On the death of a friend: 5 Lessons from Mung Mungy and One Health

 

by Jennifer Gardner, MD

 

It was a day in early March when I returned from a conference to find myself faced with what I had been dreading for months: my best friend, barely able to stand without collapsing, had deteriorated rapidly while I was away. Her body had nearly fully failed and the suffering was too great. Looking into her eyes, I knew it was time. That was the day I said a final good bye to Mung Mungy, my 15-ish year old Cairn terrier was asking me to help her go well. It was the least I could do for her after she had taught me so much.

1. The importance of the human-animal bond: Mung Mungy was part of our family.

My best friend and “first born,” I semi-joke, was a shaggy, too-hungry-for-her-own-good, rescue. I got her at the end of my third year of medical school when I realized I couldn’t go another month without a furry sidekick in my life.

My future husband and I were looking around for a Westie when my family vet mentioned he had a two-ish year old Cairn terrier in need of a home. For a hundred dollar adoption fee, he’d throw in the spaying and immunizations. To a couple of poor medical students, it sounded like a bargain, but she was so much more than “a bargain.” We moved across the street from the hospital, so I could walk her on my lunch breaks. We had joined the majority 68% of U.S. households that include companion animals—which translates to about 85 million families with at least one pet.1 And thus, Mungy’s life with a couple of workaholics began.

We named our newest family member Mung Mungy. “Mung What-y?” people of all ages would ask me. Naming our companion animals signifies an elevated relationshiop to the animal in our community.  Further, it recognizes the pet as an individual signifying a social relationshiop, acknowledging an individual attribute or personality.2 “Meongmeong” means “woof woof” or “bark bark” in Korean according to my in-laws. In Korea, children often call dogs “Meongmeongi,” which roughly translates to “bark bark thing” or “item that barks.” “Mung Mungy” was the English translation we used to name our little “bark bark thing.”

When Mungy arrived, my household felt complete in line with polls which have repeatedly shown that a vast majority of pet owners (85-91%) regard their pets as family members.2,3 Before we had kids, my parents joked that they had “granddogs.” Most of my neighbors don’t know my actual name, but they recognized me as “Mungy’s Mom.” Another term for “pet” is “companion animal” to denote the importance of the mutually-beneficial relationship between people and their non-human buddies highlighting the importance of the human-animal bond.4,5 In 2015, Oxford Dictionaries added the term “fur baby” (a noun) to denote one’s furry pet, an indication of the popularity with which English speakers, at least, articulate the idea that their companion animal is like a child to them and likewise, defines the owners as pet parents.6 To this day, I cannot understand why I wasn’t allowed to claim Mung Mungy as a dependent on my taxes. My accountant just shakes his head…

2. Mung Mungy was a Zen Master when it came to unconditional love, forgiveness, and being present

Our work days were long. If this ever bothered Mungy, she instantly forgave us as evidenced by her wagging tail as we walked through the door in the evening. It wasn’t about how long we’d been gone, it was about the celebration of the return. There was no grudge at all, just excitement to reunite…something I try to emulate when my surgeon husband comes home from the hospital hours after he estimates, though not always with success. This “uncomplicated relationship” that companion animals offer has been cited as why many workers who return home after a stressful day actually prefer to spend time with their pet, over their spouse.4

In our busy, fast-paced modern lives and uncertainty about the stability in the world, pets offer a welcome distraction and built-in link to mindfulness.4 Whenever we’d gotten lost in our work for what she deemed too long, Mungy would give this trademark Cairn “happy howl” sound as she wiggled over to her leash, “Time to forget about your stuff and take me outside to play,” she seemed to be saying. And, it worked. Whatever the cares in your mind: concerns over the past, worries for the future, pets have the power to bring their humans into the present moment.4

3. Mung Mungy had an impact on my physical and emotional well-being, and vice-versa.

A number of studies have looked at the physical and mental health benefits conferred by companion animals, and Mungy was no exception. In her younger years, Mung Mungy would run around Forest Park with me in St. Louis in the mornings before I started work in the hospital. We’d get in 6 miles before most people got out of bed. Mungy’s short legs moved so fast to keep up with mine, her tongue wagging out of her smiling face, shaggy hair blown back by the wind from our forward motion. It never dawned on Mungy that she was too small to run big distances; she just did it.

