tag:blogger.com,1999:blog-56813840126611694792024-02-18T20:45:11.959-08:00The Art of Barke DiemCombining the love of dogs with a passion for hospice work.
Making the most of each day, just as our dogs do.Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-5681384012661169479.post-27689724041223209422021-03-28T18:20:00.007-07:002021-03-29T10:43:26.815-07:00The Tiniest Goodbye<p><span face="Calibri, sans-serif" style="font-size: 11pt;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgSYyRI7Jkw804pY9mgT1laGNiMNuc06CulbYF_qed6vDX-x6O0SM2oc3KweeM8pQ1K28ofYDPfyvcjKSU1KCID3FJKO6pzsGFjmLoL6HY4SksN-oGRQwMDGlIz98XdTmdNV3UVGirfxYP/s1777/IMG_20210228_123631_075+%25281%2529.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1777" data-original-width="1777" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgSYyRI7Jkw804pY9mgT1laGNiMNuc06CulbYF_qed6vDX-x6O0SM2oc3KweeM8pQ1K28ofYDPfyvcjKSU1KCID3FJKO6pzsGFjmLoL6HY4SksN-oGRQwMDGlIz98XdTmdNV3UVGirfxYP/w200-h200/IMG_20210228_123631_075+%25281%2529.jpg" width="200" /></a></div>I picked up a package today amid a workday of visiting my hospice patients. Both the box and the paw print were so much smaller than what I am used to, compassionately handed over with a mask muffled “I'm so sorry for your loss.” As I tucked them safely away, I could only think how appropriate it was to pick up a set of tiny cremains during this week. <p></p><p></p><p class="MsoNormal">I have said so often to so many parents of adult children
“It’s not the right order in life to outlive your child.” <span style="mso-spacerun: yes;"> </span>Since taking on an occasional pediatric hospice
case, this has never been more true. <span style="mso-spacerun: yes;"> </span>There
never is an easy time to lose a child, but it’s especially tragic and poignant
to face the death of a minor child. I had been caring for an older pediatric
patient before receiving a call from our amazing pediatric palliative care team
based out of Portland, planning for the potential admission of a very tiny
patient. <o:p></o:p></p><p class="MsoNormal">In hospice care, a bare fraction of patients cared
for are pediatric. However, life threatening diseases and conditions don’t
always wait for adulthood, and families are faced with devastating diagnoses and the decisions that come with such conditions. Anxious parents and family members do all they can
to find answers and treatments to fix what is wrong with their child. Often, a
myriad of tests, consultants, and specialists can yield answers, but not always a fix.
Treatments may be straight forward, but it can feel like an unending series of
experiments, in the desperate hope for more time until a permanent lifesaving
measure can be discovered. It’s not much different than what goes on in adult
medicine, but there is something about facing the end of life with someone so young that leads
to even more urgency for answers by loved ones. We now have the internet at our fingertips,
the first place many of us go to find the beginnings of understanding about a
medical diagnosis. “Dr. Google” is not always accurate, and often is anxiety
provoking, but as much as we coach people to talk with their medical team first,
I do not blame one person for trying to find answers to ask about. Especially
in the middle of the night, when it’s dark, quiet, and yet restful sleep is
evasive, as it’s so hard to quiet our brains when stressed. <o:p></o:p></p><p class="MsoNormal">Occasionally, expectant parents hear the worst news during
pregnancy checkups. Hopes and dreams of a new baby are dashed with the words “something
is wrong,” followed by uncertainty and testing, testing, and more testing. Perinatal support through
hospice and palliative care is a growing field, as families who choose to continue pregnancy
with a baby who may die shortly before, during or soon after birth need
compassionate and dignified care and support through the unimaginable loss of a newborn. More programs are finding ways to
support these families across the country, but perinatal hospice is not a place.
It’s a way of caring and honoring the family’s pregnancy and birth plans along
with care of the baby, for however long he or she lives. While our hospice
program cares for mostly adult patients, our newly retired, long-time medical director is also a family practice physician who has always been willing to have our program
take on the rare pediatric patient and family. It matches the continuum of care
seen in family medicine practices across the country. I’m not a pediatric nurse
but am willing to be a temporary one when needed. <o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtw2gV7gncywJkFkyR5kiZPaVpwXkJJLbpLySjnfS3-LtlEWFNPjmP4FZaXzEG0OFjt2vixbFga1CNBRV_CkiWjy_Uff_fHiBC6pQx1u1oMkdVXMpeGzaHODp5Ceo-z50aGHizyHRM4eZ4/s1970/20210225_125540+%25281%2529.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1152" data-original-width="1970" height="117" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtw2gV7gncywJkFkyR5kiZPaVpwXkJJLbpLySjnfS3-LtlEWFNPjmP4FZaXzEG0OFjt2vixbFga1CNBRV_CkiWjy_Uff_fHiBC6pQx1u1oMkdVXMpeGzaHODp5Ceo-z50aGHizyHRM4eZ4/w200-h117/20210225_125540+%25281%2529.jpg" width="200" /></a></div>I was told by the palliative team that we would get the
referral in a couple of weeks when labor was induced in Portland. The phone call came as
I was pulling up to the office, parking right next to some daffodils giving a
hint of coming to life. I could only think how those blooms would be in their
full glory by the time baby arrived. <o:p></o:p><p></p><p class="MsoNormal">Just a few days later, I received the message that baby had
decided not to wait for the planned arrival. Mom was in labor at the local hospital,
so I quickly cleared my weekend schedule. As with any life-threatening
diagnosis, there was no way to predict how long baby would survive, so we went
hour by hour waiting for the delivery. For a baby weighing less than four
pounds, the wee one was clearly in no hurry to arrive. We were
preparing for them to possibly make it home, but I didn’t receive the call from
labor and delivery until Sunday, thirty six hours after the first heads-up call. The fourth-floor staff have had to deal with
tragic fetal demise cases on occasion, but they usually participate in happy discharges
home with their new family additions. The uncertainty of this case was something they had no experience dealing with. Who would know how to discharge a baby home with
hospice? It was a role new to all of us involved. </p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCHJsTMtcfIdAnJCi5TaEWHSduhmBZqAWnLRn2VBd42kljhHG2WfSIc4-VmowMDnOkniQ9Zm0JpIDXDJjaQ4REj8nULWm_-GM-bNQn0mxy1QSjFcawVJNS9ZhYnU1-dIUWehh2u6-9LNE_/s600/20070824__20070826_A18_CD26PREEMIE8p1+%25281%2529.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="397" data-original-width="600" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCHJsTMtcfIdAnJCi5TaEWHSduhmBZqAWnLRn2VBd42kljhHG2WfSIc4-VmowMDnOkniQ9Zm0JpIDXDJjaQ4REj8nULWm_-GM-bNQn0mxy1QSjFcawVJNS9ZhYnU1-dIUWehh2u6-9LNE_/w200-h133/20070824__20070826_A18_CD26PREEMIE8p1+%25281%2529.jpg" width="200" /></a></div>Sporting a pink KN95 mask, I spent three hours on a floor I have never
had occasion to visit, supporting nurses and doctors in getting orders and the
POLST (DNR) signed, along with some creative pleading with the hospital pharmacy
to please fill the morphine and lorazepam for me, as no local pharmacies had the concentration I needed in stock. Normal postpartum teaching
was being done and I didn’t want to interrupt that. When it was my turn, I had
the task of getting paperwork signed and details of getting home. My first
glimpse of baby was of tiny fingers wrapped snuggly around mom’s finger. Baby had surprised everyone in finding a way to keep taking breath, despite all odds. The palliative care and fetal teams had done an amazing job prior
to delivery in preparing for all of the possibilities, developing a very
specific birth and postnatal plan for the situation, and preparing this faith
centered family in facing whatever came. <p></p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal">With my arms loaded with supplies given to me by the nurses,
including tiny feeding tubes in case I needed to replace the one currently in
place, and juggling the lock box designed to keep the hospice medications safe
from young siblings in the home, I made my way to the hospital pharmacy. As I
waited to sign for them, my phone rang and I recognized the hospital extension from upstairs. Just as they were packing to leave, baby started having symptoms and no one was
sure they would make it home, so everything was on hold. I returned home to
wait. Five hours later, I got the call they were bundling up and making the
trip home. I told the OB physician who called to let them know I would meet
them. <o:p></o:p></p><span face="Calibri, sans-serif" style="font-size: 11pt;"></span><p></p><p class="MsoNormal">
</p><p class="MsoNormal">My main task when I arrived was prefilling syringes with
just the tiniest of doses of medication needed for any symptoms. They had
practiced with the OB nurse to give a tiny amount of formula through the tube,
the same way any medications would be given. Before I left them for the night,
I made sure they knew how to use the 24 hour number and that they understood the directions for the medications. They were settled, with a
lot of family around them in support.<o:p></o:p></p><p class="MsoNormal">I visited two more days, assisting the social worker in getting a cast made of an incredibly tiny foot, joking with everyone it was a skill set I missed out in nursing school as I mixed and mixed the formula per directions. Everyone had many opportunities to hold this special baby, shedding tears and sharing smiles. During this time, young siblings, parents, and grandparents all picked out colors of clay to make imprints of tiny hands and feet as a remembrance. This was a beautiful family, coping with grace and faith and it was easy to stay present for them. We all marveled at baby spending hours taking only one or two breaths in a minute (whereas normal newborns breathe at 30-60 per minute). </p><p class="MsoNormal">There wasn’t much for me to do, other then check in and give
support, filling medication syringes as needed. We all knew what was coming, we
just didn’t know when. Mom had wondered how much baby weighed on that second
day, so I took out the scale I use to weigh the puppies. It was clear baby wasn’t
going to tolerate being put on a scale, so we skipped that. Numbers (weight,
oxygen saturations, etc.) only increase anxiety when there isn’t a way
to fix it, so it was for the best. I was struck by two numbers though. My
current caseload ranged in age from one day to a 104 years. A reminder death does
not discriminate.<o:p></o:p></p><p class="MsoNormal">I woke up on day three to an email from our on-call nurse,
who attended baby’s death. She didn’t want to be intrusive, so I needed to visit
later that afternoon to destroy the medications and pick up the lock box. I was
told the touching story of those peaceful last breaths shared with family. A
good death, for what it was. I did ask about how the mold of baby’s foot turned
out. Despite my novice skills at such a task, it turned out well, yet another
tangible memory of a life so loved, yet so brief.</p><p class="MsoNormal"><o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSJEFwdN5L3-f1MGoceU_pU53ZnVM-71lI54Jn6qlz7l-U2sE7Cjjni-UehtiATY8Tn0204l9bvAXWPBIjiAxlLp7QOHpx1VE7Qo2TtNUzu9BWpGuWszCsR6uxYr5Mr4MO0GwDr0KzSa6C/s2048/20210224_161123.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1152" data-original-width="2048" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSJEFwdN5L3-f1MGoceU_pU53ZnVM-71lI54Jn6qlz7l-U2sE7Cjjni-UehtiATY8Tn0204l9bvAXWPBIjiAxlLp7QOHpx1VE7Qo2TtNUzu9BWpGuWszCsR6uxYr5Mr4MO0GwDr0KzSa6C/w400-h225/20210224_161123.jpg" width="400" /></a></div>I then headed off to the veterinary clinic to pick up that set of tiny
ashes and paw print. As I approached home, I noticed a full patch of open
daffodils near our house, blooming earlier than the ones at the hospice office, apparently on the same earlier time frame as baby was. I pulled out the baby scale to put away, first writing a very memorable name on the scale so each time I use it I will remember a special hospice case. <o:p></o:p><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p class="MsoNormal"><br /></p><p class="MsoNormal"><o:p></o:p></p>Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com13tag:blogger.com,1999:blog-5681384012661169479.post-15176072087188050762021-02-28T22:43:00.004-08:002021-03-03T22:10:35.750-08:00Puppies and Rainbows<p>The past twelve months have been difficult on us all. No one
was prepared for the pandemic the world has struggled to deal with. Staying at home,
isolation, missing friends and family, substituting Zoom meetings for
everything from class time, work from home, meetings, and even happy hour get
togethers. As a hospice nurse, I am used to being independent and working out
of my car, but COVID has made it so we rarely see one another, unless from a computer
screen meeting or a rare joint visit.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtKZUZPGe_nJQwgGZ3FptLDvFf5ZBZkQ3BrBcoLgC1HEuaU2mbKlrdFoOJWdHEiWMtIlRv9Q7U7-rpYOYc0emJQT94J0F2uNEIUuQXDYCQ1oJGKDMIJwXXdK07qLss-UXXxKclq3QT2PPf/s2048/AirBrush_20210106163230.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1325" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtKZUZPGe_nJQwgGZ3FptLDvFf5ZBZkQ3BrBcoLgC1HEuaU2mbKlrdFoOJWdHEiWMtIlRv9Q7U7-rpYOYc0emJQT94J0F2uNEIUuQXDYCQ1oJGKDMIJwXXdK07qLss-UXXxKclq3QT2PPf/w129-h200/AirBrush_20210106163230.jpg" width="129" /></a></div>It has now been twelve months of masking,
decontamination routines at the back of my car, rushing into the shower once
home before giving the “I’m home” kiss to my husband, and the hardest on us
all, being unable to physically comfort the hospice members of our people who
are dying. There were many times when I wanted to pen my thoughts, but the one
consistent thing of 2020 was complete and utter exhaustion accompanied simply by
an inability to muster the energy. Inequities, violence, intolerance of others, hate, the deaths
of so many in healthcare as well as the community, the attack on science, and the
need to adjust everything we do to protect others from COVID has made the year
has feel like a century. Whoever knew there were morning and afternoon loungewear,
aka pajamas? While there is light at the end of the tunnel with vaccinations
getting into arms, pandemic fatigue has been a real thing for a long time. While adding work, sharing time with puppies continues to provide me my own therapy. Yin and yang, life and death; normal ends of the life cycle.<div> </div><div>Being a midwife at the end of the life cycle has often been
balanced here with welcoming new life. At times, I am fortunate to help bring
puppies into the world and raise them, while simultaneously helping patients
and families to manage all aspects of death and dying. Over the years, I have
shared when we have had puppies, even when it makes more work</div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOg2l4uzRN4BP9QeMbFT7yLe0auNLJLJHsmFkexr3SunPNlFpOYYZoXf9uMWx6Vs4YUl1gnwaB5CFJniqnAUZS_RPQfK6-STPu0DB6IE-wPh5W4PIvuS8g5oOV08H3Pt3-4erSjtMBSnZ_/s1440/138198903_10218226832050427_7246828108361122757_o.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="817" data-original-width="1440" height="182" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOg2l4uzRN4BP9QeMbFT7yLe0auNLJLJHsmFkexr3SunPNlFpOYYZoXf9uMWx6Vs4YUl1gnwaB5CFJniqnAUZS_RPQfK6-STPu0DB6IE-wPh5W4PIvuS8g5oOV08H3Pt3-4erSjtMBSnZ_/w320-h182/138198903_10218226832050427_7246828108361122757_o.jpg" width="320" /></a></div>for me. So many
have found the puppies help them smile, cope, and I even had messages years
ago telling me seeing puppies daily was a reason not to complete suicide plans. They were even more helpful during this tumultuous twelve months when so many were staying at home trying to navigate a pandemic and political upheaval. Laughing at puppy antics and imagining being surrounded by them clearly made for a nice break for people. Sometimes though, in the background of happiness comes sadness. Life certainly is not always easy.</div><div><br /></div><div>As time has gone on and I discuss end of life topics periodically, I have learned how people project their own
fear of dying onto others, be it people or animals. I feel an obligation when sharing about our dogs publicly to also help navigate the times when something goes wrong. While so many share their lives with pets, we also share the common reality that almost all of us will outlive our animals. Talking about dying, death, and preparations doesn’t end with people. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaJGOZD0-hEsiaa9e9pK823tnY8G-xYVHUmSHa6slav2qS9_UdVwpXKFhLvXWv3VYa0ukl3DD6DnnJgvFaHRC1SGU23zW9rmvndnxuDcJCmKw7J3F2VaKHHonvBBGFyqNRp78uMaKfN1W_/s633/FB_IMG_1605676424649.png" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="633" data-original-width="485" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaJGOZD0-hEsiaa9e9pK823tnY8G-xYVHUmSHa6slav2qS9_UdVwpXKFhLvXWv3VYa0ukl3DD6DnnJgvFaHRC1SGU23zW9rmvndnxuDcJCmKw7J3F2VaKHHonvBBGFyqNRp78uMaKfN1W_/w153-h200/FB_IMG_1605676424649.png" width="153" /></a></div>When I remember JJ, her zest for puppies and life brings a smile, not tears. She thought puppies were the best from a very young age and no one could convince her she didn’t belong with them. Her last year had been intense while allowing so many to share the cancer diagnosis, treatment, and eventual death of a popular dog who provided virtual therapy for so many. JJ had been the perfect conduit over the years for sharing with others about death and dying, although at times, it made it much harder on me while we were dealing with JJ’s cancer. Now, whenever puppies arrive, I always think of JJ and her eager anticipation to see “her” new arrivals. Two months ago was the third anniversary of JJ’s last night with us and with a special group of nine puppies, nannied for their first eighteen days by the Super Nanny herself. JJ was tired, but clearly wanted a last moment with those puppies, including Ember, the sassy one in the pink collar. We all say that JJ shared some special secrets with those puppies. That last evening was just us; no sharing of the time with puppy fans, because I knew her time was short. </div><div><br /></div><div>That pink collar puppy grew up to be my next therapy dog, Ember. Her registered name matched her personality, Calhoun’s Get The Party Started. She also happily learned to take on the Super Nanny role and may be even more puppy obsessed than her great aunt. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibaWKkmxq6pjHqp7QsLbOYc2TWzAmLphylANwGSdvI95XVPpSLPjTw1IcDoEOUO-lyqros_hmN0v1RCW4hKKsxttjOyqSDly-bf9faxDR-7siNuO3ZyREbAd2w8MDgRmOYCrLcFUuJO25n/s1080/Screenshot_20210227-194347_Gallery.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1080" data-original-width="1079" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibaWKkmxq6pjHqp7QsLbOYc2TWzAmLphylANwGSdvI95XVPpSLPjTw1IcDoEOUO-lyqros_hmN0v1RCW4hKKsxttjOyqSDly-bf9faxDR-7siNuO3ZyREbAd2w8MDgRmOYCrLcFUuJO25n/w200-h200/Screenshot_20210227-194347_Gallery.jpg" width="200" /></a></div>The Year of the Pandemic has meant no therapy visits and it has been clear how much she has missed seeing people and spreading her joy and magical fibers with them. The belly rubs have become severely rationed by visitors over the many months, as we continue to wait for it to be safe to do therapy dog visits and therapy dog evaluations, as handlers have to be close to others. The one thing we could do was plan a litter of puppies and we wanted to keep one of Ember’s daughters. When we plan a litter of puppies, long before breeding, we usually have a long list of homes already screened. As sometimes happens with mother nature, three of the girls with those long lists came into heat at almost the same time. Because of the pandemic, we were home almost all of the time, so decided to sign up for some lack of sleep, knowing we would have two Labrador litters and Ember’s puppies all within a four week time frame. Get the party started, indeed.</div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY_j_rqbOCRP_bKPjS-0yISIMJFGrTek2g_KG1n76Xr-9VZem1SvWYNxB4cxlR_SHT0oJTor_QCEVjjy9lsP47BCXt05peb0GcR8_2QlY8-sqASdWFoCJAZrCcH1luHC2Z-lU_XZty5msD/s1079/Screenshot_20210227-194428_Gallery+%25281%2529.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="805" data-original-width="1079" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjY_j_rqbOCRP_bKPjS-0yISIMJFGrTek2g_KG1n76Xr-9VZem1SvWYNxB4cxlR_SHT0oJTor_QCEVjjy9lsP47BCXt05peb0GcR8_2QlY8-sqASdWFoCJAZrCcH1luHC2Z-lU_XZty5msD/w320-h238/Screenshot_20210227-194428_Gallery+%25281%2529.jpg" width="320" /></a></div>Normally, we have uneventful arrivals of the puppies here. The first twelve arrived without a hitch, requiring time, patience, and a coffee-filled all-nighter. There were two weeks of puppy bonding and snuggling with wee ones before round two was upon us. In the meantime, during a break in the dark, a very special cloud appeared for a short period over the puppy yard. It’s not uncommon to have things in nature remind us of those who have died. For me, rainbows and dog clouds bring the smiles and “Hi, JJ!” thoughts to mind. </div><div><br /></div><div><br /></div><div>I should have known the O.G. Super Nanny was up to something. Since JJ would walk hospice patients out of our inpatient facility after they died, when she died many of us would envision her role reversing to “walk in” people after they died. We knew by ultrasound and doppler that Rosie, our second lab mama, had at least nine puppies. She went into labor and had two boys before indicating to us she was having a problem with her labor and had to go into our vet team at Oregon State University. By the afternoon, we brought Rosie and three more puppies home.