Making Rounds with Oscar
Page 1
Making Rounds with Oscar
The Extraordinary Gift of an Ordinary Cat
David Dosa, M. D.
To the families and caregivers
of dementia patients everywhere
Contents
Note to Reader
Chapter One
IF YOU LOVE YOUR JOB, ON THE BEST DAYS YOUR…
Chapter Two
HAVE YOU EVER HAD A REALLY BAD DAY, THE KIND…
Chapter Three
WATCHING A LOVED ONE’S HEALTH FAIL IS HARD. MOST families…
Chapter Four
WHEN I RETURNED TO STEERE HOUSE A FEW DAYS LATER…
Chapter Five
A LARGE PORTRAIT OF HENRY STEERE HANGS OVER THE piano…
Chapter Six
WHEN A PATIENT IS TERMINAL, DOCTORS WILL TALK about limiting…
Chapter Seven
IT WAS JUST AN ORDINARY WEDNESDAY. OR SO I thought…
Chapter Eight
TO SAY THAT I TRUSTED DONNA RICHARDS WAS SOMETHING of…
Chapter Nine
IT WAS AS IF I HAD STUMBLED ON A SCENE…
Chapter Ten
IT WAS TIME TO GET BACK ON THE TRAIL OF…
Chapter Eleven
THE FERRETTI HOUSE LOOKED LIKE ONE OF THOSE spreads you’d…
Chapter Twelve
I WAS LOOKING FORWARD TO DEBRIEFING MARY ON MY conversation…
Chapter Thirteen
I HAD THE CHART FOR OUR NEW CHARGE. MRS. ARELLA Matos…
Chapter Fourteen
AS AN EARLY WARNING SYSTEM, OSCAR’S AVERAGE WAS proving to…
Chapter Fifteen
MOST MORNINGS I OPERATE ON AUTOPILOT. I GET OUT OF…
Chapter Sixteen
“DAVID, CAN YOU STOP BY? I DON’T LIKE THE WAY…
Chapter Seventeen
“THERE WAS A TIME WHEN I THOUGHT ABOUT WRITING a…
Chapter Eighteen
ONCE AGAIN, I HAD GONE OFF IN SEARCH OF ANSWERS…
Chapter Nineteen
CATS MAY HAVE NINE LIVES, BUT WE ONLY HAVE ONE…
Chapter Twenty
IT WAS TIME TO STOP. I HAD NOW SPOKEN TO…
Chapter Twenty-One
GEORGE DUNCAN LOOKED AT HIS MOTHER THROUGH tired eyes. Only…
Chapter Twenty-Two
ALL WAS QUIET ON THE THIRD FLOOR. THE RESIDENTS were…
Chapter Twenty-Three
ONE AFTERNOON A FEW DAYS AFTER RUTH’S DEATH, I was…
Afterword
Acknowledgments
Copyright
Note to Reader
THE PATIENTS, THEIR STORIES, AND THE EXPERIENCES of caregivers confronting terminal dementia are based on my experiences caring for elderly patients. I am greatly indebted to the many people who shared their stories, including the staff at Steere House and the families of those who died with Oscar at their bedside. I truly believe that readers will be as moved by these accounts as I was when I first heard them and I have tried to remain as faithful to them as possible. I apologize for any factual errors that I have made in retelling the stories and in transcribing our interviews. If I have made errors, please know that they were unintentional.
Please note that for narrative purposes I have made some changes that depart from actual events. Moreover, in the interest of preserving confidentiality in patients with end-stage dementia, I have changed some names and modified some backgrounds to protect identities. Additionally, some of the characters that appear in this book are composites of multiple patients. Nevertheless, the experiences represented in this book are based on real-life patients and their caregivers whom I have been fortunate to care for over the years.
Finally, though I was skeptical early on, Oscar the cat’s peculiar ability appears to be as real as it is mysterious, and he continues to regularly hold vigils over departing patients. It is my hope that readers will allow him to continue his “good work” unencumbered for as long as he chooses and will forgive the occasional mistakes that he makes from time to time. After all—no human (or cat) is perfect.