Improved cardiovascular health with regard to lipids, blood pressure, and even survival following a heart attack have been demonstrated in pet owners.4 Even the simple act of petting a companion animal improves blood pressure and other effects of stress, the so-called “Pet Effect.” For dogs, getting petted improves their blood pressure, too.4 Mungy’s Cairn coat was “thatchy” and coarse, and I was most relaxed sitting on the couch, reading a book and running my fingers through the fur on her back. Owning pets can also have a significant impact on emotional health, as having a pet negatively correlates with loneliness, depression and anxiety.4,7 A groundbreaking study out of Germany and Australia showed that pet owners who continuously had a pet were healthier than non-owners after controlling for a number of other factors.4,8

Similarly with regard to physical health, humans can impact the emotional well-being of their pets. Following medical school, we headed to Philadelphia for internship and residency training. One of the first things we did upon moving into our new apartment was set up a pet walking service. But, even with multiple walks set up each day for her, our 80 hour work week and overnight call schedules were too much to ask her to endure. I didn’t have the time or energy to devote to getting her enough exercise and fresh air that year and our long runs had become fewer and further between. I recall two adjacent divots that were created in our futon cushion that year: one terrier-sized and one “me-sized” corresponding to the spots where she would lay faithfully next to me during whatever hours I had to spend at home with her while we watched episodes of Planet Earth and Project Runway because that’s all the energy I had between shifts. Mungy had gained weight and was not as peppy as she’d been. My wonderful family staged an intervention halfway through my intern year and kept Mungy in Kansas City where she had a big yard to run around in and could play with my parents’ dogs. I was out of shape and depressed as much as Mungy was during that year, and I wish an intervention was staged for me…  

4. Mung Mungy improved my human-human bonds.

After internship, Mungy rejoined us in Philadelphia, and she developed an autoimmune condition that bothered her joints. Since she couldn’t be my running partner anymore, my husband and I would leisurely grab coffee and walk her to the dog park on our weekends off. It was the highlight of the week for all of us. It was a time for my busy surgery resident husband and me to catch up on our week and talk about what was on our minds. Pets have been shown to increase interaction and improve communication between family members.4 In moments of rare clarity, we’d even talk about where we wanted to go with our future during those visits to the dog park. Without Mungy, we probably would have gotten stuck in a textbook, stayed longer on the wards or stared quietly at our respective computers all day. She was the furry glue that kept us together through some tough times in training when otherwise we’d just been like “two ships (who paid their half of the rent on time) passing in the night.” In addition to busy resident doctors, we were Mungy’s parents, which made us better humans and better spouses.

After 5 years in Philly, I’m sure Mungy was expecting the yard that we’d been promising her since her adoption. She didn’t get a yard. My husband had matched into a fellowship in NYC, so we moved to Manhattan into a one-bedroom walk up with few windows overlooking beautiful brick walls. She loved us anyway. We called her the “Upper East Side Mungy” and she wagged her tail and bounced along the avenues of New York, though there was more gimp in her hops than in prior years. Central Park was the “new yard” and the steps of the Metropolitan Museum of Art were the new “window seat” for people watching.

Most of the work looking at the benefits of pet guardianship has focused on individuals, but a handful of studies have looked at the benefits of pets on communities.9 Pets provide an instant opener between pet owners and a topic of conversation making it easier for strangers to approach fellow humans to strike up a conversation over that common bond.9,10,11,12 Having a dog, specifically, has been shown to increase the likelihood that a dog owner will meet their neighbors, dog-owners and non-owners, alike.9  Even busy New Yorkers wanted to know more about Mungy. I enjoyed many a conversation with perfect strangers all over town, thanks to her. 

