Respectful Insolence

The Kitty of Doom

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgToday, I’m leaving for The Amazing Meeting in Las Vegas. I can’t wait to get there. Believe it or not, I’ll even be on a panel! While I’m there I’ll probably manage to do a new post or two, but, in the meantime, while I’m away communing with fellow skeptics at TAM7, I’ll be reposting some Classic Insolence from the month of July in years past. (After all, if you haven’t been following this blog at least a year, it’ll be new to you. And if you have I hope you enjoy it again.) This particular post first appeared in July 2007.

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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 Hank
    July 8, 2009

    A wonderful blast from the past, thank you for this trip down memory lane.

  2. #2 Liz
    July 8, 2009

    You’re wrong Orac. It’s a well-known fact that cats steal souls. Oscar is just doing his job.

  3. #3 Greg
    July 8, 2009

    My cant freaked out exactly two weeks before the 89″ Earthquake in San Francisco she must have known it was coming, or at least thats how I remember it…

    I heard about this cat a while back and I admit I want to believe its true. I can see it being a possibility, a refined perception as part of the evolved hunting instinct. We know that animals can pick out the weak from a herd, only because of the cat’s life long experience with humans in hospice it now only displays when that human is really close to death.

    I would imagine that it would be pretty easy to see if this is a real phenomenon or just a coincidence. Just place a small GPS or RTD on the cats collar to track it’s habits, correlate the data with the patients over a couple of months and see what you find. If the cat is actually picking up on something then it should be pretty clear from the data.

    Meanwhile, keep that little bugger away form me… just in case.

  4. #4 LovleAnjel
    July 8, 2009

    I’m fairly certain that Oscar actually gives most of his attention to the person that fills his food bowl.

  5. #5 Greg
    July 8, 2009

    I’m fairly certain that Oscar actually gives most of his attention to the person that fills his food bowl.

    Maybe death sounds like a can opener, only really quiet…

  6. #6 King of Ferrets
    July 8, 2009

    No, Death isn’t personified as a cat, he’s an anthropomorphic personification. He likes cats, though.

    (Half a cookie and some cheese to whoever can guess what Death I’m talking about.)

  7. #7 dinkum
    July 8, 2009

    The House screenwriters based an episode on this. I think it turned out that the butler did it in the conservatory with the heating blanket.

  8. #8 Jerry Coyne
    July 8, 2009

    Of course you haven’t addressed the alternative hypothesis that Oscar is actually KILLING THE PATIENTS!

    I sent a note to the NEJM when this came out suggesting ways to test the hypothesis that Oscar is detecting incipient demise, but of course they rejected it . .

  9. #9 Coz
    July 8, 2009

    I’m heading to TAM tomorrow…yay.
    How will we know which panel you are on?
    Will you be going under Orac and wear a mask or will your identity finally be revealed?

  10. #10 Socrates
    July 8, 2009

    Wake up people!

    Orac’s been got at by the Dogs.

    More specifically, by the Canine Association for Information and Image Management International.

  11. #11 Art
    July 8, 2009

    Oscar has learned a neat trick. He has learned how to roll the nasal cannula delivering oxygen so that he can breath the sweet air. When people show up he just lets the cannula go and the elastic returns it to its normal position … on a dead patient.

    For his next trick he will learn to do a carotid massage and holding a crimp in an IV line.

  12. #12 Socrates
    July 8, 2009

    Wake up people!

    Orac’s been got at by the Dogs.

    More specifically, by the Canine Association for Information and Image Management International.

  13. #13 Angel
    July 8, 2009

    King of Ferrets @6: Is it from The Master and Margarita? Or it could be Discworld I suppose.

  14. #16 Rbiggs
    July 8, 2009

    In defense of the NEJM, Oscar The Cat was featured in a Perspective article, not a research article. The author was using Oscar’s story as a vehicle to shed light on elderly people who often die alone in nursing facilities. The article was included in an issue that included several hard-science articles about care for the elderly.

