Making Rounds with Oscar

by David Dosa

  I hesitated. I knew he wasn’t there and I had come to see Ruth, and still felt that I hadn’t been of much solace to Mary.

  “Go on,” she said.

  I walked down the hall toward Saul’s room. On the way I passed Ruth and Frank walking together, hand in hand. I said my hellos. Ruth greeted me with a warm smile.

  “You’re looking much better, Mrs. Rubenstein,” I said. Though I sensed some recognition, I didn’t expect her to respond, so I asked her husband, “Is she eating again?”

  Frank smiled from ear to ear. “Like she’s just come off a hunger strike!” With that, he vigorously shook my hand.

  I may have actually smiled. I knew it was a temporary victory, but I was happy for them nonetheless.

  I WASN’T QUITE SURE what I expected to see in Saul’s room. It was dark and his belongings were laid out meticulously in preparation for his return. His bed had been carefully made; the comforter was drawn up above his pillow. Then I saw something move. In the dim light I recognized the shape of a cat. Oscar had started his vigil without the patient.

  On my way over to the hospital, I thought about Barbara’s decision to keep her father alive at all costs. Who was I to judge? It was so difficult to make that final call, to allow your parent or loved one to slip away. Maybe it was even a little unfair to burden a family member with such a terrible decision. Saul had insisted that he wanted everything done—back when he could still insist, back when he knew who he was. To each his own, I thought as I rode the elevators to the ICU, but I knew deep inside that I’d have chosen the cat.

  There’s little privacy in the intensive care unit. The doors to the rooms are almost always open wide so that nurses and staff can monitor their sick charges more effectively. These days the majority of ICU patients are older—in their eighties and beyond.

  Room 19 was no different. A frail, graying man lay asleep in bed. A blue heating blanket covered much of his torso; it looked like a float that my son or daughter would use in a swimming pool. The blanket, filled with warm air, provided needed warmth to a body unable to fully generate its own heat. I barely recognized Saul. The nameplate on the chart confirmed his identity. Approaching his bed, I could see that a three-pronged intravenous line had been inserted into his neck. A dialysis machine was parked at the bedside. It was an ominous development for a man who never had any problems with his kidneys.

  “I’m Dr. Dosa, Saul’s primary care doctor,” I said, introducing myself to the nurse who was standing in the corner charting at a computer. She acknowledged me with a brief nod before returning her attention to her notes.

  “How’s he doing?” I asked.

  “Not good. He’s still got low blood pressure on dobutamine and dopamine. His kidneys are failing, and the doctors are thinking about starting dialysis.” The nurse shrugged. “We’re doing everything we can.”

  I walked over and looked at the IV medications hanging from poles positioned above his head. He was on three antibiotics, all with expensive-sounding names: linezolid, Vancomycin, and ceftazidime. None of these medications had done anything thus far to threaten the bacteria in his bloodstream. The little buggers were winning and it was only a matter of time.

  “The cardiologists are coming up here this afternoon to perform a transesophageal echocardiogram. They think his heart valves are seeded with bacteria,” the nurse said, looking up from her computer.

  I shook my head. Would he have wanted any of this? Certainly the trip to the hospital had been reasonable. But life events often get in the way of good intentions. Within a day, Saul’s breathing had become labored, and his blood pressure bottomed out. Phone calls were made to the family. “He’s hypotensive and we’re going to need to put a tube in his lungs to help him breathe.”

  Looking at Saul, I realized he would now have a probe stuck down his esophagus in order to determine if his heart valves were also involved. Yet it wouldn’t change anything even if the test proved positive. He certainly wasn’t a candidate for surgery in his current state.

  “Are you sure that all this makes sense?” I asked the nurse.

  She shrugged. “Talk to the ICU doctors. Personally, I don’t think so, but no one ever listens to me.”

  I smiled at her. “Me either.”

