Respectful Insolence

The Kitty of Doom

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This sort of thing makes one wonder if the personification of Death should in fact be a cat, although, oddly enough, not a black cat:

Oscar the rescue cat is not simply a welcome feline companion at the Steere nursing home in Providence, Rhode Island. According to a new report in a medical journal he has a remarkable, though morbid talent – predicting when patients will die.

When the two-year-old grey and white cat curls up next to an elderly resident, staff now realise, this means they are likely to die in the next few hours.

Such is Oscar’s apparent accuracy – 25 consecutive cases so far – that nurses at the US home now warn family members to rush to a patient’s beside as soon as the cat takes up residence there.

“He doesn’t make too many mistakes. He seems to understand when patients are about to die,” said David Dosa, an expert in geriatric care who described the phenomenon in the New England Journal of Medicine.

To me this just looks like a load of confirmation bias. Probably what happened is that the cat happened to curl up near a patient who just happened to die within a couple of hours. After that, the staff were on the lookout and now they notice it. It’s the same reason that, even though there is no evidence that craziness, injuries, or crime are any more frequent during nights of full moons, there is the persistent myth among emergency room staffs, police, EMS drivers, etc., that they’re busier during full moons.

In fact, look at this excerpt from the story, pulled straight out of the New England Journal of Medicine:

Oscar decides to head down the west wing first, along the way sidestepping Mr. S., who is slumped over on a couch in the hallway. With lips slightly pursed, he snores peacefully — perhaps blissfully unaware of where he is now living. Oscar continues down the hallway until he reaches its end and Room 310. The door is closed, so Oscar sits and waits. He has important business here.

Twenty-five minutes later, the door finally opens, and out walks a nurse’s aide carrying dirty linens. “Hello, Oscar,” she says. “Are you going inside?” Oscar lets her pass, then makes his way into the room, where there are two people. Lying in a corner bed and facing the wall, Mrs. T. is asleep in a fetal position. Her body is thin and wasted from the breast cancer that has been eating away at her organs. She is mildly jaundiced and has not spoken in several days. Sitting next to her is her daughter, who glances up from her novel to warmly greet the visitor. “Hello, Oscar. How are you today?”

Oscar takes no notice of the woman and leaps up onto the bed. He surveys Mrs. T. She is clearly in the terminal phase of illness, and her breathing is labored. Oscar’s examination is interrupted by a nurse, who walks in to ask the daughter whether Mrs. T. is uncomfortable and needs more morphine. The daughter shakes her head, and the nurse retreats. Oscar returns to his work. He sniffs the air, gives Mrs. T. one final look, then jumps off the bed and quickly leaves the room. Not today.

Making his way back up the hallway, 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.

As I said, this looks like nothing more than confirmation bias. Of course, it is possible that the cat somehow senses something common to people who are within hours of death, but to determine whether this is indeed the case, at the very minimum, as Phil Plait points out, this is what we would need to know:

Nicholas Dodman, who directs an animal behavioral clinic at the Tufts University Cummings School of Veterinary Medicine and has read Dosa’s article, said the only way to know is to carefully document how Oscar divides his time between the living and dying.

And that is a question that has not been looked at systematically. It probably never will be, given that no one seems particularly interested in knowing whether Oscar is really detecting impending death or something related to impending death (such as more attention to the patient or simply, as Dodman put it in his comments, more warm blankets placed on dying patients), or whether this is just a classic case of confirmation bias.

Of course, what’s really disturbing is how such a foolishly credulous bit of “human interest” was published in the New England Journal of Medicine in the first place. This sort of stuff belongs in the Weekly World News, not in the NEJM.

Comments

  1. #1 Jeb, FCD
    July 27, 2007

    I believe.

    Cats would eat us if they could. It probably makes the kitty feel good to be there for the last few beats of the heart. It probably warms the kitty’s evil soul to suck the remaining life out of the pre-morbid.

