On the surfacace, Oscar does appear to be an ordinary cat, perhaps one you'd see sitting in a neighbor's window, or even in a cage in an animal shelter, waiting for adoption. His dark eyes, although clear and bright, don't show any evidence of what almost appears to be Oscar's supernatural ability of sniffing out the impending death of one or another of the patients in the third floor dementia ward of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island.
Indeed, although his self-appointed job is attending the deaths of his patients, on days when he isn't needed on the ward, Oscar might be found rolling around in kittenish exuberance in a pile of catnip.
Cast of Characters
"Making Rounds With Oscar" was written as the result of the publicity given to Dr. Dosa's original essay, "A Day in the Life of Oscar the Cat," published in the New England Journal of Medicine in July of 2007.The players in this book are:
David Dosa, M.D.Dr. Dosa had been expected to follow his family into pediatrics, however he chose to become a geriatrician instead. He is in charge of the third floor of the Steere House Nursing and Rehabilitation Center in Providence Rhode Island. Dr. Dosa explains his choice of geriatrics by describing the children in pediatric practice as "a blank canvas, portraits waiting to be drawn," while older patients are "like rich paintings, and boy, do they have stories to tell."
You will find lots of these wonderful stories about the patients on the third floor, along with their family members who visit them there: stories abrim with smiles, laughter, tears, and anger.
Oscar, the CatOscar is a fairly typical brown tabby cat with a rakish white streak above his eye, traveling into a generous splash of white on his lower face, which runs down all the way to his paws and under-belly. If "eyes are the window to the soul," is it possible that Oscar's eyes can see into the souls of patients approaching death? His eyes are such deep pools that it makes one wonder if they are the tools he uses in his uncanny ability to spot the impending deaths of certain of his patients on the third floor.
Oscar originally came to Steere House as a kitten, along with five other cats, from newspaper ads, shelters, and other various sources, after the passing of the original therapy cat, Henry, who had strolled in the door as a stray, many years prior. Although the other cats array themselves throughout Steere House, the third floor is Oscar's domain and he rules it with a velvet paw. This cat is so widely respected that a plaque, awarded by a local hospice agency adorns a wall near the nurse's office, proclaiming, “For his compassionate hospice care, this plaque is awarded to Oscar the Cat.”
Mary MirandaMary Miranda is the day shift nurse in the third floor Safe Haven Advanced Care unit, known in the book as the Dementia Ward, mostly populated with Alzheimer's patients along with other end-stage dementia victims. Although she holds no such title, Dr. Dosa and other staff members credit her with the task of "running the third floor," a daunting, but rewarding job. Mary has a background about which novels could be written, including being a beauty queen and an abused wife. Her compassion and dedication to her patients no doubt are colored by her history.
Certain Patients and Their Family MembersWhile this book title includes Oscar's name, the "Making Rounds" part is a huge part of the story. The patients and their spouses, children, and other relatives, are the foundation upon which Dr. Dosa's and Oscar's work are based. This book is every bit as much and more about them and the impact Oscar has on their lives - and deaths, rather than about Oscar.
Note: Dr. Dosa has changed names and backgrounds of various characters in this book to protect identities.
Patients and Their Families, the Heart of the Book
Although, according to the Steere House Website, Oscar has predicted their deaths and been with 24 patients at the end, in Making Rounds With Oscar, Dr. Dosa has only covered a handful of those in the book, and this review will briefly touch on just a few of them.
Dr. Dosa Meets OscarDr. Dosa was aware that cats and a few other animals lived on the premises, and had seen many of them, including Oscar. However, he did not officially meet Oscar until Mary Miranda introduced them one day. She brought Dr. Dosa to the bedside of Mrs. Davis, a woman about 80 who had been diagnosed with terminal colon cancer about three months prior. Although Oscar was sleeping quietly on the bed next to Mrs. Davis, he saw nothing unusal. After all, cats are opportunistic, and sleep wherever they find a cozy spot, right?
