Thursday, May 10, 2012

Heartwarming Animal Stories Review - "Making Rounds with Oscar"

For the fifth book in the Heartwarming Animal Stories 2012 Reading Challenge, I chose Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat by David Dosa, M.D.

It is a worthwhile book to read, and one that I found interesting in an unexpected way – it focused on Alzheimer’s Disease and dementia (my dad died of Alzheimer’s Disease in January of this year) and how Oscar made a difference in the lives of those with the disease and their families.

Oscar is a resident cat at Steere House Nursing and Rehabilitation Center in Rhode Island. He lives in a unit with 41 residents, the majority of whom have Alzheimer’s Disease or dementia. Oscar is a welcome distraction not only for the residents, but for the visitors.

He is a rather aloof cat, of the most part, until a few hours before the end of a patient’s life when, at that time, he strides purposely into a person’s room, jumps up on her/his bed, and begins his vigil. Oscar stays with the person until s/he dies and the funeral director removes the body from the room. At that point, he leaves the room – his purpose fulfilled.

Although this may seem like a rather morbid book to read, it is quite the opposite. Because of the comfort that Oscar provides to residents and visitors alike, and the positive memories that visitors have months and years after a loved one has died, it is a reaffirmation (for me) about the positive effect that animals can have on people in times of health as well as illness.

The relevance of this book – in terms of my dad and his journey with Alzheimer’s Disease; the comfort he had when Sophia and Olivia brought Eenie (one of our cats) to visit him when he was at St. Therese; and the dying process – made it all that more engaging for me to read.

Some of the parts that I found particularly interesting follow:

When the author was asked why he chose geriatrics instead of pediatrics he said, “Children are a blank canvas, portraits waiting to be drawn. When we look at them, their lives just beginning, we feel a sense of renewal and an expanse of infinite possibility. My older patients, on the other hand, are like rich paintings…and they have stories to tell.”

A patient who lived at Steere House for many years (because of having rheumatoid arthritis) said, “…every day I sit here and wait. I wait for someone to help me get dressed. I wait for breakfast, then for lunch. After that, it’s back to my room for a nap or to watch some…soap or talk show on TV. Then I wait for dinner. When I was young, I never had time. I was always on the go, didn’t have a minute for myself. Now, all I have is time.”

As a side note, this is the same issue (long periods of waiting throughout the day) that my mom has brought up as she has been in the Transitional Care Unit at St. Therese while her cracked ankle has healed and her diabetes stabilizes.

A visitor, whose mother had died, said, “With Oscar at my side…well, I felt a little less alone. It’s hard to explain, but some animals, well, the sense they give you is that they understand what’s going on …. Oscar gave me a feeling that this is all natural … If birth is a miracle, isn’t death a miracle too? My mother…well, her struggle is finally over. She’s finally free.”

There were references to Alzheimer’s and dementia that were comforting to read – knowing that I was not alone in feeling the same way.

For example, Dr. Dosa said to one visitor regarding her father: “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.”

Two sisters talked with the doctor about the loss of their mother with dementia and said, “You want them back in the worst possible way. You just want your parent back, the one who signed the report cards, the one who made the Thanksgiving dinner. But you can’t.”

Dr. Dosa wrote as a follow-up to that comment, “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.”

The sisters talked about re-directing their mother when she was confused and anxious. Sometimes there is guilt associated with “lying” to help the individuals get through the challenging time period. As one of the sisters said, “We considered it playacting. You have to learn to play a role and distract a person with memory impairment. We could never bring our mother back to our reality. We had to go to hers.”

Another family member talked about the power of music on her husband who had Alzheimer’s. She recalled, “One of the things I found most interesting about my husband’s disease was that even toward the end of his life he responded to music.”

This individual found Alzheimer’s to be a strange disease because of the response – or lack of one – regarding familiar things and people. Dr. Dosa said, “I know that at the end, [your husband] no longer knew your name. Nevertheless, I am quite sure that he knew you were important to him.”

One of the family members said: “I’m so grateful for the time we had, the good times before…I wouldn’t trade those years for anything, but I still haven’t gotten to the point where I can see him the way he used to be before the illness.”