  My patient was way past autopilot now. No one would stop to ask if any of this made any sense. His breathing was labored, so they intubated him. His blood pressure was low, so they put him on medications. His kidneys were failing, so he was being considered for dialysis. Each treatment, procedure, and test made sense in the context of the latest information, but the big picture was absent. There was no consideration of the why; instead it was full steam ahead! I left Saul to his nurse’s care and went in search of his intensive care doctors.

  “Will it make a difference?” I asked the physician I found.

  “Probably not. I think he’s dying, but his family wants it done.”

  I returned to the front desk to call Saul’s daughter. She answered immediately and I updated her about her father.

  “The doctors here would like to put a tube down your father’s throat to see if his heart valves are infected. Even if the test turns out to be positive, I’m not sure your father’s poor condition will allow us to do anything to change his circumstances.”

  “Doctor, he wanted everything done.”

  “His circumstances have changed, though, Barbara.”

  “Everything, Doctor. Everything.”

  THE CALL CAME just after midnight. I got up to answer the phone, rubbing the sleep out of my eyes.

  A young physician offered his condolences. “I’m sorry, but I just wanted to let you know that your patient Saul Strahan died earlier this evening. We tried CPR but we couldn’t get him back. We did everything we could.”

  “Did you call the family?” I asked.

  “We called his daughter. She took it really hard, but she’s in with him now.”

  I told him to offer her my condolences and thanked him before hanging up the phone. I stared off into the darkness, thinking about Saul. I said a quick good-bye to him in the night air and then thought about his daughter. Did she get a chance to say good-bye? Probably not. I wondered if his minister had been by.

  “What’s wrong?” my wife asked, half asleep.

  “My patient just died.”

  She muttered something unintelligible. In my business, these sorts of calls are not infrequent.

  I settled back into bed, but found it difficult to fall back to sleep. In my mind, I pictured Oscar looking out of the window from Saul’s room, perhaps gazing in the direction of the hospital across the street. I wondered if he knew. I am quite certain he would have been there, curled up next to Saul, had he stayed at the nursing home. In the end, all the procedures, tests, and treatments didn’t make a difference. It was just his time. We all have choices about how we die, and some deaths seem better than others. I told myself that at least Saul was at peace. He’d moved on, whatever that might mean. I just wished the transition had been better.

  CHAPTER NINETEEN

  “Two things are aesthetically perfect in the world—the clock and the cat.”

  EMILE AUGUSTE CHARTIER

  CATS MAY HAVE NINE LIVES, BUT WE ONLY HAVE ONE and we’re all terrified to talk about the ending of it.

  “Nobody likes to talk about death,” Cyndy Viveiros said, looking at me across the desk. “It’s like the dirty D word we aren’t allowed to use in polite company.”

  I knew what she meant.

  “During those last few weeks, very few…” She paused. “Look, I understand how hard it is for people to confront their fears, but for the most part, I was alone. Certainly the staff at the nursing home was great. I couldn’t ask for more. But they would come and go at the end of their shifts.”

  She gathered her thoughts.

  “Dr. Dosa, you asked me here to talk about Oscar. So here it is. I appreciated Oscar for what he did for my mother. But I also truly believe that he was there for me. D
uring the last few weeks of her life, Oscar was in and out of her room all of the time, and I found that incredibly comforting.”

  “So, you think Oscar was there for you as much as your mother?” It reminded me of the last thing Jack McCullough had said to me.

  “I think he was there for me,” Cyndy repeated. “In fact, I’m sure of it.”

  “IT HAD BEEN a long three weeks at Steere House and I think I’d spent most of my visiting time seated in a chair by my mother’s bed. The room had become my world. Unless I was singing church hymns to her, the constant drone of the oxygen machine and my mother’s breathing were the soundtrack of those early mornings. For the last three weeks, the life had seemed to ebb out of her like an outgoing tide. There was a certainty to those days, though, a certainty that those were the last days of my mother’s life and sometimes a certainty that those days would never end.

  “The last day of her life, I remember watching the clock and rubbing my eyes. A lot. It could be two in the morning but I had no intention of leaving. Still, as the minute hand would trudge its way around the clock on Mom’s nightstand I told myself that it would happen soon: one last breath, and then silence. At least that’s what the hospice nurses told me to expect. Yet after days of watching Mom’s chest moving rhythmically up and down, I wasn’t sure that the end would ever come.