  2. #2 Niobe
    July 27, 2007

    People dying in nursing homes, you say?

  3. #3 Richard Carter, FCD
    July 27, 2007

    Definitely confirmation bias, if the interview with one of the senior staff in the nursing home on BBC radio last night is anything to go by: at one point, they thought someone was about to die when the cat wasn’t there, so they rushed out to fetch the cat “so it wouldn’t break its streak”.

    Of course, the cat then realised that the person wasn’t about to die and left – only to return a few hours later, just before the old dear passed away.

    Forget ‘Oscar’, this cat should be named Shipman.

  4. #4 sailor
    July 27, 2007

    Having that cat snuggle up could be considered a CATastrophe

  5. #5 Nan
    July 27, 2007

    Well, predators supposedly have a knack for targeting the weak members of a herd. Maybe Oscar really is sensing that someone is about to become carrion and figures it’ll be an easier lunch than waiting for someone to fill the kibble bowl.

  6. #6 Rob Knop
    July 27, 2007

    Uh oh… my cat was sleeping next to me last night.

    Nice knowing y’all.

  7. #7 daedalus2u
    July 27, 2007

    It may be that the presence of the cat hastens death.

    On the one hand, cats lick themselves, their saliva has active proteases, which are why cats are so allergenic for some people. Proteases are quite allergenic because virtually all infectious agents have proteases (they need them to digest proteins). A shot of a potent allergen would no doubt hasten death.

    One the other hand, if the staff and residents think that this cat predicts who will die, that belief may be what kills the patients. The staff may withold treatment, be less aggressive in ressusitations, not give that last dose of expensive medicine so it doesn’t go to “waste” because the person is going to die. If the patients recognize that the staff has “given up” on them, that may kill them too.

  8. #8 G Barnett
    July 27, 2007

    Probably is confirmation bias, but at least in this case, it’s relatively harmless. Gives a little psychological comfort to the other residents there with the thought that they’ll have a furry companion at the end, and that’s not a bad thing at all.

    They just need to find a way to dress him in a little black robe, give him a tiny scythe, and call him the Grim Rea-PURRR.

    (and if they find bed space running short, they can always whisper in his ear, “Faster, pussycat! Kill! Kill!”)

  9. #9 mark
    July 27, 2007

    Doubtless the patients heard about this cat, and whenever it curls up next to one that person figures “Oh noooo! It’s come for me!” and dies of fright.

  10. #10 cserpent
    July 27, 2007

    Yep, sounds like confirmation bias to me. Another explanation may be that, like many cats, Oscar doesn’t like his bed to move around and poke and prod him too much. Someone a few hours from death may lie rather still compared to a healthier patient.

  11. #11 AnnR
    July 27, 2007

    Someone else suggested that the dying emit a odor too subtle for humans.

  12. #12 PuckishOne
    July 27, 2007

    This confirms my bias that says dog owners live longer. ;) Besides which, I couldn’t think of a good cat joke that hadn’t already been taken.

  13. #13 Clare
    July 27, 2007

    Cute story, but some important information is missing. For example, what are we to make of the statement that “[h]e doesn’t make too many mistakes”? Well, how many? And what kind of mistakes are we talking about? People who die when the cat is missing? People who are still alive after he’s settled in and later left? And how were those “mistakes” mixed in with his “25 consecutive deaths so far”? Or weren’t they?

  14. #14 Skeptyk
    July 27, 2007

    So, Oscar gave Mrs T his cat-scan and dx: “Not today”

    Then he went to Rm 313. Aha! palindromania and triskedecaphobia! Maybe the room killed her. I will bet other people have died in that room, too. Spooooky.

    The cat “turns around twice” before curling up. Did he turn widdershins or deosil? That may be the key right there. The sinister (to the left, counter clockwise, widdershins) circle may be part of his ritual to ease the person to Summerland.

