Just the other day I euthanised a pooch whose owner described him as having doggy dementia. She came in with him clutched to her. He was a sixteen-year-old little white fluffy who spent his days wandering the house, soiling himself and the floor, refusing to let anyone rid his coat of the tangled matts and deteriorating into a bundle of anxious quivering. She didn’t care that he stunk. She did care that he was in pain. If she could have admitted him to a nursing home for dogs maybe she would have. Maybe not. Recently she had had to go away and she’d left him with her sister. He’d not slept for three days.
Now I am reading Rebecca Mead’s absorbing article in The New Yorker about the advanced-dementia care at Beatitudes and I can’t help but think of the little white fluffy. Dogs get dementia too.
The director of education and research, Tena Alonzo, at the unusual and forward-thinking nursing home says, “All behaviour is communication.” With dogs it is even more so, since we never have a verbal language in common to begin with. We cannot ask them how they feel. To be a vet you must watch and listen. To know dogs is to observe and interpret their body language. To understand the demented human, body language needs to be read too. Alonzo gets the staff to practice interpreting non-verbal queues on each other, by having another staff member instruct them in a foreign language. She also gets the staff to brush one another’s teeth and to spoon feed each other – this is how you come to understand what it feels like to be the resident. The dedicated take to wearing adult diapers – to get a real sense of what life might be like for a dementia sufferer.
Alonzo says, “When you have dementia, we can’t change the way you think, but we can change the way you feel.” This might be true for dogs in distress too. We could always do with a little more empathy.
She describes how a black square of carpet at the entrance to the lift might stop a demented patient entering, since people with dementia have been shown to be unwilling to step onto such a black space, imagining it to be a hole. Reading this I thought – how like the cattle grid at the farm gate. Perhaps as we slide into dementia we are becoming more akin to animals. When Alonzo talks about her own old age – she says, “when I have dementia” knowing that cognitive decline comes to nearly all of us. Most of us will go there.
She says, “one of the things that create comfort for people who have trouble thinking is space. If you are too blocked in you feel frightened.” Think again of the animal that cage guards. Lunging and growling at anyone coming near, but as soon as the gate is opened and freedom is sensed, the animal can be handled.
When a patient can’t seemed to be helped with pain killers and distractions Alonzo says, “we’re going to try chocolate.” Hershey’s Kisses are a mainstay at the nursing home, because “it’s hard to feel very bad when there’s something tasty in your mouth.” We manipulate the behaviour of dogs with food rewards and lures too. Trainers and vets have long used the momentary pleasure of food to minimise distress. Keep feeding as nails are trimmed. Offer a popsicle coated in peanut butter to be licked while a coat is brushed. We can change a dog’s perception of something it is frightened of by repeated pairings of a food reward with the thing that is the dog’s monster. All the puppies I see for vaccination are injected, mostly without ever feeling the needle, as long as they are distracted by some tasty dog treat. As patients slip into deeper dementia it is as if the primitive structures of the brain take over. There is pleasure and pain. There is fear and anger. There is flight and fight. These core parts of the brain are similar across all animals so that in the end, when we are old and have lost our cognitive function, we are not so different from a frightened dog. Or horse, or cow. We may no longer be able to operate on a high intellectual level, but we still feel. Emotion lives on, sometimes stronger, unchecked, unleashed. Patients are described as “resisting care” when really they are like the dogs who are objecting to being restrained for grooming – they just want the man-handling to stop. In the nursing home the supply of pleasurable food helps avoid conflicts and makes people feel good, just as the only thing that could quell the white fluffy’s pacing was roast chicken from the corner store.
I think about how vets have learnt a lot from paediatric dentists. Today in the dentist’s there is no fear. It doesn’t even smell the same. Fuzzy green toys hang from the lights. Toys are handed out after the clean is done. The child’s dentist is so very different from what he was like when we were little. No white coat. Now they know how to distract and comfort rather than force and bully. The nursing home is changing too. It is no longer acceptable to bomb patients with antipsychotics (developed for schizophrenia) just to make them easier to handle for staff. Rather than becoming obtunded on Haloperidol, something as simple as Panadol may be all the patient needs to feel less pain and become more cooperative. It is better to lower the bed, so there is less harm in falling, than restrain people to their mattress. People need to maintain dignity, just as animals need to feel calm. It’s all about the kind of handling. You can take them gently by the hand and lead them or you can put a collar on them and pull. Which one do you do?
Just as humans are afflicted with dementia, our pets also suffer from cognitive decline. They seem to do the same things as our human relatives do. They mix day and night. Sundowning for dogs.They wander the corridors and holler for someone to help them. They don’t know where home is. They stand in corners. They forget who their relations are. They hear non-existent noises and bark at them. They are in pain.
Seeing others. Feeling like others. When we work well, at whatever we do, isn’t it because we recognise the emotion the other is feeling? Be it animal, be it human. We aren’t as different from other animals as some humans would like to think. Connectedness. When we strive to understand what another is feeling we make great steps to knowing ourselves.