Friday, November 16, 2007

Coffee break: Medical journal published article on cat's death predictions

Clearing out my inbox, I noticed this story from last summer about Oscar, a cat who intrigues doctors by sensing which residents of a Rhode Island nursing home are about to die. Oscar first came to attention through "A Day in the Life of Oscar the Cat" an essay by Brown University geriatrics professor David Dosa in the New England Journal of Medicine last summer. Here's what the cat does:
Oscar makes his daily rounds, waiting patiently outside rooms if the doors are closed, wrote Dosa. Once inside, the grey-and-white cat jumps onto beds and appears to inspect patients by sniffing the air.

If Oscar leaves the room, the patient isn't likely to die that day, said Dosa.

But when the cat curls up on the bed, staff notice. They start phoning family members because the patient usually dies within four hours.

Usually indifferent and sometimes unfriendly to staff and visitors, Oscar purrs and nuzzles the patients during their final hours, Dosa said.

Two-year-old Oscar, adopted as a kitten, is one of six cats at the Steere's nursing home, but he is the only one who behaves in this way. He was been correct about the deaths of all 25 of the patients who had died on the floor as of last summer. Hence, staff would alert families when he sat down beside an ailing loved one.

If permitted, Oscar stays until the deceased is taken away, following the body out the door and down the hall. (If not permitted to be in the room, he meows outside.)

Cat experts point out that, in principle, there is nothing unusual about a cat sensing that a human is sick. What's unusual about Oscar is his apparent ability to predict the end within a few hours. Two theories are that he senses a biochemical change and that he picks up cues from the behaviour of staff who have begun the terminal care routine (dimming lights, aromatherapy, summoning spiritual care for the family, etc.). I favour the former theory because if Oscar were only picking up cues from the staff, they might not be so surprised by his behaviour.

For example, from CNN:
Oscar is better at predicting death than the people who work there, said Dr. Joan Teno of Brown University, who treats patients at the nursing home and is an expert on care for the terminally ill.
She was convinced of Oscar's talent when he made his 13th correct call. While observing one patient, Teno said she noticed the woman wasn't eating, was breathing with difficulty and that her legs had a bluish tinge, signs that often mean death is near.

Oscar wouldn't stay inside the room, though, so Teno thought his streak was broken. Instead, it turned out the doctor's prediction was roughly 10 hours too early. Sure enough, during the patient's final two hours, nurses told Teno that Oscar joined the woman at her bedside.

Asked whether relatives might find the situation a little spooky - being called to come to the home because Oscar is sitting on a loved one's bed - a doctor replied (for example, in the accompanying video on the BBC site) that for patients on Oscar's floor, death is a release. That's because Oscar lives on a dementia floor. Loved ones have already said their emotional goodbyes, and the physical death is, perhaps, almost a formality. The patient probably does not realize the significance of Oscar's presence.

Oscar, rewarded recently by a plaque, is considered a valuable addition to Steere House's life. As Dosa says in a Note appended to his essay in NEJM,
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.

Go here, here, and here for more stories about Oscar. The last is especially recommended because there Dr. Dosa puts to rest a number of concerns (that the cat frightened patients or caused them to have allergies, etc.)

To me, Oscar shows the value of integrating animals into community residential living, wherever possible.

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