CHAPTER ONE
“Animals are such agreeable friends—
they ask no questions, they pass no criticisms.”
GEORGE ELIOT
IF YOU LOVE YOUR JOB, ON THE BEST DAYS YOUR WORKPLACE can seem beautiful, no matter how it might look to the rest of the world. An oilman looks at a flat, dusty plain and sees the potential for untapped fuel. A firefighter sees a burning building and runs into it, adrenaline surging, eager to be of use. A trucker’s love affair is with the open road, the time alone with his thoughts—the journey and the destination.
I’m a geriatrician and I work on the third floor of the Steere House Nursing and Rehabilitation Center in downtown Providence. People tell me they would find my job depressing, but I’m always a little puzzled by that. Looking at my patients and their families, I have a remarkable view not just of lives well lived, but of deep commitment and love. I wouldn’t trade that for the world. Sure, sometimes I’m caring for people at their worst, but I’m also blessed to be with them at their best.
My parents, both doctors, thought I was crazy for going into geriatrics. The family business has always been pediatrics—my mother and uncle are pediatricians, as was my grandfather. I think there was always this sense that I was choosing the wrong end of the life continuum to stake out my career. “Aren’t children so much cuter?” my mother would say.
I thought of going into pediatrics. I love children and babies, and have two little ones of my own. The difference for me has always been the stories. Children are a blank canvas, portraits waiting to be drawn. When we look at them, their lives just beginning, we feel a sense of renewal and an expanse of infinite possibility.
My older patients, on the other hand, are like rich paintings and boy, do they have stories to tell. On my best days I can look at them and see all the way back to their childhood. I think of their parents (long gone now), the places they’ve been, the things they’ve seen. To me it’s like looking through the other end of a telescope, back to the beginning.
That’s why Steere House looks beautiful to me—that and the fact that it’s a pretty nice place, as nursing homes go. The large, atrium-like windows flood each floor with light on sunny days, and on most days there’s music coming from the piano in the lobby. And then there’s Oscar…. I’d like to say I was the first one to notice his peculiar abilities—but I wasn’t. Thankfully there were others who were more astute.
THE UNIT had been empty that summer morning back in 2006, except for a pair of eyes that glared at me from atop the nurse’s desk. Like a warden cautiously evaluating a visitor to her facility, the questioning eyes sized me up to determine if I’d pose a risk.
“Hello, Maya. How are you?”
The pretty white cat made no move to greet me; she was consumed by the act of licking her front paws.
“Where is everyone, Maya?”
Aside from the cat, the third floor was strangely quiet. The hardwood-tiled corridors were vacant; the only signs of life were a few randomly placed walkers parked next to patients’ doors. Empty now, these four-sided walkers seemed strange and unwieldy, like an imaginative child’s Tinkertoy creation abandoned after play. At the far end of the east corridor, the morning light shone through the large picture windows, illuminating a broad swatch of the hallway.
I was looking for Mary Miranda, the day shift nurse. Mary is the source of all knowledge on the unit, a central intelligence agent who knows not just the story of every patient, but of Steere House itself. Though she’s not technically in charge, there’s little doubt among the physicians and staff as to who actually runs the floor. Mary is the maternal figure for each resident and she is fiercely protecti
ve of her children. Nothing happens on the unit without her knowing about it. Even her supervisors have been known to defer to her.
The doors to the residents’ rooms are generally closed this early in the morning, and room 322, where Mary was performing AM care on her patient, was no exception.
I knocked on the door and heard a muffled voice telling me to hold on. As I waited in the hallway, I studied the corkboard display of family pictures attached to the wall outside Brenda Smith’s room.