</div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2tDa_QV29LrioMeyPa4E-GTaCMja9CyGTiGBYjUWKOSiUKmAt7JJoo6_h6iH5RXicy7SAaVcn8450p2neF2TMrB3LuWLE7aaPMlnfEpes41uMyIIemr7KnFSEZqOlGywFil1Q98Ouk_G6/s691/Screenshot_20210228-132217_Gallery.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="609" data-original-width="691" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2tDa_QV29LrioMeyPa4E-GTaCMja9CyGTiGBYjUWKOSiUKmAt7JJoo6_h6iH5RXicy7SAaVcn8450p2neF2TMrB3LuWLE7aaPMlnfEpes41uMyIIemr7KnFSEZqOlGywFil1Q98Ouk_G6/w200-h176/Screenshot_20210228-132217_Gallery.jpg" width="200" /></a></div>Sometimes, things can go wrong in utero. I often comment how fortunate we have been over the years to only rarely have to deal with problems bringing puppies into the world. Five puppies didn't make it. There was no indication of problems, but in dogs, we don't do the multiple ultrasounds and fetal checks with advanced technology that can tell us when a baby isn’t developing properly. These puppies were at least one third the size of their healthy siblings. There wasn't anything obvious for our vet team to see what might have gone wrong. While I hated disappointing the puppy owners looking forward to bringing home one of these puppies, I was thankful to have a healthy, but tired, mom and five vigorous littles.</div><div><br /></div><div>The next several days were a blur, between taking care of seventeen puppies, making sure I kept up on our schedule of puppy care needs, kept track of on a white board calendar, as well as my daily hospice work. Luckily, my husband was home full time and we simply needed to stay organized. A week later, we confirmed Ember was carrying 8-10 puppies, meaning December would be a really busy time. Besides going from house to house to see hospice patients and families, we were staying home, so managing our quickly growing circus was fairly easy. Time flew as Ember spent her time nannying the Littles whenever she could, swimming anytime she could get close to the pond, hunting for rodents while proudly displaying her mud coated head, nose and feet, all while her belly grew and grew. </div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZDUzbVe-JZFK2d1TwHVRfiElyr831Yt3giSHBmiL7oITjBcTk_rZhV1CCGkAluDvyRcxsgcvq38UlS9-XLCKddYtuad_5mvROISpcTjJJFXxiTuXNebeKqYZdhOnpSSUzAJXcSJQTTvh2/s1081/Screenshot_20210227-194517_Gallery.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1081" data-original-width="1079" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZDUzbVe-JZFK2d1TwHVRfiElyr831Yt3giSHBmiL7oITjBcTk_rZhV1CCGkAluDvyRcxsgcvq38UlS9-XLCKddYtuad_5mvROISpcTjJJFXxiTuXNebeKqYZdhOnpSSUzAJXcSJQTTvh2/w318-h320/Screenshot_20210227-194517_Gallery.jpg" width="318" /></a></div>Ember went into labor during the morning, something that rarely happens here. I was thrilled to think I wouldn’t be going to work sleep deprived the next day. As Ember got to work nesting and digging in her whelping box, I received a text from a friend with the words “Hi, JJ. Must be puppy day” and a photo of a rainbow ending right at our house. I have so many photos of JJ with rainbows from her last two years of life and I send her a shout out any time I see a rainbow, which is often, especially here at home. I didn’t give it much thought as Mr. Red arrived about forty minutes later. Ember and Red spent time together as she rested and he nursed, receiving the important colostrum which gave him his mom’s protective antibodies. We have rules to follow when puppies arrive, specifically designed to make sure we are seeking veterinary attention when needed if labor stalls or isn’t progressing as we would expect. As time went on, it was clear something was off. We called the OSU team and headed out. There was no way for us or those watching the labor not to be even more nervous, given what had happened one month earlier with Rosie. And I thought of that rainbow. “Please, no more puppies for you, JJ, you have enough” was my silent plea as I sat with Ember while she continued her obviously ineffective contractions.</div><div><br /></div><div>Because of COVID precautions, vet visits are done remotely. I handed off Ember to the team, while the chief resident asked me how many I had counted a few days earlier with the doppler. “At least nine” came my reply as she nodded in agreement looking at <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9Ds5gEL-pRbfHXE2Wkk2XgnTQ3BxIKu7gGqcd4sg_gIJ5rUWhhPAYFAIrHqdQgFSIEi2P2A_OKOPecOFyYjaUEerSo3rJbIJoAA-RfACQP854sYO94TtFUdZZYMe5u3NBWUQXwWuiCvSv/s1079/Screenshot_20210228-165414_Gallery.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="572" data-original-width="1079" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9Ds5gEL-pRbfHXE2Wkk2XgnTQ3BxIKu7gGqcd4sg_gIJ5rUWhhPAYFAIrHqdQgFSIEi2P2A_OKOPecOFyYjaUEerSo3rJbIJoAA-RfACQP854sYO94TtFUdZZYMe5u3NBWUQXwWuiCvSv/s320/Screenshot_20210228-165414_Gallery.jpg" width="320" /></a></div>Ember’s very rounded and dropped belly. Ember is always happy seeing people, including vet staff, so off they went without a glance back and we returned home to wait. Shortly afterward we received an update. Some bad news, but a lot of good news as well. There was a puppy without a heartbeat blocking the way for the other eight, who were all in good shape on ultrasound. A c-section was needed and was done quickly. The relieving phone call came announcing five more boys and three girls, all healthy and nursing, and a mom who came through surgery without a hitch. By early evening, all were settled, and even while drowsy, Ember was attentive to her puppies in between naps as the anesthesia wore off. There was a collective sigh of relief as hundreds were able to see them all back on the camera. We have had so little loss over so many puppies caught here, I would be happy to have boring back for 2021 when it comes to puppies and the world we live in. </div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL8hDR4ZN_iiTpC_W106gNigRqZqQ9S14V9K8rn_6e7v2LelzIb5hzJe0rTl7uW0A2VIhAAxCAv125_WFhhMlgcFMKsvVwN0JyNpCs4AQZBji0ki_Sh7UBUEkaRzaGbJiAROWKbh4bLzwR/s640/pixlr_20210228203332367.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="640" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL8hDR4ZN_iiTpC_W106gNigRqZqQ9S14V9K8rn_6e7v2LelzIb5hzJe0rTl7uW0A2VIhAAxCAv125_WFhhMlgcFMKsvVwN0JyNpCs4AQZBji0ki_Sh7UBUEkaRzaGbJiAROWKbh4bLzwR/w200-h200/pixlr_20210228203332367.jpg" width="200" /></a></div>Time went on and the lab puppies made their way into their new homes in the next few weeks. We definitely relied on the whiteboard calendars to keep track of daily tasks for each litter and their moms, along with a different color assigned to each group. It was chaotic at times, but fun, and my husband likes to point out I thrive with chaos and will make some just to be in my happy place. Ten years ago we had three litters at one time and had said emphatically we would never repeat that silliness. I guess ten years is long enough to forget how much work it really is, but we now agree with our smarter, younger selves on this topic. </div><div><br /></div><div><br /></div><div>Once the labs left, Ember and her nine made us practically feel like empty nesters. We had a month ahead of us with fun and games, yet it seemed so quiet and lacking chaos. I spent most of that month sharing videos almost daily on JJ’s Facebook page, knowing the collective stress we were all going through in January. The puppy videos were shared around the world, often bringing slews of daily messages “I want a puppy.” I do know they helped so many take a few minutes out of a stressful day to smile and laugh. </div><div><br /></div><div>Meanwhile, I spent as much time with them as I could. Puppy therapy was helpful for me and I made sure to spend time continuing the enrichment and desensitization things we do with all puppies. It was common to hear the door open with a “Tracy, time to put your dolls away and go to sleep.” Goldie isn’t the only Fun Police in this household. People knew a girl would be staying and kept asking if I knew which one. By seven weeks I knew, but had decided to keep it quiet as I continued to watch and interact with the puppies as I worked on puppy placements for the families. <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAFsS6-9Gm46jeSd6XXicdjIlxaebD36G244hZszu1ks9Akh3DtyouyvNUGsvbMDR9b8m3bqCPRjkuOrOm7XOZG9R7SR2QBBaCCxCKali-kegIPqw8EL-B_B-3N_hsktLyVtwaVvgosfgm/s957/Screenshot_20210211-163521_Instagram+%25281%2529.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="571" data-original-width="957" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAFsS6-9Gm46jeSd6XXicdjIlxaebD36G244hZszu1ks9Akh3DtyouyvNUGsvbMDR9b8m3bqCPRjkuOrOm7XOZG9R7SR2QBBaCCxCKali-kegIPqw8EL-B_B-3N_hsktLyVtwaVvgosfgm/w320-h190/Screenshot_20210211-163521_Instagram+%25281%2529.jpg" width="320" /></a></div>While we didn’t get to do our usual Pile of Puppies visits I so enjoyed because of the pandemic, we did have a special event planned with the puppies. Just a few days before go-home, the puppies were a part of a surprise marriage proposal. Ember was certain all of the people had come to see her and she made the most of charming the people. It was such a joy filled day with some really wonderful people, a rare occurrence over the past year. The puppies loved the attention and cuddles.</div><div><div><br /></div><div><p></p><p class="MsoNormal">I talked with each puppy owner about which puppy would be going home just before the weekend, but as usual, I refrained from announcing which puppy would be staying with us. Friday morning before their vet visit, we noticed Mr. Red not feeling well. He had thrown up a few times, but when the vet checked him, nothing seemed out of the ordinary. He got an anti-nausea med and I let his owner know he would be staying a few more days so we could monitor him. He rallied and was feeling a little better, but I was concerned and had a bad feeling, a spidey sense that as a hospice nurse is not a good thing. I scrolled through hours of puppy cam footage and videos trying to pick up on any noticeable problems. With the exception of tiring out earlier than his siblings the previous few days, nothing seemed amiss. Mr. Red started to have difficulty with his breathing and I knew he needed to be seen in ED Saturday night. He was quiet and didn’t make a fuss, a concerning assessment in an 8-week-old puppy. My initial thought was an aspiration pneumonia after he had vomited the day before. I wanted to get treatment started ASAP and get him on the road to recovery. It was midnight before they could take him in to be seen and I settled in for an uncomfortable nap in the front seat. Two hours later, I received the update and I wasn’t prepared to hear his diagnosis. It was horrible and catastrophic. Baby Red had a congenital diaphragmatic hernia/tear (an opening in his diaphragm) with no air exchange on the left side, because his stomach was displacing that lung.</p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh-t2ZRfJ36th7GRCFiWiG-X32_oR2h0DlSZhr9PjmWb_g2jFq33fPNwosEZNQ4ijXX8zxBx4ZtRGPzVYd89UsRiLNMr4c0unoZLlSQHjWiY5ilrBsLOFNkEl5H1WrkJOpdD9ADnLWAiLw/s640/pixlr_20210228215224051.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="640" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh-t2ZRfJ36th7GRCFiWiG-X32_oR2h0DlSZhr9PjmWb_g2jFq33fPNwosEZNQ4ijXX8zxBx4ZtRGPzVYd89UsRiLNMr4c0unoZLlSQHjWiY5ilrBsLOFNkEl5H1WrkJOpdD9ADnLWAiLw/s320/pixlr_20210228215224051.jpg" /></a></div>For a puppy so symptomatic, even if surgery was attempted, prognosis was poor and it was something too complex for anyone in the middle of the night to attempt. I didn’t need to think too long. I had just read about this condition a couple of weeks earlier along with a discussion of treatment possibilities in puppies and poor outcomes. He was having a difficult time and there really was no choice. I decided to wake up the owner I was going to place him with before we euthanized. I couldn’t in good conscience not alert her. It was one of the hardest conversations I have had to have, much less at 2 in the morning. When I got into the clinic to spend some time with him, it was mind boggling to see how fast he was declining. It didn’t take long to call them in. The perspective I have as not only a hospice nurse, but one who had to assist families to understand when their loved one was transferred to our inpatient hospice and was actively dying, was helpful in my disbelief. I simply didn’t want him working any longer as his body had betrayed him with this hidden birth defect we were unaware of. I had been distraught, but that calm of being present as life ends is second nature and took over as I nodded my readiness to the vet. It was fitting to be the one with him for his first and last breath. He was the sweetest boy and I had such high hopes for him, moving on to his new home. Goodbyes shouldn’t have to happen so early in life, but reality can be cruel at times. What I didn’t know that difficult night was that I would be facing this same thought just a few days later, except in my work life. <p></p><p class="MsoNormal">Sleep well, little man. You were the bestest boy during your time here. Pink sister will heal hearts in the family you were destined for. Your nanny has you from here. Be sure to send a rainbow from time to time. </p><p class="MsoNormal"><br /></p><p class="MsoNormal"><br /></p></div></div>Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com11tag:blogger.com,1999:blog-5681384012661169479.post-14131937847787088492020-02-15T23:21:00.001-08:002021-02-24T16:35:21.301-08:00Midwifing, in death as in life<div class="separator" style="clear: both; text-align: center;">
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<span style="text-align: center;">Circle of life, indeed. As I slowly moved the wand of the handheld doppler over the gentle swell of an abdomen, searching for the tell tale heartbeat of life growing inside, I was instantly transported to my days as a young nurse in the ICU. I was assigned a young woman who had experienced a large bleed into her brain, caused by a silent tangle of arteries and veins that usually go unnoticed. While she was non responsive, her assessments every 4 hours included that same kind of doppler wand, picking up the heart rate of her unborn baby. They had both survived, and our job was to make sure life continued for both. Over the many weeks of those continual checks of baby's heartbeat, the sad reality was caring for a mom who had woken, but was not aware of anything around her. We were making sure her baby made it to the point a c-section could safely be performed, all the while giving her weary, yet hopeful, husband and family all of the emotional support we could muster. As is life in the ICU, we don't always hear the longer term outcomes, but as we packed the doppler away to go back to the OB floor, word of a healthy baby boy taking his first breaths downstairs in OR gave us all reason to smile. </span><br />
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Dealing with end of life matters occurs in all areas of health care, but for me, the transition from ICU to hospice was like taking a deep breath and recognizing "I'm home." That was 27 years ago, and while I miss the constant presence of attending those who are dying while I was an inpatient hospice nurse, it has been refreshing to return to visiting those we care for in their homes. As a home hospice nurse, we visit wherever "home" is for that person, be it a private home, a variety of care facilities, a homeless shelter, a trailer, or even a car. We are guests, there to guide and support during a time of high emotion, stress, and fear. Even after all of these years, the common response from others upon learning of my profession is "Isn't that so depressing?" For me, the answer has been and remains "Not at all!"<br />
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This has been a week of attending to two of my patients who are actively dying, a term we use in hospice when people reach the stage when death is hours or days away. As I gently cleaned thin and fragile skin, I was reminded of a multitude of shifts when we sat present for those close to death. Many of us in hospice nursing often equate our work to midwifing the other end of the life cycle. When death doesn't arrive swiftly and suddenly, there is a common pattern in how our bodies ease into the transition of leaving this world. It's not unlike a baby's arrival during childbirth. For some, it is quick and almost effortless. More commonly though, it takes time and work, is often messy, requires medications and a lot of coaching, education, and support. Being present at either birth or death elicits a wide range of normal emotions. As a hospice nurse, one of our most important jobs is to help prepare families and loved ones for all aspects of end of life, especially when the end draws near. I spent the morning explaining what was coming next and working out a medication schedule.<br />
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In my past life as a home hospice nurse, I hadn't fully appreciated the intimacy of being present with a person dying in their home. While all inpatient hospice facilities are mandated to appear homelike, we were able to provide care with the precision, albeit incredibly compassionate, of other hospital units. As a member of a home hospice team, I usually am by myself as I assess and provide hands on care. As I finished cleaning my patient, knowing I may not see her again, I gave a silent thanks to the opportunities I have been given to care for people in this way. I whispered into her ear to find the best cloud she could to float away on. <span style="text-align: center;"> </span><br />
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As I left, I looked forward to the other aspect of midwifery I would soon be involved with. Indeed, birth is very much like death. On occasion, we get to welcome litters of puppies, just as we did JJ and her litter mates ten years ago. In Taoism, Yin/Yang is a fundamental teaching of life, demonstrating the dance of two becoming one. As a seasoned hospice nurse, witnessing new life coming into the world is a perfect complement to being present for those leaving. To know the puppies pictured below were cared for by the most amazing hospice therapy dog ever before her death, while remembering her own birth and life well lived is a comfort. Many times we have helped to bring new life into the world over the years and this legacy continues. In the next few days, the puppy in pink will be welcoming her own puppies into the world. A very special time to be a midwife indeed.<br />
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com0tag:blogger.com,1999:blog-5681384012661169479.post-64831219129230289152020-02-09T21:09:00.001-08:002020-02-09T21:09:56.257-08:00"I think I know you!"<div class="separator" style="clear: both; text-align: center;">
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"You look so familiar! What is your last name?"<br />
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Moving back into home hospice nursing has been a smooth transition for me. Seeing patients in their homes has been the majority of my practice over the past 27 years, despite the work I have done for the past 7-1/2 years at the bedside full time. The one difference this time is the number of connections that arise simply because of my past work in this community and, of course, JJ. She was the one staff member no one forgot. "Um, I don't remember meeting you. But I met the dog and she was amazing!" was a typical conversation. My response has always been along the lines of "Well, I was her driver."<br />
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When I arrived at the Adult Foster Care Home for my new patient, I met the owner, who proceeded to ask that leading question. As it turns out, she has connections to not only myself, but to my husband as well through his dog training. This really is a small community. After visiting with my patient, I spent some time sharing and laughing at all of the connections we really did have. Many of the memories did involve JJ and her work at the inpatient hospice. JJ was always the one who could elicit smiles and laughter, even through tears. Her magical ways blended her own style of hugs with a mooching finesse and plopping demand for belly rubs that could not be ignored.<br />
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As a young hospice nurse in the Seattle area, I remember feeling awkward and uncomfortable when running into a loved one of someone I had cared for in the past. It takes time to build life experiences that allow us to navigate the often turbulent waters of emotional response. While I was comfortable with supporting my patients and families through the dying process, I was not expecting to face the range of emotions people would have when remembering how they knew me. Often, it didn't bring good memories for the person, even for those who were so thankful for the support of our hospice team. Some just have a hard time thinking back to the time their loved one was dying.<br />
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So many years later, these encounters are all understandable and much more comfortable to deal with. It may be easier because so many of people's memories include a certain Golden Retriever who always made my job easier. Even after her death, JJ has made it easier to for people to consider end of life matters and remember their own stories, in person or online.<br />