    And the town is called “Providence” Whoa, dude, I’m getting a chill here.

    And the cat is a eunuch, just like so many eunuchs in history, where the loss of knackers is supposed to aid shapeshifting and make one more fit for special vocations, such as religion and art.

    I could go on with these suggestive patterns, but I am making the point that we humans see patterns and significance and “meaning”, even when – maybe especially when – they are not there. Confirmation bias and a desire to find “meaning” and affinity for storytelling, especially tales that involve death and woo-woo and small animals.

  15. #15 Non cat lover
    July 27, 2007

    Hmm. Confirmation bias? Statistical anomaly?

    Or is someone in the nursing home easing those patients the cat visits into the hereafter?

  16. #16 Joseph
    July 27, 2007

    Dogs can be trained to smell cancer, so this doesn’t strike me as entirely implausible.

    But a likely explanation is that the nurses are the ones who pretty much know when a patient is about to die and the cat is getting cues from them.

  17. #17 Clark Bartram
    July 27, 2007

    You beat me by 14 minutes:

    http://theclayexperience.blogspot.com/2007/07/cats-part-ithe-grim-specter-of-death.html

    How about this scary thought that I bring up in my post. What is more likely? That this cat can acurately sense oncoming death or that this is a case of a self-fulfilling prophecy. Might the patient care be altered by the fanatical belief that a patient is a lost cause? The most likely explanation is of course that the cat does not accurately predict death but is a victim of the human minds inability to not find patterns amongst the random sensory noise of life.

  18. #18 wolfwalker
    July 27, 2007

    Dogs can be also be trained to detect incipient episodes of hypoglycemia in diabetics. And I think I’ve heard of dogs that can detect the initial signs of epileptic seizures, too. I don’t think it’s out of the question for either a dog or a cat to become sensitized to some subtle combination of odors that signal death approaching.

    That said, however, I’d want more than anecdotal evidence that this cat can do it. At the moment, anecdotes is all I see.

  19. #19 anonimouse
    July 27, 2007

    Dude, nobody is applying Occam’s Razor here.

    This cat *is* the Grim Reaper.

  20. #20 Alan Kellogg
    July 27, 2007

    It’s a unique dynamic between cats and people. Cats see us as parental figures. We see cats as infants. We both make compromises, but still we make errors and misunderstand.

    People who are dying smell differently, they behave differently. Cats pick up on that. So do dogs. It’s sort of like the person is getting ready to let go, and when he is ready he dies. In Oscar’s case he may be picking up on that, and is keeping them company for a bit until they do die. Sort of his way of saying goodbye.

    There’s a lot more to human-cat relations than most people think, and Oscar is showing us how complex it can get.

  21. #21 Clark
    July 27, 2007

    Stop anthropomorphizing cats! They hate that.

  22. #22 Jeb, FCD
    July 27, 2007

    Alan Kellogg,

    Cats see us as food. The sane among us see them as annoyances, or vermin catchers at best.

  23. #23 Bob O'H
    July 28, 2007

    Hmm. Confirmation bias? Statistical anomaly?

    A bit of both? I wonder how many nursing homes there are in the Western world that have cats. Probably enough that the one will have a cat that behaves in a way that can be interpreted like this.

    It’s a nice looking moggy, though.

    Bob

  24. #24 Science Avenger
    July 28, 2007

    Sounds like we need someone to put a GPS on the cat’s collar, and call EMS whenever he stays put too long.

    Seriously, my actuary’s heart screamed confirmation bias the minute I saw the story. Niobe hit the nail on the head. Reminded me of an old line by Carl Sagan about the Bermuda triangle, praphrasing from memory:

    “Of course ships and planes vanish ‘without a trace’. They are over water. Now if we had trains disappearing in the Duluth triangle, THAT would be news.”

    Let’s put the cat in the general populace and see how good its predictions are.

