Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat - By David Dosa Page 0,46

to painstakingly feed a parent who has lost all vestiges of her appetite—or even an understanding of what to do with a spoon.

It’s at the middle stages of dementia—when patients gradually begin to lose the ability to care for themselves independently—that they and their families begin to fall through the cracks of our health care system. Some seek assistance from worthy organizations such as the Alzheimer’s Association. Others look to friends or family with previous experience. They may seek information and support from a variety of sources—but rarely do they get it from the doctor.

Unfortunately, our health care system is built largely on a model of diagnosis and treatment. As medical students and young doctors we learn to assimilate signs and symptoms of disease, attach a label or name to it, and then suggest treatment courses based on the particular diagnosis. What do you do, though, when there are no medications to give or no surgeries to perform?

What do you do when there is no cure?

“HOW DID I THINK IT WOULD END?”

Joan Scheer was sitting in her kitchen. I watched as she nervously stroked her hair and her brown eyes became watery. I had seen a lot of people crying since I embarked on this listening tour and I had to keep reminding myself that it was intended to be cathartic—perhaps even good for them. But it didn’t make me feel any better. “I suppose I thought my husband would go on the way he was.” Joan’s daughter, Robin, passed her a tissue. “I knew he had dementia but I thought that things wouldn’t change, that each morning I would continue to drive him to his adult day care center, where they would care for him until four o’clock. Then he’d come home and I’d feed him dinner, watch TV, and then we’d go to bed. I suppose I thought that we would keep this routine going until one day when he would die of old age. I guess I was naïve, but I just didn’t expect it to end the way it did.”

The way it ended with Lawrence Scheer is the way it ends with most of the patients on Steere House’s third floor. Mr. Scheer died at the nursing home, dutifully accompanied by Oscar, after a prolonged battle with Alzheimer’s dementia. The last years of Larry’s life were not kind. He began to wander at home, particularly at night, and eventually fell down the stairs. In the hospital, he seemed to deteriorate overnight. He became nonverbal and delirious, pulling his cast off three times before being strapped to the bed for his own protection. He was transferred from one nursing home to another before landing at Steere House. There, he continued to unlearn everything until, in the end, he could no longer walk, talk, or even recognize his family. He ultimately died from pneumonia.

“You know, I wish the doctors had told me what to expect.”

“What do you mean?” I asked.

“They really didn’t tell me anything about the disease or what it would do to my husband.” She smiled at me through the tears. “You know how I found out how long a patient with Alzheimer’s lives after they are diagnosed?”

I shook my head.

“My husband told me!”

She laughed at the absurdity of it.

“About a year or two after he was diagnosed, we were at a friend’s house for dinner. It turned out he also had dementia and they had a book about Alzheimer’s lying around on their coffee table. He started reading it. I came into the room and saw him sitting there with the book turned over on his lap. I asked him what he was doing and he told me point blank that he had about six more years to live.”

Now she was the one shaking her head.

“He held up the book to show me and I was horrified! I raced over to Larry and took it from him. He looked at me and, very matter-of-fact, told me that based on his age at diagnosis, he had about seven to nine years—and that he had already lived for two of those years.”

“But your doctors hadn’t said anything about life expectancy to either of you?”

Joan leaned back in her chair. “Well, the doctors were always good with labeling. They would tell me that Larry had an Alzheimer’s-type variant, but none of them ever sat me down and said, ‘Your husband has dementia and here is what is going to happen to him step by step, year by year.’