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One of those memories included the Girl Scout visits JJ, and eventually Ember, loved so much. We actually had cared for the grandfather of two of the girls. For five years, girls from local troops gathered donations from the community for the family pantry of the hospice house and would deliver boxes of Girl Scout cookies and other food items. The first year, their delivery visit turned out to be only a few hours before their grandfather died with us. It's often not easy for family members to return to the place where their loved one died, but JJ definitely helped ease anxiety. and we so appreciated their support. During those years, if I was not working I would bring JJ, and then young Ember, in to see the girls. Of course, from a dog's perspective, those visits were all about belly rubs, attention, and trips to the cookie jar. They could care less about the masses of boxes. The owner of the Adult Foster Care Home was a family member of these girls and I enjoyed telling her stories of those Girl Scout visits.<br />
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Just a few days after our visit, a memory popped up on my social media related to another person we had in common. She was a family friend I had the honor of caring for intermittently over a several week period before her death. "It has indeed been a rough week for losing people we know. Tellus did make it back home last night and drove me back to work with JJ for S's walkout early this morning. It was an honor to help care for her, though it is never easy caring for those we know. JJ helped provide some laughs to everyone over the days with her mooching and slipper re-homing services." What great memories and a reminder I have a wonderful husband, as dealing with my work specialty is not easy for him.<br />
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Even with such a short time back into the community doing hospice work, it is clear there have been many connections made. I am reminded of the circle of life in so many ways. I look forward to continuing my hospice work and unearthing more memories along the way.<br />
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"Beauty exists not in what is seen and remembered, but in what is felt and never forgotten." Johnathan Jena</div>
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com0tag:blogger.com,1999:blog-5681384012661169479.post-76705703591505148452019-12-28T21:55:00.000-08:002019-12-29T09:45:41.779-08:00Finding My Voice Again<div class="separator" style="clear: both; text-align: center;">
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In healthcare, many of us are very familiar with the term "burnout". In nursing, it's becoming ever more prevalent with staffing cuts, unsafe patient:staff ratios, lack of support from administration, violent patient encounters that were unheard of when I graduated from nursing school so many years ago, not to mention health care workers being discouraged from reporting said encounters to law enforcement by management. I had started this blog over a year and a half ago, as a way to start writing again. It was a short lived effort. I had lost JJ's voice on her social media accounts and I couldn't quite get into the rhythm of writing. Even my posts about hospice, the dogs, and all things in between fizzled a bit over the next year. I just didn't have the desire to write or even to share as much as I usually did. </div>
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When I helped to build the Hospice House almost eight years ago, it was an exciting time for our program. Several of us spent a lot of time making up policies and procedures, as we figured out what on earth we were trying to do. Many of us from our home hospice team made the decision to transition to inpatient hospice and help build that side of our program, along with our medical director and an amazing nurse practitioner who led the charge. Things as simple as giving medications to patients was no simple task. We were a hospital unit separated from the rest of the hospital by over 8 miles. We had no automated medication dispenser. We had a kitchen, but no cook. Our CNAs got to quickly add short order cook to their resumes. The supply rooms looked huge during construction and tiny once they were filled. It went on and on, as we prepared to satisfy not only the building codes and fire marshal rules, but the state and federal regulations that require inpatient hospice units to look home like, have 24 hour visiting hours, and have hot running water, to name a few. In time, we all had a rhythm that adjusted as needed and we built a fabulous team as we opened all twelve beds after our first six months of being open. We learned that nursing tasks we had not done in years (some twenty!) turned out to be like riding a bike, albeit with some required cheering and "just do it" mantras as we left our comfort zones, nary a helmet in sight. I will forever be proud of what we accomplished and the amazing care we have provided to our community over the years.<br />
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JJ started working once we opened and continued up until a few days before her death. Looking back, those were magical years, never to be repeated from the perspective of working with a canine partner. While I had hoped Ember could start working with me and was in training to do so, it simply could not happen. We had become very busy with most of our beds staying full in the first eight months of 2019. It wasn't slow enough for me to be a nurse and a dog handler. JJ had the opportunity to ease into the work, when it was much quieter with the majority of people in the building being staff members, not visitors. I had no plans to stress myself out trying to add a dog to the chaos of work life. We were known to take very acutely symptomatic patients at end of life, requiring a lot of attention and medications. Our pattern of having many days at home on call had come to a screeching halt. During JJ's years of work at the Hospice House, many of our "work" days were spent at home playing, waiting to see if we needed to come in to help. Those standby days were how I finished the book on time per my contract deadline.<br />
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As a inpatient nurse, I was working twelve hour shifts, something that the majority of hospitals are doing now. The benefit is longer stretches off, but as I get older, it has taken a toll, especially the monthly schedule of three on, one off, and three on. By the end of that week, I needed two days to recover, and I may not have been joking when I talked about the couch and bonbons. There is no time during work days to get adequate sleep and find a way to work out, which are both required to recharge the batteries and stay healthy, especially when getting older. The lift limits in our job descriptions were a complete joke, so while we all did our best to be safe, often there were only two of us and our bodies paid the price. I had reached the point where I was questioning whether I was burned out from hospice, nursing, or both.<br />
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I spent a month at home during a "stay-cation" while playing with two litters of puppies. The timing was perfect and I spent time reflecting. It turned out I was not burned out at all from either nursing or hospice, but I did need a change. While I remain so proud of our team for the work we have done over the years, it was clear for many reasons that it was time to return to home hospice nursing. Over the past couple of years, the majority of our remaining original home hospice team I started with twelve years ago had left. I had reached out to another nonprofit hospice in our area during my time at home with the puppies and did an interview with them. I left with a renewed energy after meeting with members of their leadership team. I was impressed at the commitment of the organization to put patients and families first, even with the financial challenges all hospice programs face today. Even as they sort through their own changes, their priorities are in the right place. I accepted the position. I even visited the office with puppies before I officially started, which I am certain sealed the deal.<br />
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Two years ago, JJ had come to the end of a year of living with and being treated for lymphoma. <span style="text-align: center;">While she tolerated chemo amazingly well, it was no longer working and we were done with treatment. She came to work with me on Christmas Eve, but made it clear halfway through the day that she was tired and was done. I called my husband to come get her and she was able to do her own walkout of the building, in a different way she had walked out so many who had died with us. Five days later, she died surrounded by several of those who loved her.</span><br />
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While I thought my last shift at the Hospice House on Christmas would be bittersweet, it was not as much as I had thought it would be. On my days off, I had already started orientation at Lumina, which had confirmed I had made the right decision for a fresh start. My last shift was full of reflection of all the memories we had been part of, mostly JJ's antics. I had been able to share so much about hospice issues with people around the world because of her. So many had joined us along the way as JJ played, mooched, walked out those who had died, nannied, stole slippers, provided belly rub therapy, wiggled, and became the most popular "staff" member we had. Her sassy voice and introduction of the Crazy Crew, including her own Mama G, helped me to share all things end of life with such a wide audience around the world. She led me down paths I would have never imagined. Animal-Assisted Crisis Response K9 handler, reluctant author, driver of a video star, therapy dog instructor, social media secretary, and Cat-Dog minion, to name a few. Her legacy continues, although I miss her voice and the variety of Pants names she had for me.<br />
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On that last shift, one of the volunteers who was so close to JJ and his wife came to bring me chocolates and wish me well, along with giving me a little time with JJ's niece Quinna. My work wife brought us goodies, and three of my co-workers brought me the best going away basket any nurse returning to the home side could ask for. It included Febreze, wipes, pens, hand lotion, and snacks. Anyone who has done home visits will appreciate how perfect these are. The five of us shared stories from the "old" days, many vividly remembered, as we laughed and laughed. The volunteer at the front desk commented how much she enjoyed hearing our laughter and obvious relationships. It was a perfect way to spend my last day. My last shifts were on a weekend and holiday, so I was happy to have a slow day to write notes to my co-workers. The timing of JJ and I both leaving the building for the last time at Christmas was amazingly syncronous. I will so miss the people I work with, but I left the building that night for the last time with my head high and a smile on my face.<br />
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A fresh start. My passion remains. My voice is back.<br />
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com15tag:blogger.com,1999:blog-5681384012661169479.post-49017952754785499072018-08-29T22:05:00.002-07:002018-08-30T06:50:42.715-07:00End of Life Planning, Meet Critical Thinking<br />
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On occasion, I get email requests from various sources.
While I am not a social media "influencer", from time to time, JJ’s
Facebook page gets extra attention and I get requests for various projects. I
use the Facebook page to educate and support the issues around my passion,
death and dying, both in people and in our pets. When not sharing fun and silly
dog stories, videos, and photos, I share articles that talk about issues that
accompany death and dying. These have included the physical changes when someone is
actively dying, different components of grief, how to support someone whose
loved one is dying, the ways hospice can be helpful, issues around a pet’s
disease and eventual death, and how to make assessments of how a pet is doing. One
of the most important jobs of a hospice worker is to help others be educated
and prepared for the eventual death of a loved one. It’s no different for my
online education. The email request I received was a valid one in relation to
the discussions we have around end of life. However, I found this one had a
twist.<o:p></o:p></div>
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I am a very pragmatic person and I come by this honestly, as
my parents were the same and raised us to be realistic. I think in the conversation of end of life, talking
about things such as the planning that goes around someone's death is helpful
ahead of time. There is much less stress on family members if plans are in
place, including funeral plans. Sometimes, it is just too difficult for people
and their loved ones to discuss, and sometimes finances are a serious issue
when it comes to funeral planning. As hospice workers, we often are the ones to
initiate these discussions. When someone comes onto hospice, it is expected
that eventually they will die, whether it be sooner or later. We will need to know what mortuary to contact at the time of death. <o:p></o:p></div>
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My mother had ALS, and her desire was to donate her brain to
science. However, after speaking to one of the ALS researchers, we discovered
this was out of the question, as the small town in Montana was too far away to
procure her brain in the short time required. She was disappointed, but at
least we knew ahead of time. Very often, the altruistic nature of people guides
them to donate their body to science upon death. It also is a way for families
with no funds to deal with what to do after death. The email request I received
this past week was from a marketing agency, specializing in business growth as technology evolves. They serve many huge and well known companies. Specifically, the request was from the
representative of a body donation company “looking for advocates like
yourself to help spread awareness about the importance and need of organ and
whole-body donors.” JJ’s Facebook page was mentioned as a place to start
the conversation and I was invited to apply from the project manager. The link made it appear that a monetary fee would be involved for my effort. It is important to point out, whole body donation is completely different than organ donation, when the organs of someone who has been declared brain dead are used to help give life to so many others in need. I have been an organ donor for all of my adult life, and would assist families in making this decision when I was an ICU nurse.</div>
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I will take a moment to digress to a topic that has become a
big issue in the world these days. Critical thinking, or the
lack thereof. Critical thinking is quickly becoming a lost art and is simply the
objective analysis of facts to form a judgement. While this was heavily stressed
in nursing school in college, critical thinking does not require any special
education. It does require a willingness to explore a topic through more than
one internet article posted and widely shared as fact. The internet is a double-edged
sword. There is a lot of information floating about, but it requires the desire to engage critical thinking and take more time than one click to investigate
which information is correct and which is nonsense. <o:p></o:p></div>
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So, I first did some investigation. This is how I found out
it was a marketing agency who was reaching out to me. Then I went in search of
the company they were asking me to discuss, in the form of “sharing
awareness”. I have not spent much time thinking about body donation, other than
calling different ones in our area at the time of a patient’s death. Recently,
a medical school was built in our community, and many of our body donations
have been to their program. As I researched, I found out that there are
companies making huge profits by receiving body donations and then
selling either whole bodies or body parts. While not illegal, it doesn’t sound
as if this is made clear to loved ones. While they don’t have to pay for cremation
or burial, they certainly aren’t getting any proceeds when a body is sold. It
was incredibly eye opening and got my attention when one article talked about
the marketing “cash cow” of hospice patients for donation. You might imagine how this got my ire up a bit. I have downloaded
some of the consents used by different programs, and it is easy to see how these details would be missed with the nebulous language used, buried in pages of consent. I
chose to email back a response saying thank you for reaching out, but I was not
interested in the conversation centered on a company that makes great profits
but does not make it clear to families that body parts are often sold. I have
not heard back, but certainly am discussing the pros and cons to donation of
body at time of death. It probably isn’t in the form they were thinking when I
was invited to submit my application to partner with them.</div>
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None of this is to say body donation is a bad idea, but we emphasize informed consent in the healthcare world. My concern in reading
peoples’ stories is the consent is not terribly clear in many cases. For
those interested in pursuing this as an option at time of death, check into local universities that may have
a donation program, as their students are much more likely to benefit. Ask
questions. Science is a great thing and research and healthcare students need
donations. This week has made me think of just one more piece of planning when
it comes to my own death. I am also happy to have used my own critical thinking
instead of hastily jumping in uninformed, no matter what the pay may have been.<o:p></o:p></div>
<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com4tag:blogger.com,1999:blog-5681384012661169479.post-63891254682965988372018-08-25T12:50:00.001-07:002018-08-25T12:51:48.825-07:00How Do I Love Thee? Let Me Count The Ways<div class="separator" style="clear: both; text-align: center;">
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Almost four years ago during a trip to the Hospice House for a holiday photo shoot with JJ and baby Shylah, we unexpectedly met our newest family member. He was a spitfire little 4-week-old light orange kitten, found on the streets by a co-worker's neighbor. We had been considering rescuing a kitten later in the year, although it wasn't exactly the height of kitten season when Taz showed up. JJ was immediately interested in him, and he expertly stood up to her in the classic Halloween kitty, arched back stance, hissing his warning that he was the only sheriff in town. She was completely nonplussed and our decision was made. He came home with us that day and he and JJ were cuddling within a few days.<br />
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The dogs were smitten with Taz, especially JJ's Daddy-O Dash. When I brought him home, my husband was away at a retriever field event and was quite concerned about having such a little kitten around the big dogs. While he had a "safe" room, he rarely used it and took charge of his environment as only a wee twenty ounce ball of spice could. He quickly learned to snuggle with the big dogs and chose not to play with the cat toys provided him. Instead, he had a secret stash of dog toys he had dragged into his gated off room. We discovered that kittens are quite easy to introduce to friendly adult dogs. Taz loved to play and his dogs frequently joined in. He would sleep with Dash, JJ, and Mama G, although Dash was his main companion until the time of Dash's death six months after Taz joined the family.<br />
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By day two of the Tasmanian Devil's arrival, I was seriously questioning my sanity. We were just settling in to life with Baby Shylah. Who brings home a 4-week-old kitten with a 9-week-old puppy in the house? They entertained themselves by careening down the hallway, sounding like a herd of wild buffalo. How two sets of paws can accomplish this remains a mystery. Taz was frequently found with a very slobbered upon head. Shylah was enthralled with this magical creature and treated him as she did with her litter mates who had just gone home a few days earlier. I was working hard to do puppy training, while having a kitten running amok during our training sessions. I had considered finding a different home for Taz during these first days, although decided to rise to the occasion and continue raising them both. My best memories were of Taz crashing our puppy obedience sessions in the kitchen, providing the ultimate challenge of kitten proofing. Shylah was amazingly calm during these times and I am so happy to have at least one of these sessions on video.<br />
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While Taz was still a young kitten, he got to meet his first set of puppies and was fascinated by them. While JJ was always a Super Nanny, Taz thought it was the best gig ever and would follow us all to climb into the whelping box. As he has grown, he is not quite as mesmerized as he was that first year, but he can be found checking in with the new arrivals. He is most interested when they are new or sleeping, before he can get caught up in puppy energy and antics. When he is in a tolerant mood, our puppies often get to experience their first scent of cat fur before their eyes even open.<br />
