“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.”