oscar the cat

by now, i'm sure you're aware that i love animals, particularly cats. my mom (thanks mom!) sent me an article last week that summarized a publication in the new england journal of medicine. i felt i should share. enjoy!
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A Day in the Life of Oscar the Cat

David M. Dosa, M.D., M.P.H.

Oscar the Cat awakens from his nap, opening a single eye to survey his kingdom. From atop the desk in the doctor's charting area, the cat peers down the two wings of the nursing home's advanced dementia unit. All quiet on the western and eastern fronts. Slowly, he rises and extravagantly stretches his 2-year-old frame, first backward and then forward. He sits up and considers his next move.

In the distance, a resident approaches. It is Mrs. P., who has been living on the dementia unit's third floor for 3 years now. She has long forgotten her family, even though they visit her almost daily. Moderately disheveled after eating her lunch, half of which she now wears on her shirt, Mrs. P. is taking one of her many aimless strolls to nowhere. She glides toward Oscar, pushing her walker and muttering to herself with complete disregard for her surroundings. Perturbed, Oscar watches her carefully and, as she walks by, lets out a gentle hiss, a rattlesnake-like warning that says "leave me alone." She passes him without a glance and continues down the hallway. Oscar is relieved. It is not yet Mrs. P.'s time, and he wants nothing to do with her.

Oscar jumps down off the desk, relieved to be once more alone and in control of his domain. He takes a few moments to drink from his water bowl and grab a quick bite. Satisfied, he enjoys another stretch and sets out on his rounds. Oscar decides to head down the west wing first, along the way sidestepping Mr. S., who is slumped over on a couch in the hallway. With lips slightly pursed, he snores peacefully — perhaps blissfully unaware of where he is now living. Oscar continues down the hallway until he reaches its end and Room 310. The door is closed, so Oscar sits and waits. He has important business here.

Twenty-five minutes later, the door finally opens, and out walks a nurse's aide carrying dirty linens. "Hello, Oscar," she says. "Are you going inside?" Oscar lets her pass, then makes his way into the room, where there are two people. Lying in a corner bed and facing the wall, Mrs. T. is asleep in a fetal position. Her body is thin and wasted from the breast cancer that has been eating away at her organs. She is mildly jaundiced and has not spoken in several days. Sitting next to her is her daughter, who glances up from her novel to warmly greet the visitor. "Hello, Oscar. How are you today?"

Oscar takes no notice of the woman and leaps up onto the bed. He surveys Mrs. T. She is clearly in the terminal phase of illness, and her breathing is labored. Oscar's examination is interrupted by a nurse, who walks in to ask the daughter whether Mrs. T. is uncomfortable and needs more morphine. The daughter shakes her head, and the nurse retreats. Oscar returns to his work. He sniffs the air, gives Mrs. T. one final look, then jumps off the bed and quickly leaves the room. Not today.

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. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.

One hour passes. Oscar waits. 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. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, "What is the cat doing here?" The mother, fighting back tears, tells him, "He is here to help Grandma get to heaven." Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.

On his way back to the charting area, Oscar passes a plaque mounted on the wall. On it is engraved a commendation from a local hospice agency: "For his compassionate hospice care, this plaque is awarded to Oscar the Cat." Oscar takes a quick drink of water and returns to his desk to curl up for a long rest. His day's work is done. There will be no more deaths today, not in Room 310 or in any other room for that matter. After all, no one dies on the third floor unless Oscar pays a visit and stays awhile.

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.

Source Information

Dr. Dosa is a geriatrician at Rhode Island Hospital and an assistant professor of medicine at the Warren Alpert Medical School of Brown University — both in Providence.

PubMed Citation

the most prevalent question: what's a d.o.?

i don't know if i've explicitly mentioned this before, but i'm an osteopathic medical student.

wtf does that mean?

i'm sure you're wondering.

in the u.s., there are two different types of physicians who are licensed as medical doctors. one group everyone knows about. these are the doctors who have "m.d." posted behind their names. (m.d. = medical doctor) they comprise, at present, the majority of physicians in the country. the medical schools that provide m.d. degrees are known as allopathic medical schools. the other group is lesser known. these are the doctors who have "d.o." posted behind their names. (d.o. = doctor of osteopathy) they comprise, at present, the majority of medical students in the country. the medical schools that provide d.o. degrees are known as osteopathic medical schools.