    And Jeb, its their ruthlessness and independence, especially relative to those plodding slobbering canines, that gives cats their appeal to those of us that love them.

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  26. #26 trrll
    July 28, 2007

    Could be confirmation bias, but if they’re actually starting to call families to come when the cat gets in the bed, it would be hard to forget the failures. Cats (and dogs) exhibit all sorts of “psychic” behavior. Very common are pets who seem to “know” when the owner is coming home when he is a block away. The pet who can tell from the other end of the house when you are getting a can of food out of the cabinet. Most can be explained by picking up on subtle sensory cues that people don’t notice, combined with simple positive reinforcement.

  27. #27 Jon H
    July 28, 2007

    Clark wrote: “Might the patient care be altered by the fanatical belief that a patient is a lost cause? ”

    Given the short time between cat onset and expiration, I don’t think they could withhold enough treatment to really make a difference. Even if food and water is withheld it takes hours or days. These are people at the end of their lives, with the staff probably already instructed (by family) to not undertake heroic measures..

    It would be different if, say, it was a pediatric oncology unit.

  28. #28 marion
    July 28, 2007

    Could this merely be confirmation bias? Sure, but it’s a fact that cats and dogs have a much more refined sense of smell (for example) than humans, which is why you see bloodhounds, not humans, following scents to track people. If dogs can be trained to detect upcoming seizures in humans, presumably using changes in those humans’ smell, I see no reason why the occasional cat couldn’t smell a change in humans who were about to die. (And I know for a fact that dogs are trained to do this – I personally know of at least one dog who fills this exact role.) The Washington Post had a discussion with the doctor who wrote up the story; he showed no sign of believing that the cat had any sort of mystical knowledge of the universe, attributing it instead to the animal’s heightened senses.

    For those suggesting that allergies or fright may be killing the patients – they’re all in end-stage dementia. Their brains aren’t functioning enough to understand something along the lines of, “There is a cat next to me. That cat signals death. I am about to die.” And the ones that the cat curls up next to – his “sign” of imminent death – are so far gone that their immune systems aren’t reacting to much.

    Cats and dogs have found their way to their owners in bizarre, inexplicable situations; my family had a cat who somehow did just this (and yes, it was definitely the same cat). Cats and dogs can sense things that humans can’t. We have the edge in terms of complex thoughts, pure bodily strength (when it comes to cats, anyway), and opposible thumbs. There are many, many things that humans can do that cats and dogs cannot, and there are some things that dogs and cats can do that humans cannot. All of these people are basically dying in the same way – from gradual bodily deterioration caused by age and illness. I don’t have a hard time believing that, when an human body begins its final shutdown in that situation, its odor changes in a distinctive way that can be identified by a creature with a better nose than my own. I’m not saying that MUST be the case here, but I’m not sure why it should be SO outrageous as to not be possible. My cats show no interest in carrots and celery, but if they could curl up among many cans of tuna, they’d do it.

  29. #29 Jon H
    July 28, 2007

    Oh, also, I think it’s simply due to some faint odor given off by the soon-to-be deceased – perhaps some of their organs have already shut down somewhat, causing a slight change in body chemistry? (total wild guess, there)

    Being a nursing home, I doubt the patients would be monitored by the full gamut of sensors, so something subtle might go unnoticed.

    One test would be to arrange for there to be negative air pressure in all the patient rooms, so that no odors were able to enter the hallways. The cat would probably start choosing patients more randomly then, and might give up interest altogether.

    Another, ethically objectionable, test would be to let the cat be alone with the patient after his or her death for a good long while, to see if it’s really after a meal but normally gets chased out or leaves due to the commotion.

  30. #30 Jon H
    July 28, 2007

    Actually, I wonder if there is a case of unreported decedent-face-snacking in this nursing home’s past.

