them absorb the news. Our patients are human, and we are strangers entering their lives, seeing them at their height of emotional vulnerability. Show them that you are human and that you care. Unless we have been through the diagnosis ourselves, we can never truly understand, only empathize. There will be days when you will sit in your car for an extra moment, or sink further into the couch than normal. A long stare at a PET scan will not change that progression, will not make the tumor marker go down. Silently asking yourself why you are doing this is normal (I hope!) and something that we all experience. It lets you know that you are human, that bad days for you are not nearly as bad as they are for the patients who are receiving that news.

The other side of that coin is why we are able to continue with this job and don’t flee to a specialty with less stress or leave medicine altogether. The good news, the post chemotherapy visit with a patient can be amaz - ing. We all love to show a clean PET scan, or a neg ative tumor marker. I have observed my attending physicians and notice myself linger in the room with these patients, soaking it in. We walk with a spring in our step into their room, excited to deliver that good news. Tears flow, smiles break out, and what follows is rarely a hard discussion. We all exhale, and breat he easier, whether we notice it or not. The follow-up patients who are no long er receiving chemotherapy are terribly nervous when coming to the cancer center. Oncology center emesis has been described prior to our modern-day anti-emetics; stress-induced hypertension is now routinely seen as patients fear the devil they know making a return with a vengeance. Oncologists rarely speak of their failures, of the early stage patient in which things went terribly. We instead remember the exceptions, the miracles, and the patients that prove the textbooks and us wrong.

As oncologists, we have to be optimistic, as our treatments are not 100% effective for all patients. That is why our ultimate goal while training should be to further the field, to make advances in treatment options and therapeutic decisions. The National Comprehensive Cancer Network (NCCN) states that the best treatment for a patient is a clinical trial, and that is something we should all think about for every patient we evaluate. Clinical trials offer advancements in the field and are the reason why we have the therapeutic choices available today. Without oncologists screening appropriately and patients choosing the unknown for their future, the field will become stagnant. It is our responsibility as fellows to start thinking this way early in our careers so not only will our patients have better outcomes, but also the oncology fellows that we will someday train will have more options and better choices than we do today.

This is an essay written at the end of the first year of an oncology fellowship that was filled with ward months seeing leukemia, lymphoma, solid malignancies, and multiple hematologic abnormalities. In the future, I may look back at this essay and see myself as naïve, truly optimistic, and not yet weathered and jaded from years of success and failure. What I have learned can be summarized here, as many of us do while looking at consults or book s, by skipping to the end. Remember: don’t quit! There are good days and bad days for us, but no matter how high the high or low the low, the patient is the one with the disease. Screen and enroll patients in clinical trials, as research brought us the treatment choices we have today. Dr Michael Craig, one of my mentors in fellowship, left a note near the fellows’ microscope. I have stared at acute leukemia through those eyepieces, and made therapeutic decisions and diagnoses that changed people’s lives. The note encompasses what we do, what we represent as oncologists. It reads: “Cancer sucks. What can you do? Call me with questions.”

Brendan Curley, DO, MPH is a hematology/oncology fellow at the West Virginia University School of Medicine, Mary Babb Randolph Cancer Center, Morgantown, WV.

"Don't quit." These are words of wisdom passed down from one oncologist to one in training. Two months into my fellowship, I had the opportunity to listen to Dr Siddhartha Mukherjee speak at my home institution. 

Brendan Curley, DO, MPH

Articles

Canine Caring: A Therapy Dog for Cancer Patients

A Word From Your Fellows: Don't Quit