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The majority of the beginning of his life was spent being JJ's BFF. After Dash died, they slept together the majority of the time and could often be found playing together. From an early age, Taz perfected the fine art of the JJ Trap. He would give several distressed howls until JJ would run to him to save the day. Just as she would get to him, he would pounce and attack, pleased his plan had worked so well. He would try with us, although his humans apparently have better memories than his dog. One swipe of his paws on bare feet ensured we wouldn't fall for his ruse again. However, JJ would walk into the trap again and again, apparently more concerned that one day he would indeed be in trouble. Tag was also a favorite game, with the two of them running back and forth, taking turns to chase the other. JJ was very fond of many of his toys, in a twist to his stealing dog toys. She would spend long periods of time doing her best to get the ball inside of his track toy. It is no doubt Taz grew up thinking he was a Golden Retriever, thus the name of Cat-dog. None of us have the heart to tell him he's a cat.<br />
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Once JJ was diagnosed with her cancer and required treatment, there were times when she didn't want Taz sleeping with her. These were usually the times she had a shaved belly and/or chest. Most likely she did not appreciate his love kneading with his claws on her exposed skin, something I have experienced while sound asleep. Typically, where ever JJ went around the house, Taz often was not far behind. To the end, they could often be found together. He clearly misses her to this day. While occasionally he will sleep with JJ's sister Ottie, she often tires of this and he resorts to cuddling with me.<br />
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Taz now is going through what so many people and pets do after experiencing a loss. The acute grief gradually transfers to life as a new normal. He has adjusted and now has a new member of the household to train up. While I know he would love to just have his buddy back, he is slowly starting to train up his new puppy, Ember. Four years later, it is far different with his interactions than it was when Ember's mom Shylah was his puppy play toy. When it was clear Ember was staying, Taz liked it because she had a short thin leash she wore all the time to help teach her expected puppy behaviors. It was a continual moving target for him to pounce on. Ember didn't quite understand that his constant following was not because he was enamored with her. She still is fully of the belief that he loves her as much as she loves him, and Taz just is playing hard to get.<br />
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In his eyes, she is no JJ, and who knows where their relationship will end up. However, Ember is in love and thinks he is the best thing since a sliced liver treat. In fact, she often is torn between saying hello to him in her exuberant way or sticking around for a treat. Taz often will chase her and clearly knows how to get her attention; he just ends up annoyed by her puppy hops and persistent attention. She has tried to keep up with his rule changes, but has a long ways to go. Negotiations between them continue, but she gets points for persistence. No doubt, once Ember can control her excitement, they will become fast friends. It is, without a doubt, a bigger challenge to introduce a puppy to an adult cat. While we all miss JJ, her spirit continues and her influence on her Cat-dog will serve him well over time. The zoo remains as wild as ever here, and we all remain optimistic we will have a happily ever after ending. Eventually.<br />
<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com7tag:blogger.com,1999:blog-5681384012661169479.post-46217985393050913412018-08-13T23:06:00.000-07:002018-08-14T08:59:49.974-07:00Grief Felt 'Round The World<br />
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<tr><td class="tr-caption" style="text-align: center;">Courtesy Raincoast.org</td></tr>
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When I lived in the Seattle area, I commuted by
ferry for many years. In the winter months, it was always a special gift to
have the ferry captain announce the presence of orcas as he stopped the engines
to make sure they safely passed. Everyone would rush to watch the big black
dorsal fins rise and fall, hoping for a peek of a spyhop. I never minded the
extra 10 minutes being added to the trip for such occasions. The southern
resident pods J and K often are found in the winter months chasing salmon
in the inland waters off Seattle before moving on to the San Juan Islands in
the warmer months, while members of the L pod are rarely seen.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3k_wQy1A0RLFPGsGVOwJ3I3DbK2Mr0zUBWe4mDAAENUd6IMh_dGo2G9E5VXwavYUgB-nphUQP8NfkLEqCEv1b-AWmDAAx8xhKvYDeeg1bSZmFU4hA6pc_yDPlPsqcwDmoUkES7wDKPn61/s1600/IMAGE_orca+and+seattle+skyline_credit+NOAA-thumb-500xauto-22800.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="333" data-original-width="500" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3k_wQy1A0RLFPGsGVOwJ3I3DbK2Mr0zUBWe4mDAAENUd6IMh_dGo2G9E5VXwavYUgB-nphUQP8NfkLEqCEv1b-AWmDAAx8xhKvYDeeg1bSZmFU4hA6pc_yDPlPsqcwDmoUkES7wDKPn61/s320/IMAGE_orca+and+seattle+skyline_credit+NOAA-thumb-500xauto-22800.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Credit NOAA</td></tr>
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In the Pacific Northwest, orcas have been mainstays in the coastal
waters from western Canada and Washington to as far south as California. First
Nation tribes such as the Tlingit, Tsimshian, and Kwakiutl all have rich
cultures surrounding killer whales, or orcas, as depicted in stories, legends,
and artwork. In 2013, long after I had left the area, I remember reading the
story of tribal artifacts being moved from a museum in Seattle to the new
Suquamish Museum. This new museum was located not far from where I had been
living when I experienced those special ferry commutes. On this trip, as the
ferry approached the Bainbridge Island terminal, it was surrounded by close to
three dozen orcas from both the J and K pods. Whether they were giving their
blessing to the artifacts returning home or it was simply a happy coincidence, the scene would
have been an amazing thing to experience.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiih8T2T8juBm27uY0mXxUZAf9iRtUBAmETZEuA1PG1c2j666uFBQXojyvFdRpuXVkP22O1FOyGNCpLPPT2i3NFJ0bRvR1jGclyI-3OTIj2JEzcv7_Y8suUmMACiDtnJoN6Ku7SrF24pkd7/s1600/killer+whale+hat.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="797" data-original-width="538" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiih8T2T8juBm27uY0mXxUZAf9iRtUBAmETZEuA1PG1c2j666uFBQXojyvFdRpuXVkP22O1FOyGNCpLPPT2i3NFJ0bRvR1jGclyI-3OTIj2JEzcv7_Y8suUmMACiDtnJoN6Ku7SrF24pkd7/s200/killer+whale+hat.jpg" width="135" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Tlingit clan crest hat</td></tr>
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Among First Nation tribes, the killer whale symbolizes
family, romance, longevity, harmony, travel, community and protection. Orcas
travel in large groups of families, working together to protect all members of
their pod, while raising new calves with care. They often stay their whole
lives with the same pod, although there also are transient whales who live
outside the resident pods. Each orca can be identified by its unique dorsal fin
as well as saddle markings in white. The Center for Whale Research closely
monitors and documents each orca. In recent years, there has been a marked
decline in the number of chinook salmon, putting the pods into crisis and causing starvation and
death.<o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLScozX-4Tzx-SKXp6c6tDkwzSO3guWqnvUiiIGdCYjaP83NY5fkyrftcddFxe6aqJr1Fc-M4dQUkYj7w76iJSiHYeDSW5zIeqKI9qoupMzqlHaiG9xQL9CBvxMnxPdt6bNaiT8uRx12iP/s1600/b6eda2c4-92b3-11e8-b257-a7dc9131ce2a-960x609.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="959" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLScozX-4Tzx-SKXp6c6tDkwzSO3guWqnvUiiIGdCYjaP83NY5fkyrftcddFxe6aqJr1Fc-M4dQUkYj7w76iJSiHYeDSW5zIeqKI9qoupMzqlHaiG9xQL9CBvxMnxPdt6bNaiT8uRx12iP/s400/b6eda2c4-92b3-11e8-b257-a7dc9131ce2a-960x609.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Seattle Times</td></tr>
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Recently, the tragedy of J-35, known as Tahlequah, has been
broadcast around the world. She gave birth to a calf too emaciated to live more
than thirty minutes. Tahlequah was seen surfacing with the dead calf cradled on top
of her, something that had been observed in the past with other orcas. As
researchers started documenting this through photos, J-35’s story spread. It became clear how deeply she grieved, even though scientists were reluctant
to apply such an anthropomorphic term to an animal. Each day brought a new sighting of Tahlequah
continuing to carry her calf, mourning in a way no other orca had been observed
doing for so long. As daily updates were shared, the sorrow of the community and
those following the story around the world grew. During this time, many came to
learn of the deeper plight facing the critically endangered whales from the
southern pods. They are starving and at a real risk of disappearing in the very
near future. </div>
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The images and ongoing narrative elicited a deep sadness and
despair. It was as if our collective grief was being played out in the waters
off Vancouver Island. Mourning not only for a heartbroken mother's display of love and connection, but for a broken environment that has brought us to this point. Day by day, those who were keeping vigil with Tahlequah
reported she continued to carry and push her calf, while being accompanied by
the rest of her pod. If she dropped the calf, she would have to dive deeply to
retrieve it as her mourning procession continued. She was not ready to let go. By day 16, scientists were increasingly worried about her health and welfare, but would not step in to force her to give up her calf. On day 17, in a collective sigh of relief, it was over. J-35 said goodbye to her baby after traveling with her body for 1000 miles. She appeared in good health as she resumed chasing salmon with the rest of her pod, finding a way to resume some normalcy. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq8J_SpB_f1WU2MJ8ly9kCmA0iLj4X5q_eK6hzMzZNBelscZF6SMTRo_BpD_iLhvZSgLRio0S9xyeKDxqWXFGlXGRJdOfvr27u7Cw7zzSMVq7HqtqBlYtEjcxC1MLatXeUvbmNgvJzpn9Z/s1600/38152827_10212944860278473_8249231152989077504_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1600" data-original-width="1219" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiq8J_SpB_f1WU2MJ8ly9kCmA0iLj4X5q_eK6hzMzZNBelscZF6SMTRo_BpD_iLhvZSgLRio0S9xyeKDxqWXFGlXGRJdOfvr27u7Cw7zzSMVq7HqtqBlYtEjcxC1MLatXeUvbmNgvJzpn9Z/s400/38152827_10212944860278473_8249231152989077504_o.jpg" width="303" /></a></div>
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Her story struck so many,
especially mothers who have lost their own children. While our culture is not
very tolerant of grieving, especially prolonged grieving, it was as if Tahlequah
spoke to us all through her actions and conveyed the notion that this was her time and
she would take as long as she needed. It was a heart breaking reminder that grief is a part of life and there is no one way to express it. </div>
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A northwest artist, Lori Christopher, captured
this image so eloquently, in a way that struck to the core for so many who have
lived through their own grief, especially as parents. You can see more of her
story <a href="https://www.facebook.com/photo.php?fbid=10212944860238472&set=a.1081822448014.2013619.1299921143&type=3&theater">here</a> and learn about the ongoing crisis of the orcas and what needs to be done to help them survive. Thank you Lori, for letting us share your painting.</div>
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Thank you Tahlequah for reminding us that a mother's love never dies.</div>
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com0tag:blogger.com,1999:blog-5681384012661169479.post-56080318915889126672018-08-01T18:51:00.000-07:002018-08-01T18:51:24.454-07:00Starting Over<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-_yT-w8VbcE0IiQ5qlxmCe-7tAMmYhYXuHXTpqv_u4GvlwXC4aCiqIoPK32iPsqjEMdW7LDVpql3VJwGYm_D_cclmAy7ez4yh-JXu3sf847FJXuxTDApkf2sao7VeJfkvRzATtWTyWFh_/s1600/170804_1641542286621_6638259_o.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1216" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-_yT-w8VbcE0IiQ5qlxmCe-7tAMmYhYXuHXTpqv_u4GvlwXC4aCiqIoPK32iPsqjEMdW7LDVpql3VJwGYm_D_cclmAy7ez4yh-JXu3sf847FJXuxTDApkf2sao7VeJfkvRzATtWTyWFh_/s320/170804_1641542286621_6638259_o.jpg" width="252" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Baby JJ and Callie </td></tr>
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<span style="font-family: Arial, sans-serif;">My intent was
always to raise a puppy as a potential therapy dog while still having a working
dog with me while the puppy matured. When JJ was just a puppy, her mentor and nanny Callie
was working with me as the second therapy dog we had with our hospice program. When
Callie died in January 2011, JJ was only four months old. She had time to
slowly work into her new role, as we had not yet built our inpatient hospice and would occasionally see patients in facilities or private homes while training for her job as a therapy dog. JJ had
plenty of time to grow into this role, alongside her mother Gamine, who passed
her first therapy dog evaluation when she was nine years old. As time went on, it was
always my plan to have another therapy dog after Gamine retired and JJ
continued to be my partner. However, I wasn’t in a hurry, because at the time
JJ was what we all would consider on the younger side. Unfortunately, she was diagnosed
with lymphoma shortly after she turned six years old. There wasn’t going to be
time to have her raise an understudy.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3zaAOYTubPAYW7qrlaD56FGKePMoQ1NLHxqs_La0TMcW6z_7WXLhT54NLm-QG_v5ZIgNTnOzN7n_5b1UUCxUQwNxZEuGEL-w-FL3S-MbtgZBmd9xYPb5Q2BHzveVwU-ujAaLi7ciAbr91/s1600/26841001_995129753958925_7665088254402871338_o.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="903" data-original-width="1080" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3zaAOYTubPAYW7qrlaD56FGKePMoQ1NLHxqs_La0TMcW6z_7WXLhT54NLm-QG_v5ZIgNTnOzN7n_5b1UUCxUQwNxZEuGEL-w-FL3S-MbtgZBmd9xYPb5Q2BHzveVwU-ujAaLi7ciAbr91/s320/26841001_995129753958925_7665088254402871338_o.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ottie with Ember and company.</td></tr>
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<span style="font-family: "Arial",sans-serif;">After JJ died,
it was comforting to spend time with the little creatures she was so fond of. I
noticed JJ’s sister Ottie wanting to spend much more time with them as well.
She was their grandmother and often would let them pretend nurse, as she
expertly flipped them and cleaned them when needed. Her daughter Shylah was
doing very well at mothering and didn’t really need help, but graciously
allowed Ottie to have as much puppy time as she needed. It seemed to help keep
us all distracted for the several weeks when JJ’s absence was felt so keenly at
home. Videos and live streaming of the puppy antics also were good for so many
of JJ’s followers during this time. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKBorWKxcIfscdE6bggh2Wxav6S4elVnifm1V9L6O5aTUUcTJ_p76zc7z9pYBp8D_hVfIPPn10oa0TQeFVexA9-OlSU8cm7J2yZEpYC-O4MnKhthyF96I0ZJ7sL0-dIbaduYuoLX8Ilv1e/s1600/28060908_1015216601950240_4403827617003383513_crop.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="618" data-original-width="1200" height="328" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKBorWKxcIfscdE6bggh2Wxav6S4elVnifm1V9L6O5aTUUcTJ_p76zc7z9pYBp8D_hVfIPPn10oa0TQeFVexA9-OlSU8cm7J2yZEpYC-O4MnKhthyF96I0ZJ7sL0-dIbaduYuoLX8Ilv1e/s640/28060908_1015216601950240_4403827617003383513_crop.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Courtesy Albany Democrat-Herald</td></tr>
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<span style="font-family: "Arial",sans-serif;">I am fortunate
to be a part of our therapy dog organization, Project Canine. I am honored to
carry their Puppy Partner credential, allowing me to visit with puppies under
my care until they are five months old. Before I made the announcement of who
would be staying, Ember and her litter mates visited the Hospice House a couple
of times before going to their new homes. This is one of the highlights for our
hospice staff and is planned well in advance, so anyone interested can schedule some
puppy time into their work day. These visits are great for puppy socialization
as well as wonderful for people who enjoy being around puppies.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYp1iPh1CUizPFK0UmLxfRYz5v-oNe6N-CPLfVw2koXzQh_Ja-N4Du5qoAebeEmhjR9u8HiI9RIxKYpAuKcVlLLNIaj-cUSAoxkOPEzqWyeg-Fev_ThBM3slrpzijb_sjvcuqTUA-cZSWq/s1600/28161457_1013596932112207_8002804448413715256_o.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1020" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYp1iPh1CUizPFK0UmLxfRYz5v-oNe6N-CPLfVw2koXzQh_Ja-N4Du5qoAebeEmhjR9u8HiI9RIxKYpAuKcVlLLNIaj-cUSAoxkOPEzqWyeg-Fev_ThBM3slrpzijb_sjvcuqTUA-cZSWq/s320/28161457_1013596932112207_8002804448413715256_o.jpg" width="203" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Elevator adventures</td></tr>
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<span style="font-family: Arial, sans-serif; text-align: center;">At eight weeks
old, Ember’s adventure started in earnest. The announcement of which puppy was staying coincided with a newspaper article about JJ's successor. Just as I had with her mom Shylah,
Ember started doing her therapy puppy visits at different locations under my
Project Canine Puppy Partner credential. JJ’s popularity opened doors for
opportunities to visit many places I didn't have access for in the past. In between several trips to the
Hospice House, she visited the local hospital, 911 call center, infusion
center, and hung out on a fire truck. At this young age, she was curious,
confident, enjoyed people, and was resilient if anything startled her. While
some people think quiet puppies would be the ones to make good therapy dogs, it
often is the opposite. A therapy dog needs to want to initiate contact with
strangers, not something a shy puppy often does. A puppy like this typically is
not comfortable visiting new environments, at least from the outset. </span><br />
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<span style="font-family: Arial, sans-serif;">Since JJ and I </span><span style="font-family: Arial, Helvetica, sans-serif;">also did Animal Assisted Crisis Response, my goal is to </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxwm87TFm0oJqb-tP4b_Gjil7j2ED4YKeW_4llRR5qt-r3bKJB8dXo_ZHYBuxygJMDAsRVWZeiZqwl10pYSwEqg743vveePRXZUgAO0EaEHsNxdys7oOYWGzbwzSDT601d_GYvFU3ala-m/s1600/27992936_1014237208714846_458712942333147189_crop.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1303" data-original-width="1059" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxwm87TFm0oJqb-tP4b_Gjil7j2ED4YKeW_4llRR5qt-r3bKJB8dXo_ZHYBuxygJMDAsRVWZeiZqwl10pYSwEqg743vveePRXZUgAO0EaEHsNxdys7oOYWGzbwzSDT601d_GYvFU3ala-m/s320/27992936_1014237208714846_458712942333147189_crop.jpg" width="259" /></a></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">have another canine partner for this volunteer work. Crisis response dogs need to be steady, brave, and compassionate to their core while visiting with strangers in very unfamiliar places. We do our best to raise our puppies to be bold, confident, and engaging before they move on to their new homes. Ember loved to explore, and would eagerly engage with me, displaying a sassy spunk in almost everything she did. She also clearly loved meeting new people, especially children. Not only were our puppy visits making people happy, we were able to get early exposure to things like elevators, hospitals, and fire trucks. As she ages, we'll continue to find new things to explore and see, including JJ's great nemesis, the skateboard. Ember's siblings are all nice puppies, and we like to think JJ spread some of her magic to them all before she died. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoMjiBMuEyHxGTCwBkrExncMHossDOqCkWhu2IeX2JYBnEIb8qGdPycZl3vxh7J_DSndShGvOcjQdygy2x4Pdfbw89KlQhMsAgC8rI87t153RsJoVUMkZFmKBkOeOJZGzZJoLRlXXt0aQA/s1600/33141135_1063535960451637_8630970998763552768_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="628" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoMjiBMuEyHxGTCwBkrExncMHossDOqCkWhu2IeX2JYBnEIb8qGdPycZl3vxh7J_DSndShGvOcjQdygy2x4Pdfbw89KlQhMsAgC8rI87t153RsJoVUMkZFmKBkOeOJZGzZJoLRlXXt0aQA/s320/33141135_1063535960451637_8630970998763552768_n.jpg" width="209" /></a></div>
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<span style="font-family: "Arial",sans-serif;">Once Ember
turned five months old, we needed to test for her individual puppy evaluation
with Project Canine. Since I am one of the two instructor and examiners in
Oregon, one of our board members traveled down to help test her. While I helped
teach our four-hour class prior to evaluations, Ember handled the class like a
rock star, relaxing either under my feet or in her crate. Some of the dogs had
reactive barking to seeing people walk by the windows, while Ember would just
raise her head as if saying “Why are you waking me?” She did have a couple of
short episodes of whining when I left the room, but overall was a rock star.
