“Did you bring the pig?” Jill smiled and gently whispered. I arrived for my hospice home visit, worried what state of distress I would find Jill, my patient or her family…they asked that I come urgently.

P-I-G. It’s a peculiar word. It’s a short, round, funny word for an even funnier animal. Why did I want a pet pig? I’m not even exactly sure.  I am a palliative medicine physician; I needed something funny and silly in my life.  My days are emotionally draining and I was starting to ponder just how many more years could I stay in this field. Why not a pet pig? I was certain this would add some fun to day-to-day life.

Potbelly pigs, Juliana pigs, Kune Kune (Kunie Kunie) pigs—the list of breeds goes on! I had no idea how intelligent these little porkers can be. I fell madly in love. In love with their big, round snouts, human-like eyes and, of course, their chubby bellies, all supported by the stubbiest of legs adorned with tiny hooves like high-heeled shoes. All that weight on tiny hooves.  How do they not topple over?  Everything I knew about pigs was totally wrong. They aren’t dirty animals that like to live in filth and roll in mud.  They are clean, intelligent, emotionally complex creatures. Easily trained, they are social and affectionate. However, due to the absence of sweat glands, rolling in mud becomes their only effective means of cooling on warm summer days. I did learn one sobering fact: mini pigs or “teacup pigs” don’t exist.  Even the smallest breeds of pigs can weigh from 50-200 pounds.  But I was undaunted. People have Great Danes, so why not a one hundred pound house pig?

I decided on a Juliana pig. My husband had just received orders that he would be heading to Afghanistan for a one-year deployment. This would be my emotional support animal to help me through the upcoming year without my husband.  She would help fill the void of loneliness and give me a new purpose until he arrived back home.

My little piglet arrived late August. She was beautiful! She was just three months old and a little spotted bundle of grunts. My dogs were fascinated. What was this little animal that sounded like their squeaky toys? She was a tough little pig. She stood her ground and did not let the dogs intimidate her. She would stand over her food bowl and guard it from the dogs. She would chase after my sixty-five pound dog for fun to prove she was no one’s prey.  Naming her was going to be a challenge. A frilly, feminine name just didn’t match her tough character. “How about Zumwalt, like Admiral Zumwalt,” my husband suggested.   Most people just go with   food-related names like Hamlet, Bacon, Chorizo or Jimmy Dean for their pet pigs. Her moniker became Ms. Zumwalt or Zumi for short.

Those first couple months she went everywhere, meeting children, dogs and various people. I filmed it all with my iPhone to document the experience and sent video or pictures to my husband overseas.  Zumi’s interactions with my patients began to happen insidiously. To make my patients smile or ease their anxiety, I started sharing videos of Zumi.  Eventually, patients receiving bad news or having a tough time would request to see the latest picture or video. We would watch and laugh, sometimes through tears. “We are going through this together,” I would say. This pig somehow made me human in the eyes of my patients. I wasn’t just another person in a long white coat.  After all, how intimidating could a doc with a pig be?  

 Patients arriving for clinic would begin to tell me how they were doing and then pause and ask, “How’s the pig?” Patients wanted to know what new foods she was trying, what she had gotten into or what ridiculous outfit she was wearing for the current holiday. Patients began requesting me to text Zumi’s picture to their phones to cheer them up during chemotherapy. Some patients asked for her picture to be printed to hang on the hospital room wall. Once I was paged to by a nurse to tell me that my patient was delirious. “Really? That seems very odd as I just left his room and he seemed fine to me.”  “Well, doctor, he just told me you have a pig that lives in the house and can dance,” the nurse exclaimed. I could not stop laughing, I could not breathe. I DO have a pet pig that lives in the house. Zumi scratches her rump on a chair and I put the video to music so she looks like she is dancing!

Zumi became my patient’s pig too.  Zumi gave us something to discuss other than their dreaded disease. Zumi represents fun and living. Zumi is palliative medicine. She eases anxiety and lifts emotional pain.  While temporary, that relief was long enough to help break down the barriers to allow a discussion about what patients are truly fearful of…dying. Zumi is my virtual pet therapy. While not physically present in the exam room, she had quite a presence during those visits.

Word got out to nursing staff, social workers and house staff.  I was getting stopped by nurses and residents and asked to show the latest video. One day a social worker paged, “Please send a Zumi video. The weight of the world is on my shoulders today.” I obliged and sent a video to her work phone. A thank you soon came across my pager.  After a difficult decision to extubate a young mother to comfort care, the nurse, resident, respiratory therapist and I were standing outside the room in tears. We were sad and none of us wanted to go back to the hectic pace of the day. “Let’s see something to help us smile,” I suggested. The video of Zumi pig chomping repeatedly on a Starburst candy made us all laugh and briefly forget the overwhelming sadness that can occur in healthcare.

Zumi became a profitable “pork chop” when she entered our version of Bike for a Cure as a virtual rider. How could you not donate to a pig in a cycling helmet “rooting” out cancer?  In fact, she became our top virtual rider of our inaugural 2014 ride. To date, Zumi Pig has raised over eleven thousand dollars for cancer research. She is always an attraction when she attends the kick-off party down town to support the real riders. Cancer patients loved her efforts because she was earning for them and the hope that one day we would have better treatments or even cures for cancer.

Eventually, patients were requesting that Zumi come to their house to meet them. This usually occurs during the final weeks of their terminal illness when they are no longer able to come to clinic.  On a weekend off, Zumi and I would ride out to visit the patient and their family. I think many patients thought we would never come, but we did. It seems surreal to watch a terminally ill patient laugh as they are feeding a pig carrots or Cheerios from their bed. Families thank me for the visits, but it is really for me. It means so much to me that a little pig can bring such joy to someone who is dying.  Zumi is magical, transforming the saddest of times into belly laughs and smiles. I came to understand that end of life does not have to be profound or serious. Sometimes joy or silliness is just what the family, patient, or both need. I learned that taking a break from the seriousness of end of life is not only acceptable to patients and but actually appreciated.  Once, I rushed to the ICU to comfort a family whose mother had declined suddenly.  The evening before, we had sat on her bed laughing at pig videos.  As I was standing outside the patient’s room, her daughter approached me. She asked that I show her brother the video of Zumi slurping yogurt. I must have appeared very confused because she quickly explained, “that video brought mom such great joy. She laughed harder than I had seen her laugh in months. I want to share that with my brother so he too can see what all the giggles were about.”  We all stood in the ICU watching the video together, sharing a moment away from dying, a moment to celebrate her mother’s laughter as we remembered her the night before.  Zumi has taught me that laughter connects us and that it is ok to laugh even during life’s darkest moments.

 “Did you bring the pig?” were Jill’s last words. She smiled and slowly stopped breathing. I knew she was at peace. I was at peace too, because we shared a special bond, a special Palliative Pig named Zumi.

Krista Dobbie, M.D., is a staff palliative medicine physician at the Cleveland Clinic in Cleveland, OH. "Zumi, The Palliative Pig" was chosen as an Honorable Mention in the 2016 Intima Essay Contest, “Patients, Providers and Pets: One Health for All,” a call for stories that reflect the term zooeyia, which has been coined to account for the salutary effects pets bestow upon humans.