Making Rounds and Oscar (2010) (15 page)

CHAPTER NINETEEN

"Two things are aesthetically perfect in the world--the clock and the cat."

EMILE AUGUSTE CHARTIER

CATS MAY HAVE NINE LIVES, BUT WE ONLY HAVE ONE
and we're all terrified to talk about the ending of it.

"Nobody likes to talk about death," Cyndy Viveiros said, looking at me across the desk. "It's like the dirty
D
word we aren't allowed to use in polite company."

I knew what she meant.

"During those last few weeks, very few..." She paused. "Look, I understand how hard it is for people to confront their fears, but for the most part, I was alone. Certainly the staff at the nursing home was great. I couldn't ask for more. But they would come and go at the end of their shifts."

She gathered her thoughts.

"Dr. Dosa, you asked me here to talk about Oscar. So here it is. I appreciated Oscar for what he did for my mother. But I also truly believe that he was there for
me
. During the last few weeks of her life, Oscar was in and out of her room all of the time, and I found that incredibly comforting."

"So, you think Oscar was there for you as much as your mother?" It reminded me of the last thing Jack McCullough had said to me.

"I think he was there for
me
," Cyndy repeated. "In fact, I'm sure of it."

"
IT HAD BEEN
a long three weeks at Steere House and I think I'd spent most of my visiting time seated in a chair by my mother's bed. The room had become my world. Unless I was singing church hymns to her, the constant drone of the oxygen machine and my mother's breathing were the soundtrack of those early mornings. For the last three weeks, the life had seemed to ebb out of her like an outgoing tide. There was a certainty to those days, though, a certainty that those were the last days of my mother's life and sometimes a certainty that those days would never end.

"The last day of her life, I remember watching the clock and rubbing my eyes. A lot. It could be two in the morning but I had no intention of leaving. Still, as the minute hand would trudge its way around the clock on Mom's nightstand I told myself that it would happen soon: one last breath, and then silence. At least that's what the hospice nurses told me to expect. Yet after days of watching Mom's chest moving rhythmically up and down, I wasn't sure that the end would ever come.

"Even Oscar seemed a little confused by her stamina. The cat that everyone said could predict death had been in and out of the room every day for the past few weeks, and nothing. But those last few days there seemed to be a greater sense of purpose to his stride.

"I remember that last day I was there he walked over to me and sat down. When I had leaned down to pet him he purred softly, so I picked him up and placed him on my lap. I rubbed that soft belly of his while we both watched Mom across the darkened room. Before long, though, Oscar had jumped off my lap and onto the covers. Then, look, I know this sounds strange, but he seemed to sniff the air, and then he rolled over on his back and gave this very catlike stretch. It was almost as if he was striking a pose," she said, chuckling.

Cyndy looked up at me to gauge my reaction.

"You know, Oscar can be very charming, when he wants to be!" she added, attempting to justify her earlier comment. "Well, at any rate, Oscar looked over at my mother and fixed his gaze on her. I wondered if this was his sign. I think I even asked him, 'Will it happen soon?'"

If he knew, Oscar wasn't telling.

"You know, Dr. Dosa, at first I had found Oscar's visits a little unsettling." Cyndy paused, unsure of what to say next. "I knew Oscar's game. I had even had dreams about him sitting on Mom's bed, terrible dreams that woke me up out of a sound sleep and always at the same time each night: 3:00 am. It was just weird.

"During the first week of my watch Oscar would stroll by the doorway and stand at the threshold, peering into the room. At first I eyed him with anxiety, wondering if he'd cross over into our world. That's how I thought of that room, as my world."

Cyndy broke into a smile.

"After a while I came to realize that my fears were unfounded. I mean, for goodness sake. He wasn't anything supernatural. He didn't carry a scythe or a pitchfork. He was just an ordinary house cat. My mom loved cats. In fact, when I had first looked at nursing homes, I thought Mom might take some solace from the animals running around the unit, and she had.

"Now that I knew Oscar, he wasn't threatening. In fact, he had offered me more companionship than anyone. I had a lot of concerned phone calls, and people tried to be kind, but in the end only two people actually came to visit Mom. I get it. Nobody wants to visit a nursing home, let alone the dying. It's like running into a burning building; the impulse is to run the other way. But Oscar, well, he was different. He didn't shy away. Actually, he seemed to know when he was needed most.