She handled her puppy evaluation well. In addition to having to do most of the
elements of our adult therapy dog evaluation, we include several things
specific to young puppies, such as mouthing, play drive, and how they respond
to being held on their backs for a short time. Due to the timing, Ember took
the older puppy exam and easily passed, something very few puppies under the
age of one can do.<o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;">After this, we
made the trek to the Samaritan Human Resources office where she had her photo
taken for her work badge. It is always a highlight for staff to have one of the
therapy dogs come in to get their photo taken. At five months, she started coming to work with me for half days, getting used to the environment and routine of the Hospice House. It felt good to have a dog back in the building, at least part time. One of the routines we all missed greatly was JJ's presence at our walkouts after someone had died. While she had taught herself to do this, we all thought it was a great idea that should carry on. It was on one of Ember's first work days when she was able to first participate. While she remained on leash, it was as if she knew exactly what she was doing. <o:p></o:p></span></div>
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<span style="font-family: "Arial",sans-serif;">By seven months, Ember had reached the size JJ was as an adult. As puppies approach their adult size, it's easy to forget they are still puppies. However, this is the time they start what we call the teenage months. They develop selective hearing, want to make their own decisions, and rebel against the rules. It became clear when it was time to change Ember's routine. It doesn't work to have a bored, energetic puppy when I am busy with work without enough time to spend with her. It's never a good idea to rush a young dog who already is loving the job. To do so can develop bad habits that are difficult to undo. Now, it's on to the next step. Volunteer visits, maintaining structure and impulse control, working on obedience and continued learning, and a lot of play. Let the teenage antics commence.</span></div>
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com8tag:blogger.com,1999:blog-5681384012661169479.post-1058670607038655452018-05-19T22:37:00.000-07:002018-05-19T22:37:00.141-07:00Woo-Woo, Meet the Rainbow Connection<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCISJfteMiOUbVa5jc9sUuxiOmTsPZ6cCS_DJx0SbhgKwxqtvjqcFNDvJbeVnyt3Ma2pE4s_VLEg-vEiTxiUrzdypcsYS-ppRbOJ1txyp42FOWcdKTmPE_N72dxCS4wgIGEWJ83t8Y5xCK/s1600/20180519_092900+edit.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="688" data-original-width="1600" height="274" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCISJfteMiOUbVa5jc9sUuxiOmTsPZ6cCS_DJx0SbhgKwxqtvjqcFNDvJbeVnyt3Ma2pE4s_VLEg-vEiTxiUrzdypcsYS-ppRbOJ1txyp42FOWcdKTmPE_N72dxCS4wgIGEWJ83t8Y5xCK/s640/20180519_092900+edit.jpg" width="640" /></a></div>
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<span style="font-family: arial, sans-serif;">I started my hospice
nursing career in an inpatient hospice in Washington State twenty-five years
ago. Being at the bedside of those who are actively dying is a privilege, and I
was happy to return to this role when we opened our Hospice House in Oregon in
2012. When I first started in hospice, I quickly learned about something we
call deathbed visions or dreams of the dying. Very often, these would involve
family members who had died previously, but on occasion involved children,
angels, or light. Only one time in all my years has it involved darkness. It did
not take long to have these phenomena become a normal occurrence in my work. I
remember years ago talking with the daughter of patient who was close to death.
Her mother had been having long, one-sided conversations with someone she
clearly knew. Her daughter had no doubt she was speaking with her sister who
had died years before, as she had been listening to their debates for years. Often,
visions of visitors are less dramatic, and people often can answer me when I
ask who they see. When I relay these stories, there are those who scoff in
skepticism. I have no idea what it will be like when it’s my turn to transition
into death, but I do know I have been witness to many other-worldly incidents
over the years. Only time will tell what it really entails when we each take a
turn at marking the end of our lives. I have often told family members I want
to see what my patients are seeing, but that would mean I was dying, and I am
certainly in no hurry to depart the world.</span></div>
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<span style="font-family: "arial" , sans-serif;">The other things
that come with working in a hospice inpatient unit where many deaths occur is
far more “woo-woo”. When I first started working at night, I had an older
gentleman who was one of our residents for several months. He would get confused
and restless most nights but was pleasant and easily distracted with tasks such
as folding washcloths, as he kept me company in the quiet night. He died on a day
I wasn’t working. When I returned for my next shift, missing the routine of
getting him through the night, something strange occurred. I could hear a phone
ringing in an empty room, but it stopped the moment I got to the phone to pick
it up. This repeated over and over, but only in the four empty rooms. Finally,
I just looked up and said “Steve, I hear you. I’m sorry I wasn’t here, and I’ll
miss you. Go ahead and go.” The ringing immediately stopped, and I no longer
had to chase my mysterious caller. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">One of my nurse
mentors told me a memorable story of taking care of an elderly, petite Japanese
woman at our inpatient center. She was tiny and not even five feet tall. When
our nurse would go to one side of the bed to check this woman, she kept getting
poked in the lower back. She would turn around and see nothing but an empty
chair. This happened several times, but only on side of the bed that had the
chair. SJ figured she was clearly in the way of someone, and as soon as she
adjusted where she stood, she was no longer poked. SJ found out that her
patient had been a twin, but her sister had died years earlier. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Our inpatient
center had two separate wings staffed by a nurse on each side. One night, the
nurse I worked with had a childcare emergency and had to bring her
five-year-old daughter to work. Some of our rooms were empty, so her daughter
curled up and went to sleep on the couch in one of these rooms. In the middle of the
night, she came out of the room looking for her mom to help “take care of the
lady”. When her mother questioned her more fully, her daughter described the
patient who had died earlier that day in the room to T. The little girl wasn’t
concerned or scared, just thought “the lady” might need something. Young
children have not learned to dismiss things that defy explanation. Those
filters are developed over time, when adults admonish any such stories as fantasies
of the imagination. Talk to those of us who have worked over time in a place
where many have died, especially at night. There just may be something to those
“flights of fancy.”<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">When we opened
our Hospice House, I was the only nurse who had worked at an inpatient hospice
before. I remember telling someone old stories and saying, “Just you wait, we’ll
have our own stories eventually.” Sure enough, over time we have had mysterious
lights turning on and off, voices, and many unexplained happenings. Some of our night staff get frightened by these things, while others shrug their shoulders and say </span><span style="font-family: Arial, sans-serif;">“Who knows?”</span><span style="font-family: arial, sans-serif;"> It is more common to
become aware of these occurrences at night, when there are fewer distractions and it is
quiet. </span><br />
<span style="font-family: arial, sans-serif;"><br /></span>
<span style="font-family: arial, sans-serif;">We took care of one patient for weeks at the Hospice House. He was
challenging at times and had a difficult death as well, as some do. Many of
us are certain he likes to come back to cause a little chaos. When something
strange is happening and cannot be explained, I usually just say “Oh, you know
it’s J. Just wait, he’ll get bored.” All who worked during that time just laugh and nod their heads in agreement. I saw one of his daughters at a book signing last
year and relayed these stories. She chuckled and said, “That would be something
he would do!” I roll with these unexplained stories, but love to threaten my husband
with telling him my “ghost stories” if I want to rattle him.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_8S8K3YpyipPZnuywXM3EIbLLHy7RJoBUfbWJJzQ33HyrPGnbfGY53SLuyP4j7kYl5_r3X4-gnJPSwh_K1EEm3S_Qnlnu7vvW3DWH21RACmbpsYDGlb_tkxmSFl5Vo_FUk8UGKFPDIrrx/s1600/36827_1447577837631_1128127_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="622" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_8S8K3YpyipPZnuywXM3EIbLLHy7RJoBUfbWJJzQ33HyrPGnbfGY53SLuyP4j7kYl5_r3X4-gnJPSwh_K1EEm3S_Qnlnu7vvW3DWH21RACmbpsYDGlb_tkxmSFl5Vo_FUk8UGKFPDIrrx/s200/36827_1447577837631_1128127_n.jpg" width="200" /></a></div>
<span style="font-family: arial, sans-serif;">Many people
have recounted stories of something happening at the time of a loved one's death. I had
never experienced anything like that until my mom died. It was so remarkable that this story was included in the book. I had been traveling back and forth
to Montana every few weeks with Callie, my therapy dog at the time, after my
mother was diagnosed with ALS. My parents loved to feed the birds and squirrels
from their back deck. On my visit to my parent’s house a couple of weeks before
Mom died, Dad and I were commenting on the lack of birds at the feeders that
year, even when Callie wasn’t around to chase them off. After Mom died, my
sister and I started working on her obituary. In the evening, I tweaked our
draft a bit to add, “She helped to create a haven for the deer and birds in
their back yard, taking the occasional visits by pesky bears, skunks, and
turkeys in stride.” Well, the next morning my sister, Dad, and I were out on
the deck enjoying some coffee with the fresh air. There was a deer at the
feeding block, as usual, but there was melodious chaos with birds EVERYWHERE! My
sister said it was like we were inside an aviary. They were flying by our
heads, zipping about everywhere in a behavior none of us had ever seen before.
It was over quickly and then they were gone, except for a few. We looked at
each other and said, “Yes, ma’am, you have our attention!” It was quite an
experience and one I will never forget. I think of her often when we have birds
flitting about our property.</span></div>
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<span style="font-family: "arial" , sans-serif;">Our house is
surrounded by grass seed fields, so the wide expanse of land gives us great
views of the sky. We have some incredible sunrises and even more stunning sunsets. Whether it is watching a beautiful sunset, staring up at a starlit
sky, or seeing a rainbow form, these displays by Mother Nature remind me of
those who have died before me. I smile, because they always help me to
appreciate the memories of loved ones. Last year during JJ’s cancer treatments,
we had many days when one or two full rainbows adorned the sky. They brought me
peace, and I have a few photos with JJ and rainbows in them. I also have some
spectacular sunset photos with JJ’s silhouette in them. When I was outside
enjoying Mother Nature’s displays, JJ was often beside me. One morning after she
died, I was heading to work, trying to adjust to not having my work partner
riding shotgun. As I looked in the rearview mirror, I saw a spectacular sunrise
and had to pull over to capture the moment. As I kept driving, a bright rainbow
appeared. It stayed bright and was with me on my five-mile drive into town. All
I could think was “Thank you, Girlie-O”, and it was a great start to my day. </span><br />
<span style="font-family: "arial" , sans-serif;"><br /></span>
<span style="font-family: "arial" , sans-serif;">While I don't really think my loved ones are directly sending me rainbows or a magical night sky filled with radiant stars, these wonders of nature make me pause and appreciate all I have and have had with those who no longer are with me. I think of my parents when I see the stars twinkling and often say a quick hello to them. I can imagine JJ still standing next to me watching the gorgeous sunsets. Since she has died, </span><span style="font-family: arial, sans-serif;">many rainbows have appeared in the sky, often when I am outside with Ember. It’s as if JJ is giving her stamp of approval, and it makes me smile. I am thankful for these reminders of memories I hold near and dear.</span><br />
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<span style="font-family: arial, sans-serif;">In the 1970’s,
Jim Henson’s The Muppet Show appeared on televisions across the nation,
including ours. We watched weekly, and I still smile at the thought of Kermit
the Frog, Ms. Piggy, Gonzo, and Fozzie the Bear. Along
with the two cantankerous old men heckling from the balcony, who to my surprise
had names, Statler and Waldorf. With a shout-out to Kermit and his creator Jim Henson, who sang a song I
still know the words to.</span></div>
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<span style="font-family: "arial" , sans-serif;">Why are there
so many songs about rainbows<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">And what's on
the other side?<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Rainbows are
visions, but only illusions<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">And rainbows
have nothing to hide<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">So we've been
told, and some choose to believe it<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">I know they're
wrong, wait and see<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Someday we'll
find it, the rainbow connection<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">The lovers, the
dreamers, and me<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Who said that
every wish would be heard and answered<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">When wished on
the morning star?<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Somebody
thought of that, and someone believed it<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Look what it's
done so far<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">What's so
amazing that keeps us stargazing<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">And what do we
think we might see?<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Someday we'll
find it, the rainbow connection<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">The lovers, the
dreamers, and me<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Have you been
half asleep, and have you heard voices?<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">I've heard them
calling my name<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Is this the
sweet sound that calls the young sailors?<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">The voice might
be one and the same<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">I've heard it
too many times to ignore it<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">It's something
that I'm supposed to be<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">Someday we'll
find it, the rainbow connection<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">The lovers, the
dreamers, and me</span></div>
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com11tag:blogger.com,1999:blog-5681384012661169479.post-25066968848779807932018-05-13T22:37:00.002-07:002018-05-19T22:37:55.389-07:00The Passing of the Torch<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , sans-serif;">The loss of our
Hospice House therapy dog was difficult on everyone, although for me, it meant
finding a way to adjust the way I did my hospice nursing. For people who didn’t
know the role she played at our hospice, they would say “Oh, it must be nice to
take your dog to work”, not understanding the work she did with patients,
families, visitors, volunteers, and staff. Since we opened in 2012, I always
had JJ at my side during our 12-hour shifts, with the rare exception of a day
when she needed to stay home. For weeks after she died, I would look down as I
scooted my chair away from the computer, wanting to make sure I didn’t run over
her tail. I caught myself many times starting off to look where she had gone
when she wasn’t at my side. The hardest moment, however, came when we had a weekday
walkout of a patient who had died. The staff lined the halls as usual, but I could
see the sadness on their faces as they watched us approach without the familiar
figure of JJ walking next to the gurney. Her presence often elicited the most
emotion during these walkouts and everyone was acutely aware of her absence.</span></div>
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<span style="font-family: "arial" , sans-serif;">I knew I would
be picking a puppy from our litter born just eight days before we knew JJ’s
lymphoma was no longer responding to the chemo. As a hospice nurse, I always consider
my role as being a midwife at the end of the life cycle. When puppies arrive,
it’s a nice break to midwife the other end of the life cycle. It was especially
true of these puppies, although when they arrived into the world, with a very
anxious JJ waiting to greet them all, I had no idea of the short time she would
have with them. We had gotten so much extra time from the lymphoma treatments,
I dared to imagine JJ would help me pick out “her” puppy and assist me with her
training, at least for a little while. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">While JJ loved
people and enjoyed the work she did, she absolutely went bonkers when puppies
were around. She was four months old when she met her first “Littles” and would
get in the whelping box with them when mom was taking a break. Anytime the warming
box came out, signifying puppy arrival time, she was beside herself with joy,
although terribly impatient to be able to meet them and give her stamp of
approval. Over the years, she would clean, snuggle, and spend as much time as
she could with these magical creatures, even though she never had her own
puppies. The mothering instinct is incredibly strong in JJ’s family lines. Even
her sire, Dash, loved puppies and considered it Christmas morning when they
arrived.</span></div>
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<span style="font-family: "arial" , sans-serif;">JJ’s niece
Shylah had six boys and three girls. I knew I would be keeping a girl, but
those decisions come as the weeks progress. There is no way to know what a
puppy’s temperament and personality will be like when they are newly born. The
girls wore the colors lime, pink, and aqua on their collars, which helped me to
keep track of their weights. My days during JJ’s decline and after her death
were busy with the tasks of caring for “The Littles”. It is very reminiscent of
when we have young children in a family who are present at the Hospice House
when a loved one is dying. It reminds us all that life does go on, even with
death in our midst.</span><o:p></o:p><br />
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<span style="font-family: "arial" , sans-serif;">Watching these
puppies grow up was good medicine for so many after JJ died. While it has been
true that our puppies have brought joy and peace to those struggling in the
past, this was the Healing Hearts Litter, puppies helping thousands through
their grief for JJ even from afar. Long before it was time for them to move on
and spread their magic, their antics brought smiles. JJ’s sister Ottie clearly
chose to spend a great amount of time with them, in her own way of dealing with
JJ’s absence. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">I kept my puppy’s
identity a secret, even though I had made my decision by the time they were
seven weeks old. These puppies were all nice, although one did stand out with
her personality and structure. Since my goal was not only to have a therapy
dog, but another Animal-Assisted Crisis Response partner, I look for a puppy who
is bold, confident, enjoys people, has courage to encounter new and strange
things, and is willing to work with me. When we did our temperament testing a
couple of days before they went home, I got a few chuckles when I saved my
puppy for last. I had only said “You’ll see why I picked her” to the others.
This girl knew how to command attention when she came into the room and I
distinctly remember another puppy owner making the remark about a “bucking
bronco”. Luckily, some of that puppy energy has waned as she has gotten a bit
older. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif;">The great
reveal came on the day all the puppies went home. Miss Pink was the girl would
be staying. Her registered name would be Calhoun’s Get The Party Started, but
she would be known less formally as Ember. </span><span style="font-family: "arial" , sans-serif;">Only time will
tell if Ember becomes our Hospice House therapy dog successor, but early
indications are good. She’ll be her own girl, although it will be easy to make
comparisons with her well-known aunt. She already has many mannerisms that are
similar, and they resemble each other in looks. So far, she has been making
therapy puppy visits to different locations and will be starting half days at
the Hospice House, learning about her new second home.</span></div>
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<span style="font-family: "arial" , sans-serif;">The great challenge I have found was not something I would have never thought about so many years ago when I started JJ's social media sites. In retrospect, having a name more generic would be easier to pass on. Many asked when JJ died if I would start a new page for Ember. However, a lot of time and effort went into creating the community around JJ and her work. I knew I wouldn't give it up, would raise Ember on JJ's page, and am still negotiating how to transition the changing of the guard, if you will. As I remind people often, JJ is not being replaced; her legacy lives on in the next generation. Those of us who are used to living with dogs would feel an empty space in our hearts if not refilled somehow. Modeling how to move on while not forgetting is something that is important to do. We all experience loss throughout our lives, whether people, pets, or both. This may be something that just is easier for me. I'm not someone who spends a lot of time in the past, other than to reflect and smile or cry when needed.</span><br />
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<span style="font-family: "arial" , sans-serif;">I am certain people will find that falling in love with a new puppy over time will occur naturally. There with be many stories to share about this little one as she grows and learns her way in life. Unfortunately, our pets have a far shorter lifespan than we do, so experiencing the heartache of death will continue to occur as my years continue. However, the memories and connection will always make it worth it. We now have a new family member to continue the Barke Diem tradition.</span></div>
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com8tag:blogger.com,1999:blog-5681384012661169479.post-61111057284545608372018-04-30T23:17:00.000-07:002018-04-30T23:17:08.437-07:00The Gift of Time<br />
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Part 5</div>
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When we first received JJ’s lymphoma diagnosis, the realist
in me knew she probably only had a few months to live, even with the
chemotherapy. However, we were graced with not just four, or even six months,
but a full year before the cancer reared its ugly head to the point of saying
“enough”. I often tell the family members of our dying hospice patients how a
brief window of lucid time can be such a gift.</div>
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Month after month, even with the
brief bad times, the gift of time was a blessing to so many, whether they knew
JJ in person or through her virtual therapy work. I’m not a big fan of creating
a “bucket list” as so many do. Instead, I believe the things that are important
and fun should be enjoyed whenever possible. I thought about driving her to the
snow, knowing how much our dogs loved the occasional snowfall, but instead she
swam when her counts allowed and almost daily took to hunting the hay bales on our
property. It reinforced the joy of
appreciating the little things in each day. JJ’s zest for life made sure of it
and was the cause of many a smile and laugh.<br />
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I knew from the moment of her diagnosis I would be facing
the biggest challenge in my hospice career. There were many people to prepare
along the way. I made a commitment to be honest and open along the way about all
JJ would be going through. I had spent much of my time talking about death and
dying over the years using her as a conduit for difficult topics and
conversations. Even when close to home, I knew there would be many
opportunities for both teaching and supporting through sharing JJ’s illness. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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One of the secrets of being a long-time hospice nurse is the
ability to maintain strict boundaries. After twenty-four years, I knew I could
share publicly while doing my own anticipatory grieving privately. I became
excellent at scanning through comments and messages, taking in the sentiment,
while not taking on the burden of others’ angst. It’s not much different than
being able to be a caring, compassionate, and empathetic nurse, while not
taking on the emotional baggage of someone else along the way. It was a skill
set that came in very handy over the course of the year.<o:p></o:p></div>
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JJ had a good response immediately to the chemotherapy. I
knew there was time shortly after treatment started and as each month
progressed, to gently touch on what was happening without throwing the reality
of JJ’s life limiting illness like a pot of boiling water in someone’s face. We
knew we were buying time and that canine lymphoma is not curable in the sense
some cancers are. I was upfront about this, but in the manner I would be with a
hospice patient who has some time left. The conversations evolve over time from
“What has your doctor told you?” to “What would you like to know? I’ll answer
any question you will have along the way to the best of my ability” to “Tell me
your stories”, eventually arriving to “What are you most concerned about now,
as you are getting close to death? What can I help with as your nurse?” During
this time, I shared articles regarding end of life regarding our pets,
including quality of life assessment tools. It wasn’t just to be helpful in the
bigger sense of people needing this information for their own pets, but also
was a way to gently nudge people in the direction I knew we were going with JJ.
