Making Rounds and Oscar (2010) (8 page)

"Ms. Strahan, is there anyone else you can talk with about all of this? These losses you're experiencing are enormous. No one should navigate them alone. Perhaps there's a support group, a therapist, or a minister?"

"I talk to my son sometimes, when he's around. It helps, I suppose."

A hint of a mother's smile came to her lips.

"You know, he's so good with him. He'll sit here and tell him jokes or read the sports pages to him. They used to go to Red Sox games together," she said, lifting her chin in the direction of the photo on the nightstand of Saul and a boy at Fenway that I had noticed before. "He doesn't get put off by any of...this place or his condition. Sometimes he can even get Dad to smile."

Barbara's expression changed once again to profound frustration. "But I can't do that!"

I nodded and sat with her in silence for a few moments. Sometimes doing my job means saying nothing at all.

"The thing is, Doctor," she finally said, "I feel so guilty all the time. Every time I leave here I cry all the way home."

She smiled through her tears. "I can't tell you how many blouses I've ruined with mascara stains. You'd think I'd know better by now."

Looking at her blouse, it became clear that another one would soon be relegated to the trash.

"Doctor, I know you think I'm wrong when I argue for more treatments for my dad." I started to speak but she held up her hand. "But you have to understand: Sometimes I feel that his medical wishes are the last thing of him I have left. He said he wanted everything done." She was crying again.

There was a longer conversation to be had about Saul's health and his end-of-life choices; it was one I'd had before with Barbara on the telephone and one I was sure we would have again, probably soon. But this was not the time. It was not time to say to her that the father who took her and her son to baseball games would never return.

"This isn't something you need to decide today," I said. "Though it won't make you feel any better, I understand how hard it is to see someone who still looks like your father, but has lost so much of what made him the person you knew. I've had caregivers who have lost family members to cancer and car accidents tell me it's far worse seeing someone close to them die slowly with dementia."

She nodded and I could see that she had accepted what I had just said. After a few moments of silence her tears ceased and her mood brightened. Maybe it was as simple as hearing that she wasn't alone in her grief.

"Thank you, Doctor."

"For the pair of slippers?" I replied, a grin coming to my face.

"Sure." She returned my smile. "For the slippers."

CHAPTER TEN

"A cat is always on the wrong side of the door."

ANONYMOUS

IT WAS TIME TO GET BACK ON THE TRAIL OF MY MYSTERY
--but where to turn? As usual, it was Mary who pointed me in the right direction.

"You know, David," she reminded me one afternoon while I was seeing patients, "you still haven't talked to Rita and Annette. Of all the families I've dealt with over the years, they've probably spent the most time at Steere House."

Of course.

The two sisters had spent an uninterrupted decade at the nursing home, tending first to their father, and then their mother. Who better to provide insight into my four-legged enigma?

I dialed Rita's number, figuring that they would never want to set foot inside a nursing home again. On the contrary, they offered to meet me at the nursing home a few days later.

"We're always happy to talk about Oscar," said Rita. "And it'll be nice to see our old friends as well."

As I drove to Steere House from a busy day at the outpatient clinic I couldn't help but think about the last decade of
my
life and everything that had changed. My own career had transitioned from medical school through three years of residency, two years of fellowship, and toward the development of an established medical career. I had met and married my wife and fathered two children--had gone from the sort of selfish, self-sufficient life of a bachelor to a family existence, with all its joys and responsibilities. Physically, I had changed too. Much to my displeasure, I had added twenty pounds to my frame, developed a receding hairline with more gray hair than I cared to have, and learned to cope with my own chronic illness and developing physical limitations.

It seemed slightly odd to me, if not unfair, that all that had occurred while Rita and Annette were caring for one parent after another--first at home and then at Steere House. As much as I like to tell my patients that dying is a part of living, it seemed like I had gotten the better end of the deal.

I found the sisters seated in the lobby, holding court with several of the nursing home's staff. It had been months since their almost daily visits, and it was clear that they were catching up with people who had become very important to them. I lingered in the background for a few moments, watching as aides and nurses came by to chat. I noticed how at ease each daughter was with the rest of the staff. There were no tears or sad faces, just laughter and warm smiles. It was a little like a family reunion, one I didn't want to interrupt. But Rita saw me hanging in the background and greeted me with a wave of her hand.

"Hello, Rita," I said. "You look well. You too, Annette."

We exchanged pleasantries as we walked toward the library.

