When we were within close range, he read my badge, nodded, and said out loud, “Oh, Child Life.” It all made sense; this ridiculousness was Child Life. What he didn’t know was that I was on my way to help create joy for a patient who was at the end of his life, as requested by his grieving siblings. And nothing felt ridiculous about that. On the contrary, it felt painful and sad and very, very important.

Years later, in my current role as facility dog program coordinator (and handler of Ralph), I am often told I have the best job ever. And I agree with that to my core. In some ways it feels like I need to be pinched, because this cannot possibly be my job and my life.

What I don’t often talk about, however, is that it is not in any sense an easy job. In fact, there are many days that it is extremely difficult. While I am exceedingly proud of the comfort and happiness Ralph brings to so many, the reality is that in just one eight hour day as Ralph’s partner, I bear witness to some of the highest highs and the lowest lows experienced by patients and families.

On any given day, I may sit in utter silence while Ralph snuggles a patient who landed in the hospital after attempting suicide, and then leave to attend a breakout party for a child going home from the bone marrow transplant unit; we may distract a child from a blood draw and then leave to be present at the bedside of a dying child.

Some days we work to show a child who has been abused what gentleness looks like, and some days we put his paw print on a canvas to congratulate a family on reaching the end of treatment. Together as a pair we act as cheerleaders, tear-catchers, and secret-keepers. And the truth of this work is our hearts break often. It is the great challenge of this work, in my opinion, to continually put our hearts back together so that we can be available to the next child and family that need us.

Lucky for us, we also get to play a role in helping kids find joy through circumstances that are sometimes unimaginable, we get to celebrate achievements and milestones, however big or small, and we get to have a front row seat to the miracle of human resilience.

When I come to work, I try to always remember the enormous opportunity in front of me and Ralph, which far outweighs any challenge we encounter. At least a couple of times every week, a parent or caregiver tells me that meeting Ralph was the first time they saw their child smile in days or even weeks. That is the reason we do what we do.

This past January, the facility dog program celebrated its fourth Cook Children’s anniversary. The program’s impact on patients, families and staff in that time is frankly incalculable. And though there is much more to it than meets the eye, the giggles, the security, the unconditional love and acceptance brought to the medical center each day by our five dogs is second to none. We will come back and do it again every day we possibly can.

References:

American Veterinary Medical Association. (2017). Animal-Assisted Interventions: Definitions. Retrieved from https://www.avma.org/KB/Policies/Pages/Animal-Assisted-Interventions-Definitions.aspx.

Braun, C., Stangler, T., Narveson, J., & Pettingel, S. (2009). Animal-assisted therapy as a pain relief intervention for children. Complementary Therapies in Clinical Practice, 15, 105-109.

Calcaterra, V., Veggiotti, P., Palestrini, C., DeGiorgis, V., Raschetti, R., Tumminelli, M., Albertini, R. (2015). Postoperative benefits of animal-assisted therapy in pediatric surgery: A randomized study. PLoS One, 10(6), e0125813.

Creagan, E. T., Bauer, B. A., Thomley, B. S., & Borg, J. M. (2015). Animal-assisted therapy at Mayo Clinic: The time is now. Complementary Therapies in Clinical Practice, 21(2), 101-104. doi:10.1016/j.ctcp.2015.03.002

Gilmer, M. J., Baudino, M. N., Goddard, A. T., Vicker, D. C., & Akard, T. F., (2016).

Animal-assisted therapy in pediatric palliative care. Nursing Clinics of North America. 51(3), 381-395.

Signal, T., Taylor, N., Prentice, K., Mcdade, M., & Burke, K. J. (2016). Going to the dogs: A quasi-experimental assessment of animal assisted therapy for children who have experienced abuse. Applied Developmental Science, 21(2), 81-93. doi:10.1080/10888691.2016.1165098

Vagnoli, L., Caprilli, S., Vernucci, C., Zangni, S., Mugnai, F., &Messeri, A. (2015). Can

presence of a dog reduce pain and distress in children during venipuncture? Pain Management

Nursing, 16(2), 89-95.

Cook Children’s has brought in visiting dogs for decades as a way to help patients and their families cope with their situations, but it was one of the first hospitals nationwide to realize the value in having dogs as badge-yielding staff members.

“People wouldn’t have pets the way they do and treat them like family members if there wasn’t something to that,” said Facility Dog Program Coordinator Kizzy Marco.

Just over three years ago, Ralph and Chanel became the first dogs to join Sit...Stay....PLAY, the facility dog program at Cook Children's.

“We are pioneering something really new,” said Marco. “The majority of hospitals in the country have animal-assisted therapy or dogs that visit routinely and that’s wonderful, but having them here as residents and as employees makes such a difference.”