  “Even Oscar seemed a little confused by her stamina. The cat that everyone said could predict death had been in and out of the room every day for the past few weeks, and nothing. But those last few days there seemed to be a greater sense of purpose to his stride.

  “I remember that last day I was there he walked over to me and sat down. When I had leaned down to pet him he purred softly, so I picked him up and placed him on my lap. I rubbed that soft belly of his while we both watched Mom across the darkened room. Before long, though, Oscar had jumped off my lap and onto the covers. Then, look, I know this sounds strange, but he seemed to sniff the air, and then he rolled over on his back and gave this very catlike stretch. It was almost as if he was striking a pose,” she said, chuckling.

  Cyndy looked up at me to gauge my reaction.

  “You know, Oscar can be very charming, when he wants to be!” she added, attempting to justify her earlier comment. “Well, at any rate, Oscar looked over at my mother and fixed his gaze on her. I wondered if this was his sign. I think I even asked him, ‘Will it happen soon?’”

  If he knew, Oscar wasn’t telling.

  “You know, Dr. Dosa, at first I had found Oscar’s visits a little unsettling.” Cyndy paused, unsure of what to say next. “I knew Oscar’s game. I had even had dreams about him sitting on Mom’s bed, terrible dreams that woke me up out of a sound sleep and always at the same time each night: 3:00 am. It was just weird.

  “During the first week of my watch Oscar would stroll by the doorway and stand at the threshold, peering into the room. At first I eyed him with anxiety, wondering if he’d cross over into our world. That’s how I thought of that room, as my world.”

  Cyndy broke into a smile.

  “After a while I came to realize that my fears were unfounded. I mean, for goodness sake. He wasn’t anything supernatural. He didn’t carry a scythe or a pitchfork. He was just an ordinary house cat. My mom loved cats. In fact, when I had first looked at nursing homes, I thought Mom might take some solace from the animals running around the unit, and she had.

  “Now that I knew Oscar, he wasn’t threatening. In fact, he had offered me more companionship than anyone. I had a lot of concerned phone calls, and people tried to be kind, but in the end only two people actually came to visit Mom. I get it. Nobody wants to visit a nursing home, let alone the dying. It’s like running into a burning building; the impulse is to run the other way. But Oscar, well, he was different. He didn’t shy away. Actually, he seemed to know when he was needed most.

  “You know, the first day I saw Oscar sitting in Mom’s doorway I had watched him with a feeling of trepidation, I guess. He just sauntered in and walked over to Mom’s bed. I knew what a visit from Oscar might mean, and I guess I held my breath. But instead of jumping onto Mom’s bed he sat down beside me. He seated himself on his hind legs on the chair next to me and looked up at me, as if to ask how I’m doing. Can you imagine?

  “When I reached down to pet his head, well, he gave me a long, loud purr as if he was real satisfied with himself.”

  As if, I thought.

  “Then, just like that, he leaped onto the windowsill and settled himself in a classic sphinx pose. You know the one I mean, Dr. Dosa?”

  “I do indeed,” I replied. I really did know the pose. It was regal and mysterious, as if our own Oscar was descended from Egypt, as if he was in some way a temple guardian. Actually, maybe the idea wasn’t too far off.

  “Well, Oscar spent a good amount of time sitting on that windowsill, studying the world both inside and out. Each day he was there to greet me at the front door of the unit, and, well, he seemed to escort me down the hall to Mom’s room. He’d stay with me for the whole visit.

  “I really warmed to the little guy, you know? Soon I even found his presence comforting. When I felt anxious, which I often did, I would talk aloud to Oscar and he seemed to listen. He never passed judgment or offered unwanted advice, he just listened. When I needed a break from the room, Oscar would stay with Mom while I went out to stretch my legs or grab a bite to eat. Sometimes he would even escort me down the hallway toward the unit doors.