"It must feel strange to be back," I offered.

Rita and Annette nodded but said nothing as we walked down the long corridor. They seemed lost in thought, as if each door they passed was a portal to a particular memory.

"A lot of people don't want to let go," Rita said, as if out of the blue. We were in the library now, and she seemed a little distracted, looking around a room that was part of her second home for years.

"Why do you think that is?" I asked. I knew from experience that letting go is precisely what family members struggle with the most, but I wanted Rita's take on it.

"Because you want them back in the worst possible way," she said. "You just want your parent back, the one who signed the report cards, the one who made the Thanksgiving dinner. But you can't."

Knowing that, and coming to terms with that knowledge, is really the most difficult part. A relationship between two people is made up, for the most part, of invisible things: memories, shared experiences, hopes, and fears. When one person disappears, the other is left alone, as if holding a string with no kite. Memories can do a lot to sustain you, but the invisible stuff of the relationship is lost, even as unresolved issues remain: arguments never settled, kind words never uttered, things left un-said. They become like a splinter beneath the skin--unseen, but painful nevertheless. Until they're exposed, coping with the loss is impossible.

"So, how do you come to grips with the loss?" I asked.

Annette answered this time. "It takes time. But at first it's about diversion and misdirection."

I hadn't heard that before. "What do you mean?" I asked.

"I guess it's like this," Annette continued. "A few years after my father was diagnosed he called me late one night. I told him it was the middle of the night and he should go back to bed. But he was anxious."

"'There's a strange woman here with me,' he said. 'I want you to come over here and take me home.'"

Annette shook her head at the memory. "For almost an hour I stayed on the phone trying to convince him that the woman in his bed was my mother--his wife. Eventually I was able to convince him..."

"Dr. Dosa, it only got worse from there," Rita said.

"From that point on," Annette continued, "the phone calls started coming more frequently. I don't like to admit this to myself, but early on I think I got a little angry."

She paused and then broke into a smile. "Okay, a lot angry! I mean, how many times can you say that the
strange woman
is actually your mother? It was heartbreaking and frustrating at the same time. It was many things. But eventually you realize that the best way to cope with the repetitiveness is not through explanation but through distraction. I'd stop trying to convince my father that the strange woman was his wife and simply changed the subject to something else and then everything was okay."

"It was the same with our mother," Rita said. "When she became a resident on the third floor, she still recognized the nursing home as the place where she had come to see Dad before he died. It was one of the reasons she liked Steere House from the beginning: In her heart, she
knew
it--the layout, the rooms, the cats!"

Annette chimed in, "She really took to Maya. Oscar not so much," she laughed.

"And she still knew a lot of the staff, too, or at least they were familiar enough not to make her anxious. Sometimes we'd be sitting in her room and she would ask about my father." Rita smiled wryly. "We would tell her that our father was answering the telephone and would be back when he was done."

"Eventually you just become good at misdirection," Annette said. "I know I did."

"The little things you do," Rita said with a small laugh. They didn't sound so little to me.

"Did you ever feel guilty about--?"

"About lying?" Rita jumped in.

Annette shook her head emphatically. "We considered it playacting. You have to learn to play a role and distract a person with memory impairment." She smiled, then added, "We could never bring our mother back to our reality. We had to go to
hers.
"

"That helped us in a way, too," Rita said. "The distraction helped to keep us focused on the moment. Otherwise, well, your thoughts go forward and backward and don't have a place to settle. It can be unnerving."

Listening to them I realized that they had become, against their will, experts in the field.

"It sounds like you both really learned how to cope with the illness."

"Dr. Dosa, I don't want it to seem like it was easy," said Annette. "What worked for our father didn't work for our mother, so we needed to come up with different strategies. There were days when I would leave work in tears. I would have breakdowns."

Rita nodded in stoic agreement. "Toward the end, there were times when my mother couldn't tell who I was."

"So, how did you deal with that?" I asked.

"By taking comfort in the little things--"

This had a familiar ring to it.

"My mother liked Cajun music," Annette jumped in. "Even in the end, she would tap her foot to the beat of her favorite songs. Other times, even after she had stopped eating, it was ice cream. You do whatever makes them happy."

"Still, the nursing home does take some getting used to," Rita said. "For us as well as them."

I used her last statement as a segue into my questions regarding Oscar. "Did the fact that there were cats on the floor make it any easier to accept Steere House as a home for your parents?"

