Making Rounds and Oscar (2010) (10 page)

"What?"

"I can't tell you...it's a secret."

It was a familiar game we played and it was my job to guess.

"Was it a spaceship?"

He looked at me with his large brown eyes opened wide.

"Noooooo, Daddy."

"Was it...A DINOSAUR?"

"Noooooo, Daddy."

"Was it a--?"

Unable to contain himself any longer, Ethan blurted out, "It was a fire truck! And it was big and red and it made a lot of noise."

The exchange continued as I carried him into the living room where I was greeted by the sight of my beautiful wife lying on the carpet beside our newborn daughter. When Dionne saw me she flashed the same smile I fell in love with all those years ago, and for an instant I thought our daughter Emma even emulated her. These were the riches I had, and I wasn't going to wait until I retired to count them either. In good times and bad.

CHAPTER TWELVE

"Time spent with cats is never wasted."

COLETTE

I WAS LOOKING FORWARD TO DEBRIEFING MARY ON MY
conversation with Mrs. Ferretti, but that would have to wait. It was already 4:30 and the day shift had left. My office staff had called me earlier in the day to inform me that I had a new patient to see. As I made my way toward the elevators, a familiar voice flagged me down.

"Hey, you," Ida said from her wheelchair. "Where are you off to in such a hurry?"

"I've got long legs, Ida," I joked, "and lots of places to go."

"Yeah, I remember those days. Too many appointments, not enough time to get it all done. It all seemed so important at the time."

"Is this your way of telling me to slow down?"

"You've got to enjoy the journey, Dr. Dosa. Savor the moment."

It was like Ida had been reading my mail. "It's funny," I said, "but the wife of a former patient of mine was just telling me the same thing."

"Former as in 'dead'?"

Ida was never one to beat around the bush. I nodded. "One of my patients on the third floor. This woman realized after her husband was gone how precious the good times were. Those times when everything seemed just normal."

Ida grimaced a bit as if to say,
Tell me about it
. But instead she turned her focus on me.

"What about those kids of yours?" she asked. "You spending enough time with them?"

"I'm trying my best."

"You got any pictures for me? Why don't you sit down for a second?"

I pulled up a chair and then proudly pulled out my PDA.

"What is that thing, one of those new-fangled contraptions I see everyone carrying around? I suppose you've got your whole life on there."

"Pretty much," I said. I pulled up a few recent shots: my son's birthday party, my daughter's first smile.

"You realize, don't you, that raising those kids is the most important thing you'll ever do? Much more important than any of those grants you apply for or even any of your patients--except me, of course."

"I always have time for you, Ida."

"Then tell me what you're learning about our friend Oscar."

I looked at her quizzically. Maybe she
had
been reading my mail. Ida laughed. "Mary told me. She likes to keep me in the loop. So, what have you found out?"

I thought for a minute before offering an answer. "I feel like the more I learn, the less I know. I mean, why does he do it?"

"Who knows, Dr. Dosa? There's probably some scientific explanation but in the end, does it really matter? He's there when it counts."

"I guess," I said. "But I come from a family of scientists. We don't care so much if there is a genie in the bottle as how he got in there."

"You're supposed to be thinking what wish you want granted," she said with a laugh. "Are you a man of faith, Doctor?"

"Well, I don't believe in genies, if that's what you mean." Actually faith and religion are topics I've never been very comfortable talking about. "If you're asking me if I went to a church or synagogue growing up, the answer is no. My father was a Catholic choirboy when he was a kid, and my mother was Jewish, but they raised us to be pretty agnostic."

"How about your wife?"

"Well, she's from a Protestant family. I always joke that if we raise a Buddhist and a Muslim we'll have the major religions covered."

"You're forgetting the Hindus," said Ida with a laugh. "They're the ones who believe in reincarnation."

"You're right. I guess I'll have to have a third child," I said chuckling. I glanced over and pointed to Munchie, sprawled out fast asleep on the piano bench. "If we're lucky, Ida, maybe we'll both come back as cats in another life."

"Yeah, they certainly lead the good life in here."

"In all seriousness, Ida, if you're asking me whether I believe there is a deeper meaning to our time here on earth, I'd have to say yes. At least I hope there is. You can't do this job without accepting that there are many mysteries in medicine that go well beyond the science we learn in medical school."

With that, I stood up. "Unfortunately, I've got to go upstairs now."

"You're seeing that new woman up on three," she said with some certainty.

"I should just hire you as my secretary."

"You could. I make it my business to know what's going on around here, Dr. Dosa." She gestured with her head toward the elevator. "I saw the medics bring her in here about three hours ago. She didn't look so good. You better get up there before Oscar does."

