Family members of patients at the Provincial Palliative Care Centre (PPCC) in Prince Edward Island sometimes tell staff that their loved one must be hallucinating because they mentioned a horse had visited them. More than likely it was neither dream nor delusion. It was Billy.

The 17-year-old grey Norwegian Fjord horse is a regular guest at PPCC. Here, he gives terminal patients comfort, joy, socialization and, perhaps most significantly, distraction from their everyday routine, health and end-of-life concerns. Plus, said Billy’s owner Dr. Mary McNiven, “They love his little soft nose.”

When weather and scheduling permits, Billy and Mary make the half-hour trek from home to the PPCC in Charlottetown every two weeks. They’ve done so since the 10-bed centre opened in 2015. PPCC’s focus is on improving the end-of-life journey for patients and their families through various in- and outpatient programming, therapies, supports and amenities. The facility is often described as “a warm place with lots of laughter.” And Billy fits right in.

The building’s ground-level windows are large and low, giving patients an effortless view of their equine friend from bed. More able individuals can chat with him at the window up close. The patient is accompanied by at least one other person while Billy usually has a couple of handlers, as he can be mischievous.

“He’s got a little bit of his own agenda,” said Mary. Billy desperately wants to enjoy the centre’s manicured lawn and likes to raid décor such as window flower boxes, straw-laden Easter decorations and hummingbird feeders. “If you’re not keeping your eye on him, he’s got a mouthful of something,” she said. “He tries to eat everything that’s there, which, in some ways is really good because people think that’s funny.”

Despite his proclivity for food-related shenanigans, Mary said he’s kind and “so careful” when meeting people face-to-face. After making his window rounds, Billy hangs out under the awning at PPCC’s front entrance where more mobile patients, staff, friends and family can enjoy hands-on interaction with the
stout Fjord.

Newly retired as a professor of animal science at the Atlantic Veterinary College in P.E.I., Mary is familiar with the palliative and hospice world through volunteering, including as a long-time participant in St. Johns Ambulance Therapy Dog Services. In addition, she is a certified equine specialist with EAGALA, an international equine-assisted psychotherapy organization, and has offered programs, primarily for veterans coping with post-traumatic stress disorder, at her farm in Nine Mile Creek for about nine years.

Mary, therefore, was a natural fit as a research co-supervisor for Krisandra Cairns, an Islander and fellow horseperson pursuing her Master of nursing degree at the University of New Brunswick. With her own work experience as a registered nurse in the field of palliative care, Krisandra volunteered alongside Mary and Billy
for three years before embarking on her six-month-long thesis study, Experiences of Palliative Inpatients with Equine Therapy. “The topic is cutting-edge,” noted Mary. “The palliative population is very forgotten and yet their quality of life and end-of-life experience should be as good as possible.”

The overarching narrative of Krisandra’s study is “living in the moment,” which has crucial meaning for PPCC inpatients whose average stay is a mere two to three weeks, making day-to-day, even minute-to-minute, experiences so vital. She explained that, at this point in their life journey, people tend to reprioritize. What becomes important
is appreciating every day for what it is, spending time with family and friends and maintaining a sense of independence and self-worth, despite their illness. A horse, being in-the-moment by nature, reflects this back to the individual.

“A horse has no idea where the client is at in their stage of life, so it takes the client out of where they’re at in that moment,” said Krisandra, describing the human-horse interactions as honest and powerful. “It really does make some beautiful moments of connection.”

Patients often reminisce about their own horses, pets and other animals when Billy visits, while for others, the experience is entirely new and somewhat romantic in nature.

“A lot of people, when they know they’re going someplace for the last time, that’s the end of the road, it’s just a ticking clock. They’re waiting. There’s nothing new to happen or nothing more they can contribute. But when Billy nudges them or wants attention, it gives them a bit of a sense of purpose: ‘I still have value.’”

Billy also helps some patients communicate their own health and care concerns when they might not otherwise be able to do so. Mary recalled one man saying he was worried about Billy’s hips and back when he was actually projecting his own hip-related symptoms onto the horse.

In many cases, Billy’s visits mean more to the family than the patients themselves. The encounter allows for wonderful final memories and can also provide solace. Krisandra made note in her thesis about a family who saw Billy’s arrival at PPCC as a goodbye sign from their just-passed loved one. They said they would forever remember this person whenever they saw a horse. His visits also profoundly impact the staff. It’s not only something to look forward to, but is also a therapeutic outlet for these health care workers who deal in death every day. In fact, Krisandra would someday like to pursue research on equine therapy’s effects on staff and/or family of palliative patients.

Naturally, both she and Mary can’t help but be stirred by the significance of living for the moment – the core theme of her thesis – through their volunteer and research efforts. “It really helped me to reprioritize,” said Krisandra. “When you’re at that point – you’re focused on work and school and everything else – you can easily lose track of the importance of living in the moment. It’s a good lesson.”

Mary herself recalled a patient who was “wild about horses” and looking forward to meeting Billy. The woman died before his next visit. Said Mary: “You learn that if you say you’re going to do it, you do it.”

Does Billy’s Job as a Therapy Horse Stress Him Out?

Billy’s owner Mary also headed up a veterinary student summer research study to determine whether Billy was stressed by going to the Provincial Palliative Care Centre by observing his heart rate variability – an indication of stress. Billy’s heart rate was recorded at several intervals: at home just before leaving; on the trailer both to and from PPCC; before visiting patients at the windows; at the centre’s main door; and upon his return home.

“In the whole scheme of things, his highest stress level was during trailering and it wasn’t very high, but it was a little bit higher than being brushed in the barn or something like that,” said Mary. “He was the most relaxed of all standing and being talked to in front of the palliative care centre, so obviously it was a good thing for him too.”

Palliative care patient Connie Arsenault enjoys Billy’s visit in July 2017. Horses were Connie’s favourite animal, so getting to see and touch Billy in her final days was a special treat, says her daughter-in-law Dora-Lynn McNevin.