the facility. On some days he would simply walk into the elevator, curl up in the corner, and ride between floors all day long, going up and down hundreds of times.
“Do you know there is a cat just sitting in the corner of your elevator?” visitors would ask.
The staff would respond with a smile and gentle reassurance that it was just “Henry being Henry.” In truth, many members of the staff had privately started to wonder if Henry had developed dementia like so many of the human residents he lived with. Increasingly, his behavior seemed to confirm this diagnosis.
At the end of his days, Henry had trouble eating, became incontinent, and even started to lose weight. Some in the facility began to question whether he should be euthanized. Several members of the staff lovingly doubled their efforts to care for him in order to stave off a one-way trip to the veterinarian. I suppose it’s only fitting that the staff refused to stop caring for their ailing cat. Henry was no different than many of the patients they cared for on a daily basis.
Thankfully, the staff never had to make the difficult decision of putting him down. As if to do them all a favor, Henry went to bed one night and never woke up. A funeral was conducted several days after; almost everyone, staff and residents alike, was there. It was the kind of send-off you would expect for a head of state. Someone gave a eulogy; another member of the staff had even crafted a handmade coffin out of wood. When the service was over and people were still drying their eyes, Henry was laid to rest on the grounds behind the facility.
Henry changed the culture at Steere House. Thanks to him, the nursing home became increasingly animal-friendly and perhaps more of a home. Sensing the loss of their pet, members of the staff and several more able residents began to vehemently petition the nursing home leadership to replace Henry. Though resistant at first, the chief administrator gave in and staff began to scout out potential replacements. Oscar and Maya were eventually adopted from separate newspaper advertisements and came to reside on the third floor. Billy and Munchie were rescue cats whose owner had died. A hospice nurse brought them into the facility. Finally, Chico and Molly were adopted for the lower-acuity dementia unit on the first floor. All told, six cats were brought in to replace Henry, along with a handful of other animals. They were brought here because of an unwanted cat that didn’t want to leave.
Maybe we started adding cats to make this house feel more like a home. But I was starting to think they were the ones teaching us that what makes a home is a family.
CHAPTER SIX
“The real measure of a day’s heat is the length of a sleeping cat.”
CHARLES J. BRADY
WHEN A PATIENT IS TERMINAL, DOCTORS WILL TALK about limiting care. These conversations go beyond discussions about CPR and whether or not to resuscitate the patient if his heart stops or breathing fails. In most cases, these conversations involve difficult questions about withholding tests and treatments, and whether further medical care should be limited to comfort care.
In cases where the patient has a terminal illness such as cancer, comfort-care discussions are relatively concrete. A patient often has pain or nausea. She may be losing weight rapidly and finds she no longer has an appetite. She may be yellow from jaundice. At times, her organs might even be failing. As difficult as all this is, these signs and symptoms are concrete; it’s easy for a physician to talk about them with family members. The idea of treating further pain, even at the expense of length of life, is acceptable to most people. It’s what we do when there are no other treatments to offer.
The same cannot be said for dementia.
Although diseases such as Alzheimer’s are also considered terminal, they manifest themselves much more slowly. Like erosion that changes the landscape of a beach, the effects of these diseases are measured over months and years rather than days. Because it’s usually not pain or discomfort that the patient is suffering, the discussions are more complex and ethically abstract. Care providers and families are forced to grapple with decisions like withholding antibiotics for a potentially curable pneumonia or deciding when it’s no longer appropriate to conduct further diagnostic testing for an everyday condition like anemia or weight loss. In turn, doctors must also grapple