    As for Oscar himself – the article states that Oscar is not generally a very friendly cat, and does not typically seek out affection from patients or staff. Anecdotal, of course… but suggests that Nicholas Dodman’s proposed test might be worth a try.

    I have heard that EMTs often find that house cats have nibbled on their dead owners. Perhaps there is carrion feeding in the evolutionary history…?

  15. #17 Rbiggs
    July 8, 2009

    In defense of the NEJM, Oscar The Cat was featured in a Perspective article, not a research article. The author was using Oscar’s story as a vehicle to shed light on elderly people who often die alone in nursing facilities. The article was included in an issue that included several hard-science articles about care for the elderly.

    As for Oscar himself – the article states that Oscar is not generally a very friendly cat, and does not typically seek out affection from patients or staff. Anecdotal, of course… but suggests that Nicholas Dodman’s proposed test might be worth a try.

    I have heard that EMTs often find that house cats have nibbled on their dead owners. Perhaps there is carrion feeding in the evolutionary history…?

  16. #18 Matt M
    July 8, 2009

    Factual or not, I want to believe in Oscar. Does this make me a credulous person? I am opposed to the use of other forms of woo.

    The though of a cat curled up next to me as I pass is somehow comforting.

  17. #19 Anthro
    July 8, 2009

    This trend to keep animals in nursing homes is my worst nightmare. I have severe allergic asthma–even minimal exposure to cats sends me to the hospital. While this problem is not endemic, it is not rare; yet I’m seen as “eccentric” or “cranky” when I express alarm about cats being kept in public places such as shops in tourist towns. Sometimes I don’t see the cat right away–once it was a fabric store and I handled the fabric for a while and started to itch (first sign) before spotting the kitty. I do NOT hate cats; I love them–they are fascinating creatures and I would give anything not to be allergic to them, but if I arrive at the nursing home with dementia–well, I guess that’s okay because I don’t want to go on that way anyway.

  18. #21 Phoenix Woman
    July 8, 2009

    Cats are small predators that are always on the alert against larger predators, in addition to looking for food sources — especially those that are relatively easy to access (say, a sick/dying/feeble critter). When domesticated, the same things that help it to find food and stay safe in the wild might well be slightly repurposed. But yes, more study would definitely be needed.

  19. #22 shae
    July 8, 2009

    It seems possible that cats are sensitive to when people are depressed and feeling ill; pet owners report that kind of thing. Phoenix Woman’s point is a good one too — it seems there’s a fair amount of evidence that when “mean” dogs bite, they bite toddlers and sick people.

    But I agree that it’s also likely that it’s a coincidence, especially if no records are kept.

    What would be REALLY morbid, would be if it’s a self-fufilling prophesy. “Oscar’s in Miss Robinson’s room, no point in wasting food or medication on HER.” I’m sure no such misconduct occurred — just a sick little joke that crossed my mind.

  20. #23 TwoYaks
    July 8, 2009

    I liked how the House people handled it, in the TV show. Even well meaning doctors and scientists give into this sort of woo…

    Anyhow, to address whomever’s suggestion that maybe house cats were carrion eaters in the dim and distant past, this probably isn’t the case. Feliformes don’t tend to oppertunistically feed. But that’s just an educated guess.

  21. #24 Denice Walter
    July 8, 2009

    @ Anthro: breeders have created a virtually hypo-allergenic cat- it’s called the Sphynx and is (for all effects and purposes)*hairless*;however, it is somewhat odd looking.

  22. #25 katydid13
    July 8, 2009

    I feel like my cat can tell when I’m having a bad day or sick, but that’s probably just because it seems nice. If Oscar the cat doesn’t really like people perhaps he seeks out the nice warm people who are not likely to move, pet him or bother him in anyway. My cat were prefer it if I would just be still when he parks himself on me.

  23. #26 Death
    July 8, 2009

    @King of Ferrets

    I HAVE NO IDEA WHAT YOU’RE TALKING ABOUT.

  24. #27 King of Ferrets
    July 8, 2009

    @Death:
    Ah, someone got it! Great!