5. Mung Mungy provided resilience in times of transition.

Mungy was a constant in a stretch of our lives that brought perpetual movement and change. It’s not uncommon for people to adopt or turn to companion animals in times of transition such as relocation, separation, divorce or death.4 After our time in New York, we moved to Seattle when my husband and I took jobs with the University of Washington. Mungy flew cross-country with us to our new home in downtown Seattle. We excitedly told her we were all going to be Huskies but that as usual, there would be no yard in Belltown. The transition from the East Coast to Seattle was not easy, especially for me. My husband started his job months before mine started, we didn’t know many people in the city, and I missed my friends, family, mentors and routine. Additionally, we found out we were expecting our first non-“fur baby”, so I was fatigued and nauseated for a good part of my initial time in Seattle. In the face of change, pets can be a steadfast, loyal, and essential constant.4 Mungy was the one who stuck with me – getting me out of bed every morning to go for our walks, checking out the new dog park so she could play, and helping me to explore our new neighborhood. I structured my new routine around hers and it kept me going. 

Mungy also made a good confidant, and though my early days in Seattle were lonely appearing on the surface, I could always talk to Mungy, and I never felt alone. Far from “crazy,” it’s actually quite common for humans to talk to their pets. After a profoundly sad life event, some people even prefer to be “alone with their dog” rather than in the company of friends or family.4 Companion animals provide an “all ears” approach to listening and are truly non-judgemental in their reactions.13

It wasn’t long until we added a couple of human babies to our household. Mungy was amazing about the inevitable transitions that occur when new babies show up. She was curious but gentle and laid underneath their swing or crib, as if to watch over them. As my kids grew, they developed their own bond to Mungy and delighted in playing games with her right up until she inevitably snatched the cookie or other food item out of my 1 year olds’ hands. Mungy may have been getting old, but the kids learned to never underestimate a terrier’s ability to grab a snack and have developed a healthy sense of boundaries when animals show them the signs. My kids also learned how to gently show affection without crushing, poking or otherwise threatening her life and limbs. One of Mungy’s greatest gifts to my young kids was a love of dogs and appreciation of animals.

Over the last year, Mungy slept more and her arthritis started to affect how fast she could get up and get around. Long walks turned to short walks or simple stops at the park. Then, one day, I felt it as I was rubbing her tummy: “The Bump”. It was new, very firm and fixed to her foreleg. A fine needle aspiration demonstrated big ugly cells, “Probably adenocarcinoma,” our vet told us. The vet did not think surgery would offer a cure and would incur a great deal of pain and permanent disability. We’d been through some tough medical issues with Mungy: epilepsy, her autoimmune condition and arthritis, two near death experiences from corn cob GI obstructions (she couldn’t help herself when it came to corn cobs), the dental session from hell, but this was different.

One of life’s sad truths is the disparity between human and canine life spans. On that day in March, when I called my husband right off the plane in the middle of his workday, it confirmed what he already feared over the weekend. He disclosed that the day before, Mungy stopped wagging her tail for treats: a tell-“tail” sign for a terrier that the end was near. He cancelled his clinic to meet me at the vet office with Mungy. We were both by her side as she went to sleep for the last time. It was only as the medication kicked in and her breathing slowed, that I noticed how long it had been since her breathing had been quiet and unlabored. “Had we waited too long?” I wondered. There’s probably never a perfect time and if you think too much about it, you can always argue it was too soon, or too late. But, I knew in my heart that it was the right thing to do for her. But, with Mung Mungy’s last breath, a deep and empty sadness filled my chest. 

For weeks, I felt hollow. For me, grief is an empty and deep sadness. It lessened over time, but there remains a terrier-shaped hole inside me that I don’t expect to close-up. I am aware of it more or less throughout my days and weeks. At first, it was especially difficult. I found myself on autopilot in my old routines, which were so tied up with taking care of Mungy, especially in the mornings and evenings. Letting her out, feeding her, giving her medicines – these had been so entwined with my daily activities.