IDA GOT ME THINKING
, as she often did. This time it was of my own first encounter with the unexplained. As a young resident at the University of Pittsburgh, I had gone into a hospital room one morning to see a patient who had been admitted with what appeared to be a mild case of pneumonia.

Even at her worst, my patient was a beautiful woman. Young and vital, with long blonde hair and striking blue eyes, this thirty-something woman could have graced the cover of a fashion magazine. But on that morning she looked pale and frightened.

"So, how are you doing?" I asked, with forced bonhomie. I was new at this doctor thing and trying to make up for my lack of experience with what I thought to be a winning bedside manner. In reality, I probably just looked like a cad.

She had looked at me as if she were trying to decide whether or not to trust me. She was fidgeting, shifting her weight on the bed while nervously twirling her long hair between her thumb and forefinger.

"To be honest," she said after a moment, "I feel okay. But I woke up this morning dreaming that I was going to die today. I keep trying to tell myself it was just a dream but frankly, I'm scared out of my mind." I thought she might cry. "I know it's silly," she said.

I tried to remember what, if anything, they had taught us about completely irrational fear. I put my hand on her shoulder. I was doing my best to impersonate a doctor.

"You really don't need to worry," I told her. "You're so much better. In fact, I think we're going to be sending you home today. The antibiotics should take care of the rest and you'll be back to normal in a few days."

She acknowledged the news with a nod, but there was no expression of relief.

"That must have been some dream," I said. "Let me take a look at you." I might have been new to doctoring, but I knew that listening to my patient's fear was the most likely way to break the tension. I mean, don't we all want to be heard, to feel that our fears--no matter how apparently outlandish--are taken seriously?

Doing something seemed to help. As I examined her I felt her relax. I took her blood pressure and listened to her heart and lungs. At each step of my head-to-toe exam, I told her that I could find nothing wrong save for the now faint signs of pneumonia lingering in her left lower lung. By the time I was done she was smiling again.

"Thank you, Doctor," she said at the end. "I guess I just need to get out of here."

I left the room feeling quite pleased with myself. What a good doctor I was turning out to be.

Three hours later, I received a 911 call.

"Who is it?" I asked the nurse, my heart leaping into my throat.

"I don't know," she replied. "I'm just relaying the message from the patient's nurse. But you better hurry."

As I raced to the same floor where I had visited my young patient, I tried to convince myself that it couldn't be her. There were so many sicker, older patients on the same floor. The eighty-five-year-old woman with lung cancer. The brittle diabetic with the recent heart attack.

I ran toward the nurse's desk where an aide directed me down the hallway, away from my young patient's room. I had a perverse sense of relief: It was somebody else. I left the aide behind and rounded the corner at high speed. Like a football player shedding tackles in his opponent's backfield, I raced past the parked EKG machine and a dietary cart filled with the remnants of that morning's breakfast. As I passed the last obstacle I could see someone lying on the ground at the far end of the hallway. Slowing my pace to allow my heart to stop racing, I approached the patient.

It was her.

She was crumpled on the floor in a fetal position, facing the wall. Though I couldn't see her face, her long blonde hair was unmistakable. I stood there, paralyzed.

"Doctor, do you want me to call the rescue team?" a voice asked.

It was Judy, an experienced nurse of many years, racing down the hallway toward me, wheeling an oxygen container behind her. I didn't answer. I was still in shock.

"Doctor!"

I snapped back. "What happened?" I asked.

Nervously, Judy began filling me in. "We told her to take a walk this morning, to get some exercise before going home. All of a sudden she collapsed. By the time I got here she was struggling to breathe."

Judy then reeled off the vital signs, which I acknowledged before kneeling down beside my patient. As I rolled her over away from the wall, I could see that her face was ashen, her eyes filled with tears. Her chest heaved as if she were fighting against some unknown compressive force. As I leaned down to her level, our eyes met. I saw an expression--fear, betrayal, accusation--that is with me to this day. That look will be with me always.

"I can't breathe," she told me, gasping for air.

I looked up at Judy and told her to call the rescue team. Then I looked over my patient and tried to calm her.

"You're going to be fine," I said. "The cavalry's coming."

This time I was the one who was scared; she could hear it in my voice. She began to sob. I placed my hands under her arms and propped her up against the wall of the hallway. Then I applied oxygen from the portable tank and slumped down beside her. For a moment, she appeared to improve. Color returned to her face and the vigorous heaving of her chest seemed to calm. I allowed myself to relax for a moment. We would get through this.

"You'll be okay," I told her, attempting to smile.

I could hear a stampede of physicians racing down the hall toward my patient. "I told you they would come." She looked at me again. This time however her gaze was vacant. Then her eyes rolled up into her head and she slumped back onto the floor. Amid the sounds of shouting health care workers, I began cardiac resuscitation. After a few minutes of chest compressions I backed off, exhausted, breathlessly allowing one of my colleagues to take over. I stood watching the cardiac arrest unfold, with doctors shouting and nurses scrambling for supplies.

