The Cat Who Smelled Death

The July 26 edition of the New England Journal of Medicine—ultra-respectable bastion of medical research—has an article about a cat, Oscar, who can (it says) tell when patients on a ward for severely demented individuals are about to die.

Oscar barely tolerates anyone on the ward who's not hours away from death, says the article. Even if they're barely conscious, brains barely registering the world anymore. But if someone's about to go?

Oscar arrives at Room 313.^ ^The door is open, and he proceeds inside. Mrs. K. is resting^ ^peacefully in her bed, her breathing steady but shallow. She^ ^is surrounded by photographs of her grandchildren and one from^ ^her wedding day. Despite these keepsakes, she is alone. Oscar^ ^jumps onto her bed and again sniffs the air. He pauses to consider^ ^the situation, and then turns around twice before curling up^ ^beside Mrs. K.^ ^

One hour passes. Oscar waits. A nurse walks into the room to^ ^check on her patient. She pauses to note Oscar's presence. Concerned,^ ^she hurriedly leaves the room and returns to her desk. She grabs^ ^Mrs. K.'s chart off the medical-records rack and begins to make^ ^phone calls.^ ^

Within a half hour the family starts to arrive. Chairs are brought^ ^into the room, where the relatives begin their vigil. The priest^ ^is called to deliver last rites. And still, Oscar has not budged,^ ^instead purring and gently nuzzling Mrs. K. A young grandson^ ^asks his mother, "What is the cat doing here?" The mother, fighting^ ^back tears, tells him, "He is here to help Grandma get to heaven."^ ^Thirty minutes later, Mrs. K. takes her last earthly breath.^ ^With this, Oscar sits up, looks around, then departs the room^ ^so quietly that the grieving family barely notices.

Hmm. After the jump, let's think about this a little bit.

Despite appearing in NEJM, the article is a "Perspective"—essentially the observations of a practicioner. It's not peer-reviewed, nor is it even an attempt to explain Oscar's seemingly amazing behavior. Other publications, picking up on the story, take some swipes at the explanation. Maybe Oscar's sensitive to pheromones or other scents humans emit when their bodies are shutting down. Though a couple of the stories I read suggest that the cat is showing empathy for the dying, trying to somehow comfort them. I haven't seen anybody suggesting the other possibility—that the cat enjoys the smell and wants to be around it, kind of like my cat likes sleeping on my unlaundered shirts.

Not trying to be disrespectful here, folks. Just trying to be skeptical.

There's a chance, I suppose, that Oscar picks up some emotional vibe that's imperceptible to humans—or inexperienced humans, at least. My wife has done a lot of work with gerontological public health and end-of-life care, and she's been with several of our family members days or hours before they died. By the third one, she could tell what was coming, she says.

It's also true that animals are increasingly common in care facilities. Seeing-eye and hearing-ear animals you'll already know about, but some dementia wards now use dogs as guards to gently keep patients from wandering off. If you've ever seen a working dog do its thing—herding, retrieving, guiding a blind person, tracking a scent—you know that they're capable of some amazingly complicated behaviors, and they do seem to carry them out with a certain emotional commitment. No reason to think cats are any different, though Oscar wasn't trained for this sort of work.

And what a weird sort of work it is, by the way. I mean, imagine sitting in a hospital room with a relative, who for years has been slowly disappearing, piece by piece, due to disease or age. Your loved one has been dying, from an identity perspective, for years, but now her body is shutting down, too. And all of a sudden this cat appears at the door—a cat who, you've been told, is only friendly to people about to die. Reminds me, in a morbid way, of that Cheers episode where Norm gets a job as the hatchet man for his company—his role is to tell people they're being laid off. At first he does it really well because he has empathy for these guys. He cries, tells them how sorry he is. By the end of the episode he can't even muster sympathy...and the punchline is him calling his boss, using a demonic voice. Ask not for whom the cat tolls; he tolls for thee.

Despite the plaque on the wall where Oscar works honoring him for his compassion, there could be some confirmation bias at work here. This is the phenomenon that accounts for so much of people thinking they're a wee bit psychic—we remember the times we thought something was going to happen and it did. We forget the times we got it wrong. Everyone reads miraculous stories about people who decide not to get on a plane at the last minute and then the plane crashes. You never see stories about people who op out of a flight...which then goes on to land safely.

The article says Oscar has "presided over the deaths of 25 patients at Steere House Nursing and Rehabilitation Center in Providence, Rhode Island." The author takes care of patients there. But there's no hard data on, like, how long Oscar has to hang out in a room before the nurses start calling family members. And how could there be? I mean, there's a lot of good research on how to give people a good death—pain management, comforting settings, informed consent as a road to patient dignity, etc. But why would you want to mount a study of how much time Oscar the cat spends at any given spot on the third floor of Steere House, and how well it correlates with patient time-of-death? So instead we get the memories of the people who work there, now predisposed to think that anytime Oscar curls up on a patient's bed, that patient's a goner.

But look: for all that, the article in NEJM made me cry. I'm a cat person myself, and I love the idea of a cat being there at the end. And if any force is strong enough to counteract grief, it's hope.

A Day in the Life of Oscar the Cat [New England Journal of Medicine]

A Nursing Home Cat that Senses When the End Is Nigh [Knight Science Journalism Tracker]

Lots of other stories