Pawtner in Care

Squid, an inky-black Labrador retriever mix, walks slowly through the halls of Monroe Carell Jr. Children’s Hospital at Vanderbilt, surrounded by a chorus of “awww.”

Wearing his work vest and his own Children’s Hospital photo ID badge, he occasionally glances up and over his leash at his handler, Leslie Grissim, MA, CCLS, watching and listening for her instructions.

Squid, Children’s Hospital’s first facility dog, is on his way to the sixth floor to visit Camille Adkinson, 8, who is getting inpatient treatment for acute myeloid leukemia. Over the next year, she’ll have five hospital stays lasting three to four weeks each session, time she will spend away from most of her family and without her three dogs.

But her smile is wide on a gray and drizzly late September afternoon as she welcomes Squid and Grissim to her neat and festively decorated hospital room.

Grissim asks Camille what she’d like to do with Squid, and she asks to take him for a walk around the unit. She can’t leave her area of the sixth floor because the normal germs outside the unit are a threat to her small body. So, for about 20 minutes, Camille holds a short leash and walks Squid in a circle around the unit.

Camille talks about her pets to Grissim, who says she’s heard Camille has written a book about her experience so far at Children’s Hospital. Camille says that Squid is mentioned in her book. “That’s awesome,” Grissim says. “You’ll have to show me sometime.” Camille stops, smiles and rubs Squid’s silky ears.

After many laps, Squid barks, indicating that he needs a bathroom break, but before he and Grissim leave, Camille blows bubbles through a wand to Squid, who hilariously jumps and pops them. Then she tosses a colorful beach ball to him, which he bounces back to her with his nose.

“You were a good team today,” Grissim tells Camille, promising they’ll be back soon for another visit.

Squid has performed his job well, providing some valuable emotional therapy to a child in the hospital. He receives ear rubs and praise — “Good Work, Squid!” — from Grissim.

“Facility dogs are trained to engage patients to help them achieve a specific treatment goal,” Grissim said. “Engaging a patient using an animal who can decrease anxiety and increase motivation to meet a therapeutic goal is just another tool in our toolbox. Maybe if something else hasn’t worked, Squid’s presence and the task he will do will be enough to get a child to smile or get out of bed.

“Squid is a very hard worker,” Grissim said. “He loves children. He loves people. His presence, overall, brings a level of calm. He brings stress and anxiety down a level. Animal-assisted interventions offer both patients and staff the ability to talk without barriers and the opportunity to express themselves in a way that may not be possible with another human. Connecting with an animal can break down walls.”

Camille is one of four patients Squid visited on Sept. 24, 2020. He works Monday-Friday from 10 a.m. to 3 p.m., visiting up to six children a day. Grissim receives requests each weekday morning for Squid visits and she prioritizes them based on the reason for the visit and when it needs to occur.

Also, on this day, Squid and Grissim stop by the nurses’ station on the 10th floor pediatric cardiology unit. Caring for children with heart issues, some critically ill, is tough and often emotional for the staff. For those who are interested, Grissim gives the release command and Squid takes turns putting his front legs over the laps of nurses sitting in chairs. They bend down to hug and talk to him. Grissim gives each nurse who asks time with Squid, never hurrying them.

“We do informal check-ins with the nurses, along with visits to patients,” Grissim said. “He’s helpful to our staff if they’ve had a hard week.”

Bringing the program to life

Squid is a member of the Patient- and Family-Centered Care team. He joined the staff in February 2020 thanks to the generosity of Mars Petcare. The Facility Dog Program at Children’s Hospital was established through a collaboration with Mars Petcare to support a full-time facility dog and a staff position for coordination of the program, with the overall goal of showing the positive impact a facility dog can have on patients, family and staff.

“In the past year, we’ve seen more people than ever before turning to pets as a source of comfort, and we’ve loved seeing the positive impact Squid has made for the children, families, and staff at Monroe Carell Jr. Children’s Hospital at Vanderbilt,” said Craig Neely, vice president of Marketing at Mars Petcare North America. “We’re thrilled to partner with the team at Vanderbilt to bring this facility dog program to life.”