She had been scared. Why hadn't I ordered more tests? Why hadn't I stayed with her? Thirty minutes later, we abandoned our efforts and I was pronouncing a woman dead who had told me earlier in the day that she was going to die. Every part of my exam had been normal, but she had known different.

How had she known?

An autopsy a few days later would tell us that a large blood clot had traveled to her lungs. It also told us she had a rare, previously undiagnosed blood disorder that predisposed her to her terrible fate. In the end, there was a scientific explanation as to why she had died that morning--but how to explain her dream?

I've seen a lot of strange things since then. There was the man who presented with disseminated cancer only to have the disease disappear a year later, despite refusing aggressive treatment. He was someone who was
supposed
to die--but didn't. Then there was the man who insisted on being admitted because "something was wrong" despite every test to the contrary. We tried to discharge him, but he refused to leave. We all thought he was crazy and even ordered psychiatric testing until the third day of his hospital stay when his cardiac monitor finally captured the life-threatening arrhythmia that was causing his symptoms. Like my young patient he had
known
--and probably wouldn't be with us anymore had he listened to the experts.

Then there was the elderly woman who announced to me on December 31, 1999, that she had accomplished her objective of living to the turn of the century. "I'm going to die today, Doctor," she told me quite casually. Every test showed she had nothing wrong. No infections, heart problems--nothing that might lead directly to her death. She simply came to the hospital because she was ready to die. As she foretold, she did die several hours later of unknown causes.

Science has taken us a long way in our profession, but we still just scratch the surface. The rest remains a mystery. Maybe some people just know when their time has come. Some cats, too.

CHAPTER THIRTEEN

"The cat has too much spirit to have no heart."

ERNEST MENAUL

I HAD THE CHART FOR OUR NEW CHARGE. MRS. ARELLA
Matos was a ninety-year-old woman with Alzheimer's disease and a laundry list of medical diagnoses and medications. This was my introduction to someone I probably wouldn't know for long.

I went to Mrs. Matos's room and found her three daughters there, gathered close together as if in prayer. Behind them their mother lay sleeping. Her breathing was fast and she looked uncomfortable. A young boy sat on the bed next to her, playing with a pair of action figures. He had one in each hand and they were fighting each other.

"Hello," I said to the family. "I'm Dr. Dosa."

I introduced myself to each of the daughters, Gabriella, Caterina, and Ana. As I shook their hands, I studied each of their faces. You can learn a lot from faces, particularly the eyes. Happiness, worry, excitement, fear--it all shows up there. The eyes of these three women were filled with a profound sadness. Whether they had admitted it to themselves or not, these dutiful daughters knew their mother had arrived at her last stop.

"Who's this?" I asked, referring to the little boy. He was no more than five and he reminded me of my own son. Gabriella, the daughter I presumed to be the oldest, answered.

"That's my son, Freddy."

I walked over and sat down on the bed next to him.

"Hi there, Freddy. I'm Doctor Dosa. How old are you?"

Freddy put up one hand to indicate that he was indeed five years old. Then he showed me his action figures.

"This is Spider-Man and this is Superman."

"Are they helping to take care of your grandmother?"

Freddy nodded and then slipped back into his pretend world, pitting the two action figures against each other in mock combat.

I turned my attention to the daughters.

"Tell me about your mother."

Gabriella was the first to speak. "Doctor, we feel terrible about moving our mother from home. She always told us..." Her voice trailed off and became almost inaudible. I moved in closer.

"It just got to be too much for us to take care of her," Caterina said, picking up where her sister left off.

They probably felt like they had let their mother down by not heeding her wishes. Looking at Mrs. Matos and her degree of discomfort, I was reminded that circumstances sometimes make that wish impossible.

An aide entered the room to do her admissions assessment. I suggested that we relocate to the family room down the hall so we could talk. The youngest daughter, Ana, launched into an explanation.

"Our mother was always fiercely independent. She stayed to herself so we didn't see it coming until it was too late. Three years ago, Caterina and I went back to our country, the Dominican Republic, to see her. Her apartment was a complete disaster. Newspapers were everywhere, unwashed dishes sat in the sink. It was clear she hadn't washed her clothes."

Ana looked over at Caterina and I could sense that they were reliving the memory together.

"Doctor, we both went outside and just started to cry. My mother had always taken such pride in her home. You couldn't put so much as a coffee cup on the table without her taking it away to rinse it. And now? How could we let our mother live this way? Right there we decided to move her to the United States and we put her on a plane with us. That was two years ago. Since then, we've done the best we could to take care of her, but--"

Ana put her hands up toward her head as the history became too much for her to relate.