<o:p></o:p></div>
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When JJ was doing well, it was easy to keep the focus on day
to day activities, while reminding people to enjoy the moment and live in the
spirit of Barke Diem. I was transparent throughout, and it was when she was
having an off day that her cancer diagnosis was foremost in my mind. These days
always had me thinking “What if this is the progression of the cancer?” While I
didn’t post these thoughts out loud, I would reply to questions about it with
“Time will tell, and we take it day by day.” No one has a crystal ball in human
or veterinary medicine, and people often dread not knowing. I personally am not
in that category, so it was easier for me to take most days in stride, waiting
to see what the next day would bring. My mom and I often would say, “It is what
is” when she was diagnosed with ALS, and I have said it countless times since
then. This saying would run through my head, keeping me centered, when so many
expressed how unfair it was to have such a loving dog diagnosed with cancer. It
was usually during the off days when I got the most comments of either
treatment options I should be doing, because “XYZ” cured Spot the Dog of a
random cancer, or “How dare I put that dog through torture? Euthanize now.”
Those were the times I did light skimming and relied on others to keep the
outrageous in check. <o:p></o:p></div>
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One of JJ’s greatest joys in life was being a nanny to
puppies born here. Since she was four months old, she was fascinated with them,
and quickly decided that each puppy belonged to her. It didn’t occur nearly as
often as she would like, and she vibrated with joy when the magical puppy
basket started filling up. She assisted with clean-up duty and was their playmate
as they grew older, but she drew the line when any of them dared to assume she
was the milk bar. It’s strange how timing works out. Before we ever knew about
the cancer, I decided at some point I would need an understudy to carry on the
work when JJ was no longer here. I had kept one of her nieces, Bria, for this
purpose. <span style="mso-spacerun: yes;"> </span>When Bria was only ten weeks
old, JJ was diagnosed with her lymphoma and everything changed. I chose to
focus on JJ, not knowing how much time we would have together. Luckily, Bria
loved the retrieving game and she quickly became my husband’s dog, joining many
others in field training. JJ got to spend time with “her” puppy, wrestling and
playing, while I didn’t have the added stress of trying to focus on puppy
training. It was a win-win for both of us.<o:p></o:p></div>
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As the year progressed, I knew eventually I would need to
consider finding a new potential partner. We are in a unique position of sharing
our lives with a lot of dogs, and we had planned on having a Golden litter at
the end of the year. JJ’s niece Shylah was pregnant, and I had decided to keep
one of the puppies. It was something to look forward to, and it was easy to
become hopeful that JJ would be able to do some training and mentoring of her
great-niece for a while. At our Hospice House, when family visits with
multi-generations, it reminds everyone of the Circle of Life. It was the same
sentiment having a new group of puppies while knowing at some point JJ’s
disease would progress.<o:p></o:p></div>
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With canine lymphoma, very often one of the first things
owners notice is an enlarged lymph node. When JJ’s nanny Callie was diagnosed
seven years earlier, she had a huge lump on her neck from one of the lymph
nodes in that region. Since JJ’s original diagnosis came from noting a very
high calcium level on her bloodwork, her lymph nodes remained on the small side
throughout her treatment. Eleven months into JJ’s original diagnosis, I
experienced a Deja-vu moment when I could suddenly palpate a large node in her
neck. At the time, she was otherwise asymptomatic, so the oncology team said
they would recheck her during her normal every three week visit. As we got
close to that appointment, several of us at work again noticed a slight change
in her breathing. I was not at all surprised on December 19, 2017 to find out
her lymphoma was no longer responding to treatment and she again had a
recurrence of the fluid in the lining of her lungs. The malignant pleural
effusion had returned, although not to the level it had in July. While there
were more desperate, hail-Mary options to be had, it was time to stop and enjoy
the days we had left. The decision was easy on my part, as I knew eventually we
would reach this point. <o:p></o:p></div>
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Very often in oncology, whether human or animal, when a
cancer no longer responds to the treatments that are available, it is worded in
the terms “There is nothing more we can do.” This is unfortunate, because there
is a way to re-frame how to look at the end of life, whether for a loved one or
a beloved pet. Since none of us get out of dying, if treatment options are no
longer working, there is so much that can be done while facing death. We went
home and made the most of each day. For JJ, this came in the form of mooching,
pretending to retrieve, hunting her hay bales every day and drinking in the
wonderful aromas, snuggling with her therapy person, and joy of all joys,
spending time with the glorious creatures that filled the magical puppy basket
just eight days earlier. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWKi6g4bDZpdHUfXyTEIGhX3ovPGQjy8LgyD2W-LOH4R2vnpLBgESwoNncHw-ZO-MGCwOPDJ-skfEZ-dy4mL3XEO4tU9JX7uDtS0-F9pTeC3PIbffGmX8MtyvtZFeNZTKfyihgWMpxqjvQ/s1600/25626399_984365575035343_6852160032573822682_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWKi6g4bDZpdHUfXyTEIGhX3ovPGQjy8LgyD2W-LOH4R2vnpLBgESwoNncHw-ZO-MGCwOPDJ-skfEZ-dy4mL3XEO4tU9JX7uDtS0-F9pTeC3PIbffGmX8MtyvtZFeNZTKfyihgWMpxqjvQ/s320/25626399_984365575035343_6852160032573822682_o.jpg" width="320" /></a></div>
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JJ was feeling good enough that she continued to accompany
on my work days to the Hospice House. As always, she could sleep, play, and
visit to her heart’s content at what had become her second home over the years.
We worked on Christmas Eve, but as the morning progressed, she just seemed
tired and was going through too much effort with the simple things. I called my
husband and asked him to take her home, knowing her work as an extraordinary
hospice dog was ending. When the Hospice House opened, JJ taught herself to
walk next to the gurney of our deceased patients on the way to the funeral van.
Her presence during these walk outs often made us all a bit more emotional. As
she often made these unique at our Hospice House over the years, JJ had a walk
out like no other. She got to walk herself out the front door with the toy of
her choice, Lambchop. It was a poignant moment for all of us that day, knowing how
our work would be so different without JJ helping to comfort everyone. <o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh7LEdQdT15pRC_JjCQjnP_Kcdvmhja3VRun0fH3-x9LELHZdfZB7mqbHOEBO-5VeWG6goPGbcgo0tPU6tcsjkOtClTejiz9UErQ82drLijK77d-jCuQUFh14ReL79w56Xyn7qWpyrlmov/s1600/26114595_987441818061052_6164264173068729889_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh7LEdQdT15pRC_JjCQjnP_Kcdvmhja3VRun0fH3-x9LELHZdfZB7mqbHOEBO-5VeWG6goPGbcgo0tPU6tcsjkOtClTejiz9UErQ82drLijK77d-jCuQUFh14ReL79w56Xyn7qWpyrlmov/s320/26114595_987441818061052_6164264173068729889_o.jpg" width="320" /></a></div>
<div class="MsoNormal">
JJ always had special relationships with different people
who got to see her over the years. I remember taking Callie into our hospice
office for those who wanted to say their goodbyes. When I looked back, I was
struck by Callie’s ability to comfort those saying goodbye to her. In the same
vein, it was important for those who wanted to be able to say goodbye to JJ.
She was spending more time sleeping, but still enjoyed playing outside and
snuggling. Three days after Christmas Eve, I was back at work. At lunch time
for two consecutive days, my husband brought JJ for short visits. While these
goodbyes were hard, JJ channeled her nanny Callie and found a way to comfort
and make everyone laugh through their tears. </div>
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JJ spent her remaining days gopher hunting and snuggling
with puppies. It was obvious she didn't have the energy she once did, but she was able to
spend time doing what she loved. I often tell my hospice families that when a
cancer patient finally declines, it can be like cliff diving, as it goes so
fast. It is the same with our pets. I am fortunate to have been a hospice nurse
for four score and twenty years (some days it feels like that), because it is
in our bones to be constantly assessing for the subtle signs that things are
changing and to be prepared. I shared these goodbyes as a way to prepare people, although most were surprised by how quickly she declined.</div>
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<o:p></o:p></div>
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It was obvious she was changing daily, and I had made an
appointment a few days for euthanasia if she continued at the rate she was
declining. If anything, people often have regrets for making their pets live
longer than they should because it was too difficult to make the call. I
continued to keep a very close eye on her, but she primarily just slept a lot,
like so many of our hospice patients do as they are slowing down. We spent the
evenings in the whelping box with the puppies, including the same night of her
final Hospice House goodbyes. In the middle of the night, my nurse ears were
wakened to the sound of JJ having some breathing difficulties. It was bad
enough that I gave her a medication we often use for our patients when they
have these symptoms, something I had left over from my own surgery months
earlier. It was 3 am, and we had the choice to go to the emergency clinic if
needed. I stayed next to her and was relieved to have her settle comfortably
once her medication took effect. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfb44YLzyvXcGUIn5E6ZsoeMAOKc9e_JtuA1CZ7Yc9_7iSTsqN9IIpVdthk5YcNbvBR-MYkKM5n4NwRPHh2s_T475Pz_ArSrIE65elcqIHkQsW-DrelCvpiVvTcjzdNvORHO7wWUas8P1c/s1600/26172530_987441638061070_1810871378922456478_adjusto.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfb44YLzyvXcGUIn5E6ZsoeMAOKc9e_JtuA1CZ7Yc9_7iSTsqN9IIpVdthk5YcNbvBR-MYkKM5n4NwRPHh2s_T475Pz_ArSrIE65elcqIHkQsW-DrelCvpiVvTcjzdNvORHO7wWUas8P1c/s200/26172530_987441638061070_1810871378922456478_adjusto.jpg" width="150" /></a></div>
<div class="MsoNormal">
There was no question about the phone call I made a few
hours later. It was time. I was supposed to work, but I had been put on call,
knowing this quick decline might happen. I am fortunate to have colleagues who
understand, and they quickly found coverage for me. While it is never an easy
part of veterinary medicine, euthanasia is essential in the health continuum
for our pets. We were extremely thankful for the care of all the staff at our
vet clinic, who knew JJ so very well. There were several people in the room as she
took her last breath. Later in the day, I received a text with the photo of
JJ’s mosaic at work in our chapel, with a candle lit in her honor. One of the
traditions at the Hospice House is to light a candle for 24 hours in
remembrance of those who have died and now it was JJ’s turn. I was so touched
by this unexpected gesture.</div>
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<br /></div>
<div class="MsoNormal">
For me, the last week of JJ’s life was hard, but it was also easy because
of my experience. Along the way, JJ got to do the things she enjoyed. What more could anyone ask for? Personally, I would love this ending
for myself, although I might think of something other than sticking my nose in
a gopher hole. Indeed, a life well lived to the very end. There will never be another JJ, but oh, what a legacy she has left.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com12tag:blogger.com,1999:blog-5681384012661169479.post-58318692611825428042018-04-21T22:06:00.001-07:002018-04-22T09:44:04.465-07:00From Bad to Barke Diem<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju4vmifIfM3oTLgAGrtm20oD6GTKt2JHZtjfW_8Qye_EsePF9xhkvcyacABfC2xZ_sJZOLpbrrmeQAD3_SaFxiU_UIaBwCf60Dgo5Ioqton6MXU1GUmCz4JjhDssdC38ZUNjDNg0LUJ6k5/s1600/20170820_061211.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju4vmifIfM3oTLgAGrtm20oD6GTKt2JHZtjfW_8Qye_EsePF9xhkvcyacABfC2xZ_sJZOLpbrrmeQAD3_SaFxiU_UIaBwCf60Dgo5Ioqton6MXU1GUmCz4JjhDssdC38ZUNjDNg0LUJ6k5/s640/20170820_061211.jpg" width="640" /></a></div>
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<div class="MsoNormal">
Part 4<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
In the week following JJ’s thoracentesis, the removal of the
fluid from the pleural effusions, she also started to have some signs of
nausea. She stopped eating and the next day clearly was not feeling good,
appearing nauseated. I brought her to work, knowing I would have many eyes to
watch over her condition while she slept. I couldn’t get oral medication into
her very well, so I phoned our regular vet and asked for a prescription for
injectable Cerenia, the anti-nausea medication we used with JJ’s chemo treatments.
My husband picked it up and delivered it to us. In our inpatient hospice unit,
we often use injectable medications when our patients cannot swallow. On this
day, JJ was simply one extra patient to care for. When I called to make another
vet appointment, I could only say “something is really wrong”. Her breathing
was fine, but as the evening progressed, she had an episode of coffee ground
emesis (vomit that has congealed blood in it, looking like wet coffee grounds)
and then dark colored stools. I knew we were dealing with gastrointestinal
bleeding again. Our option was to go to ER or wait until the morning to get to
OSU. Given her complex care needs over the past week, I felt she was in better
hands with our oncology team that a vet team that did not know her. Our brains
don’t process well when stressed and it had been a difficult week. In
hindsight, it was very clear what was happening, but in the middle of it all, I
kept thinking that it could be her disease progressing. What I knew that night
was that JJ felt very bad, we had made it seven months from the start of
treatment, and that we had no idea if the new chemo protocol would be
effective. When a person has a life-threatening illness, a palliative care team
can get involved, look at the big picture, and help to develop care goals,
which then helps to determine which path of treatment to take or not take. I
knew this was what we would be doing at OSU the next day. It was a very long
night, as I slept next to JJ on an inflatable mattress. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
By the next morning, JJ still clearly felt bad, but was not
vomiting or having any further tarry stools. She was walking in a hunched
posture, clearly having pain. She was rushed for another ultrasound at OSU,
this time of her abdomen, which showed a significant bleeding ulcer. She had
the beginning of peritonitis, an inflammation of the lining of her abdomen, but
luckily it had not perforated. When people or animals receive chemo, the term
nadir indicates when the blood counts have reached the lowest point due to
treatment. We were facing the perfect storm of the effects of her last dose of
original chemo hitting its nadir along with the prednisone creating an opening
in her stomach lining, despite the two medications given specifically to
prevent this. She had the beginning of an infection due to her low white blood
cell count and for the first time had thrombocytopenia, a low platelet count. Our
platelets are integral in clotting, and those with low values are cautioned to
avoid any injury due to the risk of bleeding. It was bad enough to see bleeding
on the ultrasound and JJ was rushed to ICU. For as bad as she clearly felt, the
rest of her scans were clear, and we knew this was a fixable condition. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
She was started on intravenous fluids, antibiotics,
medication for the ulcer, and pain medication. Our animals only have body language
to communicate, but we know very well how painful ulcers are in humans. We had
a great team that kept me updated with messages and photos while I had to work.
