J Cb E+Umbl Vol. 43, No. 2,
pp. NW-190, 1990
0895-4356/90$3.00+ 0.00 Pcrgamoo Pma pk
Printed in Great Britain
Second Thoughts A MEDICAL HOMILY: OLD DOGS DO TEACH NEW TRICKS
2525 NW Lovejoy, Portland, OR 97310, U.S.A. (Received 8 May 1989)
I have an old dog, an 18 year old African Black Bush terrier. In simple arithmetic of 6 years of human for 1 year of dog life he factors out at about 108 and he shows it. His muzzle has turned pure white which gives the impression he has been sticking his head in a flour barrel, for the white shades through grey to a jet black back and tail. He is a small mutt; you have to lean far over to pat him which I have pretty much given up doing since his age shows up in attitude as well as body. He growls when touched, even when touched with the best intentions. In fact my dog is a catalogue of aging, querulous, indolent, incontinent and impatient at even the slightest deprivation, say breakfast not forthcoming at 5 a.m. He regularly awakens my wife and me before dawn with an intermittent whine which grows to a crescendo of wailing, if not keening, sounding like an ancient refrigerator complaining of worn out bearings, all for an early breakfast. Giovanni, that is his name, is the last one in the world who you might look to for teaching new tricks but in his senescence he has proved himself a master instructor in the art of love. At least he has taught me some new tricks, which I think are worthy for the entire medical profession reflecting on, what St Paul refers to as the greatest quality of all, “charity”. Our relationship, Gio’s and mine, has been flawed from the very start for I have expected too much of him since he was a pup. To begin with there is the matter of his name I called him Giovanni, out of my respect for Giovanni
Bellini (1430?-1516), a master of painting the school of the Venetian Renaissance; respect born of the artist’s mastery of expression, dark canvases slashed with bolts of lightning revealing the vital symbol of a pregnant woman, burgeoning plants, vibrant life shooting up through dim landscapes replete with crumbling ruins. I wished to find in my pup some reverberation of a refined Italian sensibility. Too much, for at best all he did was jump and bark when I came home or run wildly about our precise backyard, circling me in breathless orbits more like an American Indian than a Venetian lord. No fetching for this canine, only a continual tug of war over the ball. None of the discipline of a sophisticated hunt in the woods for us. At the beach he was at his wildest, off across the sand, completely on his own, searching for a dead seagull for an indecent roll in the rotting remains. To give dimension to my how much I wronged my dog with false expectations I must acknowledge his breed is my complete fabrication. Early on I concealed from a knowing friend that I had bought him at the pet counter in a local supermarket and asked what he thought of Giovanni’s background. He paused a minute and said, “Perhaps part rat terrier.” This too much for such a small, muscular bit of flesh with an audacious wiggle to his walk that would put a wart hog to shame, with teeth long enough to initimidate a panther, with enough hsty spirit to worry a bull elephant. Since he had the game I gave him the name, an ancestry, wholly factious, of the great and imaginary 189
190
Second Thoughts
breed of African Black Bush terriers. I thought he would relish coming from such an illustrious line but no, he just went on being a hairy individual who defied all my hopes for his glory. He has never forgiven me. In fact our relationship of late has gone even further downhill from its low start. Not that we are, or ever have been enemies, but with age, his and mine, simple family disagreements, like, “It is time to go out” meet with embittered opposition. In part he has the natural resistance that goes with deafness, and though he never shouts back at me, “What did you say!“, he remains aloof with sneering distrain to my, for him, muffled commands and foot stamping. He has lost the sight in his right eye and the left is occluded with a ripening cataract which leaves him with a propensity of growling at aggressive chair legs and stumbling down steps. Yet gratitude never colors his response to my carefully lifting out of his basket to dispatch him “out”, only a growl with predictable snap at where I grasp him under his chest. Of all his infirmities none prove as unsettling as his breath. Through the years his teeth have unwittingly accumulated a vast crust of plaque which ferments his favorite food, cat chow-no gourmet Giovanni-and slavered foam gives off a wretched, purulent odor which hangs like a cloud about his head. Nor has this condition gone unnoticed by the vet at Gio’s regular physical examinations. In fact during one recent visit the vet explained that the plaque could be removed with a flick of the fingernail and then went on to demonstrate only to end up with a bloody finger. All of which leads me to see a glimmer of respect for me from the old dog since he never bites me, which he does frequently, hard enough to break the skin. Oh, he is still full of surprises. Take for example his ability to sham death. My wife and I have composed a living will for the scoundrel. No heroics for him when he can no longer get around. It will be a call to Dr Werner who has cared for him since he was a pup and away he goes. But what do you do with a dog who plays dead, and I mean stone cold dead? It is not uncommon for my wife to return from a shopping trip to find him “as one dead”, his body twisted into a strange shape, captured by the sides of his basket, his geriatic creche, splayed legs at every angle give signs of a final convulsion, his head catiwampus over the edge of the basket, nose thrust into the carpet, jaws agape with tongue lolling on its own, eyes open in a
