In the world of oncology (cancer), hospice, palliative medicine, and the intensive care unit, there is a responsibility for us medical professionals to patients and families to outline prognosis within reason. In other words, we are asked how long someone will live with a certain disease, and that response is uncomfortably inaccurate because we simply do not know.
Most patients and families do understand that this is a very inexact science, and most are reasonable in their understanding. But there is tremendous value in sharing with patients and families from our clinical experience and from population-based studies how long a patient may live.
Why is this outlook important? Such understanding allows the work of dying to take place: fences can be mended, relationships can be healed, and the unspoken becomes spoken for some patients and families. It may be a time of peace and reconciliation. A time to connect the dots, to close the files, and to slowly move on.
So how does this prognostic scenario play out? Let us look at the rest of the story.
Medical education is being transformed from the traditional face-to-face auditorium environment to online platforms where thousands of healthcare professionals can participate in an educational activity by simply using a smartphone. COVID has moved one of my bimonthly palliative medicine programs online.
A recent session focused on the review of dozens of sometimes complex, clumsy, and time-consuming algorithms to estimate survival. Companies have weighed in with machine learning and artificial intelligence to fine-tune prognosis.
But none of these can take the place of Oscar.
Oscar the cat was born in 2005 and was adopted by a nursing and rehab facility in New England. Oscar was a solitary, independent creature who would aimlessly wander throughout the facility almost invisible to the staff and the patients.
He was low maintenance. A bowl of water and some food was all he needed. But he provided an invaluable service. And his job description was documented in the New England Journal of Medicine—one of the most prestigious medical journals in the world.
Oscar had the gift, the power, the presence to appreciate when death was near. Oscar would jump onto the bed of a dying patient, curl up, and cuddle. With almost supernatural certainty, that patient would die within a day or two.
On a recent Zoom meeting where I was a speaker, it was astonishing how many of the participants—many of them hospice and palliative care directors—chimed in with a similar story. The name of the little creature was different, but the story was the same. This is an example of the powerful animal-human bond.
Oscar could somehow “feel” the energy and emotion, or some attribute of a patient that would signal that death was near.
To be fair, cats are not alone in this super power.
A beloved friend and neighbor is a professional woman in her late fifties who took a leave of absence to care for her dying father. His was a difficult transition, but this was a challenge that our friend needed to address. Part of the household was a four-year-old mixed breed dog, who was never a candidate for the Westminster championship in Madison Square Garden.
One evening I accompanied our hospice nurse to the bedside of the patient so we could address some medical and psychological issues. As the visit wrapped up, the family’s furry friend jumped on the bed.
The hospice worker stopped in her tracks rather than leaving and sat down at the kitchen table.
“You know what this means?” she said.
The family was dumbfounded so the nurse explained that in her thirty-five years of experience when the pet would not leave the bedside, and the pet would be physically with that patient, death would typically occur within a day or two. And that is exactly what happened in this case. And in many others. You may know of some yourself.
We simply cannot understand certain medical circumstances. So we accept the reality, we move on as best we can, and we recognize that there is a predictability and a prognosis estimator far better than machine learning or artificial intelligence: Oscar the cat.