The work to bring Squid to Children’s Hospital began almost three years before Squid came to Nashville.

The Children’s Hospital team, led by Janet Cross, MEd, CCLS, CPXP, administrative director of Patient- and Family-Centered Care, first contacted Vanderbilt University Medical Center’s Development Office, to help identify potential funding. Through its Better Cities for Pets program, Mars Petcare North America enthusiastically agreed to fund the project for three years.

Once funding was secured, Grissim and Erin Munn, Child Life Specialist 3, were chosen as the dog’s handler and secondary handler, respectively, before the application was submitted to Canine Companions for Independence (CCI), a nonprofit organization that provides highly trained assistance dogs.

Children’s Hospital was placed on a waiting list for acceptance into the program. The acceptance came one and a half years later, just as Squid was completing an extensive two-year training regime.

Squid and his siblings (a litter of eight), born in Santa Rosa, California, were delivered to different regions of the country for training about eight weeks after they were born.

Canine Companions puppies are raised by volunteers who take them to puppy classes to teach them basic obedience and house manners. When they are old enough to enter the organization’s professional training program, the dogs come to one of six regional training centers.

Squid, sent to Orlando, Florida, was raised under the Canine Companions Prison Puppy Raising Program, which partners with the Gadsden Correctional Facility in Quincy, Florida.

Squid spent nearly one year under the care of a female inmate, then was transferred to a another puppy raiser, called a finisher, for more socialization, then back to the CCI campus in Orlando. Professional trainers teach the dogs the advanced commands they need to obtain treatment goals — which for Squid as a facility dog are engaging patients in their treatment and providing comfort and affection to support families and hospital staff experiencing the impact of a child’s intense medical situations.

After graduating from the program (dogs must be evaluated for their temperament and must be highly proficient in their skills), Squid completed an intensive two-week instruction in Orlando in early February with Grissim and Munn. On Feb. 14, 2020,  after his graduation, the trio took an airplane back to Nashville. Three days later, Squid began easing into his job at Children’s Hospital.

Squid is owned by CCI. Grissim must be re-assessed periodically by CCI, and she frequently updates the organization about Squid’s weight and veterinary visits. Grissim, Cross and Munn have calls with Mars Petcare every other month to update them on Squid’s progress. Facility dogs work about eight years. After that time, they retire and spend their golden years just being a pet.

“Over the years, the positive impact that facility dogs have on children in hospitals has been well documented,” Cross said. “I can’t say enough good things about the work that Leslie and Squid are doing. They recently helped with a school-age patient in intensive care who needed to be extubated. The child was very anxious about it and Leslie and Squid stayed with the child during the extubation and she did very well. You can tell just by watching Squid that he’s so well trained. He knows what he’s doing.”

Cross said the COVID-19 pandemic has probably helped Squid to acclimate more quickly to his new hospital surroundings. “They tell you in training it probably takes four to six months for the dog to acclimate to a new hospital, but with COVID-19, Squid came in February, and we pretty much shut down in March (limiting visitors), so Squid didn’t have to get used to all the distractions of having a lot of people around. We think, because of that, he probably had an easier time acclimating.”

Home life

Squid lives in Brentwood, Tennessee, with Grissim, her two adult sons (when they are home from medical school and college) and German Shepherd mix Sasha, cat, snake and tarantula. “The lid’s secure,” Grissim jokes.

In addition to becoming comfortable in his work environment, Squid also needed to acclimate to living with Grissim. If she goes on vacation or somewhere she can’t take Squid, Munn, who lives close to Grissim, steps in to care for Squid.

Grissim has been at Children’s Hospital as a Child Life Specialist for 27 years. When the opportunity came up to apply for the position of Squid’s handler, she jumped on it.

“I’ve had dogs since I was a youngster. The routineness of taking care of a dog and being with a dog is not new for me. But the excitement of starting this new program, in addition to being able to bring this furry, fun guy to work with me every day to do amazing things, was very attractive to me. I’m bringing the skills of working with patients and families in a family-centered environment with me (to this new role). Bringing this very highly trained professional dog into this setting is very, very exciting.”

