The Death Dog


Jonathan Peng, MD1

Accompanying artwork: Ryan Alexander-Tanner

Perm J 2019;23:15.135 [Full Citation]
E-pub: 11/01/2019

This is a story and illustration from the upcoming book 100 Little Stories of Big Moments published by The Permanente Press.

Most of the stories and poems were written by clinicians in 15 minutes in writing workshops about meaningful moments in their work and life of practicing medicine. Professional artists were asked to create a visual representation of the story.

Animals often have an innate sense of their surroundings. We’ve seen this in studies showing how birds migrate early when large storms are imminent. There have been studies of dogs who can “sniff” out urine that has malignant cells. And we know for a fact that certain ocean predators, such as sharks, can sense fear in prey.

When I was an intern in the CCU, a pilot pet therapy program was started that entailed bringing animals to patient rooms. My first thought was that these animals would bring their own bacteria from room to room, despite the fact that infectious disease seemed okay with it. I later saw how patients responded and felt more “alive” with these companions. From even the lonely fish in a tank to the hyper canine, patients spoke only good things about the program.

One such pet who made a lasting imprint was a dog named Snowball. He was a large, almost bear-like, white dog that had the fluffiest coat of hair I had ever seen on a dog. His presence was definitely known in the room as he weighed probably as much as I did. The pet therapists would tell us that he had a way with patients but was also peculiar in that he was very picky about whom he interacted with.

As time went by, we noticed a strange pattern. Snowball would be very engaging with specific patients—jumping up on the bed, playful and interactive—and with other patients he would remain distant. There was no obvious pattern, disorder, or common denominator among patients except one: Each patient he played with would have a life-threatening event in the next 24 hours. There was Mr S, who came in with ventricular tachycardia and improved, but one day from discharge he coded unexpectedly and passed that night. There was Ms B, who was admitted for diabetic ketoacidosis and easily treated only to end up dying from an unknown pulmonary embolism the next day. Lastly, there was the young cancer patient, Mr P, whom we saw that day actually play with Snowball and incidentally he suffered a septic event and ended up in the ICU. We started referring to Snowball, as the “death dog“ and the “grim reaper.”

As time has gone by, I often wonder if that was truly a fair assessment of this well-meaning creature. As physicians, we also encounter our patients and establish a good rapport with them, only to have them decline, sometimes shortly after meeting them—but that does not make us a harbinger of death. Perhaps Snowball was merely meaning to give these kind souls a caring goodbye and not acting as a messenger of morbidity.


How to Cite this Article

Peng J. The death dog. Perm J 2019;23:15.135. DOI:

Author Affiliation

1 Santa Rosa Medical Center, CA

Corresponding Author

Jonathan Peng, MD (

Artist Information

Ryan Alexander-Tanner is a Freelance Cartoonist in Portland, OR. Web site:

The story “The Death Dog” was originally published in leaflet, 2017;5(2). Available from:


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