Even after Mary told him that Oscar had accompanied a few other patients lately who had died in his presence, Dr. Dosa was skeptical. He was even less crazy about the concept after Oscar scratched him for trying to pick him up. When Mary called him later that afternoon to tell him Mrs. Davis had died with Oscar beside her shortly after he had left, it gave him some pause for thought. Sometime later, Mary called again to tell him that Ellen Sanders, another patient had died and Oscar was there, even though the ward personnel had no reason to expect her imminent demise. Mary added that Mrs. Sanders was the fifth or sixth of Oscar's patients to die simce Mrs. Davis, and Dr. Dosa experienced a sort of an epiphany.
He became more of a believer after talking one day to Ida, a widow in complete charge of her senses, a patient downstairs because of crippling rheumatoid arthritis. Ida was a cat lover who once had a cat who could sense when she was in particular pain. Ida believed that cats have a sixth sense and that they can communicate with us if we understand their language.
Oscar was remarkably discerning. He "triaged" his patients much the same way disaster teams do. He became a sort of early warning system for patients' demise, and at shift change when the nurses discussed various patients, one of the first questions might be, "Is Oscar in her room?" A negative response would be received with a sigh of relief.
Common Threads Within This BookAt Mary Miranda's suggestion to ask someone he trusted, Dr. Dosa talked with Donna Richard, the office manager of Steere House. Donna had brought her mother, a dementia patient, in for an appointment one day and asked a colleague if they needed an office manager. Donna, like so many other of the patients' families, were the "sandwich generation," those who were caught between raising youngsters and caring for elderly family members. A feeling of guilt almost always accompanies those responsibilities. It is impossible to be at a kid's soccer game and visiting a lonely, confused parent at the same time. This dilemma is a thread that unites many of the spouses and children of the patients on the third floor.
Another is the demand to spare no cost in treating unrelated physical illnesses, no matter how minor, or whether real or imagined.
- Frank Rubenstein, a frustrated, angry man, demanded hospitalization for his wife, Ruth, because she had lost some weight, an unfortunate but common side effect of Altzheimer disease.
- When he bacame a patient, Saul Strahan had requested that every possible treatment be used to help slow the progress of his deterioration, and did not sign a DNR form. His daughter, Barbara, was stressed with her efforts at enforcing her father's desires against what appeared to her to be uncaring staff members.
The third thread, of course, was Oscar. Among the many survivors of deceased patients which Dr. Dosa interviewed, the love and appreciation expressed for Oscar's caring deathbed presence was almost unanimous. Woven throughout these lives and deaths was Oscar's attendance on the patients' beds at the end. He often remained curled up next to the deceased until the coroner or mortuary attendants arrived, and then, satisfied that his job was done, would leave the room.
Where Does Oscar's Magic Come From?
A popular theory about Oscar's ability to accurately predict impending death is the odor of ketones coming from the patients' breath. Ketones, a product of cells breaking down, have a distinct odor, and Oscar has almost unfailingly been seen to sniff a patient's breath shortly before his or her death. This theory doesn't take into account at least one time Oscar was seen sniffing at a patient's feet. Perhaps it was just Oscar being a cat, and any strange odor tends to draw cats' attention. After all, cats' sense of smell is 14 time stronger than that of humans.
Carol Wilburn, cat behavior expert and author of The Complete Guide To Understanding And Caring For Your Cat, was interviewed about Oscar by NBC TV. Wilburn stated that all cats are aware of the needs of their nurturers and that some cats are more in tune than others. She also theorized that Oscar may sense the flow of energy prior to death.
We may never fully understand where Oscar's unique ability comes from. Dr. Dosa, while acknowledging the possibility of the scent factor added. "Perhaps, but I like to think of Oscar as more than a ketone early warning system. " "On a floor where the staff has gone to great lengths to make the dying experience tolerable for the residents and their families, I'd like to think Oscar embodies empathy and companionship. He is a critical cog in a well-oiled and dedicated health care team."
That works for me. This is a very sad book because it reminds us of our human frailties. Alzheimer's disease affects more than 5.3 million people in the United States, and I think many of us fear it even more than cancer. As the patient worsens, the burden transfers to the family, as depicted so eloquently here. On the other hand, it is a lovely book, as it vividly describes the positive impact one cat has on so many people. When my time comes, I hope I have an Oscar by my side to pave my way with a velvet paw.