"You know, the first day I saw Oscar sitting in Mom's doorway I had watched him with a feeling of trepidation, I guess. He just sauntered in and walked over to Mom's bed. I knew what a visit from Oscar might mean, and I guess I held my breath. But instead of jumping onto Mom's bed he sat down beside
me.
He seated himself on his hind legs on the chair next to me and looked up at me, as if to ask how I'm doing. Can you imagine?

"When I reached down to pet his head, well, he gave me a long, loud purr as if he was real satisfied with himself."

As if,
I thought.

"Then, just like that, he leaped onto the windowsill and settled himself in a classic sphinx pose. You know the one I mean, Dr. Dosa?"

"I do indeed," I replied. I really did know the pose. It was regal and mysterious, as if our own Oscar was descended from Egypt, as if he was in some way a temple guardian. Actually, maybe the idea wasn't too far off.

"Well, Oscar spent a good amount of time sitting on that windowsill, studying the world both inside and out. Each day he was there to greet me at the front door of the unit, and, well, he seemed to escort me down the hall to Mom's room. He'd stay with me for the whole visit.

"I really warmed to the little guy, you know? Soon I even found his presence comforting. When I felt anxious, which I often did, I would talk aloud to Oscar and he seemed to listen. He never passed judgment or offered unwanted advice, he just listened. When I needed a break from the room, Oscar would stay with Mom while I went out to stretch my legs or grab a bite to eat. Sometimes he would even escort me down the hallway toward the unit doors.

"You know, Dr. Dosa, I had a lot of time to think, sitting there with Mom, and I wondered how I would feel when she finally passed. I had experienced so much guilt during the long duration of Mom's illness that I had begun to think of guilt as my birthright, something passed down to me like a family heirloom. How had I not noticed my mother's illness sooner? Did I do a good enough job dividing my time and attention between my children, my full-time job, and my needy mother? Did I do the right thing by putting her into the nursing home when I did?

"No matter how much I did there always seemed so much more to do, so much always undone."

Cyndy paused for a minute, to laugh or cry, I wasn't sure. I don't think she was sure either.

"Now I realized that I was beginning to feel guilty for
not
feeling guilty. In truth, my mother's death seemed a natural end to her suffering.
But why do I feel okay with it?
I asked myself. Searching for solace, I grabbed my mother's rosary from the bedside table and began to recite the Lord's Prayer aloud:

Our Father, who art in Heaven, hallowed be Thy name.

Thy Kingdom come thy Will be done, on earth as it is in heaven.

Give us this day our daily bread

And forgive us our trespasses, as we forgive those who trespass against us.

And lead us not into temptation, but deliver us from evil.

Amen.

"When I was finished, I sat back down again, suddenly feeling very tired. For the first time I had a strong desire to go home. I spontaneously murmured a heartfelt prayer:
Please, Lord, just take her.

"I closed my eyes for a moment and was consumed with a flood of loving memories of my mother from years gone by. They were comforting memories, and I allowed myself to almost drift off to sleep, listening to the white noise of the oxygen machine in the background. Suddenly I bolted upright. The noise from the oxygen machine was all I could hear. I looked over at Mom and realized she had stopped snoring. For the first time in days, she appeared peaceful. I looked at my watch. It was 3:00 am."

"
THE NURSE CAME IN
a couple of minutes later and listened to my mother with her stethoscope, confirming what I already knew.

"She gave me her condolences and then left to telephone whoever was on call. For a while I just sat quietly in the chair watching my mother. Inside, I knew that she was gone but I still watched her, searching for movement. I leaned over and kissed my mother on the forehead, telling her that her beloved late husband was waiting for her. Almost immediately, I felt this incredible sense of closure, like both my mother and I were finally free."

Cyndy started to smile ever so slightly. "After some time passed, I got up and left the room to get a cup of coffee. I wasn't quite ready to call my family yet; I needed to wake up. I remember it being eerily quiet on the unit. As I'm walking down the hall, I hear this pitter-patter of paws hitting the linoleum floors next to me. I looked down and saw Oscar walking next to me."

