Making Rounds WITH OSCAR
The Extraordinary Gift of an Ordinary Cat
By David Dosa
HYPERION
Copyright © 2010
David Dosa
All right reserved.
ISBN: 978-1-4013-2323-3
Chapter One
"Animals are such agreeable friends-they
ash no quuestions, they pass no criticisms."
GEORGE ELIOT
IF YOU LOVE YOUR JOB, ON THE BEST DAYS YOUR WORK-place
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 protective 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
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 cars 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.
"I told you he's not that friendly," Mary said with a smile.
"Friendly! He damn near tried to maul me!" I replied with
an air of unnecessary drama.
"Oh, he's okay. Oscar really is affectionate when he wants
to be. He just tries to protect his patients."
"Mary, he's a cat-cats don't do anything unless there's
something in it for them. He's probably just looking for some
empty real estate and a warm blanket to sit on."
I studied my hand some more, looking for the nonexistent
scratch.
"God, you're a baby. He barely even touched you."
"The truth is, Mary, I really don't like cats. And from the
evidence I can honestly say that I don't think he much likes
me either."
Mary laughed. "Cats don't hate you, they just know if you're
afraid or not. If you are, they respond accordingly."
"Don't laugh," I said, "but I had a bad experience with a cat
while I was a kid and it left me a little traumatized."
For a moment I contemplated telling her the story of my
grandmother's cat, but the look of mock sympathy on Mary's
face convinced me that it would be better to keep the past in
the past.
"Some cats are just ornery," she said breaking the silence.
"Some people too, I suppose. But you can't forsake every cat
because of one bad experience. Besides, you know we wouldn't
have a cat here if there was even the slightest chance it would
hurt anybody. Even a doctor!"
"Very funny." I looked back at Oscar and Mrs. Davis. "You
know, maybe he likes patients who are dying because they don't
give him any trouble."
"I don't know, David. I really think there's something more
to it."
"So does that mean that Mrs. Davis is going to die today?"
"I guess we'll see."
* * *
I LEFT THE HOSPITAL and drove across town to my outpatient
clinic. Unconsciously I found myself thinking of the cat at my
grandmother's cottage. His name was Puma, and appropriately
so. In my mind, he was a thirty-pound behemoth of a
cat-as any fisherman will tell you, size tends to get larger over
time-and for years he terrorized me every time I entered "his
house." As I thought of his eyes burning with hatred toward
me, I told myself that my fear of cats was not irrational.
Mid-reverie my cell phone rang. It was Mary.
"Mrs. Davis died a few minutes after you left."
It had been less than an hour since I was standing in her
room watching her breathe. Even after years of seeing it happen,
I still feel a sense of humility at being so close to a death.
"Look, Mary. Don't make too much of that cat business.
She was going to die soon anyway. She has two horrible diagnoses."
(Continues...)
Excerpted from Making Rounds WITH OSCAR
by David Dosa
Copyright © 2010 by David Dosa.
Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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