Truly, until I read that statement, I thought that perhaps that was a unique situation to the way I was feeling about my dad. It is the years that he had Alzheimer’s Disease – particularly the most difficult last year – that clouds how I remember him. In going through his belongings and files, I am reminded of what he was like before the disease. Nonetheless, sustaining those memories of what he was like prior to the disease, is incredibly challenging.

One family discussed how their mother’s doctor never told them about hospice care, despite the clear indications that their mother was dying. It was through a physical therapist’s inquiry about why hospice wasn’t involved with their mother’s care that they became aware of it.

Dr. Dosa explained, “Many doctors don’t consider hospice until the very end because they don’t understand the concept themselves. They don’t realize that hospice care isn’t limited to hanging a morphine drip at the end of life. It can be an indispensable resource, a well of support throughout.”

I would agree. My dad was fortunate to have had over a month of hospice care that attended to his physical, emotional, and spiritual needs. He had visits from a massage therapist, music therapist, chaplain, nurses, and other health care professionals. Concurrently, the social worker was attending to the family’s needs and making sure that we were okay through this aspect of my dad’s life.

The one thing he didn’t have was pet therapy at this stage. I’m wondering how that might have helped him and/or provided comfort during the last month of his life.

One of the family members talked about her father’s Alzheimer’s Disease. She said that as her father, a college-educated man, couldn’t remember how to button his shirt or turn on the television, she would get angry thinking that a child could do this same task. “The difference is that a child is learning. A patient with Alzheimer’s is…unlearning.”

Once she realized this, she felt guilty for having been irritated or not having more patience. Dr. Dosa said, “Every caregiver experiences the same thing, the guilt associated with getting angry. It’s ultimately something you can’t possibly control.”

I know this is something that my mom struggled with – the guilt. We would encourage her to go to support groups with others who had a loved one who had Alzheimer’s Disease. She didn’t want to go. I think if she knew that this was common, perhaps she would have not been as hard on herself.

One of the families said that about an hour or so before their father died, a hospice nurse had come into the room to do an assessment. She suggested that they take a break. “Your father still has time” the nurse said.
The daughter told Dr. Dosa, “Mom and I both looked at each other, but neither of us wanted to go. We figured we should take our cue from Oscar. It was a good thing too, because he was right. Had Oscar not been there at the end, we might have listened to the nurse and missed being there when he died.”

She continued, “It’s not that we trusted the cat more than the nurse….It was…well, there was just something about Oscar. He seemed so convinced of what he was doing. He was so clear in his intention and dedication.”

One of the possible explanations for why Oscar is able to identify residents who are almost dying is described in the book: “When cells stop working, you get a state of starvation and you can smell ketones…referring to the sweet-smelling chemical by-product that can also be sensed in out-of-control diabetics.”

Dr. Dosa said that the value in writing this book was that he not only gained more insight into what Oscar does, but he learned more about the diseases that affected the patients’ lives and their families. He said, “Today, there are over five million people in the United States with Alzheimer’s Disease and hundreds of thousands more with other less common forms of dementia. Without new treatments, estimates suggest that this number is likely to skyrocket as our population continues to age. But the tragedy of dementia is not measured merely by the number of patients directly affected. For every patient with dementia, there are many more caregivers whose lives will never be the same.”

Dr. Dosa concludes the book by offering suggestions for caregivers, particularly those dealing with family members with memory impairments:

- Take care of yourself. There are lots of resources on the internet so I won’t go into detail here with suggestions about how to do this.

- Be present. “Try putting aside daily work and life responsibilities and making the time to spend with someone at the end of life …. So many of our day-to-day responsibilities are ultimately inconsequential. Animals like Oscar can teach us through their steadfastness, their patience, and their presence.”

- Celebrate the little victories, but see the big picture. “For every little victory that brings joy – an upswing in appetite, a remembrance of a name – there is the ultimate certainty of continued decline.”

- Become an advocate for high-quality care. It is “about being involved and asking questions. It is also about choosing your battles and understanding the limitations inherent in dementia care, particularly in the nursing home environment. It is possible to get good care or bad care at every nursing home. What makes the difference is family involvement.”

- Love and let go. “Eventually, every caregiver has to let go – whether it’s letting go and sending a loved onto a nursing home or letting go when death is near. When this time comes, please remember that letting go of a person with terminal dementia is not a sign of defeat: It is an act of love.”

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