fixed stare, not a twitch, not a breath, or so it seems until wife exclaims tearfully, “Oh poor dog, he is gone. You better get the shovel, Ralph”. Then he will let out a flatulent gasp, which might pass as giving up the spirit, but is actually just a command to the now independent parts of his little body to get organized and renew his whining demand for dinner. Lest you think there is little wisdom to so much description bear with the moral of the tale. There is a palpable connection between our relationship, Gio’s and mine, and making rounds on a hospital geriatric service or in nursing home, for here is where I have been taught a new trick by an old dog. He teaches me, every time I catch him again in command of his world, that where there is life there is spirit. From time to time he “takes over” and I come upon him standing in the middle of the living room, four square, legs braced against the natural sway which comes with advanced age, nose up, ears alert, blind eyes fixed on an undisclosed horizon, back in his youth, in his imagination searching the backyard for invading squirrels, birds or cats. He is fully alive-+very bitter sweet part of him prepared to do his duty until he dies. There is no gratitude should I pick him up and slip him back in his basket. Certainly, he thinks of me as just another unwarranted meddler unworthy of more than a perfunctory nip. No, gratitude is in the. other’s heart, for Giovanni has taught me how to think and act when I enter a geriatrics ward. He has taught me what lies behind the unpleasant smells, the disagreeable messes, the moans and groans, the calls to the weary, overburdened nurse. He has given new meaning for the incontinent, blind, deaf, irascible patients weakly struggling against their bed bars. They have become more than an echo of Giovanni. Much as the earth is part of the sun and the moon a part of the earth, they are a part of him as he is part of them. You see my dog has taught me that I am part of him and thus a part of the sea of suffering that surrounds me. He has taught me even more, for to be part of him, I partake of security and dignity in old age. As certainly as he knows who he is so I can know who I am. All of which is no mean feat for an old dog to teach a physician a new trick. I only wish he would include a few more practitioners. Our profession could do with a new trick in which we learn, and relearn that the soul of compassion is how much we are a part of our suffering world.
pp. NW-190, 1990
0895-4356/90$3.00+ 0.00 Pcrgamoo Pma pk
Printed in Great Britain
Second Thoughts A MEDICAL HOMILY: OLD DOGS DO TEACH NEW TRICKS
2525 NW Lovejoy, Portland, OR 97310, U.S.A. (Received 8 May 1989)
I have an old dog, an 18 year old African Black Bush terrier. In simple arithmetic of 6 years of human for 1 year of dog life he factors out at about 108 and he shows it. His muzzle has turned pure white which gives the impression he has been sticking his head in a flour barrel, for the white shades through grey to a jet black back and tail. He is a small mutt; you have to lean far over to pat him which I have pretty much given up doing since his age shows up in attitude as well as body. He growls when touched, even when touched with the best intentions. In fact my dog is a catalogue of aging, querulous, indolent, incontinent and impatient at even the slightest deprivation, say breakfast not forthcoming at 5 a.m. He regularly awakens my wife and me before dawn with an intermittent whine which grows to a crescendo of wailing, if not keening, sounding like an ancient refrigerator complaining of worn out bearings, all for an early breakfast. Giovanni, that is his name, is the last one in the world who you might look to for teaching new tricks but in his senescence he has proved himself a master instructor in the art of love. At least he has taught me some new tricks, which I think are worthy for the entire medical profession reflecting on, what St Paul refers to as the greatest quality of all, “charity”. Our relationship, Gio’s and mine, has been flawed from the very start for I have expected too much of him since he was a pup. To begin with there is the matter of his name I called him Giovanni, out of my respect for Giovanni
Bellini (1430?-1516), a master of painting the school of the Venetian Renaissance; respect born of the artist’s mastery of expression, dark canvases slashed with bolts of lightning revealing the vital symbol of a pregnant woman, burgeoning plants, vibrant life shooting up through dim landscapes replete with crumbling ruins. I wished to find in my pup some reverberation of a refined Italian sensibility. Too much, for at best all he did was jump and bark when I came home or run wildly about our precise backyard, circling me in breathless orbits more like an American Indian than a Venetian lord. No fetching for this canine, only a continual tug of war over the ball. None of the discipline of a sophisticated hunt in the woods for us. At the beach he was at his wildest, off across the sand, completely on his own, searching for a dead seagull for an indecent roll in the rotting remains. To give dimension to my how much I wronged my dog with false expectations I must acknowledge his breed is my complete fabrication. Early on I concealed from a knowing friend that I had bought him at the pet counter in a local supermarket and asked what he thought of Giovanni’s background. He paused a minute and said, “Perhaps part rat terrier.” This too much for such a small, muscular bit of flesh with an audacious wiggle to his walk that would put a wart hog to shame, with teeth long enough to initimidate a panther, with enough hsty spirit to worry a bull elephant. Since he had the game I gave him the name, an ancestry, wholly factious, of the great and imaginary 189
