WebMD Pet Health News
Louise Chang, MD
July 25, 2007 -- Predicting the death of a patient, even an elderly,
demented one, is an inexact science, even for a doctor with decades of medical
But a cat in a Providence, R.I., nursing home, an animal shelter refugee
named Oscar, seems to have a sixth sense about when residents in the home's
advanced dementia unit are about to pass away. And his actions can sometimes
help alert the staff to notify family members in time for them to get to the
nursing home to tell their loved ones goodbye.
When he senses their time is near, Oscar goes to the room, jumps onto the
bed, curls up next to the patient, and purrs. The 2-year-old cat provides
welcome company for grieving family members and staff keeping their bedside
vigil; sometimes he fills in for family members who haven't yet arrived at the
So far, Oscar has "presided over" the deaths of more than 25
residents in the advanced dementia unit of the Steere House Nursing and
Rehabilitation Center. Although the story sounds far-fetched, David M. Dosa,
MD, MPH, a geriatrician who cares for patients at the nursing home, thought it
was time the story of Oscar was heard.
On a whim, he wrote an essay about Oscar and submitted it to The New
England Journal of Medicine, known more for its scientific reports on
chemotherapy regimens, drug reactions, infections, and heart defects than
reports on feline behavior.
"I was quite surprised they agreed to publish it," he tells WebMD.
"It is not usually the type of article they will publish." The saga of
Oscar, complete with his photo, is in the July 26 issue of the journal.
Oscar's been living at Steere House since he was a young kitten and staff
members bailed him out of a nearby animal shelter. "I first heard about him
from the nurses on the unit," says Dosa, also a geriatrician at Rhode
Island Hospital and an assistant professor of medicine at the Warren Alpert
Medical School of Brown University, Providence, R.I. "It came to light that
he was spending time with patients as they were becoming terminal."
The cat, Dosa says, seems to snap to attention when he senses a patient is
about to die. In the essay, for instance, Dosa tells of Oscar arriving at the
room of a woman and curling up beside her for more than an hour, purring and
paying attention to the patient as the family arrives and the priest gives last
rites, then quietly taking his leave minutes after the woman passes away.
"As people would pass, the question [among staff] was always, 'Was Oscar
at the bedside?'" Dosa tells WebMD. "And the answer was invariably
'yes.' This is an end-stage dementia unit. Deaths are common."
Oscar typically arrives at a dying patient's bedside a few hours before
death, Dosa says, but sometimes a half day before. His presence has been
a comfort to many family members, Dosa says. And his presence, coupled with a
resident's worsening state of health, can help alert the nursing home staff to
let family members know the patient may be nearing death. As Oscar's
reputation grew, so did appreciation for his mission. "The largest hospice
organization in the state presented him with a certificate ... acknowledging his
work," Dosa says.
Explaining Oscar's track record and seeming ability to "read" a
resident's end-of-life stages and predict death is a mystery, Dosa and others
at the nursing home acknowledge. "Your guess is as good as mine," Dosa
says when asked how Oscar picks up the sense of impending death.
"We know from some objective findings when death is imminent," Dosa
says. For instance, if respirations grow difficult in a very sick patient, he
says, doctors may tell loved ones death will probably occur soon.
The cat, however, might be picking up on specific odors surrounding death,
Dosa and others say.
"I think there are certain chemicals released when someone is dying, and
he is smelling and sensing those," says Joan Teno, MD, professor of
community health and medicine at the Warren Alpert Medical School of Brown
University, Providence, R.I., who also cares for Steere House residents.
Another possibility: "I think he is following the patterning behavior of
the staff," Teno tells WebMD. "This is an excellent nursing home. If a
dying person is alone, the staff will actually go in so the patient is not
alone. They will hold a vigil."
Oscar has seen that pattern repeated many times, she says, and may be
"Animals are intuitive," she says. "We don't give them enough
One of the first cases, Teno says, involved a resident who had a blood clot
in her leg. "Her leg was ice cold," Teno says. "Oscar wrapped his
body around her leg," she says, and stayed until the woman died.
Three animal behavior experts say the explanation about Oscar sensing a
smell associated with dying is a plausible one.
"I suspect he is smelling some chemical released just before dying,"
says Margie Scherk, DVM, president of the American Association of Feline
Practitioners, an organization devoted to improving the health and well-being
of cats, and a veterinarian in Vancouver, British Columbia. "Cats can smell
a lot of things we can't," she says. "And cats can certainly detect
"Cats have a superb sense of smell," adds Jill Goldman, PhD, a
certified applied animal behaviorist in Laguna Beach, Calif. In Oscar's case,
she says, keeping a dying resident company may also be learned behavior.
"There has been ample opportunity for him to make an association between
'that' smell [and death]," she says.
While the sense of smell may be one explanation, there could be another,
says Daniel Estep, PhD, a certified applied animal behaviorist in Littleton,
Colo. "One of the things that happen with people who are dying is that they
are not moving around much. Maybe the cat is picking up on the fact that the
person on the bed is very quiet. It may not be smell or sounds, but just the
lack of movement."
SOURCES: David M. Dosa, MD, MPH, geriatrician, Rhode Island Hospital;
assistant professor of medicine, Warren Alpert Medical School of Brown
University, Providence, R.I. Dosa, D. TheNew England Journal of
Medicine, July 26, 2007; vol 357: pp 328-9. Joan Teno, MD, professor of
community health and medicine, Warren Alpert Medical School of Brown
University; associate medical director, Home and Hospice Care of Rhode Island,
Providence. Daniel Estep, PhD, certified applied animal behaviorist, Littleton,
Colo. Margie Scherk, DVM, Vancouver, British Columbia; president, American
Association of Feline Practitioners. Jill Goldman, PhD, certified applied
animal behaviorist, Laguna Beach, Calif.
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