what does all this mean? well, truthfully, it depends upon who you ask. the history of how osteopathy came about and split from allopathy is one that proves quite complex. interesting, no doubt--but way beyond the scope of what i can explain here. historically, osteopathic medicine has proven more "holistic" than allopathic medicine. many (if not most) of allopathic physicians would say, however, that allopathic medicine is more grounded in medical science than osteopathic medicine. as with any fine splitting of hairs in a discipline, the two sides tend to bash each other quite a bit. this is unfortunate, because in reality, both types of practitioners and students have tremendous expertise that they could share with each other if they'd get over the notion that one type of doctor is "better" than another.

given the increase in awareness on both sides of the educational divide regarding "alternative" medical practices, today's medical school graduates are, imho, all equal. some people would argue with this--after all, is getting a degree from man's best medical school the same as getting a degree from man's worst medical school? i argue that either notion is fiction. there really aren't "opposites" in medical schools in terms of best and worst. some schools have better programs in certain areas than others, some have more research opportunities, some have superior clinical opportunities, some have different styles of instruction, etc. the old notion that some schools are better because they've attracted more students with 4.0 gpas and scores of 35+ on the mcat...these "predictors" (as they're dubbed by med school admissions committees) are rather arbitrary. of the thousands of people who apply to medical school, only about 1/10th actually get a seat at a school. i highly doubt that there's any "dumb" person amongst those who get in. in fact, it's arguable as to whether or not any applicants could be considered "dumb"--anyone who applies is hyper-educated, at the very least. also, as anyone who has been through the process can tell you, there's a point at which an applicant realizes that s/he doesn't care where s/he gets to go to school--everyone who gets in is simply grateful to be able to go. so, do the students at mbms have higher iq's than those at mwms? probably. does this mean they'll end up becoming better physicians? hell no.

in my opinion, it matters little which type of doctor one is or where one did her or his training. the important thing is how a physician practices.

nevertheless, the most oft asked question of an osteopathic medical student is "what is a d.o.?" everyone asks this question. some more than once. the students at my school have been talking about this all week. how do we answer this question? what is the difference? what do we want people to know?

a group of osteopathic physicians in california, in collaboration with two osteopathic medical schools in that state, created the following youtube video as a response. it's a little bit commercial-y for my taste, but it gives a very basic overview.

other than this, there are a few details about osteopathic physicians that i'll delineate here, particularly since they're often misunderstood:

1. d.o.s are licensed by the same medical board(s) as m.d.s
2. the curriculum in an allopathic medical school differs from a curriculum in an osteopathic medical school only by one class: d.o. students are required to spend the first two years studying osteopathic practices (osteopathic practices are similar to techniques used by a chiropractor, a physical therapist, or a massage therapist, etc.--i.e. they're hands-on techniques used to treat dysfunctions of the musculoskeletal system)
3. d.o.s and m.d.s, for the most part, end up doing residencies together (so their training is identical in the post-graduate sense)
4. d.o.s and m.d.s do the exact same things, ranging from performing a school physical on a kid in family practice to conducting a heart-lung transplant operation in surgery
5. the "holistic" philosophy to which d.o.'s subscribe is defined as follows:
1. the body is a unit; the person is a unit of body, mind, and spirit
2. the body is capable of self-regulation, self-healing and health maintenance
3. structure and function are reciprocally interrelated
4. rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function

so, there's my brief answer to the most prevalent question. if you find it helpful/interesting, please pass it on!

the ponderous patient: the magic needle

in the continuing saga of my lack-of-a-gallbladder sod dysfunction, mr_dr_do suggested that i see an acupuncturist/traditional Chinese medicine (TCM) physician. i'd been to an acupressurist in college, but never to an acupuncturist. this was largely because, up until the last few years, i'd been terrified of needles. not to mention that i was a tad skeptical--in my years as a patient, the number of times i've been asked to purchase extras (i.e. herbs, vitamins, supplements, salves, etc.) from a physician has been directly proportional to how close one adheres to "western" medicine. in other words, the more "alternative" the practitioner, the more extras one has to buy, and therefore, the more expensive the overall treatment becomes. since i have some ethical qualms about whether physicians should sell products in their offices (a rant i'll indulge in at a later date), it's turned me off a bit to "alternative" pracitioners.* nevertheless, i'm curious about "integrative" medicine and what it can offer. so i decided, in spite of my fears about the costs, to pursue this course of treatment.