I found out during my visit after work that my little princess was too “high”
on her pain medications, so her dosages were decreased. I knew the night before
she was discharged that she was feeling better. Not only was she starting to eat, but I watched her as she
started picking at the blankets. This meant she had enough energy to consider
being naughty. To this day, we still have “swiss cheese” blankets decorated by
JJ when she protested being locked up against her will. She was thrilled to be
broken out of the place the next morning and couldn’t wait to get home.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It took about a week for her ulcer to finally heal. She did
come to work with me, as her MAR (medication administration record in human
medicine) looked like some of our patients’. Her medications needed to be
spread out so they didn’t interfere with others she was taking, so JJ was getting something
about five times daily including an antibiotic, two different medications for her
ulcer, and a pain medication. Dogs, like our patients who are at the point
where they cannot speak, are unable to tell us they have pain. Just as we give
these hospice patients their scheduled pain medications they have needed to
control baseline pain, we continued to give JJ pain medications on a schedule
for three days knowing how painful ulcers are. It would have been far easier
had she been able to answer my question of how she rated her pain, but no such
luck. She spent a lot of time sleeping those first few days, but it was far
better to err on the side of ensuring her comfort. By the third day, we all
breathed a collective sigh of relief when she could be woken from a dead sleep
to the sound of her cookie jar rattling.<br />
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
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<div class="MsoNormal">
It was during this crazy time when I started emphasizing
how I started taking a cue from JJ and did my best to live each day to the fullest. One of our long-time
followers helped coin the phrase “Barke Diem”, a dog’s take on Carpe Diem, or seize
the day. It was a helpful reminder to me and so many others to live our lives a little
more like our dogs. We all know with our hospice work how none of our days are guaranteed. After a short rehab period, JJ was able to return to her usual routine of playing,
eating, and doing her amazing work at the Hospice House. She responded to the
rescue chemo protocol and seemed happy to only have to make vet visits every
three weeks.<br />
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Knowing eventually, time would run out, we packed a lot into our days. While some people create a bucket list for their dogs, we chose to find ways to have fun daily and take advantage of any other opportunities that arose. Even though we had not done any deployments since JJ's lymphoma diagnosis, we were still a volunteer team for HOPE Animal Assisted Crisis Response. I chose to attend our annual meeting in September in Colorado, knowing it would be the last we would attend together.<br />
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<br /></div>
<br />
<br />
While flying would have been so much quicker, and our canine partners are allowed to fly in the cabin for HOPE deployments and events like this on some airlines, we were due during that time to have another blood test follow up to know if she was safe to take her dose of oral chemo. We decided to drive and make our appointment at Colorado State University, one of the top veterinary oncology programs in the country. Along the way, we had quite the adventure. JJ was feeling good, we got to visit family in Utah, and CSU found her to be doing well and she was able to take another dose of her medication. I was able to consult with the oncologists about one of the latest drugs developed for canine lymphoma at CSU. I had researched it myself, and knew Tanovia had a better response for B-cell lymphoma. The oncology team had just been talking about the use of it for rescue protocols that morning in their staff meeting. It was reassuring to hear them tell me that they concurred with the current chemotherapy agent she was on. Her blood work was normal and we were cleared to be among our fellow HOPE members, including the dogs. It was a bittersweet time, knowing that everyone attending could relate to both the intense bond I had with JJ and the intense loss when our canine partners were no longer with us.<br />
<br />
We made the most of those days on the road. JJ was always a great sport and more than willing to be my road dawg. While people expressed sadness anytime I reminded them of the reality of JJ's disease and prognosis, I was busy soaking in as much as I could. Spending time and making memories was the priority. We took the scenic route, stopped often to take in the sights and stretch, and frequently heard from my husband “You’re stopping again??? When are you ever going to be
home?”<br />
<br />
Not once during JJ’s year of living with cancer did I think “Why her?” This isn’t to say I was not sad, especially during one of the few days when she did not feel good. I know all of my years in hospice work has clearly taught me that we all have to take our turn, although I would have loved to have had her longer. I remain grateful she tolerated the treatments well, and for the most part, tolerated going to vet appointments so often. When I expected she may live only four to six months, each month afterward was celebrated as a bonus. She continued to have a blast on days off, spent time with her people at work, and treated each day as if it were the best ever. JJ enjoyed some more months of mooching from people at work, passing out hugs, stealing bumpers from the field or dog truck, continuing to perfect the fine art of the non-retrieve, and snuggling with her therapy person, my husband every chance she got. It was a life well lived. Looking back, we would not have changed a thing, except for skipping that darned prednisone the second time around.<br />
<div class="MsoNormal">
<o:p></o:p></div>
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<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com10tag:blogger.com,1999:blog-5681384012661169479.post-62495686134371328922018-04-15T21:31:00.000-07:002018-04-22T09:44:27.181-07:00Chemo, A Part of Life<div class="separator" style="clear: both; text-align: center;">
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<br />
<br />
<div class="MsoNormal">
Part 3<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was committed to sharing our experiences day to day with
JJ’s cancer and treatment. I knew very well that the chemotherapy’s purpose was
to alleviate the symptoms stemming from her very high calcium level. Hopefully,
it would slow down the progression of the disease. While many people would
prefer to handle something like this privately, I was committed to being open
about what we were going through. It would have been disingenuous of me to not to
find a way to share these details. Dealing with a life limiting illness is not
that different between people and our pets. Talking about the concepts of
palliative care applied to both, and it has always been my goal to continue
these difficult conversations, even when it was so close to home. I also knew
from the very beginning that I would need to guide so many people through JJ’s
disease progression and dying process when that time came.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I learned quickly after JJ’s video went viral that anything
I put on her social media drew all sorts of opinions, usually posted through
comments, but often through private messages as well. I have had family members
of patients tell me how opinionated people could be through a keyboard,
especially when it came to decisions around treatments. For the most part,
people were supportive of how we chose to treat JJ, although of course, there were
people who thought we were cruel to “subject” her to it. My husband and I had
both been told how well dogs tolerated chemotherapy but had no experience. Our
oncology team was very open to giving information and letting us choose the
course of treatment with no pressure either way. My goal in being transparent
with what we pursued was to share information and our experiences for anyone
who chose this option. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Along the way, I got many, many comments and messages on
what to do. “Tumeric.” “Ketogenic diet, otherwise you must be fine with killing
her.” “CBD for pain.” “CBD to cure.” On, and on it went. I get that it was
coming from a place of good intention with people trying to offer ideas and
support, but it often didn’t feel this way as the recipient. It was a good
lesson for me to remember to offer any information if asked, not when
unsolicited. These days, I think it is safe to say that most people and pet
owners have resorted to an internet search or two when faced with any
challenging diagnosis. As a nurse, I also am fully aware that no one person or
animal responds to treatment in the same way, so a blanket statement of “xyz”
curing cancer is silly and not helpful. We felt very confident of our plan after
coordinating care between conventional and holistic veterinarians. The critical
thinking nurse in me also had done some research but chose not to pursue
options that only had anecdotal evidence behind it. JJ was started immediately
on a raw cancer diet and was on an assortment of supplements chosen to support
her immune system and organs from the effects of the specific chemotherapy she
would be getting. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Knowing the prognosis for T-cell lymphoma, even with
treatment, was typically no more than six months, I took a page from JJ’s
playbook and decided we would make sure to enjoy each day. Dogs are brilliant
at living in the moment, and as a longtime hospice nurse, I see every day that
we have no guarantees.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Except for needing to delay a few weeks of chemo due to low
blood counts, the first six and a half months were uneventful. JJ continued to
play and work as she usually did, even on work days. In July, however, we all
noticed she was starting to have some changes with her breathing pattern. In
hospice, we are all highly attuned to the changes in breathing. Our assessments
tend to pick up subtle changes, and my co-workers and I had been watching her
for a couple of days. On our regular follow up visit to OSU, I mentioned my
concerns to the student, but I clearly was not insistent enough when I said I
wanted a chest x-ray. I left JJ for her bloodwork and checkup. Because her
physical exam showed nothing out of the ordinary, they chose not to x-ray. By
the next day at work, even our clerical people were noticing a change. The next
day was a Friday, the research day at OSU, so I took JJ in to our general
veterinary clinic to have an x-ray done. I wasn’t sure what it would show but
knew something was changing. She had developed bilateral pleural effusions,
meaning she had fluid in the lining surrounding each lung. This also happens in
people and is often related to a cancer. It makes it more difficult to get
breath. I immediately called OSU and JJ’s oncology resident called back,
wanting us to get to them as soon as possible. On ultrasound, they did find
fluid and were able to remove 800 milliliters, which is quite a lot for a fifty-pound
dog. True to her nature, JJ stood quietly while the fluid was removed with a
needle. The pleural effusions were caused by the tumor in her chest, which had
been present from her initial diagnosis and was not something that could be
removed surgically. It was clear that the current chemo protocol no longer was
working, so we immediately changed to a rescue protocol. Most of the time you
get about half the remission time received from the first chemo protocol, but
we were just hoping to slow her lymphoma down again, so she didn’t have a
recurrence of her pleural effusions. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
As I continued to share what JJ was going through, I learned
that people had a very low tolerance for any perceived suffering she might be
experiencing. When I would share stories from work, many would insist JJ needed
rest, although she was the queen of sleeping half of the day away long before
ever having cancer. Despite what I shared, I believe people equated her chemotherapy
to the horrible side effects well known in people. During the time when she developed
the pleural effusions, I started receiving many comments and messages along the
lines of “How long are you going to make your dog live like this?” These were
typically from people who didn’t know our story. It was upsetting at the time,
but interesting to think back on. Over the time span of an entire year, JJ had about
twelve "bad" days total. Having people tell me “you need to put that dog
down” during one of these bad days made me wonder if they would choose
euthanasia simply because they couldn’t stand thinking an animal had short term
symptoms from a fixable problem. I was reminded of when JJ's sire Dash was hit by a car and fractured his femur. It took surgery and time to repair, but we had years together after his surgical repair. My viewpoint may differ because I am a hospice nurse and
specialize in managing symptoms, while being present with the person
experiencing those symptoms. Had we not fixed her simple medical complications
at this time, we would have all missed out on several more months of
enjoying her antics while she lived life. I have no doubt we made the right decisions for JJ. <o:p></o:p></div>
<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com23tag:blogger.com,1999:blog-5681384012661169479.post-86853352585591521372018-04-13T17:40:00.000-07:002018-04-22T09:44:45.859-07:00The Long Walk<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWN4ul1rOSbLjrntVnKxC5W8tPE_dS8RYdh4RFdbNdkVpDaJvxsQbA0tOXriIad5LS9pHvVgUKaBqtqYrVghr7sQy2jgmzqDmy06HClMjZhATKkBIznT0uop3VL7zIQzggJXNBLuvx0A1O/s1600/osuhall.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="900" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWN4ul1rOSbLjrntVnKxC5W8tPE_dS8RYdh4RFdbNdkVpDaJvxsQbA0tOXriIad5LS9pHvVgUKaBqtqYrVghr7sQy2jgmzqDmy06HClMjZhATKkBIznT0uop3VL7zIQzggJXNBLuvx0A1O/s320/osuhall.jpg" width="180" /></a></div>
<div style="text-align: left;">
<span style="font-family: "arial" , sans-serif;">Part 2</span></div>
<div style="text-align: left;">
<span style="font-family: "arial" , sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: "arial" , sans-serif;">As with any person choosing treatment
for a life-threatening disease, deciding treatment options for a pet is deeply
personal. Veterinary medicine now has access to many choices used in human
medicine. However, such options usually come with steep costs. The reality is,
without pet insurance, cancer treatments can go from the thousands to the tens
of thousands of dollars. At the end of the day, while many may not agree with
me, our pets are animals, and while a part of our family, humans come first. I
begrudge no one for making the decision not to treat because the money is
needed for food and living necessities. I will tell you that after this experience,
we now have pet insurance.</span></div>
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<br /></div>
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<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;">We were in the position to try
chemotherapy to help with JJ’s symptoms. I knew well the effects of different
chemo medications on the human body but had not yet experienced an animal being
treated with it. As a young nurse, I had been chemotherapy certified, as our
hospital had an orthopedic surgeon who performed radical surgeries to remove
bone cancers. He wanted to ensure people could recover to the best of their
abilities with staff who knew how to handle these complex surgeries post-op,
but they also needed to start chemo as soon as possible. During that time, we
gave a wide variety of chemo medications to these patients, and I developed a healthy
respect for what it did to the human body. With JJ, we started down this road knowing
we could change our minds at any time if it either wasn’t working to slow down
the lymphoma or if she had symptoms that were intolerable.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
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<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;">I was very familiar with the different
medications JJ would receive, as they are the same ones used on human patients.
As with people, the protocol varied week to week with which drug she received,
and it required monitoring of her blood work, which any chemo patient can tell
you all about. The response between people and dogs is very similar regarding
the effects on bone marrow. JJ was very sensitive to one of the chemo drugs,
which often caused her neutrophils, one of her white blood cells, to drop
drastically. Our neutrophils are one of the elements that help to ward off
infection. In people, we have a drug that helps to stimulate production of the
neutrophils for cancer patients who need it during treatment, but it is not
used in veterinary medicine. </span></span></div>
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<br /></div>
<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;"> Instead, our protocol was to skip a week of chemotherapy
to give JJ’s bone marrow a chance to bounce back. When her counts were low, she
didn’t feel bad at all, but she was at risk for an opportunistic infection.
During these times, she was on antibiotics and we could not go anywhere that
might have had a high number of dogs. She was cleared to go to work, even when
neutropenic, as it would be rare for her to encounter a zoonotic disease (a disease that can be
passed from people to animals) at the Hospice House. Otherwise, she acted
normally most of the time. She did have a two to three-day time frame once
every month or so when she had no appetite and sometimes had diarrhea. </span></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjslW7ZKEpjal9epXlXbwlSPCOUpn-ddUM0wCws3os_lE4DweEOk8j7WYMuG3jW4riHXEf3jtCWfbECmcXOsga4ZFP2G49GWlTMbRH1XYBvNhH0G8q8u-ddmNHPRWucRuQHfSds35xqZvlB/s1600/20414117_911348605670374_7120813364023435955_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="810" data-original-width="1342" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjslW7ZKEpjal9epXlXbwlSPCOUpn-ddUM0wCws3os_lE4DweEOk8j7WYMuG3jW4riHXEf3jtCWfbECmcXOsga4ZFP2G49GWlTMbRH1XYBvNhH0G8q8u-ddmNHPRWucRuQHfSds35xqZvlB/s320/20414117_911348605670374_7120813364023435955_o.jpg" width="320" /></a><span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;"> As with
people, anticipated side effects can be managed by giving medications ahead of
time, which worked well for her. She was a huge fan of the turkey that wrapped her pills. Different cancers involve different treatment
options and we knew we also would have secondary protocols we could consider if
the current one stopped working. </span></span><br />
<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;"></span></span><br />
<div class="separator" style="clear: both; text-align: left;">
<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;"> At OSU, she quickly became a favorite
patient, passing out hugs and love to everyone she met. I knew that she spent a
lot of time in clinicians’ laps throughout her treatment days. This was no
surprise to anyone who knew her from work at the Hospice House. I would drop
her off in the morning, and usually pick her up later in the afternoon,
especially on the days she required IV chemo. In the never ending small
community we live in, one of the techs knew JJ from the Hospice House when we
took care of her mother. It was common to read on JJ’s discharge paperwork
things like “She is such a sweet girl” and “She’s the best.” She was very
tolerant of these visits, although she made it very clear she would have
preferred to go home with me each visit. The look on her face slayed me as she
dutifully walked next to the tech or veterinary student down the hall for her treatment, looking back
in hopes that I had changed my mind. It reminded me of all of the time I spent in hospitals as a young child, not necessarily understanding much other than I would rather be home than on a multi-bed ward drinking mineral oil chased by a sugar pack. Dogs, however, are typically more obedient than young children when it comes to procedures, and I have no doubt JJ was a much better sport than I ever was. In her usual dog-self, living in the
moment, all was well in her world when I picked her up and got her settled back
into her chariot. Those days typically ended up at a drive through, delivering
a small burger or fries her way, further reinforcing life was good.</span></span></div>
<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;">
</span></span>
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<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;"><br /></span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjStXcKMfsc8v_E3i_-YnYK0ncUi6n3TTgphP6gnZuITtzrp68NfN8B1u2_OHytY4QD-sswCH7fiofRRuWMGqjf9H_yABcIWLuxPhprpVENfsOUbuKRm4KH7EnyeivWULne5_7cJ8Mz86Xu/s1600/IMG_20170623_182918_475.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1600" data-original-width="1600" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjStXcKMfsc8v_E3i_-YnYK0ncUi6n3TTgphP6gnZuITtzrp68NfN8B1u2_OHytY4QD-sswCH7fiofRRuWMGqjf9H_yABcIWLuxPhprpVENfsOUbuKRm4KH7EnyeivWULne5_7cJ8Mz86Xu/s200/IMG_20170623_182918_475.jpg" width="200" /></a></div>
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<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;">I’m not sure people, including my co-workers, fully understood how
well JJ tolerated chemo until we had to have her scheduled at OSU on one of my work days. I took my lunch break and picked her up in the afternoon, bringing her
back to work with me. She didn’t miss a beat, as she passed out hugs and
mooched from anyone she could find. On the days we returned straight home from OSU, she
immediately ran and played hard, usually doing her best to dig up some creatures at "her" hay bales before taking a nap. While people usually lose
their hair on the protocol JJ is on, it is much less typical to have alopecia
with dogs. </span></span><span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;">However, Goldens do shed their undercoat typically twice a year, and
since JJ did this three months into her protocol, her coat remained sparse throughout the year because
of the chemo. The most noticeable thing was her lack of whiskers. Most of the
year, it looked as though I had shaved her closely and I can always tell at a
glance if a photo of her was pre- or post-chemo. </span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: "arial" , sans-serif;"><br /></span></div>
<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "arial" , sans-serif;">Along the way, I continued to share the
day to day stories, normalizing what we were going through to the best of my
ability. There was a great deal of support along the way, although I also knew I was easing everyone into what eventually would be a very difficult outcome. I was straightforward in my discussions about JJ's cancer and treatments, and spent more time posting articles and discussions about end of life care in our pets. However, early on it was very clear that people were hoping for a very long remission, if not a cure. My fellow hospice and palliative care workers understood my words without needing further explanation, and they knew I was slowly preparing people, just as we do daily with our own patients and families. At the beginning, the reality was she could very well die before June, even with treatment. Despite this, it became very easy for me to follow JJ's lead in taking it one day at a time. Dogs are pretty awesome in this way and we would all be better off if we could mimic them more often. The majority of the time, it was fairly easy for me to focus on what we had, rather than get lost in the anticipatory grief of what was to come.</span></div>
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<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="mso-bookmark: _Hlk511396052;"><span style="font-family: "arial" , sans-serif;">We knew at the beginning of her cancer diagnosis that she did not tolerate the prednisone well, which was one of the reasons she was on it for just a couple of weeks at the beginning. It wouldn't be until midway through the year, after weeks and weeks of marching down that long hallway on the way to treatments, that we would find out just how damaging it could be.<o:p></o:p></span></span></div>
<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com2tag:blogger.com,1999:blog-5681384012661169479.post-37602968098176469222018-04-11T22:09:00.000-07:002018-04-13T18:20:29.278-07:00When Cancer Comes Calling<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiW7UvY8LXev5h-I24LH8NFen_8zNsuu6aqy61qA9x9Y8EwDVZcn9WK4VR_1dwUntjMBT9iUmv_so10PEGx2zeSd6zSKFDUFbRF5Nsxw3uxMSEMJKx7xJ6AY7vnCdYVT5A9B208eBiYhQ6U/s1600/16179364_807432369395332_4280956684238326359_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="601" data-original-width="1080" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiW7UvY8LXev5h-I24LH8NFen_8zNsuu6aqy61qA9x9Y8EwDVZcn9WK4VR_1dwUntjMBT9iUmv_so10PEGx2zeSd6zSKFDUFbRF5Nsxw3uxMSEMJKx7xJ6AY7vnCdYVT5A9B208eBiYhQ6U/s640/16179364_807432369395332_4280956684238326359_o.jpg" width="640" /></a></div>
<br />
<br />
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">Part 1</span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">JJ was my
partner not only at work, but also as my teammate in volunteering for HOPE Animal-Assisted Crisis
Response. Each year, before we renewed our membership, JJ was required to
undergo a physical exam. In December of 2016, during her veterinary exam, I asked to add a blood panel as it had been a couple of years since she had anything checked. She was six years old and it was a random request on my part. She had
just started to have some excessive thirst and urination the day before and
acted tired, although nothing abnormal showed on exam. My nurse brain immediately
thought to have her kidney function and glucose levels checked, easily done
through lab work, but I really wasn't worried about it. Three days later, I hadn’t heard the results, so called the
clinic. We were back at work on a Monday and I asked to have the results
faxed over so I could look at them. By the time I was able
to take a break and scan the lab findings, I saw all was normal except for a very high
calcium level. While we had to wait several days for a consultation appointment
with a specialist, I tried to be optimistic that the cause of her high calcium
and corresponding symptoms had a surgical fix due to an endocrine gland gone
haywire. However, I had done my research and I was not surprised during our visit when I heard “lymphoma.” Still, my heart sunk to my feet and
