Monday, 19 July 2010

Making the Rounds with Oscar

I was always going to be the perfect reader/buyer for this book. I was already in Oscar's thrall, having read about him way back in 2007, and he was even the topic of my first ever blog post! Oscar of course is a very famous cat who lives on the third floor of a nursing home in Rhode Island. Oscar has a special calling- he will go and sit on the bed of patients during their final hours. He will often jump up on a bed, sniff the air and jump off, but when he settles himself in the staff quickly learnt that the patient wasn't long for this world. It's a remarkable skill really. Of course, many animals, usually dogs I suppose seem aware when their people are unwell and will sit by them. Is that more of a devotional motivation? Oscar doesn't seem to particularly bond with these patients, and indeed the patients who live on Oscar's floor all have severe dementia and they probably don't know that Oscar is there for a long part of their illness. Still, I think it's a really nice idea for a nursing home to have a cat. It helps accentuate the home and not just the nursing. Actually this place has two cats per floor, it's more than just a token gesture.

So, I was intrigued enough by Oscar's habits to buy this book when I first saw it. Yes I wanted it so much I was happy to pay full price, just in case I never saw it again. Unusual behaviour. More typically it sat unread for several months. Then, whilst looking for something gentle to read whilst trying to combat jet lag it seemed the perfect title. And in some ways it was. It was a rather gentle, and easy to read book. It wasn't the book I was expecting however. I was expecting little anecdotes about the cat I guess, padded out with filler. It was much more a book about dementia than about cats.

David Dosa is a physician, a geriatrician. Early on he describes how the "family business" is paediatrics. His mother, uncle and grandfather were all paediatricians. They weren't necessarily thrilled when he developed an interest in geriatrics. In my favourite non-feline sections he discusses the differences between paeds and geris (although perhaps these are somewhat obvious, I liked his turn of phrase).

I thought of going into paediatrics. I love children and babies, and have two little ones of my own. The difference for me has always been the stories. Children are a blank canvas, portraits waiting to be drawn. When we look at them their lives are 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 boy, do they have stories to tell. On my best days I can look at them and see all the way back to their childhood. I think of their parents (long gone now), the places they've been, the things they've seen. To me, it's like looking through the other end of a telescope, back to the beginning.

David Dosa works both delivering palliative care to dementia patients in the nursing home, and also does on call at a hospital some times. I found his tone a bit disengenuous at times, can he really be that naive and ignorant? It is one of the senior nurses Mary who initially points out Oscar's gift to Dr Dosa. He isn't a cat person, and is disbelieving that a cat can have such a higher sense. He does of course come around to belief as Oscar sits with each person who dies. Indeed, Oscar will wait outside closed doors to get into the room of dying people, and even scratch and bang at doors and walls to get in if the door is shut for what he feels to be too long.

But the book is much more about dementia, and more particularly the final stages of their illness. And this is where I found David Dosa particularly disengenuous. He goes to talk to family members who had Oscar with their loved one in their final hours. He comes across as if he's never particularly thought how it must be for the families to watch their loved one wither away, both intellectually and physically. He needs to get a lot of help from the ever-present, ever-sensible Mary. And the families of course. Did he never really ponder this during his training? Or have a particularly poignant experience or discussion with a family before? Maybe he didn't. Perhaps my perceptions were coloured by reading this book basically in the wee small hours when I couldn't sleep. And it was a perfect jet-lag book. But I wanted more about the cat. Perhaps there isn't that much to say about the cat, I don't know. It is an endlessly fascinating feline behaviour though,isn't it? Comforting to know that Oscar is there bringing comfort to these people as they die.

Interesting to see how a relatively simple book about a cat can need multiple different covers for the different markets around the world. I think Portugal's cover is the best, as this is meant to be a book about a cat (although I don't think it quite achieves that aim). And France, I'm sorry I do love you, but you really have some of the worst book covers in the world. I suppose you save all that creative flair for making chocolates and maccarons and wine, and there is precious little left over for book covers. Browsing your bookshops is interesting, and somewhat difficult for a foreigner, all the books look the same, all the spines of the books seem to actually be the same. It's confusing for the non-French, almost as much as your disdain for the burqa and the humble boardie.


readerbuzz said...

I was surprised to find the book was well written; I am always worried when the author is writing an autobiographical piece....did the book get published because of the coolness of the story or because of the author's writing ability? Usually it is because of the coolness of the story. In this case, it seemed to be a little of both.

I'm afraid that doctors in the US do not spend much time learning about their patients. I do not know why. It seems to be quite important to me as a patient.

Louise said...

Oh, I think this is definitely a book published because it was a cool story. Oscar's actions are compelling after all. I don't think David Dosa would have got a book deal without Oscar- multiple demented patients dying doesn't really make compelling reading I suspect. It needs the death seeking cat.

I did think the writing flowed smoothly, and was easy to read without being great.

It's a shame that American doctors don't take the time to learn something of the social circumstances about their patients. You can't understand them and their illness without it. I've read stuff in the NYT about how taking a history and examining the patient are becoming a bit passe too. Which is just ridiculous. A good history and examination remains the foundation of diagnostic medicine, and will continue to be so for the forseeable future.