“Cats always know whether people like or dislike them.
They do not always care enough to do anything about it.”
WINIFRED CARRIERE
TO SAY THAT I TRUSTED DONNA RICHARDS WAS SOMETHING of an understatement. It was like saying that Sherlock Holmes trusted Dr. Watson, or that Captain Kirk trusted Scotty to run the engine room.
As any doctor will tell you, good office managers are worth their weight in gold. They manage large staffs, stay one step ahead of government regulations, and make sure that important phone calls get returned. They see that the billing is current and that everyone gets paid, and make sure we don’t run out of supplies—everything from tongue depressors to copier paper. Office manager is one of those thankless jobs that only gets noticed when something goes wrong. That may be why it can be such a difficult position to fill. I know that’s why we snapped up Donna Richards when she, quite literally, landed on our doorstep.
Donna had brought her mother into our office one morning for an appointment and happened to ask one of my colleagues if we needed an office manager. She had recently returned to Rhode Island after fifteen years in California to take care of her parents and needed a job. Talk about synchronicity.
During the three years we worked together, Donna and I would often chat long after my patients and the rest of the staff had gone home. We would sit together in my office as we finished up paperwork. She’d ask me about my newborn son, offering the kind of parenting advice you couldn’t find in any medical manual. In turn, I’d ask her about the balancing act she performed every day as a single working mother with the added responsibilities of caring for a parent with dementia. It was during those evening talks that I first saw the complexities of dementia care through the eyes of a friend. Donna opened up to me about the compromises she made in leaving her career to return home to take care of her mother. She spoke of the difficulties of navigating the health care system—one that she knew well from her days as a senior health care executive—to ensure that her mother had high-quality care. It was Donna who introduced me to the term “sandwich generation,” and it was from her that I began to really understand what it’s like for the millions of Americans caught between raising kids and caring for elderly family.
Now I hoped she could help me once more by giving me some much-needed perspective on Oscar. But first we had to catch up. It had been two years since Donna left our office for another job and over a year since her mother had passed away with Oscar by her side. We had a lot of ground to cover.
“IN THE WEEKS AFTER my mother died I would wake up in a cold sweat.” I was sitting with Donna in her suburban home outside of Providence. “My mother would come to me in my dreams,” she continued. “She was younger, the way I remember her from my childhood, and she would look up at and accuse me: ‘I wanted to go to the hospital but you didn’t let me…If you had just sent me to the hospital.’”
Donna looked up at a far-off corner of the ceiling, as if the movement itself would keep her from crying. She took a drag off her cigarette and let the smoke waft up through the air.
“David, I know how much you hate my smoking,” she said with a smile.
I rolled my eyes but said nothing. It’s not my place to come into someone’s home and tell them to stop smoking. I do that enough in the office.
Donna considered the cigarette again and then stamped it out in the ashtray. “After one of those dreams I would sit in bed for hours, trying to talk myself out of what she had said. I knew she didn’t like the nursing home, or at least she didn’t like it when she could still process things. You have to realize, putting her in the home was the hardest decision of my life, but I really had no other choice. I was a single mom trying to provide for my son as best I could. I just couldn’t take care of her at home anymore. She had that dementia with Lewy bodies and her decline was just so quick.”
Aside from neurologists, geriatricians, and psychiatrists, few people are familiar with Lewy body dementia (LBD). Though it’s likely the second most common cause of dementia, LBD is frequently underdiagnosed because of its similarities to Parkinson’s and Alzheimer’s diseases. As with Parkinson’s, LBD involves a movement disorder: Those afflicted become rigid and unsteady on their feet. They frequently suffer from psychotic symptoms such as hallucinations, sleep disturbances, and significant behavioral changes—as well as an extreme sensitivity and intolerance to the antipsychotic medications that are often mistakenly prescribed for the hallucinations. This behavioral component of the disease makes caring for patients with LBD especially difficult.
“It was like one minute, my mother was fine, and the next month she was lost. She just wasn’t herself anymore. We took her to the best doctors, the best specialists, and they would give her pill after pill. She must have tried them all at one point. The doctors thought she was depressed, so they gave her antidepressants. She couldn’t sleep, so they gave her sleeping pills. Her memory failed, so they gave her a memory pill. The more medications they gave her, the worse she got. Eventually, things got so out of hand that your colleague finally admitted her to a psychiatric hospital just to wean her off the medications. Turns out, they probably were just making it worse.”
She shook her head at the irony of it all. “Kind of strange that we had to admit her to a hospital to get her off medications.”
It’s actually not so strange. Over one-quarter of hospitalizations today result from the collective effects of overmedication. The fact is that all medications, even herbal and over-the-counter drugs, are potentially dangerous in certain clinical situations. Elderly patients today are exposed to more and more medications all the time.
“When she got out of the hospital,” Donna continued, “it was obvious that she couldn’t come home. From that point on she went from one nursing home to another. What an eyeopener that was!
“When my mother was in the first nursing home, I got a phone call from the nurse at the facility telling me they were sending her to the emergency room for evaluation. I asked them why and she told me that, at eighty-four years of age, my mother had hit an aide while they were trying to change her. Now, my mom was feisty, but she never would have done this if it wasn’t for her disease. I rushed off to the ER and they did the workup. The doctors ended up finding nothing, but when they tried to get her back to the facility, the nursing home refused to take her. In the end, my mother stayed in the emergency room for three days while we tried to find a place for her to go.”
Donna got up from her chair and walked nervously around her kitchen.