"Absolutely," Annette said. "Both my sister and I took great comfort in the fact that Oscar and Maya were here. It just makes the place so much more livable. They were such a nice distraction--not just for the residents, but for the visitors too. Watching a cat can be mesmerizing. You know the way a cat will find a sheath of light and just stretch out..."

"Kitty yoga!" Rita said. "And the way it will stare out of the window as if the Macy's parade is passing by? And what about the way it will clean itself as if nothing else matters in the world?"

You can say that again, I thought.

"The cats proved to be...well, another diversion. A lovely one at that," Rita said.

"Was Oscar there at the end for your mother?"

Rita smiled before she answered. "Dr. Dosa, if I hadn't been there, I wouldn't have believed it."

"Believed what?"

"There were several false alarms with my mother before she died. With every turn for the worse, Oscar would come in and out of the room, checking in on her. He wouldn't stay for long. Sometimes he would simply come in, smell her feet, and then leave again."

Smell her feet? That was a new one.

"Were you surprised?"

"No, we had heard that the cat did these things from other families on the unit."

Taking a deep breath, Rita launched into the story of her mother's last day.

"At first, it was just the distinct sounds of scratching--
scratch, scratch, scratch
. I remember looking at my sister, wondering where it was coming from. We looked out the door and didn't see any cat. Then it would come again:
scratch, scratch, scratch.
This went on for probably an hour before there was a knock on the door."

"Then one of the aides walks into the room," Annette interjected, "closing the door behind her. She asks if we would be okay with the door open. I think we both looked at each other in bewilderment. We ask her why. She tells us that Oscar has been outside our door, desperately trying to come in."

"But where was the scratching coming from?" I asked.

"Apparently Oscar got tired of sitting at the door and had gone to the next room over. He just kept scratching at the wall to let us know he was there and that he wanted to come in."

"The aide told us that he had been pacing outside our door for several hours," Rita added. "So she asked us again if we would mind leaving the door open. We looked at each other and said okay. Well, as soon as the door opens, Oscar comes charging into the room from next door at breakneck speed, and then he leaps onto the bed with our mother. He stamps out a place next to her and then looks at us with this satisfied expression on his face. Then he sits down next to her, curls up in a ball, and goes to sleep."

"We both just kept looking at each other," Annette recalled, "totally bewildered by what we were seeing."

"So, was he there when she died?"

Rita held up her hand to interrupt me. I can tell she's told this story before.

"It gets better, Dr. Dosa," she said. "The same aide came back a little later to change the bed linens. She walks up to the bed to shoo Oscar away so she can change the sheets. Oscar just looks at her, stubbornly refusing to budge. When she tried to pick him up, he hissed and swatted at her with his paw."

I thought back on my first encounter with Oscar and unconsciously rubbed my hand where he had scratched me.

"So, who won?" I asked with a smile, knowing full well how it turned out.

"Oh, Oscar did," Rita said. "The aide finally gave up. Oscar didn't leave my mother's side until she passed. In fact, he didn't leave until the undertaker arrived."

"The strangest thing," Annette recalled, "was after the undertaker came, and they were wheeling her out, Oscar stood up, like he was at attention."

"Sort of like a sentry," her sister said.

"Yeah," Annette agreed, "like a sentry."

IT'S FUNNY
, but until that day I had imagined that Rita and Annette would run from the nursing home the way you might flee the scene of an accident. If anything, they seemed reluctant to go. As Rita had said, "Steere House was like our second home." While some of the affection was no doubt due to the friends they had made there over time (it was like old home week that afternoon), I also knew that some of that love came courtesy of Oscar and his four-footed friends.

"Like a bridge between the mother and daughter," Mary had said, after my visit with Donna, and I was starting to think of Oscar in that way, as a sort of gentle guide who could take people from someplace scary to one more forgiving.

I think it's one of the reasons we've kept cats at Steere House all these years. The patients like them, for the most part, either because they hark back to some forgotten relationship they may have had with a pet, or maybe because they are nonjudgmental. A cat doesn't care what you do for a living or whether you're rich or poor. A cat doesn't care if you're able to remember its name or if you're up to date with the latest news. But we were beginning to realize that cats mean something to the families, too, long before Oscar started his vigils. They seem to help reassure family members who enter into the nursing home with some trepidation. For a lot of visitors, the reality of nursing home existence can be a rather harsh wake-up call. All the more reason to take comfort in something familiar. Even if it is a cat.