I could picture Oscar walking alongside Cyndy, matching her gait, keeping pace.

"So, he was, like, your companion for those three long weeks?" I asked.

Cyndy nodded and I could see the awe dawning on her expression. I had seen this look a lot, of late, as people talked to me about Oscar.

"Doctor, I remember walking into the bathroom to splash some cold water over my face. When I left the bathroom, Oscar was right there waiting for me at the door. I stopped in the kitchen to pour myself a cup of coffee. Then I sat down at a table in the dining area to begin to plan out who I needed to call. Suddenly, there was a noise in the chair next to me. I looked over and there was Oscar sitting on his hindquarters, eyeing me. It was like he was checking up on me to make sure I would be okay."

She smiled widely now. "You know, throughout this process, people would come and go. But Oscar would stay. He was really there for me. In fact, he was the last 'person' I saw that morning as I left the unit. He just sat there on the nurse's desk staring at me as the doors closed behind me."

CHAPTER TWENTY

"I love cats because I enjoy my home; and little by little,
they become its visible soul."

JEAN COCTEAU

IT WAS TIME TO STOP. I HAD NOW SPOKEN TO A HALF
dozen people whose loved ones had died with Oscar by their side. I had plumbed their memories and emotions, and learned a lot more about what Alzheimer's does to families. But I was still surprised by how little I knew about Oscar.

I didn't feel frustrated, though. While I didn't feel enlightened necessarily, I did feel oddly elated. The image I was left with was that of Oscar walking Cyndy Viveiros down the hall and sitting with her in the darkened dining area--as he had sat with her mother in her final days. Maybe that's all he was: a companion, a sentient being who might accompany one person on their journey to the next world, or another through the grief of losing one they loved--a kind of underworld of its own. Wasn't that enough?

Did it matter if he had some extrasensory power of perception, if he could pick up on impending mortality before the best minds of medicine could? Maybe he was just a master of empathy. Maybe caring was his superpower.

I needed to talk to Mary.

"I've been thinking about what you said, that Oscar has forty-one family members and when one of them is in trouble, he goes and stays with them."

It was a little before three in the afternoon and Mary and I were sitting in her office. She had asked the staff to assemble at the nurse's desk at three, and I had arrived in time to get a few words in with her before the changing of the guard. The worries of our last encounter--the latest funding crisis, the Sisyphusean task of running the floor of this nursing home--seemed to have vanished, and she was looking calm and collected. She was also being quite modest.

"Oh, David, that's just my theory," she said. "What do I know? You have to remember, I'm a dyed-in-the-wool animal lover. It's not like I'm objective."

"Objectivity has its limits," I said. "Remember, I started out not believing in Oscar. To be honest, I thought you guys were all a little crazy."

"You know what the sign says," said Mary with a smile. "you don't have to be crazy to work here--but it helps!"

"But now I think that Oscar has some purpose," I continued. "Maybe he's meant to help the residents--the family members, as you put it. But also
their
family; they may be the ones who suffer the most."

"Don't forget the staff," said Mary. She was fully engaged now, playing Watson to my Holmes. "You can't work up here and not become involved in the lives of your patients. We come to love these people, David. Their loss grieves us, too. In the end, we often become as close spiritually and emotionally to these patients as their own family members."

"Does it help to have seen so many die with Alzheimer's?" I asked. "Doesn't it make it any easier?"

She thought for a minute before answering. "It makes it easier to understand what's happening," she said finally, "but not why. Why would anyone be afflicted like this? Why would God allow this to happen?"

Though we seldom touched on the subject of religion, I took a chance and asked her, "Do you pray, Mary? I mean, have you asked God why?"

She smiled without directly answering the question. "I don't think He'd answer right away," she said.

No
, I thought.
He'll take a message and get back to you.

"As I've said before, the thing you have to remember about domesticated animals," Mary said, as if she'd been reading my mind, "is that people started to keep them because they had a purpose. They worked. If you were a dog, you were herding sheep or something. Any cat that wasn't doing some serious mouse hunting around the farm wasn't going to be there for long. They had to earn their keep."

"So you think that's Oscar's job," I said, "to take care of people?"

