Working With a Facility Dog in a Veterans Affairs Hospital

Elizabeth Holman

Elizabeth Holman, PsyD, is the palliative care psychologist at the Rocky Mountain Regional VA Medical Center and an assistant adjunct professor in the Department of Medicine, University of Colorado School of Medicine. Elizabeth is joined in her work by Tootsie, a facility dog who brings comfort and support to the veterans they serve.

When I tell people about my job, they murmur sympathetically, “That sounds so hard.” I work with veterans who are seriously ill and at end of life, but in truth, I love it. Being a palliative care psychologist at the Veterans Affairs hospital is everything I’ve ever hoped for in a career—challenging, fascinating, and deeply meaningful. There are definitely tears. But the work is also filled with laughter, growth, and flashes of grace. Best of all, it also involves dog fur.

My path was anything but linear. With degrees in religion and theology, I’ve always been interested in what matters most to people. I worked in education policy, then did mediation and child advocacy in high-conflict divorce. I entered a PsyD program in my late 30s, hoping to find a career that fed both my spirit and practical needs. Health psychology classes and a geropsychology practicum rekindled my interest in the workings of body and brain. After an internship at a Veterans Affairs hospital (VA) and postdoctorate position on a bone marrow transplant unit, I was fortunate to return to the VA as the psychologist on the fledgling palliative care team.

I had joyful companions on this path—service dog puppies. My spouse and I raised five puppies for Canine Companions for Independence (CCI). Volunteer raisers have pups from 8 weeks to 18 months, teaching basic commands and socialization skills. I took these pups to stores and movies, courthouses, difficult interviews, and psychology classes. I saw that in stressful settings people soon were smiling and connecting. One of our puppies became a facility dog, trained like a service dog but partnered with an able-bodied handler in their work. I dreamed of one day having my own facility dog.

First, though, I had to focus on my new job. I had never done palliative care, and the team had never had a psychologist. The VA has all the drawbacks of working for a vast bureaucracy and some of my most teeth-grinding moments have come from these structural challenges. But it also has a nationwide community that helped our interdisciplinary team develop my role.

My days include assessing patients and families’ mood and coping; facilitating family meetings; assessing decision-making capacity; supporting patients and families; and helping the team understand the psychological factors affecting our patients. I work primarily on inpatient medical wards, but also see outpatients for individual therapy.

As I became more comfortable in my role, my thoughts returned to the potential benefits of a facility dog partner. Veterans seen in palliative care are often in pain, frightened, and suspicious of the VA generally and psychology in particular. My experience told me that our veterans would connect with a dog. However, there were no facility dogs in acute medical settings in any other VA. 1 proposed my idea, and although it was well received by leadership, it still took a year to satisfy safety and cleanliness concerns before I could even apply.

After a lengthy application process and two weeks of Team Training at Canine Companions I was matched with Waffle, a yellow Lab-golden cross. Through the years of my partnership with facility dogs I have continued to learn from classes in animal-assisted therapy, reading, and consulting with other facility dog handlers. Waffle and her successor, Tootsie, make literally every day better for me, my team, our patients, and colleagues. These dogs open doors for our team as veterans who are unsure about us allow the dog in, giving us an opportunity to join with them and offer care. They provide a moment of softness, sweetness, and heart connection that heals patients and staff alike.

In my current position, 1 rarely work evenings or weekends. But the job involves bearing witness to grief, loneliness, and suffering, plus tremendously meaningful moments. This affects not just my work, but how I move through the world. Learning how and when to metabolize these emotions with colleagues, family, and a therapist is an ongoing challenge. I also have a responsibility to my canine partner, including monitoring her well-being and ensuring she gets exercise and play, both of which take me out of myself and remind me to give myself the same care.

This career choice can demand all your brain and all your heart. It also requires patience; it can be a long time between the idea and reality of an animal partner. Plenty of people, rules, and structures will say it won’t work. During my long process of trying to get approval for a facility dog, a friend said, “It seems you’re in the grip of something larger than yourself.” I did feel there were forces beyond me moving to bring a facility dog to our VA. That kept me asking and working until we outlasted the naysayers. If you sense that your path includes working in human-animal interaction, keep stepping forward until the road unfolds.

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