  25. #28 King of Ferrets
    July 8, 2009

    Oh, almost forgot: *gives half a cookie and some cheese*

  26. #29 Anthro
    July 8, 2009

    Denice Walker:

    Thanks, but that’s just not true. Hairless cats are just as likely to cause allergy as any other cat. The allergy is to a protein which is contained in saliva, dander (skin flakes) and urine–all of which are present in any cat. In fact, the hairless cats possible throw off more skin flakes because there’s no undercoat to keep it down. There are, however, individual animals that don’t cause allergic respose–I just haven’t found one yet and have suffered greatly in the process.

    Also, before someone advises me, antihistamines do little to help allergic asthma and the inhaler only helps a reasonably mild attack. I can’t even have allergy shots because they cause symptoms! I can’t even sit next to a cat owner on the bus! It really is a bummer.

    At any rate, I loved these comments.

  27. #30 Wehaf
    July 8, 2009

    I don’t know that I believe in Oscar’s alleged abilities, but they certainly seem plausible to me. If (some) dogs can accurately predict seizures, why couldn’t a cat predict death?

  28. #31 Death of Rats
    July 8, 2009

    SQUEEK?

  29. #32 Death of Rats
    July 8, 2009

    SQUEEK?

  30. #33 FreeSpeaker
    July 8, 2009

    Hmmm…32 comments already. I guess this proves the soon-to-be-old adage, Old Orac ios better than no Orac at all.

  31. #34 Rogue Medic
    July 8, 2009

    @30 Wehaf,

    If (some) dogs can accurately predict seizures, why couldn’t a cat predict death?

    Many patients experience sub-clinical symptoms prior to a seizure. This is known as an aura. They may see colors, smell something odd, or demonstrate some behavior that the dog picks up on.

    Some spouses are able to finish each other’s sentences. That does not involve the paranormal, but only familiarity. It certainly doesn’t mean that it is a match made in heaven.

    Selective memory explains a lot of what people believe is cause and effect. Full moons, Friday the 13th, saying slow or quiet to medical people, mentioning anything that would be bad if it happened, black clouds, white clouds, . . . all of these things (except working with the white cloud) are supposed to lead to more bad stuff happening. Research clearly demonstrates otherwise.

    If they really want to know what is happening, they need to have the cat sit down with a ouija board. How do we know what is going through the cat’s mind if we don’t ask? Gosh.

  32. #35 LovleAnjel
    July 8, 2009

    “when “mean” dogs bite, they bite toddlers and sick people.”

    From my cat:

    Lil peoplz loud and scary. Sicks peoplz smell funny. Ize must bites. kthanxby

  33. #36 Tim
    July 8, 2009

    I’ve seen cats give extra attention to depressed people, no clue what’s up with that, but where cat is, is civilization. And the occasional allergic reaction.

  34. #37 Wehaf
    July 8, 2009

    @ 34 – yes, I know all that. Don’t you think it is possible that in the hours before death some people undergo metabolic changes that, while not noticeable to people, might be noticeable to a cat, with its superior sense of smell? Or they display slight behavioral changes? Again, I don’t specifically believe in Oscar the death-predicting cat’s ability, but I find it plausible.

  35. #38 Wehaf
    July 8, 2009

    @ 34 – yes, I know all that. Don’t you think it is possible that in the hours before death some people undergo metabolic changes that, while not noticeable to people, might be noticeable to a cat, with its superior sense of smell? Or they display slight behavioral changes? Again, I don’t specifically believe in Oscar the death-predicting cat’s ability, but I find it plausible.

  36. #39 Rogue Medic
    July 8, 2009

    @37 & 38 Wehaf,

    Don’t you think it is possible that in the hours before death some people undergo metabolic changes that, while not noticeable to people, might be noticeable to a cat, with its superior sense of smell? Or they display slight behavioral changes?

    So why is this cat special?

    Why don’t other cats indicate that other people are on death’s door?

    I understand about the difference in the senses between humans and other animals. That would make sense, if we were trying to explain a general tendency of cats to curl up with the predead, but we are dealing with Super Kitty the John Edwards of cats.

