New Haven, Connecticut, United States
|An Old Man with a Dog. Giacomo Ceruti. 1740s. The Metropolitan Museum of Art.|
“You ever seen a dog like that?” I smile and shake my head. Tony sips his black coffee, his eyes lingering on the open doorway. “What a dog. What a beautiful dog. Most dogs, they try and bite you. This dog? Wouldn’t stop kissin’ me. What a dog.”
Tony is in his mid-seventies and speaks with a thick New York accent: dog is dawg, coffee is cawfee. His nose is long, his eyebrows thick and grey. He has been in the hospital for sixty-eight days and has not shaved: his beard grows in uneven patches across his chin and neck. He is always sporting white Nike sneakers, even atop his bed, and has worn the same navy sweatsuit for six days in a row, despite the fact that it is coated with dandruff and cracker crumbs.
I interrupt Tony to ask him how he slept (terrible), how his breakfast was (cold), and what he is watching on television (Yankees highlights). He sighs and readjusts himself on the bed. “Are you gonna listen to my heart or what?” I nod and quietly press my stethoscope to his chest. Beneath the layers of sweatsuit, his ribs protrude over a sunken belly. As I listen, his attention drifts once again to the doorway. “I’ve never seen a dog like that, Doc.”
Several weeks ago, I received a page from Tony’s nurse asking me to stop by his room and look at a rash on his back. I knocked on his door and entered to find him sitting on the edge of the bed with his head in his hands. He glanced up at me with weary eyes. “Good timing, Doc. Just got back from the social security office. They hired me to work here, but those sonsofbitches still haven’t paid me.” I dragged a small stool to Tony’s bedside and perched upon it, bracing myself for today’s misanthropic tale. “Let me see this rash, Tony.”
He pointed me to the dry patches along his scalp and ears, worn thin by the scratching of uncut fingernails. As I examined, my thoughts wandered to Tony’s previous stories and perseverations on deceit. Yesterday Babe Ruth cheated him out of $1,000, and the day before that his bookie refused to pay him after the horse race. It was only a matter of time before he discovered that we—his doctors, nurses, lawyers, and social workers—were the ultimate deceivers.
I reassured Tony that the social security office would pay him eventually, and that his rash was just a case of dry, irritated skin—nothing a little lotion and a fresh sweatshirt couldn’t fix. “Atopic dermatitis,” I whispered to myself as I marched down the hall to my workroom. Another diagnosis, another code to tack onto his chart, another bill to the insurance company. Meanwhile Tony sat in limbo: his body trapped in a hospital room, his memory trapped in a brain with rusty wires and faulty connections.
Nearly two months ago, Tony was found confused and disheveled on a park bench during a thunderstorm. He was brought to the hospital, where he was subjected to blood tests, CT scans, and evaluations by internists, psychiatrists, and neurologists. He was ultimately diagnosed with Korsakoff dementia: an error in memory in which patients invent stories of a past that never happened. Since his admission, Tony has been stuck in the hospital “awaiting placement,” a term used to suggest that a patient’s care is no longer an acute medical issue, but rather a problem that can only be solved by the Holy Trinity of insurance companies, lawyers, and long-term nursing facilities. Only when the Trinity agrees on a safe location and payment will we trick Tony one last time and send him to his final destination: a locked memory ward in a nursing facility.
On a rare morning, Tony’s stories would stray from their usual bitterness and reveal a softer side, frequently in the form of Bruce Springsteen lyrics. “I wound up like a dog that’s been beat too much.” Even more rare were musings from childhood. When Tony turned seven years old, his father bought him what he had always dreamed of—a hound dog. Shortly after his birthday, the dog bit Tony’s hand and his father forced him to return it to the pound. “Most folks would hate that dog. But me? I loved that goddamn dog. What a dog.” Tony’s eyes sparkled, and for a moment he was able to escape the 200-square-foot hospital room and travel back in time.
That was when we introduced Tony to Gracie. Gracie is a ten-year-old hypoallergenic golden doodle with short curls that cascade over her eager eyes. Like a surgeon, she commands the attention of any room she enters with her sense of importance. She is nonjudgmental: she does not flinch at the tubes and catheters sticking out of patients’ bodies, nor does she wince at the sight of bodily fluids. Her services are paid in head pats and scratches behind her ears. We consulted Gracie with a single request: to cure Tony of his bitterness.
From that day on, Tony’s medical care consisted of three square meals a day and daily visits from Gracie, the therapy dog. In the brief moments that Tony spent with Gracie, he was transformed. There was no more financial stress, no obsessions with taxes, or vendettas against Babe Ruth. In the presence of Gracie, his well-worn themes of malice and deceit were replaced by stories about Elvis, jazz music, and cross-country drives.
Today is a Gracie day. Tony is sitting up in bed dressed in a crisp navy sweatsuit. A breakfast menu is propped open on his lap. The whiteboard on his wall reads “Goal for today: be happy!” He sees me in the doorway and removes his glasses with a grin. He folds them and places them neatly on the bedside table. “Doc, you ever seen a dog like that? What a dog. What a beautiful dog.”
REBECCA OSBORN, MD, is a third-year internal medicine resident at Yale-New Haven Hospital in Connecticut, where she also serves as editor-in-chief of The Beeson Beat: a quarterly humanities journal for residents. She received her medical degree back home at the University of Nebraska Medical Center. She always wanted to grow up to be a librarian/author/scientist, but settled on doctor instead.