Sunday, December 20, 2009

Oscar: The Hospice Cat

I love this story because of the mystery and the compassion of cats!

(Story as seen here)
Oscar, a two year old cat that lives at a nursing home in Providence, Rhode Island in the New England region of the United States, appears to know when residents at the home are approaching their final hours because he curls up next to them.

The story of Oscar, the hospice cat who conducts daily rounds like a feline version of a hospital consultant and appears to be able to predict when patients are going to die, is told in an essay about a day in his life by one of the doctors, David Dosa, in the New England Journal of Medicine.

Dosa said that Oscar has been accurate in 25 cases so far. He sits with patients at the Steere House Nursing and Rehabilitation Center in Providence, Rhode Island, when they are in their last four hours of life.

"He doesn't make many mistakes. He seems to understand when patients are about to die," said Dosa in an interview with the Associated Press news agency. Dosa is professor of medicine at Warren Alpert Medical School at Brown University, Rhode Island, and a geriatric consultant at the nursing home.

Dosa said that relatives of the dying patients "take solace" from this curious phenomenon. The companionship that Oscar provides is appreciated, he said.

Oscar was adopted by the medical staff as a kitten and his home ever since has been on the third floor of the nursing home, with the dementia patients.

Soon, he was making his own rounds, sniffing patients and looking them over, then he would curl up beside a patient who died a few hours later.

Staff at the hospital trust Oscar's instinct so much that they call the patient's relatives to let them know it's likely their loved one will be passing away soon.

Dosa says Oscar is an "aloof" cat who is not normally friendly towards people, he describes him as hissing at a patient when she walks past. But he seems to take his work very seriously, and when he settles next to a patient who is dying, he purrs and nuzzles them.

Sometimes, when he is ejected from his vigil beside a dying patient (some families don't like him there), he paces and meows outside the room.

Cat experts say that cats can sense illness, especially in their owners or other animals. They can also sense changes in the weather, and their ability to sense impending earthquakes is well known.

According to a report in the Washington Post yesterday, another doctor at the home, Joan Teno who is also of Brown University and experienced at treating terminally ill patients, said that Oscar can predict who is going to die more accurately than the staff.

She became convinced of Oscar's "skill" while she was treating a patient who had stopped eating, was breathing erratically and her legs had started to look blue. She thought the patient was near death. But although Oscar called in to see her, he did not stay in the room.

However, as Teno later found out, this was 10 hours before the patient actually died, and the nurses told her that Oscar came back to sit with the dying patient 2 hours before she finally passed away. This was Oscar's 13th accurate prediction.

Speculating on the accuracy of Oscar's predictions, Teno said she wondered if he smells something, or he notices subtle changes in the behaviour of the nurses while they attend the patients.

There is a commendation wall plaque at the nursing home, awarded to Oscar by a local hospice agency. The plaque reads: "For his compassionate hospice care, this plaque is awarded to Oscar the Cat".

"A Day in the Life of Oscar the Cat." David M. Dosa. NEJM Volume 357:328-329, July 26, 2007, Number 4
Oscar the Cat awakens from his nap, opening a single eye to survey his kingdom. From atop the desk in the doctor's charting area, the cat peers down the two wings of the nursing home's advanced dementia unit. All quiet on the western and eastern fronts. Slowly, he rises and extravagantly stretches his 2-year-old frame, first backward and then forward. He sits up and considers his next move.

In the distance, a resident approaches. It is Mrs. P., who has been living on the dementia unit's third floor for 3 years now. She has long forgotten her family, even though they visit her almost daily. Moderately disheveled after eating her lunch, half of which she now wears on her shirt, Mrs. P. is taking one of her many aimless strolls to nowhere. She glides toward Oscar, pushing her walker and muttering to herself with complete disregard for her surroundings. Perturbed, Oscar watches her carefully and, as she walks by, lets out a gentle hiss, a rattlesnake-like warning that says "leave me alone." She passes him without a glance and continues down the hallway. Oscar is relieved. It is not yet Mrs. P.'s time, and he wants nothing to do with her.

Oscar jumps down off the desk, relieved to be once more alone and in control of his domain. He takes a few moments to drink from his water bowl and grab a quick bite. Satisfied, he enjoys another stretch and sets out on his rounds. Oscar decides to head down the west wing first, along the way sidestepping Mr. S., who is slumped over on a couch in the hallway. With lips slightly pursed, he snores peacefully — perhaps blissfully unaware of where he is now living. Oscar continues down the hallway until he reaches its end and Room 310. The door is closed, so Oscar sits and waits. He has important business here.

Twenty-five minutes later, the door finally opens, and out walks a nurse's aide carrying dirty linens. "Hello, Oscar," she says. "Are you going inside?" Oscar lets her pass, then makes his way into the room, where there are two people. Lying in a corner bed and facing the wall, Mrs. T. is asleep in a fetal position. Her body is thin and wasted from the breast cancer that has been eating away at her organs. She is mildly jaundiced and has not spoken in several days. Sitting next to her is her daughter, who glances up from her novel to warmly greet the visitor. "Hello, Oscar. How are you today?"

Oscar takes no notice of the woman and leaps up onto the bed. He surveys Mrs. T. She is clearly in the terminal phase of illness, and her breathing is labored. Oscar's examination is interrupted by a nurse, who walks in to ask the daughter whether Mrs. T. is uncomfortable and needs more morphine. The daughter shakes her head, and the nurse retreats. Oscar returns to his work. He sniffs the air, gives Mrs. T. one final look, then jumps off the bed and quickly leaves the room. Not today.

Making his way back up the hallway, Oscar arrives at Room 313. The door is open, and he proceeds inside. Mrs. K. is resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.

One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar's presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.'s chart off the medical-records rack and begins to make phone calls.

Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, "What is the cat doing here?" The mother, fighting back tears, tells him, "He is here to help Grandma get to heaven." Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.

On his way back to the charting area, Oscar passes a plaque mounted on the wall. On it is engraved a commendation from a local hospice agency: "For his compassionate hospice care, this plaque is awarded to Oscar the Cat." Oscar takes a quick drink of water and returns to his desk to curl up for a long rest. His day's work is done. There will be no more deaths today, not in Room 310 or in any other room for that matter. After all, no one dies on the third floor unless Oscar pays a visit and stays awhile.

Note: Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the residents whom he serves.

1 comment:

Amy said...

I've been keeping up with Oscar for awhile now. My father has Parkinson's; I hope if needed, he'll find his way to such a progressive place as Steere, and an advocate such as Oscar.

Enjoyed your post.