He was just an ordinary black-and-white tabby, adopted from an animal shelter. Oscar was one of six cats that lived at the Steere House Nursing & Rehabilitation Center on the Rhode Island Hospital grounds in downtown Providence, where I work as a geriatrician for patients with advanced forms of dementia. In the beginning, he wasn’t chummy with the staff or the patients. He was the kind of cat that hid under the bed or stared out the window for hours on end. So most everybody took notice—eventually even me—when he began padding down the halls making house calls to one ailing resident or another.
The third floor of Steere House is often the final stop for my patients. Many of them have forgotten almost everything they knew. They seldom remember the year they were married or the names of their children. They don’t know how they made a living or where they were when Neil Armstrong landed on the moon. But they enjoy having the cats around—a love of animals seems to be among the last things to go. You could even say that in small ways, pets connect people to the lives they used to lead and the world they’ve mostly left behind.
Since I’m the last doctor my patients see, it’s my job to take care of all their medical needs, to ease their pain, and to make them comfortable. That’s a job I take seriously, which is why Oscar eventually won me over.
“David, do you have a few minutes?” Mary Miranda asked me. “I want to show you something in room 310.”
As the day-shift nurse on our third-floor unit and a longtime employee, Mary was the source of all knowledge at Steere and fiercely protective of her “children.” As we walked down the hallway together, she began to tell me the story of Lilia Davis.
“She’s 80 now and has been here for 18 months,” said Mary. “Recently, she started losing weight. One morning, she started to bleed. We sent her to the hospital, and the doctors diagnosed colon cancer; it had spread everywhere. Given her severe dementia, her family decided not to treat the cancer. They sent her back to us on hospice services.”
That sounded reasonable. We got to Mrs. Davis’s room. She was lying on her back, her eyes closed, her breathing shallow. A morphine pump was connected to her arm by an IV. On the other side of the room was an empty cot. Judging by the rumpled sheets on that bed, I figured someone had been sleeping there recently.
“Mrs. Davis’s daughter,” Mary said before I could ask. “I sent her home for a few hours to shower and change. She’d been here for 36 hours straight.”
“What did you want to show me?” I asked.
Mary pointed to Mrs. Davis’s bed. “Take a look.”
As I stepped closer, Oscar raised his head from where he lay nestled against Mrs. Davis’s leg. The bell on his collar jingled slightly, and his ears perked up; he glanced at me with questioning eyes. I ignored him and moved toward Mrs. Davis. Oscar put his head back down on his front paws and purred softly.
I looked at the patient’s face. She seemed comfortable. “Do you need an order for medication or anything?” I asked.
“It’s not the patient I wanted you to see, David,” said Mary. “It’s the cat.”
Truth be told, I had no use for cats, due perhaps to an unfortunate childhood relationship with a hostile cat my grandmother had owned. But I knew how devoted many of the staff members and residents were to the Steere House cats. Our nursing facility had brought in the cats to make the place more homelike. On any given afternoon, our lobby was bright with sunshine and filled with the music of a player piano—and at least two cats could be found rolling and playing there like happy kids.
“Okay. So the cat’s hanging out with a patient,” I responded, a little impatiently.
“Well, that’s just it,” Mary said calmly. “Oscar doesn’t really like to hang out with people.”
It was true: I’d seen him only a few times in the hallways. His usual spot was by his food and water bowls at the third-floor entrance, where he was often curled up asleep on an old blanket under the desk.
“He’s probably here because he found someone who won’t bother him,” I said.
“David, lately a couple of us have noticed that Oscar has been spending a lot of time with certain residents.”
Then Mary added, “He gets close only to patients who are about to die.”
I looked over at Lilia Davis and realized that, sadly, she might indeed pass away today. But that wasn’t Mary’s point. “Yesterday, Oscar wandered into another patient’s room right before she passed away,” she said. The look on my face must have said enough because Mary stopped talking. For a brief moment, we both observed the scene in front of us.
“Don’t get me wrong, Mary,” I began again. “I love the concept of an animal sitting with me as I die. It’s really quite sweet.”
I walked over to the bed and reached down to pet Oscar. A paw flew out toward me, and I snatched my hand back.
“Maybe he just likes patients who are dying because they don’t give him any trouble,” I said ruefully.
She gave me an indulgent look. “I think there’s something more to it, David.”
As I crossed town on the way to my outpatient clinic a short time later, my mind wandered back to the cat I had known years before, the one who had lived at my grandmother’s cottage. His name was Puma, appropriately so. In my memory, he was a 30-pound behemoth (as any fisherman will tell you, size grows with time), and he glared and hissed every time I visited the house. I reassured myself that considering the past, I was not irrational about cats.
That’s when my cell phone rang.
I picked it up and heard Mary’s voice. “David, Mrs. Davis died a few minutes after you left.”
I sucked in a breath. It had been less than an hour since I had been standing in Mrs. Davis’s room, watching her sleeping form. Even after all these years in my line of work, I still felt humility from being so close to death.
We talked over the details, and then I said, “Look, Mary, don’t make too much of this cat business. The fact is that Mrs. Davis had two dreadful diagnoses.”
“Yes, she did,” Mary said. “But this is happening with some regularity. It’s pretty much happening every time someone dies. Some of the residents’ families are starting to talk about it.” She was quiet, then added, “I really think Oscar knows.”
Several weeks later, Mary called me to report the unfortunate news that another dementia patient had passed away.
“And just like all the other times,” Mary said, “Oscar was at her bedside.” The staff calculated that this was probably the 12th visit to a dying patient that this mysterious cat had made since his unusual behavior came to light.
In fact, the timing of this particular patient’s death was surprising. There had been no indication that she was terminally ill. Aside from her dementia, she had been an advertisement for good health.
My faith in science and my own intellectual vanity led me to reject the notion that some four-legged feline possessed special powers. As a researcher, I’d been taught to consider facts dispassionately—to analyze them, form theories, and poke holes in them until new theories arose that were closer to the truth. From a scientific point of view, it seemed ludicrous that a cat could predict human death. It was much easier to say that Oscar was drawn to warm, quiet beds—cats sleep two thirds of the time anyway, right?
Still, there was a plausible biological explanation for the “sweet smell of death,” which was perhaps what Oscar had sensed. As cells die, carbohydrates are degraded into many different oxygenated compounds, including various types of ketones—chemical mixtures known for their fragrant aroma. Ketones are also found in abundance in untreated diabetics, and in medical school, we were taught to sniff a diabetic’s breath to determine whether sugar levels are high. Could it be that Oscar simply smelled an elevated level of a chemical compound released prior to death?