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Tuesday, 2 June 2015

Dr David Dosa - Making the Rounds with Oscar

review written by Ro Bennett and read live on bookshow 4th June 2015

Oscar the cat was born in 2005. He was adopted as a kitten from an animal shelter and grew up in the third-floor end-stage dementia unit at Steere House Nursing and Rehabilitation Center in Providence, Rhode Island, USA. 

When the care home was originally being built there was a stray cat on the site who refused to move. The staff eventually adopted him as a therapy pet and called him Henry after the benefactor Henry J.Steere who had initiated the building of the facility. When Henry died, Oscar was one of six cats adopted as part of the home’s pet friendly policy.

The 41-bed unit treats people with Alzheimer’s, Parkinson’s Disease  and other illnesses, most of whom are in the end stage of life and are generally unaware of their surroundings.

Oscar came to public attention in July 2007 when he was featured in an article by David Dosa, a geriatrician and assistant professor at Brown University, in the New England Journal of Medicine.

According to Dr Dosa, Oscar appears able to predict the impending death of terminally ill patients. After about six months, the staff noticed that Oscar, just like the doctors and nurses, would make his own rounds. But he never spent much time with the residents —until they are in their last hours. Then, as if this were his job, Oscar curls up on the bed, and begins his vigil.

Dr. 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. Mary Miranda is the day shift nurse in the third floor Safe Haven Advanced Care unit, 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 earlier.  Although Oscar was sleeping quietly on the bed next to Mrs. Davis, he saw nothing unusual.

Even after Mary told him that Oscar had accompanied a few other patients lately who had died in his presence, Dr. Dosa was skeptical and even more so 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 made him wonder. 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 passing. 
One of the first cases involved a patient who had a blood clot in her leg that was ice cold at the time. Oscar wrapped his body around her leg and stayed until the woman died.  In another instance, the doctor had made a diagnosis of impending death based on the patient's condition, while Oscar simply walked away, causing the doctor to believe that Oscar's streak (12 at the time) had ended. However, it would be discovered later that the doctor's prognosis was 10 hours too early: Oscar later visited the patient, who died two hours after.

As of January 2010, Oscar had accurately predicted approximately 50 patients' deaths. Oscar's accuracy led the staff to institute a new and unusual protocol: once he is discovered sleeping beside a patient, staff will call family members to notify them of the patient's (expected) impending death.

Most of the time the patient's family has no problem with Oscar being present at the time of death. On those occasions when he is removed from the room at the family's request, he is known to pace back and forth in front of the door and meow in protest. When present, Oscar will stay by the patient until they die, then after death will quietly leave the room.

In consulting with families when Oscar has been present, it has been a universal theme that he has been a source of companionship to the patients and has proved a great comfort to the family at this difficult time. 

The book takes us through the thought processes of the doctor and his initial cynicism about Oscar's importance and the feelings of relatives of the deceased about Oscar's visits.

In 2010 it was announced that the story was going to be made into a film but I can’t find any more about that. There is a 5 minute clip from Fox News,  The Rhode Show on You Tube. 

Dr David Dosa is a geriatrician in Rhode Island and an assistant professor of medicine at the Warren Alpert Medical School of Brown University. Dr Dosa has published in scientific peer-reviewed literature in the areas of nursing home quality improvement, delirium and end of life care. He lives in Rhode Island with his wife and two children.

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