A Dog Walks Into a Nursing Home

Introduction

Pransky, my soon-to-be ten-year-old dog, is lying
on the living room couch, her body filling it end to
end, for though she is not a big dog, she is double-
jointed, which means that her hips lay out flat. If I weren’t
typing this I’d be stretched out next to her because I’m
tired, too, as I often am on Tuesday afternoons. Every
other day of the week, Pransky is a carefree country dog
who operates by instinct, roaming the meadow around
our house. But Tuesday mornings we spend time at the
county nursing home, going door-to-door dispensing
canine companionship and good cheer. Working at the
nursing home requires us to pay attention—Pransky to
me, to her surroundings, and to the people she is
meeting, and me to her, to our surroundings, and to the people
we are meeting. After three years you’d think we
would have gotten tougher or more robust, but that’s
never happened and probably never will.

When I first considered training Pransky to be a therapy dog
she was in her late adolescence. Dog years being
what they are, she is now about the same age as most of
the people in the nursing home. Even so, the words
“work” and “walk” still get her to her feet in a unit of
time that is less than a second. Is she better at her job,
more empathetic, now that she, too, is of a certain age? I
doubt it. I doubt it because I don’t think she could be
more empathetic.

As foreign as the nursing home environment was to
both of us when we first started visiting County, it was
a little less so to me, since my first job was at a medical
school in a teaching hospital where I sometimes
went on rounds. I was in my late twenties, with a newly
minted doctorate, hired to teach ethics to second-year
students. This should tell you all you need to know about
how seriously that place took the ethical part of medical
education: at that age I had about as much experience
with the complicated ethical dilemmas of sick people
and their families as the second-years in my class had
treating sick people and dealing with those ethical dilemmas,
which is to say, basically, none. Still, reality
was not our mandate. We were supposed to consider
what might happen “if,” and then think through the best
“then.”

The one thing you need to know about modern
philosophy is that the operative word in the previous
sentence is “best.” The first thing we had to do in that class
was figure out what it meant. Was it what the person in the
bed said she wanted, what the doctor wanted, what the
hospital’s risk manager wanted, what the church
(whatever church it was) wanted, what the husband wanted,
what the other doctor wanted, what the wife wanted,
what the parents wanted, what the partner wanted, what
the children wanted? Sorting out what was best was, to
say the least, challenging. For guidance, we read works by
Kant and Aristotle and Bentham that were harder to get
through than the textbooks on human anatomy and
organic chemistry, and, for my students, who were itching
to get into the clinic, largely beside the point. While I
didn’t think for a minute that an abstract principle, like
Kant’s categorical imperative, say, was actually going to
lead to the right decision on whether or not to give a new
heart to a homeless man, it seemed like a reasonable idea,
in a place where right answers were often not as black-
and-white as they might appear, to inject some of these
notions into the future doctors’ heads. If ideas like these
could become part of their mental landscape, then in the
future, confronted with that homeless man, they might
see the terrain with greater definition.

Historically, when people looked for guidance on how
to conduct their lives, they turned to philosophy or religion or both.
That’s less true now, as formal religious
affiliations drop away and academic philosophy becomes
more and more arcane. It’s not that people are less inclined
to examine their lives or to seek wisdom, it’s just that they
are more likely to look for it in other places: in support
groups, on radio call-in shows, from life coaches, on the
Internet, in books, or, in my case, inadvertently, with my
dog, in a nursing home.

When Pransky and I started working at County, I
expected to learn things—how could I not?—though
what those things would be I had no clue. I assumed I’d
learn something about old people, and about the thera-
peutic value of animals in a medical setting, and about
myself in that setting, which was alien and not a little
scary. What I found myself learning quickly sorted itself
into a template that anyone with a Catholic education,
especially—which would not include me—would
recognize as the seven virtues: love, hope, faith, prudence,
justice, fortitude, restraint.