As facility dog program coordinator, a large portion of Marco’s job involves handling Ralph, answering referrals and working one-on-one with patients and their families.

“I feel like people moved mountains to make these dogs available for our patients and families,” said Marco. “I’ve always loved working at Cook Children’s, but that was the moment I realized how much this place cares, probably beyond words, about the emotional well-being of its patients. Of course health care exists to take care of people physically, but we also have a responsibility to take care of people emotionally and these dogs are doing that.”

When Ralph comes in contact with a patient, the atmosphere changes immediately.

“I’ve seen kids at their very sickest,” said Marco. “I’ve seen kids at the end of their lives light up to see Ralph.”

Stephanie Myers witnessed the power of dog therapy first-hand when her 4-year-old daughter Baylee was introduced to Ralph after being diagnosed with stage 4 neuroblastoma.

“She hadn’t walked or gotten out of bed in about a week,” said Myers. “Kizzy brought Ralph in and I saw a light in Baylee’s eyes I hadn’t seen in a while. She instantly wanted to sit up and then stand so she could pet him.”

Ralph brought normalcy and softness to the situation with Baylee, as he does with so many others.

“Anytime Baylee has needed a little push, Ralph has been there to guide her through it,” said Myers. “He is such an amazing therapy dog and has given our daughter strength and a smile when we thought she might be out.”

“What our dogs do for patients is deep. A patient once vulnerably told me that he loved Ralph because he knew Ralph would never judge him. That says it all right there,” said Marco.

Because of the large number of both inpatient and outpatient cases, therapy dogs are not able to sit on every child’s bed or walk the halls with them or get ready for surgery with them.

However, many patients, families and staff members get the experience of seeing one of the dogs in passing walking down the hallway or in the cafeteria, which Marco considers a therapeutic encounter.

“You don’t know what people are carrying emotionally when they’re walking through the hallways,” said Marco, “so adding this goofy, smiling, prancing, fluffy, handsome Golden Retriever to the environment is so important. If you never knew a single patient story, if you never knew how much of an impact these dogs make, just knowing that is huge.”

When Ralph does have the opportunity to work one-on-one with a patient, they form a bond so strong that every child thinks Ralph is their best friend. When they see him and start calling his name, his tail starts to wag, he squints his eyes and starts shaking around with excitement.

“It’s almost like he remembers every kid he’s ever met,” said Marco.

While the dogs are a friendly face for children at the medical center, they really do serve an important role in the physical and emotional well-being of these patients.

Whether giving a dog a syringe of water mixed with juice to get a child to take medicine or taking him for a walk to get kids up and moving, these animals are trained to relate to the patients and their difficult experiences in a way that normalizes their environment and gives them something else to focus on.

Using dogs as a means of reducing anxiety in patients is especially true for Child Advocacy Resources and Evaluation (CARE) Team, which assesses cases of child abuse.

“When you’re talking about abuse and really difficult subjects with these kids, having a dog there can really ease their anxiety and help them voice what happened to them,” said Jamye Coffman, M.D., a child abuse pediatrician at Cook Children’s. “When you reduce the anxiety in a child, it reduces all the stress hormones so you don’t have any of the effects of stress on the child that can contribute to illness.”

Dr. Coffman has handled Kitty since she came to Cook Children’s nearly a year and a-half ago. Kitty stays with the CARE Team and is trained to jump up on the couch with patients when they are being interviewed to help relax them and their parents, making the environment feel less like a doctor’s office and more like a home.

But there is also an art to the things that dogs can do innately, the things that cannot be taught.

Not long after Marco and Ralph began working as a team, they were asked to visit a patient with a severe developmental delay. Marco was admittedly nervous because this patient was unpredictable in her movements and she was not sure how Ralph would react.

Without hesitation, Ralph walked up to the patient, looked her in the eyes and put his head on her lap while he sat there and let her do whatever she wanted.

“That’s the true gift of our dogs is that they don’t see any differences,” said Marco. “We know patients whose illness or treatments make them look or behave in a certain way. We know the ones that have especially great challenges, and hopefully it doesn’t alter how we interact with them, but Ralph doesn’t even know those things.”

For that child and her family, interacting with Ralph was a completely normal experience and there was nothing atypical about the situation.

“That’s an innate art that is something that we as a health system found a way to provide. It had never been provided to our patients and their families before,” said Marco. “It is very humbling to know that our dogs can make moments like that happen for families.”

It's important to remember that Ralph is only one dog out of five at Cook Children’s, making up only one-fifth of the program. Our most recent addition is a 2 year old Golden named Lulu who started working in inpatient psychiatry and partial hospitalization program just about a month ago.