    Did the cat train for years in medical school?

    Did the cat train with a voodoo priest dealing with undead zombies?

    Did the cat spend a few seconds with Jenny! McCarthy listening to her A mother just knows knowledge, before Jenny!‘s mind flitted off to some more shiny topic? After all seconds with Jenny! are more enlightening than years in medical school. If doctors are so smart, why does it take doctors so long to figure out what Jenny! just knows? She! doesn’t even have to think about it. It’s so obvious it’s Jenny! Obvious.

    Has this cat been on the cover of all of the cat fancier magazines? Has the cat had Botox and implants?

    Where does this fabulous feline acquire this ability?

    Or the more likely explanation. The observers of cat behavior in the nursing home are not all that observant of cat behavior.

    If it took 25 cases, don’t you think they would have started to do something to try to ward off the grim reaper a bit sooner. In some nursing homes, their reason to send the patient to the hospital is low pulse oximetry. Even if I get a reading of 98% when I get there.

    It will sound stupid, when I explain it to EMS, is not a valid excuse for not sending these patients to the hospital. They call the doctor, the doctor says send the patient to the ED, I arrive to transport, and another life is saved. ;-)

  37. #40 Wehaf
    July 8, 2009

    RM – I’m not sure why you are attacking me so strongly and sardonically. I don’t know why this cat, if it does have such an ability (something I have stressed I don’t necessarily believe), has it. I don’t know why other cats don’t (of course, most cats do not live in hospices and so are probably exposed to very few dying people). Can you tell me why most dogs can’t predict seizures, but some can? How about why most dogs don’t make good drug-sniffing dogs, even after training? Why are so few dogs good at detecting cancer by smelling the urine of patients? And what the fuck do quacks/idiots/charlatans like John Edwards and Jenny McCarthy have to do with any of this?

    All I am pointing out is that there are plausible mechanisms to explain this phenomenon, if it does exist.

  38. #41 Stella
    July 8, 2009

    From observing my own cats, I’ve made some conclusions that might be relevant.

    When a cat ‘comforts’ an owner who is sad or sick, it’s actually a hierarchy thing. You are the cat’s alpha, and if alpha is ill, this might signal a hierarchical change coming. The cat needs to know whether you are still fit to perform your alpha duties. Some cats look forward to the opportunity to supplant the alpha, and some would rather not. Either way, the possibility that you can no longer be alpha would mean the cat has a status change in the future. With multiple cats, the status change may involve a series of catfights until a new alpha emerges.

    (They still might eat your dead body… after all, cats have short memories, and when a new alpha is established, the cats are soon going to notice the huge slab of meat fortuitously sprawled on the floor. Cats don’t have much sense of, “Hey, this used to be someone I knew…”)

    As for Oscar… well, cats sleep around. There are two reasons cats sleep in multiple places; warmth and territory. If different spots are warm at different times, a cat may be inspired to shift spots frequently. Assuming for a moment that Oscar really is visiting nursing home residents hours before they die, the warmth hypothesis seems unlikely – dying people would be cooler, not warmer, I’d think. Therefore, territory. What Oscar may be doing is identifying the beds he thinks are likely to be vacated soon and claiming them proactively as his territory.

    I’m just throwing ideas out… I’m not claiming they’re great ideas or anything.

  39. #42 Anna Haynes
    July 8, 2009

    > Oscar is not generally a very friendly cat

    Perhaps Oscar is just expressing a preference for patients who don’t give him unwanted attention.

  40. #43 Joe B
    July 8, 2009

    The Cat was right, House.

  41. #44 pathgirl
    July 8, 2009

    @ king of ferrets… I thought it was Dream who liked cats?

  42. #45 Tsu Dho Nimh
    July 8, 2009

    You are the cat’s alpha, and if alpha is ill, this might signal a hierarchical change coming.

    If you change “alpha” to “food source” you might have something there.

  43. #46 King of Ferrets
    July 8, 2009

    @Death of Rats:
    Wow. Never thought of that before. What a thoughtful and amazing insight!

