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Sunday, July 29, 2007

House(Cat), M.D.

You may have seen stories last week about Oscar the Cat, the feline angel of death who was profiled in the New England Journal of Medicine.  The full article is here.  According to the piece's author, Dr. David Dosa, Toonces Oscar, who was adopted as a kitten by the staff of the Steere House Nursing and Rehabilitation Center in Providence, R.I., has "an uncanny ability to predict when residents are about to die."  Dr. Doha writes, "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."  Thus, from the story:

Cat Making his way back up the hallway, Oscar arrives at Room 313.  The door is open, and he proceeds inside.  Mrs. K is resting peacefully in her bed, her breathing steady but shallow. . . . A nurse walks into the room to check on her patient.  She pauses to note Oscar's presence.  Concerned, she hurriedly leaves the room and returns to her desk.  She grabs Mrs. K's chart off the medical-records rack and begins to make phone calls.  Within a half hour the family starts to arrive. . . .

Of course, this is one of those cute, touching, tender, "animals are so sensitive" pieces.  I get that; I do.  But . . . . Not to be a spoilsport or anything, but I'm just a little disturbed by this one.  This is really Frank's area, not mine, but I have a few thoughts.  1) Is it not at all worrisome that a licensed health care facility apparently is making significant end-of-life decisions based on a decision-maker -- an adorable one, to be sure! -- that lacks a medical degree, professional accreditation, and, oh, opposable thumbs?  2) When choosing a licensed institution to take care of me in my final days, might I hesitate to choose the place that will call in my loved ones from whatever they're doing with the message, "You might want to come in quickly.  Our . . . uh, cat . . . tells us it won't be long now."  3) If, as the story suggests, Oscar is, as cats are wont to be, indifferent at best to the living (he hisses at one resident) and deeply attentive to the goners, is the cat really welcome company for the residents?  4)  Seriously -- are there HIPAA issues?

My own dearly departed cat -- actually, my wife's, but it was a package deal -- was actually a great comfort to me long ago when I was recovering from back surgery.  In this case, though, I'm pretty sure I'd keep the door to my room closed and get rid of all the catnip.         

Posted by Paul Horwitz on July 29, 2007 at 05:22 PM in Culture | Permalink

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Comments

My cat can leap three times the length of her own body with no machinery or other mechanical assistance. Show me a human that can do that. My point is that animals may have certain abilities that humans do not have. These animals may be God's gift to us as well as to humble us; letting us know that if He wants to make a simple cat abilities we don't have, He can. I have seen animals behave in ways that are unexplainable through science not superstition. My parents had a Siberian Husky that never barked unless very upset or disturbed. She would otherwise "talk" like the Star Wars character Chewbacca. She would howl when she was lonely (or just wants to make a lot of noise). Despite this usual behavior for her, she barked obsessively when my parents took her on vacation with them to White Fish Point in the UP of Michigan when only looking over the water of Lake Superior. This dog has been to other parts of the Great Lakes previously. However, she barked her head off when looking over the waters where the Edmond Fitzgerald went down.

Posted by: Douglas McCarty | Aug 1, 2007 6:36:57 AM

Scott,

Oscar does not seem to be a narcissist.

"Murderer or psychic", as Jim above makes clear, are not the only possibilities.

Sometimes reality is indeed stranger than fiction.

Posted by: Patrick S. O'Donnell | Jul 30, 2007 11:04:03 AM

(1) If Oscar stares at himself in the mirror, does that mean he's about to die?

(2) Have we considered the possibility that Oscar is a murderer? I'd say I'm kidding, but given that the other possibility is that Oscar is psychic....

(3) I feel like this is the plot of a lame Sci-Fi network movie. Or maybe the PAX network if it turns out Oscar has a direct line to Jesus.

Posted by: Scott Moss | Jul 30, 2007 10:53:18 AM

Just slightly less seriously, we might view this story as a contemporary version of a Jataka Tale from Buddhism, i.e., 'birth-stories' of the Buddha in which we learn of his karmic connection to previous births, many of which were as non-human animals and which illustrate (for children in particular) various virtues (e.g., compassion, courage, kindness) found in Indic religio-philosophical traditions that carried over into Buddhism proper.

Posted by: Patrick S. O'Donnell | Jul 30, 2007 12:24:03 AM

My commenters are, as always, more precise than I am. In particular, Daniel Goldberg's point number 1 is well-taken, if by end-of-life decision you mean a decision to render or withhold care, etc. (I could have been using the term more loosely to include decisions taken around the end of life, such as whether to call in the relatives, but still -- point taken, Daniel.) I will continue to kibble -- sorry, I meant quibble -- with some of the other comments, on the grounds that they took my own post more seriously than I did.

Just slightly more seriously, I think that there is still something that actually *is* a little disturbing about the story, although of course I certainly have no objection to pets comforting patients, etc., etc. What still strikes me as a little curdling (get it? curdling?) is the idea of the staff actually calling in family and warning them that their loved one is ABOUT TO DIE on the basis of Oscar's picks, notwithstanding what I'm sure is a very high accuracy rate and the scientific or quasi-scientific explanations for it. Granted, better to be there than to miss it, but I'd still hate to be the one explaining the false positive to a family that's already halfway through Kubler-Ross by the time they show up at the home and discover it's all been a false alarm. "No hard feelings, huh? Here -- have some liver bits."