Mary shrugged. "Why not? Maybe he's just more highly evolved than the other cats. Maybe it's his way of paying the rent." She checked her watch and smiled at me. "We're all just guests here, you know."

At that, the door to the unit opened and a parade of evening staff shuffled through.

Mary got up from her chair. "I've got to get the troops together so we can run our list. Are you sticking around?"

I shrugged.

"Please do. There's one more patient I'd like you to see before you go. Our sign-out should just take a minute."

A few moments later Mary was standing with her back to the door, addressing the afternoon charge nurse and four aides about the day's events. This was her daily change-of-shift meeting, when she would advise the incoming staff on what to look out for and which residents might need special attention. I took my place by one of the aides and tried to be unobtrusive as I listened in on the conversation.

"Over on the west side," Mary said, "there are a few things going on. In 312, Mrs. Carey seems to be--"

As Mary continued with her report, I began to daydream. Farther down the hall a handful of residents sat watching TV. This time of day it was probably one of the soap operas they seemed to enjoy. All that drama and nothing ever seemed to change. Behind them, I noticed the silhouette of a cat perched on the windowsill staring intently at the world outside. It appeared that Oscar was off the clock and had found a favorable place to while away the day. It seemed like there would be no deaths on the third floor today.

Mary's voice brought me out of my reverie.

"Dr. Dosa, you might want to hear about Mr. Grant. He's the resident I want you to see."

I turned my attention back to the group and Mary continued her report. "Mr. Grant has a pressure sore developing again. We're changing the dressings twice a day and it looks fairly clean. Just make sure that we turn him often. He's completely bedbound now so we really need to be careful that the ulcer doesn't get worse."

To me she added, "I need to change the dressing before I leave. Why don't you take a look with me in case there is something else you'd like us to do?"

I nodded as Mary wrapped things up. "Finally, there's Ruth Rubenstein. She's really rebounded over the last few weeks. She's walking again and her weight is back up. As you know, her confusion is finally gone and physical therapy has been working with her. By the way, Frank just got here and he's requested some privacy. Please keep her roommate in the dining area, out of respect. I think today is their anniversary or something and he wants to be alone with her."

When Mary mentioned the request for privacy, a few of the aides exchanged knowing looks. Requests for privacy between patients and spouses are not uncommon; still, sometimes the people who work here can act like schoolkids. Mary cast a cold eye on the smirkers and order was restored.

As the group broke up I followed Mary back to her office. "Now, why is the idea of the Rubensteins wanting privacy so funny to them?" she asked. "They're a married couple. Just because she lives here doesn't mean that they don't have needs."

Mary raised her head. "You know, one of the other male residents has been spending a lot of time in the room with Ruth lately. The thing is, she doesn't seem to mind his attention."

"Frank won't be happy," I said in a hushed voice.

"I suppose we'll have to tell him eventually."

"Please make sure I'm on vacation when you do," I said. I'm not sure I was joking.

Mary shrugged. "I've got to get out of here, so let's take a look at that pressure ulcer."

We left her office and headed down the hall toward Mr. Grant's room. Suddenly there was a scream and Ruth Rubenstein charged out of her room. The look on her face was one of pure terror and she ran past us without stopping.

A moment later Frank followed her out. He stopped when he saw Mary and me.

"Dr. Dosa, I need to speak with you," he said breathlessly. His face was a study in anguish.

I directed him down the hall in the direction of their room while Mary went in search of Ruth. We entered her room and sat down next to each other on Ruth's bed. Frank looked at me through eyes heavy with tears.

"Dr. Dosa, I need to tell you what happened today, but I need you to understand a little bit more about us first."

"All right," I said.

"Ruth and I were married shortly after the war. I don't know if you are aware of this, but we met at a concentration camp." He looked at me to gauge my response.

"I didn't know that," I said.

"Dear God, I still remember it to this day. It was late October 1943. I had already been at the camp for a few months." Mr. Rubenstein paused for a moment and became lost in his memories. A minute passed before he began again. This time his voice was low and uneven.

"They say when you get older that you forget. It's not true. I remember the past more vividly every day. In some ways, I envy my wife--she doesn't remember any of this anymore but I live with the memories every day. At night I dream about it: the humiliation, the suffering..." Frank paused briefly and looked at the floor before continuing.