  31. #31 Orac
    July 28, 2007

    I admit the possibility that there may be some odor given off by the nearly dead that attracts this cat. (Of course, there is no evidence other than anecdotal that this cat even spends more time curling up with those near death than with those not–which to me is confirmation bias until proven otherwise,) Given this concept, though, I have to wonder why we don’t see evidence for dogs doing this. After all, dogs have a much more acute sense of smell than even cats; so if this were true, one would expect that dogs would be more sensitive to it than cats.

  32. #32 daedalus2
    July 28, 2007

    One of the early symptoms of essentially every kindn of shock, is profuse sweating. This is (according to my nitric oxide bacteria hypothesis) to release ammonia onto the skin so as to generate NO and nitrite with the biofilm that is “supposed to” be there (i.e. has been there on every single human ancestor for the last 100+ million years, (except for the last couple hundred years when bathing removed it).

    Presumably that happens in the terminal phase of life too.

    That terminal phase sweating would certainly be detectable by odor, especially by a carnivore.

  33. #33 Jon H
    July 28, 2007

    “Given this concept, though, I have to wonder why we don’t see evidence for dogs doing this.”

    I think there probably are stories of dogs’ interactions with the sick and dying, and others have noted them being trained to sniff out illnesses.

    I think it’s just unusual to have a dog (or cat) in a nursing home with a high frequency of deaths. (Having to walk a dog probably makes them a poor match for that environment.)

    In the typical story, you’d have a dying person visited by their own dog/cat which would likely be interpreted as being due to their attachment to their keeper, and sensing that person’s distress, etc. Sprinkly woo liberally to taste.

    In this case, there’s a resident cat at a nursing home, showing up for the dying moments of people it probably hasn’t known long. It may very well have the same root explanation as the other stories of people and their own pets, but Oscar stands out due to his environment.

  34. #34 William The Coroner
    July 28, 2007

    I don’t know. I’ve seen companion animals comfort upset people. They may be responding to cues from the nurses, or the humans, or the smell. One of my cats acts differently when people in the house are upset. Of course, could be conformation bias, or the desire to believe.

    Personally I kind of like the thought of a cat as a spirit guide. Kinda puts one in the eye of the folks who sneer at the souls of animals. I realize this will cost me my skeptic credentials, though.

  35. #35 William The Coroner
    July 28, 2007

    I don’t know. I’ve seen companion animals comfort upset people. They may be responding to cues from the nurses, or the humans, or the smell. One of my cats acts differently when people in the house are upset. Of course, could be conformation bias, or the desire to believe.

    Personally I kind of like the thought of a cat as a spirit guide. Kinda puts one in the eye of the folks who sneer at the souls of animals. I realize this will cost me my skeptic credentials, though.

  36. #36 marion
    July 28, 2007

    Orac: It’s entirely possible that dogs smell the “scent of death” on humans, but just don’t find it strongly appealing. I’m sure my cats can smell, say, broccoli more vividly than I can, but they aren’t attracted by that scent in the slightest. I have one cat who likes to re-live kittenhood by burying her face in my hand; perhaps something in the scent of those dying reminds Oscar of being with his mother and litter. Or perhaps he’s just drawn to the smell the way I am to the scent of oranges. And, as others have said, dogs are trained to sniff out things such as seizures. I bet you could train a dog to sniff out death, but dogs tend to have less freedom of movement than cats, both because they’re larger and because they can’t jump as well.

    As for the staff not noticing when Oscar curls up with the non-dying…apparently he’s not a very friendly cat unless you 1) have food in your hand or 2) are dying. He obviously doesn’t go around swiping everything with claws, or else he wouldn’t have lasted long inside the nursing home, but he resists petting, cuddling, etc. I THINK (but could not swear for sure) that he sleeps cooped up somewhere at night. That having been said, it’s entirely possible that the staff just isn’t noticing something, true.

    “It may very well have the same root explanation as the other stories of people and their own pets, but Oscar stands out due to his environment.”