Posted by: Paul Horwitz | Jul 29, 2007 9:46:02 PM

One reason publicizing this particular cat's apparent ability might not be odd is because it might be determined whether or not this cat's apparent ability is also its actual ability. Perhaps it might alert other homes throughout the country that may be experiencing similar demonstrations by other felines. Even absent such other felines this simple article might be successful in inciting enough interest to get the phenomenon studied. Perhaps Frank is right that it is not the impending death cats sense but the overall poor health. Might that not be useful nonetheless? Isn't that what all of you scholars out there are supposed to be about, finding something of interest and determining what is true about it? Perhaps pushing the story into USA today or the NY Times may be testing the limits of propriety but this small write up in the NEJM is certainly not beyond the pale.

Posted by: Jim Green | Jul 29, 2007 8:10:19 PM

Frank,

Can you point me to the publicity that evidences the owners' intention to paint this "as some sort of spooky occult prediction"?

Posted by: Patrick S. O'Donnell | Jul 29, 2007 7:44:10 PM

Toonces rulz!:
http://www.youtube.com/watch?v=BQkL9LpvKl0

Posted by: Anon-e-mouse | Jul 29, 2007 7:39:53 PM

I was pretty disturbed by the "death-predicting" cat, and I don't think it was a wise decision of the staff to publicize its purported powers.

But I also am happy to see that that nursing home permitted a companion animal among the residents. That's a big part of the new movement for "Green Nursing Homes." Great stories on the trend at these URL's:

http://www.pbs.org/wnet/religionandethics/week1047/cover.html
http://www.npr.org/templates/story/story.php?storyId=4713566

As the NPR story says, "We know that people find pleasure in the company of animals, the laughter of children, and the growth of green plants, so every Green House must offer elders opportunities to be in contact with the living world that surrounds us all."

The other thing that's odd here is that perhaps the cat just has a keen sense of who's in the most distress, or weakest (slowest heart rate or respiration rate, etc.). It seems odd for the nursing home owners to try to publicize this sign of basic, visceral compassion in an animal as some sort of spooky occult prediction.

Posted by: Frank | Jul 29, 2007 7:38:22 PM

I think you are all missing the larger problem here. Guys, this is a cat. We're probably looking at serial murder.

Posted by: Sarah L. | Jul 29, 2007 7:26:50 PM

Daniel beat me to it (and more articulate than I would have been), so I second his points here. As I understand it, most if not all of these terminally ill residents have significantly diminished mental capacity (is there a better way of saying that?) and appear not to be aware of the cat's presence.

Our cat snuggling up against me during my daily naps on the couch (I'm a firm believer in afternoon naps) will, however, never be quite the same experience again.

Posted by: Patrick S. O'Donnell | Jul 29, 2007 6:47:16 PM

I have always been curious and somewhat sympathetic to claims about animals' ability to detect events that to humans are, except prehaps in rare instances, imperceptible often even with technology. Perhaps it is nothing more than wishful thinking and perhaps it is something beyond our present understanding. But when faced with such apparent perceptions, as I was being raised on a horse farm in Florida where the horses without the advantage of the weather channel uniquely altered their behavior immediately prior to being surrounded by a hurricane, it is difficult not to be curious and sympathetic.

Nevertheless I too would be disturbed if significant end of life decisions were based on such apparent perceptions. The article, however, does not suggest that such decisions are being based on Oscar's behavior. The fact that the nurse alerts a patient's family to Oscar's behavior does not seem to me a significant end of life decision. In fact, if the article is accurate the familys of those at the facility are aware and appreciative of what Oscar has to offer.

Further, the hiss you reference is exactly the opposite of an indication of indifference or inattentiveness. It is a warning to a patient who has a "complete disregard for her surroundings." Were Oscar indifferent or inattentive surely he would not try to alert the patient who may be approaching dangerously close with what can only be described as a dangerous instumentality to our little feline protagonist.

Finally, I too married into a package deal, cat and woman. The cat remains and has as yet offered no proclivity for unbelievable perceptiveness. In fact, we often debate whether the little feller is fat (as I call him) or merely big boned (as she would have it). Now, however, I will always think twice if he ever sees fit to sleep near me.

Posted by: Jim Green | Jul 29, 2007 6:36:44 PM

Paul,

1) I'm not sure I see anything in the article that suggests the staff is permitting the cat to make significant end-of-life decisions. Rather, the article notes the staff's conviction that the cat has an excellent sense of when someone is about to die. This enables the staff to notify the family that death may be imminent, to make adequate preparations, etc.

This may or may not be ethically problematic, but I suggest it is not tantamount to permitting the cat to make significant end-of-life decisions.

2) That's a reasonable position. Others -- perhaps cat-loving families? -- might well find nothing strange or off about taking their loved ones to an assisted living facility that provides excellent palliative care (assuming the facility in question does do this, about which I have no knowledge) and which has an apparently remarkable cat.

The notion that domestic animals may sense certain phenomena is certainly not new. Scientists have known for some time that certain dogs can be trained to smell cancers, and it is also well-known that dogs detect something -- the supposed pathway is electromagnetic -- moments before an earthquake.

Oscar's behavior could be entirely coincident and anthropomorphized. Given the awesome power of the human brain's pattern recognition capacities, we often perceive patterns which are not teleological at all, but are simply system behaviors produced by nonlinear dynamical systems. But, it's certainly not beyond the realm of what cats are capable of, IMO, given that the more we understand about cats and dogs, the more complicated their worlds seem to be.

3) If he was really a significant antagonist for the residents, I doubt he would be made welcome by the staff. In any case, as long as he's not bothering anyone and is not a danger to the residents (as Paul Ewald has noted, cats carry a number of microbes that could be deleterious to those with weakened immune systems), I don't see the problem with his being ornery.

(4) I can't see any here. As William McGeveran noted, HIPAA's protections are full of sound and fury signifying very little.

JMO.

Posted by: Daniel Goldberg | Jul 29, 2007 6:19:27 PM

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