"I remember the first moment I saw Ruth like it was yesterday," he said. As he spoke his accent seemed to become more pronounced, the Eastern European inflections and inverted sentences bubbled up through time to the surface. "She must have just arrived at the camp. She was dressed in a brown dress, torn. Her overcoat...it was still new, but stained now from travel. This heavy suitcase through the mud she was pulling. I still remember her long dark hair: tangled and dirty but oh! it was beautiful. For some reason--maybe it was fate--our eyes met. Doctor, she had the most magnificent eyes I'd ever seen. Most important, there was no fear in her eyes. She was in this horrible new place but all she looked was determined: She was going to live!

"So like that I fell in love with her. I had to know her. I walked over and offered to carry her bag."

Frank looked over at me, the hint of a smile coming to his face.

"She turned me down, but never once did I stop thinking of her. It was weeks before we met again. This may sound crazy, given our surroundings, but, Doctor, it was the happiest day of my life. From that day we were inseparable. For nine months we were together. Then suddenly, we were sent to different camps. Before we were separated we agreed that if we survived we would look for each other after the war. We chose a place to meet--a church in my hometown. Neither of us knew whether the other person survived."

"Mr. Rubenstein," I interrupted, "I can't even imagine what you went through."

He put his hand up to stop me from talking.

"Dr. Dosa, it was sixty-three years ago today that we met in the courtyard." He paused to allow the news to sink in. "For the first time since that day, Ruth does not know who I am."

As he spoke his tears poured down his cheeks. I looked at him in silence, unsure of what, if anything, I should say.

"When we came to the United States, we didn't have a lot of money. All we had was each other. We couldn't speak the language. Ruth cleaned rooms at the hospital and I went to school during the day to learn English. At nights, we would walk around New York City, looking in the store windows. Then we would go back to our little apartment and lay down together. That we could afford!

"Things got better. My English became not so bad and I got a job as a laboratory assistant. Ruth took a job as a nanny for a rich New York couple. She loved that job and those kids. Maybe because we couldn't have kids ourselves."

Frank began to tear up again.

"I'm sorry," I said.

He acknowledged my response with a quick nod before continuing. "We never had it easy but we made do. Our lives got better. I went back to school and finished my Ph.D. For my first real job we came here to New England."

I looked at Frank for a clue as to where this was going. Perhaps he realized that he was rambling. He stopped himself and looked at me.

"Today, for our anniversary, I brought her a dozen red roses and a piece of her favorite pear tart from that excellent bakery downtown on Federal Hill."

I glanced over and saw the unopened pastry box on the bedside table along with the vase full of roses.

"I walked into her room and said, 'Happy anniversary,' like so many times before. I sat on the bed and bent over to give her a kiss on the forehead."

He paused. "In her eyes all I could see was terror. Dr. Dosa, I was a stranger to her. She just started screaming...."

It was as if all the air had left the room.

"I didn't know what to do," he continued. "I tried to kiss her and she just kept screaming. I put my hand up to comfort her and she slapped me in the face. Then she got up and ran out of the room."

I could see the red mark on his left cheek. We settled into an uneasy silence. Finally Frank spoke.

"Doctor, I don't want my wife to live in fear like this."

I looked at Frank. He had stopped crying. His expression was fierce, as determined as hers must have been back in the camps. I understood now why he had wanted to tell me the story of his marriage.

"Will you help me, Doctor?"

Deep in my soul, I knew where he was coming from--and I knew where he was going. His heart was broken; there was nothing left. They had survived; they had come this far and now he was alone. I put myself in his shoes and for a moment, I thought of how easy it would be to break a cardinal medical oath and do what he was asking.

"No," I finally said. "I can't help you with that."

There was another awkward silence that I finally broke. "Mr. Rubenstein, your wife is terminally ill. Physically, she's been doing better lately, but when her time comes, we can put her on hospice and just make her comfortable."

"How long does she have?" he asked me.

"Mr. Rubenstein, only God knows that."

He allowed my answer to sink in. I wondered what he thought of God. Maybe God no longer existed for someone who had experienced so much horror. "Doctor, in my mind my wife died today."

He gathered his things from the bed. "Please just make whatever is left of her comfortable and don't let her suffer anymore."