    Good point, Jon H. Also, there’s the fact that all of these people are dying in the same way – the cat is in a terminal dementia ward. It’s not as though Oscar runs around town “predicting” the deaths of fifteen-year-olds from bike accidents and twenty-five-year-olds from gang fights. We’re talking about a situation in which the process of death – the smells, the actions, etc. – would be very, very similar every time. Animals do tend to pick up on certain behavioral patterns every time (which is why one of my cats now meows, expecting food, when she sees me about to leave the house – long story). I don’t mind the idea of a cat as a spirit guide, but I really think this is just the equivalent of my cats curling up in my suitcase whenever I’m packing for a trip, but serving an actual practical purpose.

  37. #37 Robert Madewell
    July 29, 2007

    You know, I don’t doubt the cats ability at all. Cats most certainly do not possess any psychic ability. What they do possess is a keen sense of smell. I wouldn’t be suprised that Oscar is smelling something that humans cannot. Maybe he likes the smell a dying human has. Wouldn’t suprise me if there are dogs that do it too.

  38. #38 Inquisitive Raven
    July 29, 2007

    I know of at least one cat that’s certified to detect seizures. It, and its human are regulars in the Darkover Dealer’s Room. AFAIK, it figured when its human was about to have a seizure on its own.

  39. #39 sara
    July 29, 2007

    When my grandmother entered the final stage of her illness, her doctor told my father, “If you ask me when someone is going to die, I can’t tell you how many weeks, or how many days. But when you ask me how many hours someone has, I’m almost always right.”

    It sounds like Oscar is in the “hours” category of prediction, and while I’m usually pretty skeptical, I think its fully possible that something about the earliest stages of organ shutdown is detectable by animals, probably based on smell.

    Its not like he’s picking his victims days in advance and stalking them. He curls up next to the dying in their last few hours. Feasible.

  40. #40 Nan McIntyre
    July 30, 2007

    The cat is resident in a place where dying is inevitable.
    Nursing’s better exponents are adept at signs and signals, as a previous comment observes, and I am sure that the staff don’t need cat behaviour to confirm their own expert observations; they are with the dying all the time.

    However, the interposition of a furry fourlegged familiar in the dreary work of watching and comforting both the dying and their relatives as life’s flame sputters is a forgivable myth to feed inside the nursing home; it relieves staff of the direct pang of calling relative’s attention to a person’s final hours, and of the more indirect stigma of being too certain of when the last breath is due. Nobody really wants to be called a ghoul.

    For the rest of the business of providing a composed corpse for those relatives too late for the last breath, nurses are not unfamiliar with the ability of an external heat source – or at least insulation – to slow down the cooling of the body, and it’s as likely that Oscar’s comfort-seeking, but people-averse nature (reported in the NEJM paper and in a couple of popular press articles) was easily shaped to distinguish those beds with least occupant activity and therefore most warmth to be anticipated, as it is that Oscar is attracted by some more complex combination of senses.

    My sister, a nursing sister of around 35 years experience, typically of most who work with pain and death all their lives, was quick to suggest that there may be a shortage of beds in the facility and Oscar was a godsend for helping with a good turnover timetable management!

    Give the staff a break and leave speculation on a feelgood story to a minimum.
    I agree that it’s a shame that a serious medical journal runs this kind of dreck, but it’s not exactly the thin end of the wedge; the benefit of pet ownership to the health of older people has been touted in similar circles with as little good population analysis.

  41. #41 Jim Lemire
    July 30, 2007

    maybe, when no one is looking, the cat pounces the poor helpless patient and pulls out the IV…

  42. #42 kw
    August 19, 2007

    Does the cat ever curl up on the staff’s laps? And if so, how many have died in horrible car accidents etc. within hours of the incident? None? But a cat curls up next to a dying woman and within half an hour a priest is called to perform the last rights? Hell, I’d give up too, I mean, would you want to disappoint the priest and family once they’ve decided that it was your time to die?