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?
It's certainly clear that many animals' sense of smell is far superior to humans'. A 2006 study, published in a leading cancer journal, suggested dogs could be trained to identify microscopic quantities of certain biochemicals excreted by cancer cells. Other studies have identified melanoma-sniffing dogs, not to mention reports of earthquake-predicting fish.
"Where is the cat now?" I asked Mary, coming out of my reverie.
"He's still in your patient's room on her bed," she said, adding that the woman's daughter was in there too. I thought of a well-known quote: "A coincidence is God's way of remaining anonymous." I was strangely elated by the idea that Oscar's presence at my patient's deathbed might have a deeper meaning.
This time, I had lots of questions. I grabbed my coat and headed over to Steere House.
As I got off the elevator on the third floor, I stepped directly into an intense conversation between several people at the desk. It was about Oscar.
"So he did it again," I said.
"Yes, he did," said Lisa, the hospice nurse. "This cat has quite a talent."
Down the hall in the room, I found Kathy Jones holding her mother's hand and crying quietly. Oscar lay sprawled on the bed, his front and hind legs extended, his spine resting gently against the woman's leg. The daughter turned to greet me. She rose to give me a hug.
"I'm sorry," I said.
I felt her warm tears through my shirt. Her eyes were bloodshot and swollen. I searched for something to say, but Kathy broke the silence.
"Dr. Dosa, I want to thank you for everything you've done for my mother."
She wiped her eyes and sat back down near the bed. The movement stirred Oscar, who blinked and looked at Kathy.
"Can you believe this cat?" she asked.
"I heard he was here when your mom died," I replied gently.
Through her tears, she smiled. "Yeah, he and I are buddies now," she said. She reached over to pet him on the head. Oscar accepted the attention and nuzzled Kathy's hand. "He's a really special cat," she added.
I said a private goodbye to my patient. Oscar continued to sit there and purr. Finally, after several minutes, I asked the question I'd been contemplating during the last hour.
"Kathy, how did you feel about Oscar being here at your mother's passing?"
She looked at me. "Dr. Dosa, Oscar is my angel. He was here for my mother and me. With Oscar at my side, I felt a little less alone."
So this cat was not only a harbinger of death but also a comforter during tough times for both patients and family members. It was eye-opening.
A few days later, I found Mary seated at the nurses desk on the third floor, brushing Oscar. Sprawled out in full glory, he looked like a boxer after a major bout.
"The man of the hour," I announced.
Mary smiled. "The last couple of days, Oscar has seemed pretty beat from his vigil."
"Sure, sleeping on a bed is really hard work," I said jokingly.
I was finishing my examination of a patient a little while later when I felt another presence in the room. I looked down: Oscar was sitting on the floor, watching me intently.
"Hey, you," I said. "Are you making rounds with me now?"
I reached over and offered my hand. Oscar sniffed it intently, then stood up to move toward me, allowing me to gently scratch him behind the ears. Then he leaped onto my lap and sat down, eyeing me.
"So what do you think?" I asked him, nodding toward the patient.
For a second, Oscar looked over at my patient as if he were assessing the situation. He leaped onto the arm of the recliner and sniffed the air. Finally, he jumped down and scampered out of the room. It occurred to me that I had just received a second opinion from a cat.
Returning to the front desk, I found Mary writing in a chart. "I've just been on rounds with Oscar," I said.
"So are you a believer now?" she asked.
"I wouldn't go that far," I said. I advanced my theory that Oscar could smell some chemical process that we cannot.
Mary shrugged. "Perhaps when people show unusual interest in a patient, he wants to be part of the team," she said.
"But that still doesn't explain why he's sometimes the first to enter a room whenever a patient is dying," I responded.
Mary offered a hint of a smile. "Dr. Dosa, it looks like you're starting to take our cat more seriously."
I threw up my hands. "Who knows, Mary? I'm still a scientist at heart. I've always been taught to look dispassionately at the facts."