mr_dr_do clearly spent a considerable amount of time looking for an appropriate referral and came up with a female physician at a local college of acupuncture, whom i'll name here as dr_tcm. three weeks ago, i went to see dr_tcm for the first time. i liked her instantly (she personally came to the waiting room to get me! who does that?!?)--during the first appointment, i discovered that she's witty, intelligent, cogent, and thoughtful. she'd also been a medical doctor (md) in china, then came to the u.s. and got a ph.d. in endocrinology. this made our encounter all the more interesting because she knows the difference between which types of medicine work best in which situations. she's now one of the main faculty physicians at a local college of tcm.

she didn't promise me the world: "i don't have any magic needles!" she said. but she noted that she has worked on many patients who had various g.i. complaints following surgeries like mine and, based on her experience with them, felt that she could help me.

if somebody had told me that laying on a table naked with needles stuck in various parts of my body would help me feel better, i would have called him/her a fruitcake. i mean, seriously, can you imagine? it sounds like quack.

only, it's not.

when i appeared for my first session, i rated my pain and nausea at 4/10 (10 being highest). by the end of the session, i had *no* pain or nausea. at first i wondered if i'd merely not realized that lying down helps with the pain/nausea (i spent about 1.5 hours laying on the table with the needles in me). but the symptoms were better the next day, too. this continued--i noticed that after every session, i felt better. it didn't mean that my symptoms stopped completely--they haven't--but i've found some relief that doesn't involve massive amounts of heavy-duty medications or life-altering surgeries. how cool is that?!?!?

i did end up buying some products (the "pancakes" of chinese herbs she's given me to put on my abdomen at night were just too neat to pass up--i'd never seen anything like that before, even though "western" medicine now uses a transdermal approach frequently, so i was curious to try them). but most of what dr_tcm has suggested (prescribed?) has proven to be relatively straightforward. some of it, in fact, has been so straightforward that i've felt like smacking myself in the head for not thinking about it myself.

case in point: since surgery, i've been completely intolerant to food that contains fat. (i'm not going to delineate what intolerant means in this context--use your imagination.) so i've dropped all fat containing foods from my diet and had been eating a relatively "raw" diet--that is, i was only eating stuff that, if left on my kitchen counter for any period of time, would go bad (e.g. organic fruits & veggies, etc.). i always had been under the impression that such a diet is about the healthiest one a person can follow. (the only upside to this whole process is that i've dropped about 15 lbs and now weigh close to what i did in college; i don't recommend this as a weight loss program...but at least something good has come of it...i never imagined i'd have a flat tummy again!) the first thing that dr_tcm asked me to do, though, was to change my diet! needless to say, i was perplexed when she asked me to do this. but then she told me what she wanted me to do: eat foods that had been cooked, because the compounds in them would already be broken down a bit and thus would require less effort for my body to digest. she also asked me not to eat anything cold--only hot foods. puzzled by this, i asked my favorite question: why? and then she noted a basic science concept--the cold would make my gut seize as my body tried to regulate its internal temperature. duh, i thought, why didn't i think of that? what's more basic to science than the notion of how temperature is transferred and its effects? apparently, there's a reason i didn't major in science in college....

needless to say, between the diet, the funny herb pancakes, and the acupuncture sessions themselves, i've been beginning--albeit slowly--to feel better. i've got my fingers crossed in the hope that this will last. as she said, there are no magic needles in her arsenal...but there's something profound in her treatments, that's for sure. it's magic enough for me. :-)

....

recently, grey's anatomy had an episode in which they depicted acupuncture. it's a wonderful vignette on what having tcm done for the first time is like--particularly in this country. i hope you enjoy the video as much as i did! :-)

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*a note on language: i have a strong dislike for the manner in which the english language has been used to name various medical practices. i don't believe that "western" medicine is better than "eastern" medicine; i have difficulties calling u.s. physicians (m.d.s or d.o.s) "traditional" given that tcm and other such practices have been around for many a millennia longer than the medicine we think of as traditional today; and, overall, i'm not the type to think in terms of opposing forces. mwms has just assigned us a new textbook for the upcoming year called "integrative medicine." it discusses the problematic aspects of the terminologies and suggests the term integrative to describe what practitioners with an "holistic" (<--another problematic term) perspective practice/perceive such medicine to be. i personally don't know the best way to describe these different types of medicine--hence i'll put the terms in quotation marks to indicate that they're not terms i've created/i'm not using them as labels.