At home, Squid needs to remain in his crate for rest and sleep while he’s adjusting to his home and to Grissim. He can’t go to dog parks or run free with other dogs (besides Grissim’s Sasha, Vanderbilt University Medical Center’s other facility dog, Norman, housed in the Department of Hearing and Speech Sciences in Medical Center East, and other CCI graduate friends in Nashville).

Grissim inserts three to five short (5- to 15-minute) training sessions into Squid’s day so he can maintain his skills and work on new ones as well.

Before his workday begins, Squid must be groomed (hair and teeth brushed and nails and ears checked). And he gets at least an hour of exercise a day, including two walks and playing fetch. He gets a professional bath every three to four weeks with a spot bath in between.

And even though he’s a dog, he’s a working professional, just like any other staff member at Children’s Hospital. So, there are expectations for those who encounter Squid at work.

It’s not OK for bystanders to pet or distract him while he’s working, and staff know not to interrupt a Squid visit at the bedside unless it’s for timely medications or vital signs that can’t wait. “Ultimately, it’s the patient’s choice,” Grissim said. “If the patient wants to invite a nurse in to see Squid, sure that’s OK, but the patient needs that total time with Squid.”

Unless “released” to play, Squid must maintain control, a task that he’s becoming better at as he gets a little older, Grissim said. So, no jumping on or rushing at people. And he can’t accept treats from anyone other than Grissim — his treats are the tiny pieces of kibble extracted from Grissim’s fanny pack that he gets for a job well done.

Squid can perform more than 40 commands, including basic ones like “sit” and “stay.” They include “visit” (Squid rests his head on a child’s lap if they’re sitting, or nose to nose for a child who is in bed); “lap” (he puts his front paws up and into someone’s lap for a hug); “cover” (Squid places his legs gently over the top of a patient’s legs, like a weighted blanket); and “nudge,” often used for a sedated child, (he gently nudges the child’s hand with his nose).

Grissim carries a set of laminated flip cards showing the commands with her, so children can visually select what they want to Squid to do. He can tug a wagon or basket and pull it along, open a refrigerator door and drawers and turn light switches on and off.

Cross said that Children’s Hospital hopes to soon add more facility dogs to its team. Texas Children’s Hospital has three; Children’s Hospitals of Atlanta has over a dozen.

“Squid is only able to see at most six children a day, but there are models out there with each service having its own dog — cardiology, oncology, etc. We could certainly put more dogs to work. We just have to find the funding.”

On a September afternoon, Squid and Grissim stop by 17-year-old D.J. Townsend’s room for a much-needed distraction for D.J. who is recuperating from a complicated spinal surgery.

Already in the hospital for several weeks with about six weeks left to go, D.J. wears a “halo,” a medical device used to stabilize the cervical spine after spine surgery. He is limited as to what he can do and where he can go.

When Grissim asks D.J. what he’d like to do with Squid, he already has something in mind — he wants to take Squid from his room, on the eighth floor of Children’s Hospital, down the elevator to the main entrance and outside to the pond filled with beautiful orange, white and black koi — a first for Squid, but not for D.J.

“I like to stand back and let the patient interact with Squid,” Grissim said before the visit with D.J. “It gives them control and lets them guide the interaction.”

D.J. sits down carefully in a wheelchair outside his room and Grissim hands him a short leash designed just for patients. She holds Squid’s longer leash attached to a prong collar designed for training. “You show us the way, D.J.,” Grissim says. “We’ll follow you.”

D.J. smiles as he, Squid, Grissim and his mother walk out of the unit. When they return to his room after about 10 minutes at the koi pond, Grissim directs Squid to gently put his legs onto D.J.’s lap. D.J. puts his left arm around Squid’s neck and scratches his silky ears with his right hand. “He’s awesome,” D.J. says.

— by Nancy Humphrey

Hope – Winter 2021