Gabriella picked up the story. "When my mother got to Rhode Island, she became confused. Her English was not very good, and I think the language barrier only added to her confusion. She had no idea where she was. At night, she would get up and wander. One time we even had to call the police to help us find her. You can't imagine how frightening it is to wake up and realize that your mother isn't there. One night about a year ago, she walked out of my sister's house and fell down the stairs. She didn't get hurt--thank God!--so they sent her home from the ER. No one ever suggested we needed help or offered us any advice."

Caterina jumped in. "A few weeks later, my mother stopped eating. Then she developed pneumonia. Each time, we talked to her primary care doctor and he just sent us home. She's depressed, he told me, and he gave us a medication. She has pneumonia, he told Gabriella, so here's an antibiotic. He just gave us pills. None of us knew what to do. We started sleeping next to our mother on the floor to make sure she wouldn't get up in the middle of the night. It was just so exhausting. Finally, a few months ago, Mom stopped walking so I had to ask my doctor to send a physical therapist to help us. When the therapist arrived, she took one look around and asked why we didn't have hospice involved. I was stunned. I remember calling up my sister that night and asking her why the therapist would ask us about hospice. It seems silly now, but honestly, none of us even considered that Mom was dying. The next day, I contacted our doctor and asked him about it. He told me he hadn't even thought about hospice."

The months of frustration had taken their toll. "I wish doctors would let people know that hospices are there for other things besides dying from cancer," Gabriella said. "People hear the word
hospice
and go, 'Oh, they're terminal. They're dying of cancer.' But my mother isn't dying of cancer. She has dementia."

I felt sorry for the Matos family. It seemed particularly tragic that the family would have to learn about hospice through a random comment like that. But 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. Hospice workers provide more than information on the physical act of dying; they offer practical and emotional guidance. Hospice can often provide the necessary custodial care and nursing support needed to keep patients at home as their diseases get worse, services that can actually sometimes extend a life.

"I'm sorry that you had to go through all of this," I said. "Hopefully we'll be able to help your mother pass peacefully."

"We wanted to keep our mother at home, Doctor, honestly." Gabriela spoke for the three of them.

I nodded. I understood their situation better than they might have imagined. Hearing their description of their mother's unkempt home, I thought of my own mother-in-law and the last visit my wife and I had paid her. My wife and I appeared to be headed down an identical path to that of the family in front of me and their experiences left me with a sense of dread for what the days ahead might hold for the two of us.

"The good news is that your mother's here right now and you're with her," I said to the Matos sisters. "That's what counts."

BACK IN MRS. MATOS'S ROOM
a hospice nurse had arrived to evaluate her. She was not the only visitor, though. The darkness of the window reflected the unmistakable silhouette of a cat perched above the bed. Oscar had arrived. He ignored us, focusing on his patient instead. Then he settled in, turning himself around--once, twice, three times--before sitting down with his head on his paws. By the looks of it, he appeared to be staying.

Freddy noticed.

"Look, Mama, there's a cat."

I looked at the boy. For the first time his face was animated, excitement in his eyes.

"That's Oscar," I said.

"Does he live here?" the child asked, walking over to get a closer look.

"Yes, Oscar lives with all the other people on the floor."

"What does he do?"

"Well, mostly cat things, but I guess he also takes care of everyone."

"Will he take care of my grandma while she's here?"

"Yes, Freddy, he will. Would you like that?"

Freddy thought for a moment before responding with a solemn yes.

I wondered if a five-year-old could truly comprehend what was going on. Could he grasp the finality of his grandmother's situation? Probably not. My own son was just now starting to grapple with the idea of death. I recalled a recent conversation with Ethan while I was tucking him into bed. "Dad," he asked, "when I die, will I go to college?"

Still, Freddy seemed relieved by the thought of a cat helping his grandmother. He offered his hand to the cat. Oscar sniffed at it and for a second I cringed, but Oscar didn't seem bothered. He allowed the boy to pet him, and even seemed to enjoy it.

I guess I'll never really understand cats.

The hospice nurse finished her assessment of Mrs. Matos and introduced herself to the daughters. I used this as my opportunity to leave, offering my good-byes. I knew I wouldn't see them again.

As I left the room to take care of my own paperwork I heard a voice behind me.

"Doctor!"

I turned to see Caterina. "Thank you for your time, Doctor, but I have one last question. We have a fourth sister, Maria, who lives in California. She's used up so much of her sick time to help us care for our mother. Do you think we should tell her to fly in?"

I looked past her into the room. Through the door I could see the silhouette of Oscar, sitting quietly on the bed. He was still receiving affection from his new friend.

"Yes," I said to Caterina with certainty, "you should all be here."