"So do some investigating," she said reasonably. "You're a researcher. Talk to some of the family members of patients who died on Oscar's watch. See what they have to say."
To satisfy my curiosity, I did just as she suggested. Over the next few months, I spoke to half a dozen family members who had seen Oscar at work. I wanted to understand exactly how events had unfolded and what people had felt about this cat.
One of the people I went to, Donna Richards, was a single working mom whose mother had become a patient at Steere House. She was a former office manager at my outpatient clinic, so I felt comfortable talking with her in detail.
She told me, "First off, my mother hated cats. And it wasn't just cats. She really didn't like animals, period. Didn't see the point of them. Yet, as her dementia got worse and worse, she seemed to take more comfort from the animals on the third-floor unit. I don't know what it was about them or about what was happening to my mother, but something had really changed. She seemed more receptive on some deeper level. Does that sound strange?"
"Not at all," I said. "In fact, lately I've been wondering about the true nature of our connection with animals, especially when we're very young and very old. My son, Justin, has always been drawn to animals, even before he could talk. And I've seen that same intense curiosity with some of my patients. It's as if the relationship transcends language. I'm learning only now just how smart animals are."
"Well, Oscar was smart," Donna said. "He generally kept a safe distance from my mother, but when she'd stop to talk to him, he'd stop too. He never stayed long, and he never cuddled up to her—he was more like a visiting dignitary than a house cat. But he always made time to hear her out."
I asked her to tell me about how things went at the end.
"When my mother got sick for the last time," she said, "Oscar seemed to warm toward me. In the last 72 hours of her life, when I was sleeping in a recliner next to my mother, Oscar would wander into the room and snuggle next to me. After a while, he would jump onto my mother's bed and sit beside her. He did that for pretty much the entire time she was dying. He always seemed to know when he was needed, although he never asked for anything in return. He would let me stroke him under his chin and rub his little ears. It was as if he knew it was helping me. Which it did. There is something very calming about petting a cat."
She paused and, seeing how engaged I was, continued.
"I went home for a little bit at one point," Donna said. "And sure enough, my mother died shortly after I left her room. Honestly, she probably waited for me to leave before she let go. That was just her style." She smiled. "But my mother wasn't alone. She had Oscar. When she took her last breath, that cat was next to her. He was right there."
I was no animal behaviorist, but I was gaining compelling insight.
I had an image in my head of Oscar sitting with Donna and her dying mother in a darkened room during the woman's final days. I could see it. I thought, Maybe that's all Oscar really was: a companion, a sentient being who accompanied one person on his or her journey to the next world. Or accompanied a family member through the grief of losing someone he or she loved, a kind of underworld of its own. Wasn't that enough?
I wondered: Did it matter that this cat had some extrasensory power of perception that allowed him to pick up on impending mortality before highly trained medical minds could? Or was he just a master of empathy? Maybe caring was this cat's superpower.
Certainly Oscar had a lot of family members to bestow that power on—all the residents of the third floor, in fact. This was his home, after all. And when someone in his family was in trouble, he went to that person and stayed with him or her for as long as he was needed.
Yes, I had started out not believing in this cat. But I now concluded, with awe, that Oscar indeed had a purpose. An important one.
I went to Mary and shared what I'd learned about this enigmatic and stalwart cat.
"The thing you have to remember about domesticated animals," she responded, "is that people began keeping them because they, in fact, had a purpose. They worked. Dogs herded sheep or other animals. Cats hunted mice on farms. One way or another, the animals earned their keep."
"So you're saying it's Oscar's job to take care of people?" I said.
Mary shrugged. "Why not? Maybe he's just more highly evolved than other cats. Maybe it's Oscar's way of paying the rent." She checked her watch and smiled at me. "We're all just guests here, you know."
David Dosa, MD, a geriatrician since 2003, lives in Barrington, Rhode Island. (He has changed most of the names here for privacy.)