Oscar the cat makes his grand entrances just as life is about to leave.
A hop onto the bed, a fastidious lick of the paws, then a snuggle beside a nursing home patient with little time left. Oscar's purr, when keeping close company with the dying, is so intense it's almost a low rumble.
"He's a cat with an uncanny instinct for death," said Dr. David M. Dosa, assistant professor at the Brown University School of Medicine and a geriatric specialist. "He attends deaths. He's pretty insistent on it."
In the two years since Oscar was adopted into the third-floor dementia unit of the Steere House Nursing and Rehabilitation Center in Providence, he has maintained close vigil over the deaths of more than 25 patients, according to nursing staff, doctors who treat patients in the home, and an article in tomorrow's New England Journal of Medicine, written by Dosa.
When death is near, Oscar nearly always appears at the last hour or so. Yet he shows no special interest in patients who are simply in poor shape, or even patients who may be dying but who still have a few days. Animal behavior experts have no explanation for Oscar's ability to sense imminent death. They theorize that he might detect some subtle change in metabolism -- felines are as acutely sensitive to smells as dogs -- but are stumped as to why he would show interest.
"It may just come down to empathy," said Dr. Nicholas H. Dodman, a leading behaviorist and professor at Tufts University's Cummings School of Veterinary Medicine, when told about Oscar's eerie knack.
In any event, when Oscar settles beside a patient on the bed, caregivers take it as sign that family members should be summoned immediately to bid their loved one farewell.
"We've come to recognize him hopping on the bed as one indicator the end is very near," said Mary Miranda, charge nurse in the Safe Haven Advanced Care Unit, the formal name of the surprisingly cheery floor that is home to 41 patients suffering in the final stages of Alzheimer's, Parkinson's, stroke, and other mentally debilitating diseases. "Oscar's been consistently right."
Said Dosa, who treats patients at Steere: "This is a cat that knows death. His instincts that a patient is about to die are often more acute than the instincts of medical professionals."
Oscar's tale is emphatically not one about people dying alone and neglected, with only an animal for company. The Steere staff has a reputation among geriatric professionals for dedication, compassion, and top-notch care. The center is sunny, clean as, well, a cat's whiskers, and filled with antique furniture, flowers, and nature prints that impart the feel of a cozy country home.
"Caregivers are always there trying to make the patient comfortable until the very end," said Brenda Toll, a registered nurse and unit manager. "But Oscar's a component of dying... It's kind of weird, but kind of lovely. He's become part of the death ritual, along with lowered lights, aromatherapy, and gentle music.''
Keeping pets has been a trend in nursing home care for several years. The Steere Center, founded in 1874, has 120 residents, plus six cats, a slew of parakeets and a floppy-eared rabbit.
Oscar's sole domain, however, is on the locked dementia ward. He came to the unit as a kitten in July 2005, brought by a staff member to replace the floor's previous resident feline, Henry, who had died some months earlier.
A gregarious cat, quick to solicit ear scratches from a visitor, Oscar can be clownish at times. "Just go and try completing a medical form when Oscar's near enough to whap the pen," laughed Dr. Joan M. Teno, professor of community health at Brown and associate medical director of Home & Hospice Care of Rhode Island, an agency specializing in end-of-life care.
But it is Oscar's keen sense of impending death, not his occasional kittenishness, that has made the mixed-breed cat legend.
"Medical people are skeptical at the start. But you wind up believing," said Teno.
"Oscar is a normal cat with an extra-normal sense for death," she said. "He is drawn to death. Either he wants to give comfort. Or he is just attracted to all the quiet activity that surrounds a patient close to dying.
"As a scientist, I want to offer a biological explanation for this," she said. "But I can't."
Occasionally, families are spooked by a cat keeping death watch. And their wishes trump Oscar's. The cat is shooed from the bed and locked from the room. Oscar doesn't like this.
"He kind of rubs aggressively against the door, paces back and forth, yowls in protest," said Teno.
Other families are deeply appreciative of Oscar.
Jack McCullough of East Providence lost both his mother and aunt at Steere; the octogenarian sisters, suffering from disease-induced dementia, shared a room. Marion, his mother, died in November 2005; Aunt Barbara died on March 9 of this year.
In both cases, Oscar predicted death: Hopping onto each woman's bed near the final hour. Cuddling close and purring.
"Oscar's presence gave a sense of completion and contentment," said McCullough. "Both women loved pets."
He added: "The staff was wonderful. But Oscar brought a special serenity to the room. What's more peaceful than a purring cat? What sound more beautiful to fill one's ears when leaving this life?"
And as with any feline, a hefty portion of Oscar's days are given to zzzzs. He likes to sleep on stacks of patient reports. Or on the desk at the nurses' station. Or in the linen closet.
When awake, however, and strutting about, Oscar the cat projects something very much like the quality that ancient Romans called gravitas -- a solemn dedication to duty.
"He seems to take very, very seriously what he does, for whatever reason he does it," said Dosa.
Oscar makes regular "inspection" rounds of the unit, sauntering in and out of patient rooms -- as if checking on the condition of the occupants. But he never joins them for a snooze.
"He only shows great interest in individuals when they are about to die," said Dosa.
Dodman, the Tufts professor, was puzzled by Oscar's death fixation. "Sounds like a pretty scary cat -- I'm surprised people don't hold up crucifixes when it enters a room," he said jokingly, referring to the belief that a Christian cross will deter vampires.
But Dodman, author of "The Cat Who Cried for Help: Attitudes, Emotions, and the Psychology of Cats" and other bestselling books on animal behavior, said felines don't deserve their reputation for indifference.
"There are just so many stories of cats who sense when their person is sick, and how the cat will show special attention to them," he said. "Cats give comfort and affection as much as they take comfort and affection.''
As for Oscar, Dodman said, "perhaps [he] senses some change in the metabolism or mental aura of the dying person.''
Meanwhile, Oscar is surely the only cat to have won official recognition for his dedication to the dying.
At the entrance to the dementia unit hangs a plaque from a hospice organization saluting Oscar "for his compassionate quality end-of-life care."