  “You know, Dr. Dosa, I had a lot of time to think, sitting there with Mom, and I wondered how I would feel when she finally passed. I had experienced so much guilt during the long duration of Mom’s illness that I had begun to think of guilt as my birthright, something passed down to me like a family heirloom. How had I not noticed my mother’s illness sooner? Did I do a good enough job dividing my time and attention between my children, my full-time job, and my needy mother? Did I do the right thing by putting her into the nursing home when I did?

  “No matter how much I did there always seemed so much more to do, so much always undone.”

  Cyndy paused for a minute, to laugh or cry, I wasn’t sure. I don’t think she was sure either.

  “Now I realized that I was beginning to feel guilty for not feeling guilty. In truth, my mother’s death seemed a natural end to her suffering. But why do I feel okay with it? I asked myself. Searching for solace, I grabbed my mother’s rosary from the bedside table and began to recite the Lord’s Prayer aloud:

  Our Father, who art in Heaven, hallowed be Thy name.

  Thy Kingdom come thy Will be done, on earth as it is in heaven.

  Give us this day our daily bread

  And forgive us our trespasses, as we forgive those who trespass against us.

  And lead us not into temptation, but deliver us from evil.

  Amen.

  “When I was finished, I sat back down again, suddenly feeling very tired. For the first time I had a strong desire to go home. I spontaneously murmured a heartfelt prayer: Please, Lord, just take her.

  “I closed my eyes for a moment and was consumed with a flood of loving memories of my mother from years gone by. They were comforting memories, and I allowed myself to almost drift off to sleep, listening to the white noise of the oxygen machine in the background. Suddenly I bolted upright. The noise from the oxygen machine was all I could hear. I looked over at Mom and realized she had stopped snoring. For the first time in days, she appeared peaceful. I looked at my watch. It was 3:00 am.”

  “THE NURSE CAME IN a couple of minutes later and listened to my mother with her stethoscope, confirming what I already knew.

  “She gave me her condolences and then left to telephone whoever was on call. For a while I just sat quietly in the chair watching my mother. Inside, I knew that she was gone but I still watched her, searching for movement. I leaned over and kissed my mother on the forehead, telling her that her beloved late husband was waiting for her. Almost immediately, I felt this incredible sense of closur
e, like both my mother and I were finally free.”

  Cyndy started to smile ever so slightly. “After some time passed, I got up and left the room to get a cup of coffee. I wasn’t quite ready to call my family yet; I needed to wake up. I remember it being eerily quiet on the unit. As I’m walking down the hall, I hear this pitter-patter of paws hitting the linoleum floors next to me. I looked down and saw Oscar walking next to me.”

  I could picture Oscar walking alongside Cyndy, matching her gait, keeping pace.

  “So, he was, like, your companion for those three long weeks?” I asked.

  Cyndy nodded and I could see the awe dawning on her expression. I had seen this look a lot, of late, as people talked to me about Oscar.

  “Doctor, I remember walking into the bathroom to splash some cold water over my face. When I left the bathroom, Oscar was right there waiting for me at the door. I stopped in the kitchen to pour myself a cup of coffee. Then I sat down at a table in the dining area to begin to plan out who I needed to call. Suddenly, there was a noise in the chair next to me. I looked over and there was Oscar sitting on his hindquarters, eyeing me. It was like he was checking up on me to make sure I would be okay.”

  She smiled widely now. “You know, throughout this process, people would come and go. But Oscar would stay. He was really there for me. In fact, he was the last ‘person’ I saw that morning as I left the unit. He just sat there on the nurse’s desk staring at me as the doors closed behind me.”

  CHAPTER TWENTY

  “I love cats because I enjoy my home; and little by little,

  they become its visible soul.”

  JEAN COCTEAU

  IT WAS TIME TO STOP. I HAD NOW SPOKEN TO A HALF dozen people whose loved ones had died with Oscar by their side. I had plumbed their memories and emotions, and learned a lot more about what Alzheimer’s does to families. But I was still surprised by how little I knew about Oscar.