It should be said that the Catholics didn’t have a corner
on virtue, in general, or on these seven in particular;
they just happened to enumerate and, in a sense, popularize
them, so when we think of virtue, we tend to think in
sevens. But well before Catholic theologians codified their
list, Greek philosophers, most notably Plato and Aristotle,
offered advice as to the traits and behaviors that should
be cultivated in order to live a good, productive, meaningful
life, a life with and for others. It was to Plato’s original four—
courage, wisdom, justice, and restraint—that, centuries later,
Saint Augustine added love, hope, and faith—what are commonly
called “the theological virtues.” These, he believed, both came from
God and delivered one to God and, ultimately, to a place in heaven. In
our own time, for most people, love and hope and even
faith, if you think of it as loyalty and consistency, are
unmoored from visions of an afterlife. Still, the virtues
remain as guides not only to good conduct but to our
better—and possibly happier, more harmonious, most
humane—selves.

Happiness, as it happened, was the dominant emotion
for both Pransky and me when we were at the nursing
home, strange as that sounds, and strange as it was. I
didn’t go there to be happy any more than I did to learn
about hope or fortitude, or to think about courage and
faith, but that’s what happened. You could say I was lucky,
and, in fact, by landing at County, I was lucky. County
happens to be blessed with tremendous leadership, a devoted
staff, and a larger community that embraces rather than
isolates it. I wouldn’t presume that it is comparable to any
other nursing home. But I do believe that in settings like
nursing homes, as well as hospitals and hospices and any
other place where life is in the balance, we get to essentials,
which is what the virtues are.

More than luck was at work, too. My dog was at work,
and she brought to it a lightness and easiness that seemed
to expand outward and encompass almost everyone she
encountered. We often talk about “getting out of our
comfort zone,” but rarely about entering someone else’s.
Pransky made that possible. With her by my side, and
sometimes in the lead, I was able to be a better, more
responsive, less reticent version of myself. One day a man
I didn’t know was sitting idly by himself in the nursing
home hall. He was wearing a badly tied hospital johnny
that exposed part of his back, and nothing else. It was
rare for people at County not to be dressed in street
clothes, but it wasn’t his attire that caught my attention.
The man was jaundiced and almost as yellow as the liquid
running through the tube that started under his hospital
gown and ended in a bag on the side of his wheelchair.
That, and he had no legs. This was not Joe, another double
amputee who became one of our regulars and will
appear in these pages, but someone I’d never seen before
and never saw again. If I had been alone, I might have
nodded in his direction and kept going, because that man
represented most of the things that scared me about nursing
homes: debilitating illness, a lack of privacy, bodily
fluids. But I was not alone, and my partner veered in his
direction, which meant that I had no choice but to go
over and talk to him. What a nice guy! We talked dogs
(he had two Yorkies at home), sports (he was a Steelers
fan), and dogs some more. I was in his comfort zone,
and Pransky’s, and then, ultimately, mine. It was, in the
scheme of things, a small thing, but small things add up.

My mommy would like your doggie,” a youngish
woman with developmental disabilities said to me
the first time we met her at County.

“My doggie would like your mommy,” I said. “Where
does she live?”

“In heaven,” she said.

“Oh,” I said. “Pransky has a lot of friends in heaven.”
And after what was by then a year at County, it was true.

A certain amount of death is inevitable in a nursing
home. This is where the virtues can be helpful. They
point us at what’s important and valuable in life. They
can offer perspective and frames of reference, and if a
dog is in the frame, all the better.

As I was working on this book, and friends asked me
what it was about, I would say “right living and
dogs” or “moral philosophy and dogs” or “old people and
dogs.” Eventually I realized that every one of those
descriptions was wrong. I was saying “dogs,” plural,
when it was actually about one singular, faithful, charitable,
loving, and sometimes prudent dog. That dog has
risen from her slumber and is standing behind me now,
showing great hope, restraint, and fortitude as she waits
for me to stop typing and go for a walk.