Mrs. Smith’s full name, gertrude brenda smith, and her date of birth, JANUARY 21, 1918, were stenciled in block letters on a rectangular piece of paper at the top of the corkboard. Each letter had been cut from construction paper and meticulously decorated with beads and other trinkets, the loving effort of some grandchild no doubt. Underneath the artwork there was a black-and-white photograph of a beautiful young woman in her early twenties. She wore dark lipstick that contrasted with her pale face, and she was fashionably dressed in a 1940s summer outfit. She was walking arm-in-arm with a handsome man in a Navy uniform. A parasol hung on her other arm. I imagined them in a park on a warm summer’s afternoon shortly after the war. I studied their faces. They were happy, and clearly in love.
Beneath that picture was a second photograph of the same couple years later with two young children. This one was in color, the faded stock of an earlier day. His hair had receded some and hers now revealed a few streaks of gray. This picture contained a promise of a different sort. They weren’t just young lovers now; they were proud parents, thinking of a future larger than their own.
The last picture in the collection was of Mrs. Smith in her later years, meticulously dressed, her silver hair neatly pulled back below a tastefully chosen hat. Her husband was gone, but she was surrounded by several generations. A banner hung in the background proclaimed HAPPY 80TH BIRTHDAY, GRANDMA. Eight years had passed since then.
I knocked again and made my way inside where Mary was tending to her patient. Gone was the vibrant, well-dressed grandma of the birthday picture. In her place was a smaller replica of the woman that was. Until I worked with patients in the late stages of Alzheimer’s the expression “a shadow of her former self” was just a cliché. This is what I saw with Mrs. Smith and so many of the other residents here. But behind that shadow I still saw the substance, even if she seemed no longer to see me.
“Do you need me?” Mary asked, a little annoyed by the intrusion.
“Yes,” I replied. “I need to know who has to be seen today.”
“Let me finish up here and I’ll meet you at the front desk.”
As I turned to leave, Mary stood up from her stooped position at the bedside, arching her back against the strain.
“On second thought, David, I’m going to be busy here for a little bit. Why don’t you go take a look at Saul’s leg? It’s red and angry looking. I think he has that skin infection again.”
“Fair enough. I’ll go see him.”
I left the room and headed off in search of Saul Strahan, an eighty-year-old man who has lived on the unit for many years. I found him dressed in his usual garb—a Boston Red Sox sweatshirt and baseball cap—in his usual place, a La-Z-Boy recliner in front of the TV. The television was tuned to a morning talk show.
“What’s on TV?” I asked, not expecting a reply.
I sat down beside him and glanced at the television. A young actress was telling the show’s host how annoyed she was by the paparazzi that followed her everywhere.
“Everyone’s got problems, right, Saul?”
I looked at him more closely. In addition to his progressive Alzheimer’s, Saul had been the victim of a nasty stroke that had robbed him of his language four years ago. His eyes stared back at me with life, though, and I could sense that he was trying to speak. I placed my hand on his shoulder and told him that I was there to examine his leg.
As Mary had said, Saul’s legs were both swollen with edema, a result of his twenty-year battle with congestive heart failure. Yet his right leg seemed angrier and decidedly warm to the touch. Mary’s concerns seemed justified.
“Saul, my friend, I’m sorry but it looks like you’re going back on antibiotics.” I made a mental note to call his daughter.
I returned to the nurse’s station where Maya remained hard at work cleaning her fur. Startled by my return, she leaped off the countertop, but not before giving me one of her this place isn’t big enough for both us looks.
I finished my note and sat at the desk waiting for Mary to return. A nurse for most of her life, Mary started as a nurse’s assistant when she was in high school in the seventies and in nursing school discovered she loved working with old people. Not only is she one of the most dedicated nurses I know, she has some sort of intuition for the profession. She always seems to know who actually needs the most attention.
“Hello, sorry to keep you waiting.” Mary’s pleasant voice kept me from feeling too bad about my dependence. If she had been annoyed before it was all forgotten now.
“David, do you have a few minutes? I want to show you something down in room 310.”