“You know, David, this is what really gets me. It was like no one in the hospital really cared where my mother ended up. They just wanted to get her out of the ER as soon as possible. I had to fight tooth and nail; finally, I was able to pull strings and get my mother into a nursing home like Steere House. To this day, I know that the only reason they took my mother was because I knew all of the doctors who worked there. Imagine if I hadn’t had those connections or hadn’t known how to find information about those different nursing homes? The whole system is just plain bad.”
Donna became quiet. The memories washed over her and again tears came to her eyes. This time she let them flow.
“Sometimes, when I think about those days, I don’t know how I did it. I had a plan every day that was minute-to-minute; I had to have a strategy just to be able to work, care for my son, and be there for my mother.”
“That must have been hard on you.”
Donna looked at me as if I’d just said something like “It must snow a lot in New England in the winter.”
“David, unless you go through it, you truly have no idea. I had no life for myself.”
In anyone else this might have seemed like self-pity. With Donna it was just the facts.
“I had no life, but that wasn’t so bad. I could deal with that. I understood that this was my cross to bear. The worst part was the guilt about not being there for someone else. When I would miss my son’s swimming meet because something was going on with my mom, I would feel terrible. When I would go to the swimming meet, I would feel guilty that I was not visiting my mother. Sometimes when I left Steere House, I would feel so guilty about putting my mother in the nursing home that I would drive home crying the whole way. ‘Good Italians’ are not supposed to put their parents into nursing homes.”
Donna managed a halfhearted smile and shrugged her shoulders.
“In the end, I guess I didn’t have a choice. I just did the best I could.”
She looked at me and I could tell that we had gone as far as she intended to go.
“Doesn’t stop the guilt, though?” I asked.
“It never really goes away. And those dreams…”
WE TALKED for another two hours, about everything from her job to her social life as a single parent, and then I told her about the recent birth of my daughter. Eventually I glanced at my watch and realized how late it had become. I got up off the kitchen stool and began to gather my things.
“Wait!” Donna said. She looked at me with the hint of a smile. “You came here wanting to find out about Oscar and you almost left without asking me.”
“I guess our conversation seemed to go in a different direction,” I said. “Or maybe I’m not as open to the idea of Oscar as I thought I was.”
She laughed and gestured for me to sit down again.
“So, Ms. Richards,” I said, putting on my best reporter’s voice, “what do you think about our four-legged friend, Oscar?”
Donna laughed and gave me her Oh brother! look, an expression I hadn’t seen since we worked together.
“First off, my mother hated cats! Earlier in her life, I would have half expected her to poison Oscar had he jumped on her bed. It wasn’t just cats. My mother really didn’t like animals, period. Didn’t see the point of them. Yet, as she got worse and worse with the dementia, she seemed to take more comfort from the animals on the unit. I don’t know what it was about them, or about the changes in my mother, but something really had changed. It was like she was more receptive on some deeper level. Does that sound strange?”
“Not at all. In fact, lately I’ve been wondering a lot about the true nature of our connection with animals, especially when we’re very young and very old. My son has always been drawn to animals, even before he could talk. I’ve seen that same intense curiosity with some of my patients, too. It’s as if the relationship somehow transcends language. I’m just now learning how smart animals are.”
“Well, Oscar was smart. That much I’ll say. He generally kept a safe distance and left my mother alone, but when he’d wander by and she would stop to talk to him, well, he stopped too. He never stayed long and he never cuddled up to her—Oscar was more like a visiting dignitary than a house cat—but he always stopped as if to hear her out.”
Visiting dignitary indeed.
“What did you think of the animals at Steere House?”
“Well, in a way, it was strangely comforting. A distraction of sorts. I mean, it didn’t change the fact that my mother was in the nursing home, but it did make her surroundings a little more bearable. More like home than a home, you know? In a way, I think the presence of the animals also helped my son.”
“What do you mean?”
“Well, nursing homes are not easy places for kids. Sometimes he’d come up to the floor and go off in search of the cats. It was better for him, playing with Billy or Munchie on the first floor rather than sitting in a straight-backed chair swinging his legs. And it would give me a little more time to spend with my mother.”
“Was Oscar there at the end?”
“Absolutely. When my mother got sick for the last time, Oscar spent more and more time in the room with me. It was as if he knew I needed the support. It was truly bizarre. He seemed to warm toward me. More than that…he seemed to understand.”
Donna gauged the look on my face and continued.
“Well, I was at the bedside for pretty much the last seventy-two hours of my mother’s life. I even slept in the recliner next to her during that time. When I would try to rest, Oscar would wander into the room and snuggle up next to me. Then he would jump over from my chair to my mother’s bed and sit down beside her. He did that for pretty much the entire time that my mother was dying.
“The thing I can’t get over is that Oscar always seemed to know when he was needed, and he never seemed to want anything in return. Oh, he’d let me stroke under his chin and rub his little ears, but even that—well, it was as if he knew that it was helping me. Which it did. There’s something really calming about petting a cat…”
“Was he there when she died?”
“A few hours before my mother died, one of the nurses came to talk with me and convinced me to go home for a little bit. I wasn’t sure if it was a good idea, but the nurse persuaded me to go. Sure enough, my mother died shortly after I left. Oscar never left, though. He was there when she drew her last breath.”
“Were you upset that you left before she died?”
“No. Quite honestly, my mother probably waited for me to leave before she let go. That was just her style.”
Donna smiled.
“Besides,” she said, “she wasn’t alone. My mother had Oscar.”