my stomach was in knots. On the drive home, it struck me how we had been down
this exact path before. When JJ was just 9 weeks old, her nanny Callie was
diagnosed with lymphoma at 6 years old in December of 2010. Now, we had the same
diagnosis in the same month at the same age, as our young puppy Bria, who JJ
nannied, waited at home for us. The similarities were uncanny and all I could
think was “not again.”<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">While in the
past we chose not to treat cancer in our dogs, given the diagnoses came late in
the disease process, this time we all felt we had caught the cancer early and
had a chance to buy some time with chemotherapy. Realistically, canine T-cell lymphoma
is the more aggressive type and even with treatment, only 50% of dogs treated
live past 4 to 6 months. At the time of JJ’s diagnosis, all her symptoms were a
result of the high calcium level. The goal with starting chemo was to
alleviate these symptoms and slow down the progression of the cancer. She also was started on prednisone, a steroid, for a short time. We
often use steroids for symptom management in hospice patients, so I am very aware
of its side effect causing appetite stimulation. Some people can get to the
point where they want to eat almost around the clock. Animals are not
different, and JJ was in constant search of something to eat. Her charming,
mooch behavior rocketed to a whole new level when on the prednisone. Luckily, we
tapered her off this medication within a few weeks and her ravenous appetite
subsided somewhat.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">At the time of
diagnosis, I made the decision to be transparent about all we would go through
on JJ’s Facebook page. I had spent years sharing about end of life and hospice,
so focusing a bit more on these issues with our pets made sense. My experience
over the years has shown that if anything, coping with end of life decisions
and grief for our pets can be so much more intense than even family members. I am
a pragmatic hospice nurse after all these years, so knew what the eventual
outcome would be, even if I did not know the timing. I had spent years sharing JJ's voice, silliness, and compassion, all while building a large community around her. I knew
I would be able to multitask and help guide people through this journey as a hospice
nurse, while taking personal time and energy at home to cope and grieve with a very
difficult situation.<o:p></o:p></span></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtGIqa1CpcN19YnZkft6xVQjsVVVVxwIG8HV_ypJYbDO-OTyS5eQt9n38fjh-KKdhjKvsIOkqq48AGMPpMJ7GR6op0eC829RsbLJjW5KZerA12lAH1HcNpmZOeOn6KQ07WlZZmVOYPOZoz/s1600/22095900_941667695971798_7561761284980504171_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1080" data-original-width="1080" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtGIqa1CpcN19YnZkft6xVQjsVVVVxwIG8HV_ypJYbDO-OTyS5eQt9n38fjh-KKdhjKvsIOkqq48AGMPpMJ7GR6op0eC829RsbLJjW5KZerA12lAH1HcNpmZOeOn6KQ07WlZZmVOYPOZoz/s320/22095900_941667695971798_7561761284980504171_o.jpg" width="320" /></a></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">We chose to
transfer JJ’s care to Oregon State University, </span><span style="font-family: "arial" , sans-serif;">where they have a vet school and
teaching hospital. They are closer in proximity to us and have access to the
latest cancer treatments. When I first called, they were booking new patients
almost three months out. Once they reviewed her records—the prognosis of dogs
with lymphoma is only one to three months without treatment, so time was of the
essence––they found a way to fit her in and we had our first appointment three
weeks later. We didn’t want to wait to start treatment, so JJ received her
first two chemotherapy treatments at the specialty clinic before transferring to OSU.</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">When vets say
dogs in general tolerate chemotherapy well, they aren’t kidding. In people,
chemo is given in search of a cure, which means higher doses that cause many
awful side effects. Honestly, it takes humans to hell and back. As pet owners,
it would be a rare person willing to do the same thing to their animal. The focus
on veterinary treatments are instead palliative in nature. Palliative care
focuses on quality of life when choosing treatment options. Animals are given a
less concentrated amount of chemo with the goal of slowing down or stopping the
cancer without making them miserable. From my first discussion with our
oncologist at OSU, I was reassured that she had this same approach. We all knew
we were buying time from the beginning, though as in hospice work, there is no
crystal ball.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "arial" , sans-serif;">Through the generosity of JJ's many followers, we knew we would be able to get her the treatment she required without a second thought. We were, and remain, incredibly thankful for this. What we didn't know when we transferred to OSU was how much time we would have with JJ. </span></div>
<br />Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com12tag:blogger.com,1999:blog-5681384012661169479.post-882970645481491352018-04-10T16:32:00.002-07:002018-04-10T16:39:17.831-07:00Memories, rebooted. <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPF03Oa7PYFeQrjfDi-g6dgRgOf_38eoIHe_S1aqMFy33baNnfFzCNxWiinkSuenb6DNCFUNPSd3nsWZ9IZ-wp85H0WOu7NPF6YcVdJSonwOCnWX4UwE_1GS-0PbyDtxbZa2pDL4yqUfUm/s1600/17855322_10208752695242928_8619374275876539424_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="474" data-original-width="1600" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPF03Oa7PYFeQrjfDi-g6dgRgOf_38eoIHe_S1aqMFy33baNnfFzCNxWiinkSuenb6DNCFUNPSd3nsWZ9IZ-wp85H0WOu7NPF6YcVdJSonwOCnWX4UwE_1GS-0PbyDtxbZa2pDL4yqUfUm/s640/17855322_10208752695242928_8619374275876539424_o.jpg" width="640" /></a></div>
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<span style="font-size: 19px;"><span style="font-family: Georgia, Times New Roman, serif;">While I am not a grief professional, as a hospice nurse, grief is something that comes with the territory of my specialty. I have spent time over the years sharing articles referring to the pain of loss, have talked with people privately about their grieving, be it people or pets, and have worked to normalize the vastly different ways people mourn after loss. I spend almost every work day doing my best to be present for those experiencing anticipatory grief and for those newly bereaved once their loved one dies in our care. Like so many others, I am also someone who has experienced plenty of personal grief over the years.</span></span><br />
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<span style="background-position: 0px 0px; border: 0px; font-family: Georgia, Times New Roman, serif; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Grief is one of those tricky things that isn’t quite as clear cut as so many would like. In nursing school, we all learned Elizabeth Kubler-Ross’ five stages of grief from her revolutionary book <span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-style: italic; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">On Death and Dying</span>, written in 1969. It presents one of the most commonly known and accepted concepts of grief. The stages outlined developed a framework for what was a revolutionary view for grieving at the time. Dr. Kubler-Ross helped promote compassion and care of the dying and those left behind. Unfortunately, these stages are often perceived as something linear and time limited, an event for people to “get over”. Our culture can be sensitive to loss, but often it is not well tolerated if it is perceived as excessive or prolonged. Mourning loss is a far more complicated process, resembling a tangled mess intersecting each stage at different points and often more than one time. It also is something that never completely goes away, reappearing from the depths when you least expect it.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: Georgia, Times New Roman, serif; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Over the weekend, news broke about a fatal accident in the Canadian province of Saskatchewan, involving a bus carrying a junior hockey team and a tractor trailer. Since we now live in an era where we get our news in real time, as well as updates on social media, it did not take long for me to become aware of the accident. This news included a narrative by one of the physicians who cared for the victims and their families. As a long time nurse, reading this story cut me to the core, knowing how deep the impact this will be long term for all who were involved. An event and response like this affects all the community including the Emergency Medical Services and law enforcement, medical staff, and those who helped prep rooms, get supplies, and otherwise ensured care could be provided to those in need. As I read his story, I couldn’t help but imagine being a part of that team, because as medical professionals and staff, we would all step in and rise to the occasion if it were to happen in our community.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: Georgia, Times New Roman, serif; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">However, my response to the news was a visceral, raw emotion rising from a place of a grief borne long ago during our small town’s own tragic accident involving the fatal collision of a team bus and a truck. Even for those of us not on the bus that night, the crash left a deep hole in our mountain community. On a January evening in 1984, many from my high school were at the gymnasium watching the boys’ basketball team play. Our wrestling team had traveled over the pass to Browning for their own competition and were making their way back home. Conditions that night were treacherous, but to those of us young enough, it was simply another snowy Montana day. In contrast to today, there were no cell phones for texting, calling, and posting to social media. Whitefish is a small town, with a population at the time of about 3,700. We had all of 99 students in our senior class. As with anyone from our town and the surrounding areas, I remember exactly where I was when the news filtered in. The home side of the gym was on the right-hand side, and a stream of people started running out upon hearing the shocking news. Nine people died, including four girls from the junior class, the bus driver, our beloved teacher and head wrestling coach, his assistant coach, his wife and their baby boy. Immediately afterward, I don’t remember much other than being angry when national media reporters started showing up to interview anyone they could at school. It felt so intrusive not only to me, but to so many of my classmates as well. As senior class president, I remember wanting to find a way to kick the intruders out, allowing us to grieve privately. The following many days remain a fog to my memory banks.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: Georgia, Times New Roman, serif; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Tragic loss is hard to process for anyone dealing with someone’s abrupt death, but it was even harder for those on the bus that night who survived with horrific memories. Our minds have a way of shielding us from these memories immediately afterward, but with time comes reckoning as they return. I remember conversations with a good friend of mine who was there that night. I had a hard time trying to process the things he told me, much less imagine what he and my other classmates had to deal with. I have wished many times in the past several years to be able to transport my adult self back in time. The adult who has responded to countless deaths, even though most aren’t trauma related, and the adult, who with a canine partner, who has learned how to be present during crisis response deployments. Oh, if I could have one thing, it would be this. Would it help? I don’t know, since we all live with “what-ifs”. High school was hard enough, and some mulligans would have been nice.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: Georgia, Times New Roman, serif; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Grief, but especially traumatic grief, has a way of never completely letting go. That tangled web of grief comes back for visits from time to time, no matter how long it has been. Anniversaries are common reminder, even after so many years. January 21st is one such anniversary. I know my tears this past weekend were not just for those in this most recent accident. The depth of my response took me by surprise, but I’ve learned enough to just go with it. This too shall pass, as I look up to see this reminder through the rainbows I see. Sending love to all who were affected 34 years ago.</span></div>
Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com3tag:blogger.com,1999:blog-5681384012661169479.post-28371058066137655162018-04-10T16:21:00.001-07:002018-04-10T16:55:07.924-07:00Heartwarming meets surreal<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnj1MhyY8cCaF0XAE3CBuewO9TAf_Rx_b00s7H54CXTDON7CIHh0S5VziW16qM-uBU8jL2DxdIdPbdHJbCUJhDCuV6irO4PQU8pVWwxbX-R9G04HdzlgIzsyM2kdrk6xijMh9fUVLy4SfU/s1600/20140222_173956.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnj1MhyY8cCaF0XAE3CBuewO9TAf_Rx_b00s7H54CXTDON7CIHh0S5VziW16qM-uBU8jL2DxdIdPbdHJbCUJhDCuV6irO4PQU8pVWwxbX-R9G04HdzlgIzsyM2kdrk6xijMh9fUVLy4SfU/s400/20140222_173956.jpg" width="400" /></a></div>
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<span style="font-size: 19px;"><span style="font-family: inherit;">Those of us at the Hospice House had been witness to the power of JJ’s connection with patients, families, staff, volunteers, and visitors since we opened almost six years ago. Simply having a dog in the building decreased the stress level for so many. When JJ wasn’t power napping or mooching, she often would check in with staff in various parts of the Hospice House. She was known for seeking out those who needed comfort for different reasons, often giving hugs to those she hadn’t connected with for days or even weeks. She clearly knew who needed some therapy, although this is always a two-way street for therapy dogs. A good therapy dog enjoys seeking people out, but they also enjoy the attention and love that comes back to them during any interaction. When I shared the video of JJ’s bed visit with the 1,385 people who followed her Facebook page, I never dreamed how this would be viewed by so many around the world.</span></span><br />
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<span style="font-family: inherit;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Some dogs are more intuitive when it comes to providing support to people, and I have often said JJ was my most intuitive therapy dog to date. She spent most of her time off leash and was well known for performing her own rounds. She learned to wait for permission to enter a room, although would often pop her head around the door, checking if it was someone she already knew. Some patients or families wanted her in the room but would have to wait until I had a chance to take her in myself, especially if it was someone I wasn’t taking care of. It was common for staff members to hear stories of how JJ helped people, in</span><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">cluding when our bereavement counselor followed up with family members after their loved one’s death. She was easily one of the favorites on staff, providing hugs and a quiet presence during times when words rang hollow. It was a common sight to look down one of the halls and see her on the floor with family members, giving them a short respite from their sadness and grief.</span></span></span><br />
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<div class="font_8" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;">I have always loved sharing the stories of the impact of the human-animal bond in hospice work. I distinctly remember telling a story of JJ doing a “bed visit” and re-posting the video I had taken a year and a half earlier when someone asked me to describe what I was talking about. We frequently would spend quiet time sitting with someone who was alone. While sitting at the bedside of one woman, JJ indicated she wanted up on the bed with her. Her caregivers had indicated she liked animals when she was admitted to the Hospice House. Our patient was actively dying, and as JJ would do even with those who were not responding, she nudged her head under the woman’s hand trying to get her to pet her. This intimate video shows this woman moving her fingers on JJ’s head and afterward, JJ settled in for a nap while I finished my charting.</span></span></div>
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<div class="font_8" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;">I remember the day I re-posted the video so well, because we were getting close to 1,500 followers, and I had decided to have a raffle for a photo book of JJ at work and play once we reached that number. I had posted about the book raffle earlier that day and several people told me they were going to share the page. The next day, JJ and I headed back to work for our long work stretch. All of us work 12-hour shifts, and once a month, my schedule has me working six out of seven days. You might imagine how I get little done during that time other than eat, sleep, and work. JJ on the other hand, spent those 12 hours sleeping, mooching, and playing to her heart’s content, all while wearing her virtual Super Dog cape, ready to spring into action whenever needed.</span></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;"><br /></span></span></div>
<div class="font_8" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;">The very next day at work, I noticed a big jump in activity on JJ’s page during my first break. I was surprised to see a couple of hundred new followers and could only think “people must really want that book raffle to be held.” It took me another day to realize someone had shared the video, making it go viral. I was too busy at work to notice anything other than the staggering activity over the next couple of days. Phone and email requests for interviews started coming in from different media sources including Huffington Post, The Dodo, Three Million Dogs, and Fox 13 in Tampa. The following day there continued to be interest from various media outlets. USA Today, ABC World News Tonight, BuzzFeed Espanol, and Inside Edition all wanted to speak to me while I was at work. My supervisor called in another nurse to relieve me so I could answer JJ’s media requests. I would have happily appointed her a personal assistant by day four. Even our on-call hospice nurse got a phone call from NBC looking for my contact information. By the end of the week, the story was featured across a wide variety of online media outlets around the world. I think the most interesting one I saw was featured on the Daily Braille. It was incredibly appropriate to have an article written in Braille that described the interaction between JJ and a dying woman who was blind.</span></span></div>
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<div class="font_8" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;">During this time, I was deluged by messages from curious viewers asking how to make their dog a therapy dog, requesting a visit for an ill relative (who was often overseas), and how to get involved with my organization. At the peak of the week, JJ’s social media had a reach of over 27 million people, when we were used to having around 5,000 reached.</span></span></div>
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<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;">It was clear people around the world were touched by their brief glimpse into the innate qualities of JJ that made her such a great therapy dog, while considering our work in end of life care. I was stunned by how far and how many our story reached, although not surprised at the response to this very powerful example of the human-animal connection during such an intimate time in life.</span></span></div>
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<div class="font_8" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; font-size: 19px; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: 0px 0px; background-repeat: initial; background-size: initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="font-family: inherit;">While brief, the craziness of having a video go viral helped boost our reach to many who have given very little thought to the end of their lives and how hospice can be of assistance. While I miss my work partner terribly, I will be forever grateful to the petite Golden Retriever who helped me to continue the conversation about end of life care, hospice, and what is normal during these times. Those who would be reluctant to even entertain such conversations often were drawn out by the antics and compassion of JJ.</span></span></div>
Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com2tag:blogger.com,1999:blog-5681384012661169479.post-89015958583257327582018-04-10T16:20:00.000-07:002018-04-10T16:37:18.658-07:00A dog, a nurse, and the love of hospice<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: inherit;">I am a hospice nurse who has been able to combine my love of therapy dogs with my passion for end of life care. In the past several years, I became the scribe for my hospice partner, a Golden Retriever female who went by the name JJ, although she had a much fancier name, Calhoun's The Color Purple. What started almost six years ago with some touching memories, photos, and stories of JJ's work at the Hospice House, has grown exponentially over the years as her social media presence widened.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The topic of hospice and end of life is not something that makes people feel warm and fuzzy, much less encourage them to engage in conversation. In fact, nothing will clear the room like responding to the question "What kind of work do you do?" In twenty five years, I wish I had a nickel for every "That must be so depressing" response to my answer. However, one of the constants in life is the eventual end of such life. No one gets out of it, and as I age, quite frankly I am grateful I don't have to live to be 400 years old.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">When we first opened our Samaritan Evergreen Hospice House in 2012, JJ was just a year and a half old. Her nanny and mentor Callie, was the second therapy dog utilized by our hospice program. Callie visited patients with me in their homes before our inpatient facility was built. Unfortunately, she died in 2011, when JJ was just four months old. At such a young age, JJ started her therapy dog training in earnest and passed her first therapy dog exam the day she turned one year old. In our hospice program, we all recognized the benefit of a therapy dog's comfort for not only our patients, but for families and staff as well. We were hopeful JJ would be a good fit once we opened the Hospice House. Since I was the only nurse with inpatient hospice experience, I joined the weekly meetings during the building of our facility. JJ was one of the earliest visitors, long before we were open for business, and the Hospice House quickly became her second home. She worked twelve hour shifts with me, quickly taking on the head of Quality Control role, ensuring our patients were satisfied with their meals through supervising their every bite. She considered herself the official greeter of the Hospice House and could nap as much as she wanted without a dock in her pay. Early on, it was clear she was one of the most popular staff members we had. It was during these first few months that I developed JJ's Facebook page in an effort to share the human-animal bond in relation to hospice care.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">While my dedication may be to end of life care, it became clear over time how helpful a dog could be to help bridge a difficult topic with those who aren't used to being pragmatic and open about these matters. JJ was such a dog, and she quickly taught me how her antics and stories could reach others in a way a person never could. While some people decided having a dog "speak" to them was childish, I found her voice gave a more lighthearted approach to an often heavy topic. She was sassy in her approach to life at home, and quickly became sassy online as well. She made it easy to present the fun-loving, playful aspects of her work day, showing how dogs can live in the moment, show love and compassion in times of need, and yet shake off the stress and move on to the next mooching assignment or belly rub demand.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">I shared the heartwarming and often emotional stories of her spending time with dying patients and their families, as well as the very poignant descriptions of JJ’s self-taught walkouts. When a patient dies, we honor them by having staff line the halls as we walk their body out to the funeral van. We have a special walkout quilt, either for a veteran or civilian, and JJ taught herself to walk next to the gurney during the very first walkout we had. These stories are the ones that often elicit the most emotion in readers.</span></div>
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<span style="background-position: 0px 0px; border: 0px; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">JJ was also known for her “bed visits”, when she would get up on the bed with a patient who wanted her up with them. This could only happen when I was at the bedside and it often required careful positioning of JJ next to the person. These visits were often very helpful to help relieve a person’s anxiety or agitation. I often enlisted JJ's help in easing someone's symptoms as we waited for medication to take effect. The magic of these interactions was an amazing thing to witness. When things were slow, there were times I would sit at the bedside of a dying patient if they didn’t have anyone else. During these times, JJ often joined me. A few years ago, we were sitting with someone who was actively dying. She had no children, but I knew from her caregivers that she liked pets. JJ indicated she wanted to get up on the bed. It was a rare time when I got video of JJ putting her head under this woman’s hand, finally getting her to pet her after she was non responsive all day. Yeats was playing in the background and after I took this short video, JJ settled in for a long nap with her as I finished my charting. When I reviewed the video and saw there was no identifying information, I shared it as an example of a bed visit. About eighteen months later, after a re-share of this video, I experienced viral video madness, and JJ's stories and message started to reach so much farther than I could ever imagine.</span></div>
Tracy Calhounhttp://www.blogger.com/profile/12359133670098271398noreply@blogger.com4