As we walked down the hall, Mary told me a little about Lilia Davis. “She’s one of your colleague’s patients. She’s about eighty now, and has been here on the unit for eighteen months. About three months ago, she started losing a bunch of weight. Then one morning, she started to bleed from below. We sent her to the hospital and they diagnosed her with colon cancer that had spread everywhere. Given her severe dementia, her family decided not to treat it; they sent her back on hospice services.”
A reasonable approach, I thought to myself.
We found Mrs. Davis lying on her back, her eyes closed and her breathing shallow. A morphine pump was connected to her left arm via an IV. On the other side of the room was an empty cot, the sheets displaced off to the side. Someone had been sleeping here not long ago.
“Mrs. Davis’s daughter,” Mary said before I could ask. “I sent her home for a few hours to shower and change her clothes. I think she’d been here for thirty-six hours straight.”
“So, what did you want to show me?” I asked.
Mary pointed to the base of the bed. “Take a look.”
As I approached, the head of a black-and-white tabby cat rose up off the sheets. Moving caused the bell on his collar to jingle slightly. The cat’s ears perked up and he glanced at me with questioning eyes. I ignored him and moved toward the patient. The cat put his head back down on his front paws and purred softly while nestled against Mrs. Davis’s right leg. I looked over at her face and noted that she was clearly comfortable.
“She looks okay,” I said. “Do you need an order for medication or something?”
“Not the patient, David. She’s fine. It’s the cat.”
“The cat? You brought me in here to see a cat?”
“This is Oscar,” she said, as if introducing me to someone at a dinner party.
“Okay,” I said. I was starting to share Maya’s bad mood. “He’s a cat hanging out with a patient.”
“Well, that’s just it. Oscar doesn’t really like to hang out with people. I mean, how many times have you actually seen him up here? Usually he’s hiding somewhere.”
It was true: I’d only seen Oscar a handful of times, even though he had lived on the unit for about a year by then. Sometimes I would see him by the front desk, where his food and water bowls were, or curled up asleep underneath the remains of a tattered old blanket. Oscar did not have a reputation as a sociable cat.
“He’s probably just warming up to us a little,” I said. “Though I don’t profess to be an expert in cats, my experience says they do whatever it is they want to do. He’s probably sitting here because he found someone who won’t bother him.”
“I know this is weird, David, but the thing is, Oscar never really spends any time with the patients. He usually just goes off and hides, mostly in my office. Lately, though, a couple of us here have noticed that he’s spending more time with certain residents.”
I shrugged. “And why is that weird?” Looking at Oscar curled up beside Mrs. Davis, I was reminded of the cats they buried with the ancient Egyptians. This scene was certainly peaceful enough.
“The thing is,” Mary said slowly, “Oscar only spends time with patients who are about to die.”
Now I’d heard everything.
“So you’re telling me Mrs. Davis is going to die today?” I looked over at her and immediately regretted what I had said. Her breathing was clearly labored and I felt guilty for my breach in decorum. I realized that Mrs. Davis indeed might die today—a fact that had more to do with her dementia and rapidly progressing cancer than the presence of a cat on her bed.
Mary smiled but I could sense her embarrassment. I felt bad for scoffing at her.
“I suppose it’s possible that a cat might know when someone’s going to die. Remember that article recently about the cancer-sniffing dogs? And there are those Japanese fish that sense earthquakes before they happen. And what about Lassie? He always knew when Timmy fell down the well.”
Mary was not amused. “You know, Oscar wandered into another patient’s room right before she died yesterday.”
The look on my face must have said it all because Mary stopped trying to convince me. For a moment we both looked in silence at the scene in front of us. The cat, curled up next to Mrs. Davis’s leg, was quietly purring.
“Don’t get me wrong, Mary,” I said, breaking the spell. “I love the concept of an animal sitting with me as I die. It’s really quite sweet. I had a dog growing up and he was always by my side.”
I walked over by the bed and reached down to pet Oscar. With lightning reflexes he slapped my hand with his front paw. I pulled back, searching for evidence of blood.