Twenty Children, Six Teachers, Two Sets of Eyes, a Dog, and a Transformation

  • Daniel G. Federman
    Request for reprints should be addressed to Daniel G. Federman, MD, VA Connecticut (11ACSL), 950 Campbell Ave., West Haven, CT 06516.
    Yale University School of Medicine, New Haven, Conn

    Department of Medicine, VA Connecticut Healthcare System, West Haven, Conn
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      Twenty children, six teachers, two sets of eyes, and a dog were a terribly tragic catalyst for my metamorphosis as a physician and person. Let me explain. Until the cataclysmic event, I was an academic physician at an Ivy League institution who worshipped at the altar of evidence-based medicine and thought housestaff and students should supplicate alongside me. If a physician were to affect a change in plan for a patient, I demanded they knew the evidence to support the intervention, especially when there existed what I considered to be a landmark study. It was as if I had a secret love affair with acronyms: TIMI, CAPRIE, ALLHAT, 4S, and so forth, and my learners rewarded me and reinforced this practice with glowing evaluations.
      But then on a mid-December day a little more than 5 years ago something happened, something so heinous and vile that it will always be one of those things you'll remember where you were when you heard about it, like where you were when Kennedy was assassinated and where you were on 9/11. That's the day when a gravely mentally ill young man entered an elementary school, Sandy Hook Elementary School, in our idyllic rural Connecticut town that we called home for 20 years, and robbed the world of those educators and innocent elementary school children in one of the most deplorable acts in American history. He was a classmate of my son.
      Newtown is a small town, one where we run into one another at the diner, or the general store, or Ferris Acres farms, home of what has to be the best ice cream in Connecticut. If you're in the area, I highly recommend the Moose Tracks or the Bada-Bing in a waffle cone. You can add sprinkles for a nominal charge, if you like.
      Although my children were not directly involved in the massacre, because it is a small town, we knew so many who were directly affected: teachers at the school, some who heroically saved children, parents who received calls summoning them to the firehouse to find out their child's fate, physicians summoned to the emergency department to await children who never arrived, and yes, someone who lost her precious son, Noah.
      It was at his family's Shiva, a Jewish ritual of mourning, where I stumbled to find a few impossible words of solace for a grieving mother when I encountered those eyes, the tortured eyes of a mother who had innocently sent her son to school one morning and never had another opportunity to hear his laugh or feel his loving hug. Her faraway eyes told a story of dark despair and unimaginable, unrelenting pain.
      Those eyes and her pain haunted me long after I left the home. I saw them at night when I tried to sleep, I saw them when I watched Anderson Cooper interview friends and neighbors on TV, I saw them as the incessant news trucks rode through town, I even saw them when I was with patients. During the ensuing days, I cried every day; often sobbing, shoulder-shaking, nose-running cries. By day, I went to work. I was there, for sure, but I was certainly not present. When I walked the halls of my Veterans Affairs hospital, my second home, I could not look anyone in the eyes when I passed them. While normally I walk the halls looking to greet or interact with anyone I pass, during this time, the floor seemed a much more hospitable place to entrust my gaze.
      During that time social media was our form of communication—we learned where funerals were to be held, where physicians against gun violence was going to meet, what our politicians were trying to do, and how the National Rifle Association was reacting to their cries for reform. That is where I first saw the dogs. After they kept appearing on Facebook, instead of quickly scrolling past them, I read that healing dogs were working with the children. My initial reaction was skeptical. What can a healing dog really do in the face of such unimaginable horror? Where do they poo? Is there any liability if a dog bites someone? Being a doctor makes you think about liability sometimes, even when you don't want to.
      I went on crying daily. I was clinically depressed, but too dedicated to miss work and too proud to seek professional help. It was at the 1-month anniversary candlelight vigil in town where I had my epiphany. My wife, son, and I encountered a lady with a dog. His purple vest informed us that this was no ordinary mutt. When we chatted its owner up, we found out that he was a healing dog, and together, they had made a 5-hour drive from Baltimore to help our community heal. We were moved by this truly selfless and generous act of kindness in a world that had seemed so far off its axis. Because nobody was interacting with them, I somehow felt it was my responsibility to interact with the dog, if only to allow her to go home and feel good about herself and perhaps give the dog a treat. I never would have predicted what transpired in that moment. It was as if something magical occurred as we looked into each other's eyes. I don't know what my new purple-vested friend saw in my eyes, but I saw unconditional love and innocence in his. I can't really explain it more than that, but from then on, I stopped crying. I began to see a mother's pained eyes less often and more of the panting, smiling dog's.
      When I returned to work and reflected, the evidence-based me realized that there are no randomized, controlled trials published in respected peer-reviewed journals demonstrating the salutary effect of healing dogs in school shootings in small-town Connecticut. Just because there is no study to support something doesn't mean it doesn't work, it certainly did for me. Similarly, for many situations where there is “good evidence” to support something, because of some artificial study conditions and inclusion-exclusion criteria, the evidence may not apply to the human being before you. If a healing dog could help me, perhaps other integrative medicine modalities could help others. I now embrace practices such as auricular acupuncture, turmeric ingestion, meditation, and mindfulness in ways I have never before.
      I write this with a heavy and grieving heart, the day after another senseless tragic school shooting, this one in Parkland, Florida—on Valentine's Day, of all days. I don't need a P value or confidence interval to know that we need fewer assault weapons, and unfortunately, unless we as a society address the causes of these tragedies, we will continue to need more dogs in purple vests. Both as citizens and physicians, we need to do what we need to do.