Abstract
Buddy greets me at every visit and recognizes me more than some of the people I regularly see at visits. He is friendly and inviting, eager for the attention and conversation I give to my patient, Joe. I have been coming to this house for home hospice visits for two months and have gotten to know Joe and his family fairly well. This past week has been somber. Joe usually meets me downstairs with gardening tips, but this week has brought a rapid decline. He has been in bed most days with Buddy by his side. For the past two visits, he has not gotten out of bed at all. The signs of decline have affected everyone, including Buddy. Not eating, sleeping more, communicating and waking less…the family has been prepared for this by the hospice team.
Buddy has been more agitated this week, obviously not included in the hospice teaching. Something is wrong, but he does not know what it is or what hospice or decline means. There has been no outside time in the garden and no time for casual walks around the yard. No food was snuck under the table, for Joe had stopped eating. For the past two days more people have been coming in to say good-bye to Joe. As with many families, I can see that the increased stimulation from visits has been pleasant and unsettling at the same time. All the while, Buddy has been taking it in, circling the bedroom, losing his patience. Why is everyone here? There is a heightened sense of vigilance, and he seems aware that there are imminent changes. He watches my every move when I go to Joe’s bed. He seems to be waiting for attention from Joe, from someone. No one else really seems aware of him…Except for Joe, peaceful in his bed, reaching out for him (or something) at times.
At this morning’s visit, I let the family know things seem to be progressing rapidly, and we reviewed arrangements, what to do, and who to call. Buddy remained sullen, snuggling with Joe, who was still sleeping. This whole week Buddy was pacing around, waiting uncertainly as Joe slept more, and at today’s visit he seemed tired and lost. I mentioned my concerns in passing to Joe’s spouse, and she quietly nodded. I wondered silently if I had crossed a line.
It is evening, and I am called back to the home. The terminal hour has arrived, and the family wants additional support as Joe approaches the last good-bye. I greet the spouse and daughter when I arrive, and they lead me into the room. Buddy is there, watching, standing guard. I nod over to acknowledge him as I enter with Joe’s family. Buddy remains in the corner as I move through the doorway toward Joe, now shrunken in the bed. Things have progressed since morning, and I prepare the family for Joe’s imminent passing. We sit around Joe’s bed and talk with him quietly, letting him know we are all there. It is ok. It’s time to go. His wife and daughter will be ok.
Joe gently moves from being in a state of semi-presence to being fully gone from us. I look at the family. They know. I somberly perform the mechanics of the pronouncement while quietly managing my own grief over losing my patient. I excuse myself to make my calls and step out of the room to give them some time to grieve. As I leave the room, I notice that Buddy moves from his place in the corner of the room and joins Joe on the bed. He begins to moan and wail. He nudges Joe with his nose and has no intention of moving. He is desperately aware of the situation and is inconsolable. I am uncertain of what to do and unsure of my role in doing anything for him. Joe’s spouse and daughter are indifferent to Buddy’s cries; they are managing their own grief and loss and are huddled together, texting loved ones by the bedside. They seem to almost not hear the sounds coming from Buddy as we all wait for the funeral director to come to the home.
When the funeral director arrives, I hand over my paperwork. I hug the family for the last time, and I say my good-bye. I leave with uncertainty. Have I done everything? In my car, I sit and gather my thoughts and try to document and make the necessary calls before my next stop. I continue to hear Buddy’s howling and cries vibrating through my car windows. My training has not prepared me for the vicarious grief I am experiencing, listening to Joe’s pet as Joe is removed from his home by gurney. My calls and paperwork do not cover this. My patient has been cared for. His spouse and daughter are comforting each other and will have continued services through the hospice agency. But I ask myself, who will alleviate the pain for my patient’s grieving pet? I wonder, not for the first time, what will happen to this faithful family member who is confused in his grief, as I drive away toward my next visit.