    @pathgirl: …don’t think dreams have an anthropomorphic personification in the setting I’m thinking of.

  44. #47 Anna Haynes
    July 8, 2009

    The previous (July 2007) Kitty of Doom post. Favorite comments:

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

    A shot of a potent [feline] allergen would no doubt hasten death.

    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.

    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.

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

    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.

    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.

    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.

  45. #48 Gruesome Rob
    July 8, 2009
  46. #49 Scrabcake
    July 9, 2009

    The article doesn’t actually say whether these people were making noise at all at the time of their deaths. From personal experience, which doesn’t really count for a whole lot, when my younger sister would get in a teen-angst broodathon and throw herself down on the bed sobbing, the cat would always follow her into the bedroom, sniff her face and howl. I think there was some sort of distress on the cat’s part that the person she was attached to was upset.
    I don’t think that it’s far fetched that an animal could have a vague impression that something was amiss from sensory clues.

  47. #50 alison
    July 9, 2009

    @ 47: well, from things some folks have occasionally said, some round here read Terry Pratchett :-) Cat… death… DEATH… cats :-)

  48. #51 Mark P
    July 9, 2009

    Maybe the Oscar likes a nice warm bed, but prefers people who don’t twitch? People who don’t shoo him off, or try to stroke him?

    I’ll go for confirmation bias myself though.

  49. #52 MadScientist
    July 9, 2009

    If the kitteh had a high associated fatality rate, I’d be wondering what parasites it was giving to the victims. Then again, the kitteh could be the devil in disguise and it’s stealing the life force of those victims … Yeah, I’ll go for the demonic explanation; I think I saw it in a Hammer movie.

  50. #53 Another Greg
    July 9, 2009

    Completely off topic…

    Reading this post on the heels of the one about the woman who let her Autistic son die of cancer, I couldn’t help but think of this book: http://www.amazon.com/All-Cats-Have-Asperger-Syndrome/dp/1843104814/ref=sr_1_1?ie=UTF8&s=books&qid=1247166513&sr=1-1

    :)

  51. #54 Rogue Medic
    July 9, 2009

    @40 Wehaf,

    I’m not attacking you, but the concept.

    Why is this the one cat in the world with this magical ability.

    If it isn’t magical, why don’t other cats have it.

    As for dogs, different species probably have different abilities. Dogs certainly have much more perceptive noses than humans.

    I suspect that the dogs are trained to recognize signs of a seizure, the same as other guide animals are trained as guide animals.

  52. #55 Scrabcake
    July 9, 2009

    Well, firstly, I don’t think there are many cats in clinics for terminal dementia, so there aren’t many cats in a position to be studied for this ability. The sample population of cats in this circumstance is too small to be able to say definitively that other cats do or don’t have this ability. I don’t think it was ever implied that Oscar was unique.
    Secondly, Greg on the off chance you were serious about oscar giving people parasites, I think it would probably take those people a little longer than a few hours to die if they were dying of toxoplasmosis, etc.
    This seems like it was simply a fun little story and a reminder that there is still much in this world to be understood and studied. This is all probably a result of bad observation or coincidence, but unlike dilution (homeopathy) or reiki, we don’t know a whole lot about what animals think about or what they can or can’t perceive, so we can’t dismiss it as complete woo out of hand. There is a small chance that it is true, and isn’t it the province of the scientist to look a little closer?

  53. #56 Wehaf
    July 9, 2009

    Most dogs that begin training to become drug dogs, seizure dogs, guide dogs, search and rescue dogs, etc. do not end up making it through. And these are dogs that have been preselected. This is because different dogs have different abilities; not all dogs are capable of being seizure dogs, in fact, very few of them are. The same goes for people; why isn’t everyone in the world a perfumier or sommelier? It is because it takes magic to be a sommelier? No. Duh. Why isn’t everyone an Olympic sprinter? Sprinting must be magic, therefore it doesn’t exist!!!

    The idea that a cat might be able to sense something reasonably specific to dying people is not far-fetched.