Every day these dogs have encounters like this one, and every day they are doing something to make the hospital a better place for patients and their families.

The impact that these dogs have made and the moments they have shared with people in the time they have been at Cook Children’s is remarkable.

“It is profound that they know and have the ability to mourn with people who are mourning, to celebrate with people who are celebrating and to play with people who are playing,” said Marco. “I think there is a bond or intuition that connects them to people exactly where they are, and to watch that is amazing."

How to Help

The generosity of donors helps make it possible for Cook Children's to bring programs like Sit ... Stay ... PLAY to our patients. To support our dog therapy program and other programs like it, please call 682-885-4105 or donate online by clicking here. Learn more about Sit ... Stay ... PLAY by clicking here.

1. Save your bark for when you really need it. One afternoon when Ralph and I were on a walk through our quiet neighborhood, we were mutually startled by a big dog with an even bigger voice, sprinting back and forth behind a fence, barking ferociously at us. I squeezed the handle to his leash tightly for fear that he may want to take part in conversation with the barking dog. To my surprise, he did nothing but tilt his head, study the dog for a moment, and keep on his way. I was struck with the realization that Ralph barks so sparingly, that surely he is saving his bark for when he really needs it. In life, a lot of dogs are going to bark at you, and a lot of them are trying to get you to bark back, but maybe it's better to tune them out and just enjoy your walk. You can always bark when it's really necessary.

2. Meet people where they are. When I first returned to work with my new constant companion, I felt reasonably unsure of his ability to read the room in an unfamiliar environment. I worried when we were called to see very young patients, I worried when we were called to see very fragile patients, and I worried when we were called to see patients with conditions or diagnoses that changed their appearance. It turned out, of course, that my worry was for nothing. Ralph showed me that he instinctively knew to mourn with families who needed to mourn, to be very gentle with children who were critically ill, and to play with children who wanted to play. He showed no judgment to any child, only the love and reassurance they were looking for. I strive to be as unwaveringly accepting as Ralph has proven to be.

3. A little encouragement goes a long way. In a hospital that has four adorable golden retrievers on staff (who are often confused for each other), Ralph has become known as the one with the silly tricks. In teaching him to do new things, I have seen very clearly the difference between what happens when I am unenthusiastic and directive, versus when I am excited for him, cheer him on, and let him know I believe in him. He now recognizes the words, "you can do it" and "you got it," and when he hears those words, he almost always tries again (usually with more "umph!"). Maybe we should practice that with each other. Maybe we should pay attention to the difference it makes to our family members, our friends, our coworkers, even our pets, when we cheer them on. Sometimes all it takes is one voice saying what you already know deep down: you got it.

4. Seize every opportunity you possibly can. While at times Ralph has seized opportunities I am not as proud of (like helping "clean up" spilled food off the floor), he also seizes opportunities to find joy and make a difference. He beelines in the hallway to people I haven't noticed, who he somehow knows need him close. He photobombs families capturing a memory here at the hospital and by doing so, causes an eruption of laughter. He finds patches of dirt to roll in immediately after his bath. And he literally always stops to smell the roses. To Ralph, an elbow resting on the edge of a table is not an employee paying close attention to their work, it is an opportunity for a nose-nudge to initiate petting. To Ralph, unless it's nap time, every passing moment is an opportunity for something. Thinking about that makes me wonder how many opportunities I miss when I think I'm too busy to notice them.

5. Last but certainly not least, don't take yourself so seriously. I knew from the very beginning that Ralph had excellent comedic timing. One night while still in Georgia for training with Ralph, I was laying with him and telling a story. He reached his long arm out into the air and dropped his paw directly over my mouth, as if to say "shhhhh." He has been making me, and everyone else, laugh ever since. From perfectly-timed audible groans during long meetings, to prancing so wildly that he trips himself, Ralph is one funny dog. And even though he has an incredibly important job, he knows not to take himself so seriously. It's as if no amount of accolades, photos taken or articles written could ever make him arrogant. He does what he does because it is fun and joyful and it matters. It's as simple as that. Oh, and around 4:45 p.m. every day, you can find him rolling on his back care-free in the grass outside the south tower, reminding me as I stand there and laugh, to stop taking things so seriously. 

About the author

Kizzy Marco is a certified Child Life Specialist and the Facility Dog Program Coordinator at Cook Children's. She is Ralph's handler. Ralph came to Cook Children's with his sister Chanel. He is known for his big personality and many tricks! A warm and fuzzy hug can help anyone feel better. A dog's healing presence is known to have a positive influence on wellness. That's the driving force behind Sit...Stay....PLAY, the resident dog program at Cook Children's. Click to learn more about the program.