190
Second Thoughts
breed of African Black Bush terriers. I thought he would relish coming from such an illustrious line but no, he just went on being a hairy individual who defied all my hopes for his glory. He has never forgiven me. In fact our relationship of late has gone even further downhill from its low start. Not that we are, or ever have been enemies, but with age, his and mine, simple family disagreements, like, “It is time to go out” meet with embittered opposition. In part he has the natural resistance that goes with deafness, and though he never shouts back at me, “What did you say!“, he remains aloof with sneering distrain to my, for him, muffled commands and foot stamping. He has lost the sight in his right eye and the left is occluded with a ripening cataract which leaves him with a propensity of growling at aggressive chair legs and stumbling down steps. Yet gratitude never colors his response to my carefully lifting out of his basket to dispatch him “out”, only a growl with predictable snap at where I grasp him under his chest. Of all his infirmities none prove as unsettling as his breath. Through the years his teeth have unwittingly accumulated a vast crust of plaque which ferments his favorite food, cat chow-no gourmet Giovanni-and slavered foam gives off a wretched, purulent odor which hangs like a cloud about his head. Nor has this condition gone unnoticed by the vet at Gio’s regular physical examinations. In fact during one recent visit the vet explained that the plaque could be removed with a flick of the fingernail and then went on to demonstrate only to end up with a bloody finger. All of which leads me to see a glimmer of respect for me from the old dog since he never bites me, which he does frequently, hard enough to break the skin. Oh, he is still full of surprises. Take for example his ability to sham death. My wife and I have composed a living will for the scoundrel. No heroics for him when he can no longer get around. It will be a call to Dr Werner who has cared for him since he was a pup and away he goes. But what do you do with a dog who plays dead, and I mean stone cold dead? It is not uncommon for my wife to return from a shopping trip to find him “as one dead”, his body twisted into a strange shape, captured by the sides of his basket, his geriatic creche, splayed legs at every angle give signs of a final convulsion, his head catiwampus over the edge of the basket, nose thrust into the carpet, jaws agape with tongue lolling on its own, eyes open in a
fixed stare, not a twitch, not a breath, or so it seems until wife exclaims tearfully, “Oh poor dog, he is gone. You better get the shovel, Ralph”. Then he will let out a flatulent gasp, which might pass as giving up the spirit, but is actually just a command to the now independent parts of his little body to get organized and renew his whining demand for dinner. Lest you think there is little wisdom to so much description bear with the moral of the tale. There is a palpable connection between our relationship, Gio’s and mine, and making rounds on a hospital geriatric service or in nursing home, for here is where I have been taught a new trick by an old dog. He teaches me, every time I catch him again in command of his world, that where there is life there is spirit. From time to time he “takes over” and I come upon him standing in the middle of the living room, four square, legs braced against the natural sway which comes with advanced age, nose up, ears alert, blind eyes fixed on an undisclosed horizon, back in his youth, in his imagination searching the backyard for invading squirrels, birds or cats. He is fully alive-+very bitter sweet part of him prepared to do his duty until he dies. There is no gratitude should I pick him up and slip him back in his basket. Certainly, he thinks of me as just another unwarranted meddler unworthy of more than a perfunctory nip. No, gratitude is in the. other’s heart, for Giovanni has taught me how to think and act when I enter a geriatrics ward. He has taught me what lies behind the unpleasant smells, the disagreeable messes, the moans and groans, the calls to the weary, overburdened nurse. He has given new meaning for the incontinent, blind, deaf, irascible patients weakly struggling against their bed bars. They have become more than an echo of Giovanni. Much as the earth is part of the sun and the moon a part of the earth, they are a part of him as he is part of them. You see my dog has taught me that I am part of him and thus a part of the sea of suffering that surrounds me. He has taught me even more, for to be part of him, I partake of security and dignity in old age. As certainly as he knows who he is so I can know who I am. All of which is no mean feat for an old dog to teach a physician a new trick. I only wish he would include a few more practitioners. Our profession could do with a new trick in which we learn, and relearn that the soul of compassion is how much we are a part of our suffering world.