I’ve meditated a lot on the importance of grief over the past couple of months. There has been a move to “normalize” bereavement of pet loss. It’s common for owners to experience sadness over the loss of their pet, and the effect can be intense if the human-animal bond was characterized by significant attachment, as mine was with Mungy.14 Some 20% of owners endorse experiencing significant symptoms associated with grief following the loss of their pet, myself included. Though more severe symptoms of complicated grief can occur, it appears to be relatively rare.15 People often grieve the loss of a pet as they would the loss of a dear friend, and the effect the loss can have on the surviving owners is similar to reactions to the death of a human loved one.16 As much as I have read about this topic and anticipated the sadness that would come with Mungy’s passing, I was still surprised how deeply this loss affected me. Truly, I had lost a member of my immediate family. Simply put, loss is loss. 

Having strong social support is helpful, but this can be difficult to come by for some, as the loss of a pet is not always recognized by others as a “significant loss,” especially by those without pets.16 I will always be grateful for the support and understanding shown to me at work, especially by the nurses and staff with whom I am privileged to work. Their sincere understanding of how the end of Mungy’s life affected me allowed for the space to carry on nearly seamlessly at the office. My experience is not at all unique when it comes to losing a pet and for many pet owners, the symptoms can last 6 or more months.15 I theorize that the time it can take to grieve the loss of a pet is grossly under appreciated, as I have been surprised myself the time it’s taking me to work through the feelings of loss.

With time, the grief gets easier to bear, but the loss was significant because this particular human-animal bond was so important in my life. Mung Mungy was a rescue, but no surprise, she was the one who rescued us from ourselves many times over. She taught me about the significant role pets play in our families and households, the importance of their “uncomplicated” companionship, the true meaning of forgiveness and unconditional love, how to leave work at the office, the importance of play, how to be a better spouse and neighbor, how to weather change, and generally how to be grateful for the present moment. Reflecting on all that my little “bark bark thing” taught me, I am a better human because of my canine companion. On the death of a friend, I try daily, despite my human flaws, to be more like Mungy. It’s not complicated.

References

1. http://www.americanpetproducts.org/press_industrytrends.asp

2. Charles, Nickie. ‘Animals just love you as you are’: Experiencing kinship across the species barrier. Sociology 2014;48(4):715-30.

3. Cohen, SP. Can pets function as family members? Western Journal of Nursing Research 2002;24:621-38.

4. Walsh, F. Human-animal bonds I: The relational significance of companion animals. Family Process 2009;48(4):462-80.

5. https://petpartners.org/about-us/petpartners-story/

6. http://time.com/4010748/oxford-dictionary-update-2015/

7. Friedman E., Tsai C-C. (2006). The animal-human bond: Health and wellness. In A. Fine (Ed.), Animal-assisted therapy: Theoretical foundations and practice guidelines (2nd ed, pp. 95-117). San Diego: Academic Press.

8. Headley B, Grabka M. Pets and human health in Germany and Australia: National longitudinal results. Social Indicators Research 2007;80(2):297-311.

9. Wood LJ, Giles-Corti B, Blusara MK, Bosch DA. More than a furry companion: the ripple effect of companion animals on neighborhood interactions and sense of community. Society and Animals 2007;15(1):43-56.

10. Chandler CK, Fernando DM, Barrio Minton CA, Portrie-Bethke TL. Eight domains of pet-owner wellness: valuing the owner-pet relationship in the counseling process. Journal of Mental Health Counseling 2015;37(3):268-82.

11. Melson, F. Psychology and the study of human-animal relationships. Society & Animals 2002;10:347-52.

12. Messent, P. Social facilitation of contact with other people by pet dogs. In A. Katcher & Beck (Eds.) New perspectives on our lives with companion animals Philadelphia: University of Pennsylvania Press.

13. Maharaj N, Haney CJ. A qualitative investigation of the significance of companion dogs. Western Journal of Nursing Research 2015;37(9):1175-93.

14. Walsh G. Human-animal bonds II: the role of pets in family systems and family therapy. Family Process. 2009;48(4):481-99.

15. Adrian JAL, Deliramich AN, Frueh BC. Complicated grief and posttraumatic stress disorder in humans’ response to the death of pets/animals. Bulletin of the Menninger Clinic 2009; 73(3):176-87.

16. Tzivian L, Friger M, Kushnir T. Associations between stress and quality of life: differences between owners keeping a living dog or losing a dog by euthanasia. PLoS ONE 2015;10(3):e0121081.