1. Harpham, Wendy S. MD

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As you strive to provide compassionate care, I'd like to share some personal reflections on losing Summit.

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD, is an internist, cancer survivor, author, and mother of three. Her books include

I won't play around: Summit is my seven-year-old dog, now dying of cancer. You might be wondering why I'd use this space and your time talking about the death of a dog. People are not dogs. Dogs are not people.


Yet physicians and veterinarians take similar oaths before beginning their careers. A joke comes to mind about knowing the difference between physicians and veterinarians. [Answer: Physicians are veterinarians with a limited practice.] Unexpectedly, caring for Summit has given me a fresh perspective on clinicians' everyday opportunities for compassion.


Summit's story began seven years ago this month when I adopted the young, stray black Labrador mutt that had been roaming my neighborhood. A more affectionate dog you'll never find. All she had to do was look at me once with her soulful eyes-one dark brown and one light blue-and reel me in.


Summit embodied the carefree life until Thanksgiving week when our vet performed an excisional biopsy of a small, benign-appearing lesion on Summit's belly. Despite the wide clear margins, the pathology carried a grim prognosis.


Telephone consultations with veterinary medical and radiation oncologists felt unsettlingly familiar, yet surreal. We used the same language to discuss all the same factors as when I weighed treatment options for me. But the calculus was different for a dog.


Summit's vet and I concurred: The best option was not the harsh high-tech medicine that offered her little benefit; it was hope. So I took Summit home, hoping her 12-inch incision was long enough to land her on the good side of bad statistics.


Meanwhile, Summit healed quickly. I marveled, watching her lope after a squirrel and scarf down dinner in literally 20 seconds. Such carefree enjoyment provided clarifying contrast to how people's grief and fear of tomorrow can suck all the pleasure out of an otherwise ordinary day.


My husband and I were the ones trying to find peace. One day, at the invitation of Summit's briskly wagging tail, a friend leaned over to pet her. My husband informed our friend, "Summit's a very sick dog."


I bristled. "No, she's not."


Summit was not sick. Just as I was not sick that day years ago when, while waiting outside my kids' school, another Mom said tenderly, "I heard you're back in treatment. I'm sorry you're sick."


Knowing she wanted to say the right thing, I corrected her: "I'm not sick. I just have cancer."


The memory of my yearning to be treated normally gave me confidence in dealing with Summit. I continued our routines and enforced the same rules, trusting it would help her live fully after cancer.


I made one exception, though. I began spoiling my four-legged gourmand with extra treats and an overflowing dinner dish. If she survived, I could put her on a diet. If she didn't, she'd have experienced maximum joy to the end.


Weeks later, in a hug that crushed any hope for cure, my fingers slid over a huge lymph node. Skin lesions began to appear, all similar to the original one. I requested a stash of pain meds from Summit's vet and went on alert for the first signs of discomfort. While expecting to begin administering the medication soon, I was hoping it wouldn't be for a while.


Mounting evidence dampened this hope, too. More lesions appeared, replacing plugs of fur with small, pink cauliflowers. The pong of weeping lesions lingered in whatever room Summit had wandered through. When my son stopped by home for a quick visit, his horror at the sight-and stench-of his beloved dog reinforced what I knew: Summit was dying.


Of course, Summit didn't know that. She continued to bark at birds and loll in the sun. And she wriggled with the same excitement whenever I walked by her dog dish, as if her dance would make me forget I'd already fed her and would fill her dish again.


As always, her mismatched eyes begged for affection, devoid of the self-consciousness sometimes seen in patients who feel shocked by the stranger in their mirror.


Today my hopes revolve around treating Summit responsibly and compassionately. Every day I ask myself: "Is she comfortable? Is she enjoying life?" As for how I'll know when to say good-bye, I can't predict what will happen. Most likely, I'll put down her dog dish and she won't care.


Lessons from a Dog

From the moment of diagnosis on, clinicians strive to respond to patients' emotional needs in healing ways. When the news is bad, the challenges are great because, unlike dogs, patients wrestle with grief and fear.


You show compassion when you proactively help patients work through their grief and unleashed fears. So along with antineoplastic therapies, offer patients hopeful words, timely referrals to counselors and support resources, and prescriptions for medications, when needed. The sooner patients feel empowered to seek a balance of hope and acceptance that works for them, the sooner they can tap into their ability to find and create joy in trying times.


You show compassion when you use words and actions that dignify patients. At every visit, at least for a moment, look into patients' eyes and talk about them-and not about their body. And reassure patients who are healthy that they are not sick, even though they are being treated for cancer.


If treatment options run out, you show compassion by giving patients permission to let go of unpleasant health-promoting measures. And by honoring relationships and supporting patients' efforts to set the stage for meaningful good-byes.


Yes, I know: Summit is just a dog. But she's my dog, and I'm going to miss her. Oh, how I wish Summit could talk. All I can do is hope she somehow senses my gratitude for the joy she has given me and knows I will remember her for the rest of my life.


On April 27, 2011, Summit died peacefully in my arms.