From:tmc-...@googlegroups.com on behalf of
Bill Frazier Sent: Thu 7/26/2007 12:46 AM To:tmc-...@googlegroups.com Subject: {Three Mountain Chapter - IAFN} Fw:
[PAFORUM] an incredible article from NEJM Volume 357:328-32926 JUL
2007
Oscar the Cat awakens from his nap, opening a single eye
tosurvey his kingdom. From atop the desk in the doctor's
chartingarea, the cat peers
down the two wings of the nursing home'sadvanced dementia unit. All quiet on the western and
easternfronts. Slowly, he
rises and extravagantly stretches his 2-year-oldframe, first backward and then forward. He sits up and
considershis next
move. In the distance, a resident approaches. It is Mrs. P.,
who hasbeen living on the dementia unit's third floor for 3
years now.She has long forgotten
her family, even though they visit heralmost daily. Moderately disheveled after eating her
lunch,half of which she now
wears on her shirt, Mrs. P. is takingone of her many aimless strolls to nowhere. She glides
towardOscar, pushing her
walker and muttering to herself with completedisregard for her surroundings. Perturbed, Oscar watches
hercarefully and, as she walks by, lets out a
gentle hiss, a rattlesnake-likewarning that says "leave me alone." She passes him
without aglance and continues
down the hallway. Oscar is relieved. Itis 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
aloneand in control of his domain. He takes a few moments to
drinkfrom his water bowl and
grab a quick bite. Satisfied, he enjoysanother stretch and sets out on his rounds. Oscar
decides tohead down the west wing
first, along the way sidestepping Mr.S., who is slumped over on a couch in the hallway. With
lipsslightly pursed, he
snores peacefully -- perhaps blissfullyunaware of where he is now living. Oscar continues down
thehallway 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 walksa nurse's aide carrying dirty linens. "Hello, Oscar,"
she says."Are you going inside?"
Oscar lets her pass, then makes hisway into the room, where there are two people. Lying in
a cornerbed and facing the
wall, Mrs. T. is asleep in a fetal position.Her body is thin and wasted from the breast cancer that
hasbeen eating away at her organs. She is
mildly jaundiced andhas 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 interruptedby a nurse, who walks in to ask the daughter whether
Mrs. T.is uncomfortable and
needs more morphine. The daughter shakesher head, and the nurse retreats. Oscar returns to his
work.He sniffs the air,
gives Mrs. T. one final look, then jumpsoff 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
restingpeacefully in her bed,
her breathing steady but shallow. Sheis surrounded by photographs of her grandchildren and
one fromher wedding day.
Despite these keepsakes, she is alone. Oscarjumps onto her bed and again sniffs the air. He pauses
to considerthe situation, and then
turns around twice before curling upbeside Mrs. K. One hour passes. Oscar waits. A nurse
walks into the room tocheck on her patient. She pauses to note Oscar's
presence. Concerned,she hurriedly leaves
the room and returns to her desk. She grabsMrs. K.'s chart off the medical-records rack and begins
to makephone
calls. Within a half hour the family starts to arrive. Chairs
are broughtinto the room, where the relatives begin their vigil.
The priestis called to deliver
last rites. And still, Oscar has not budged,instead purring and gently nuzzling Mrs. K. A young
grandsonasks his mother, "What
is the cat doing here?" The mother, fightingback 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
roomso quietly that the
grieving family barely notices. On his way back to the charting area, Oscar passes a
plaquemounted on the wall. On it is engraved a commendation
from alocal hospice agency:
"For his compassionate hospice care, thisplaque is awarded to Oscar the Cat." Oscar takes a quick
drinkof 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. Afterall, no one dies on the third floor unless Oscar pays a
visitand stays
awhile. Note: Since he was adopted by staff members as a
kitten, Oscarthe Cat has had an uncanny ability to predict when
residentsare about to die. Thus
far, he has presided over the deathsof more than 25 residents on the third floor of Steere
HouseNursing and
Rehabilitation Center in Providence, Rhode Island.His mere presence at the bedside is viewed by physicians
andnursing home staff as an almost absolute
indicator of impendingdeath, allowing staff
members to adequately notify families.Oscar has also provided companionship to those who would
otherwisehave died alone. For
his work, he is highly regarded by thephysicians and staff at Steere House and by the families
ofthe 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."
Shepard B. Stone, MPS,
PA Associate Clinical Professor of
Anesthesiology Yale University School of
Medicine Physician
Associate-Anesthesiologist Yale-New Haven Hospital State Aviation Medicine Officer Connecticut Army National Guard
* * * * * *
Visit the
ADVANCE for Physician Assistants PA blog by going to www.ADVANCEweb.com/pa,
scrolling down to "Daily News Watch," then clicking on "PA blog.
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camorrison
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Jul 26, 2007, 9:17:55 AM7/26/07
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