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Jen’s Jewels | Interview with Dr. David Dosa

February 3, 2010

Growing old is something most people don’t like to think about, no matter what their age. Sure, retirement does sound appealing. Sleeping in late and watching glorious sunsets. No worries, just ample time to lazily enjoy precious moments with your spouse. Yet for some, with age comes the telltale signs that something more serious is happening. Simple occurrences like misplacing keys and not remembering familiar places become the norm. All too often, these are the beginning stages of a debilitating disease called Alzheimer’s.

Rounds withThis month’s Jen’s Jewels Dr. David Dosa has experienced firsthand the devastating effects of dementia. In his debut novel, MAKING ROUNDS WITH OSCAR, he shares with us the incredible story of a cat named Oscar who changed his life forever. For those of you with loved ones suffering from Alzheimer’s, this book is a must-read. And, for those of you who are just curious, you won’t be disappointed. Truly, this is a story that needs to be told.

As part of this interview, Hyperion Books has generously donated five copies for you, my lucky readers, to win. So, don’t forget to look for the trivia question at the end. And as always, thanks for making Jen’s Jewels a part of your reading adventure.

Jen: In order for a book to be exemplary, it must take the reader on a journey to a place where unknown truths and miraculous discoveries are made. MAKING ROUNDS WITH OSCAR epitomizes the essence of a feel-good book with just the right blend of compassion and courage. So that my readers may have a better understanding of the man behind the words, please give us a glimpse into your educational and professional background.

David DosaDr. Dosa: I’d first like to thank you for inviting me to participate in this Question and Answer and for your interest in my book. Writing this book has been an incredible journey for me—and the finished product is meaningful to me on many levels. My wife is now the caregiver for a family member with dementia and, in part, I tried to write a book that she could read to better understand the disease that she was confronting. Obviously, though, there is a lot of Oscar in the book….

I am a trained geriatrician and internist. For those who may not know, a geriatrician is a specialist who focuses on the care of the elderly. Despite the aging population, there really aren’t many of us—only about 6500 by the last count I saw. The biggest difference between being an internist and a geriatrician is the particular focus on improving quality of life for patients with multiple chronic medical conditions.

I received my bachelor’s degree from the University of Virginia where I did a fair amount of creative writing and journalism in addition to biology. After settling on medicine as a career path, I attended medical School at the George Washington University in Washington DC and then trained—first as an internist and then as a geriatrician at the University of Pittsburgh. While there, I also received my Masters in Public Health.

Since finishing my training in 2003, I have been on the faculty at Brown University in Providence RI where I conduct health services research; teach medical students and residents, and see patients in a variety of different environments. When I’m not working I try to spend as much time as I can with my wife and two children—ages 5 and 3.

Jen: In the beginning of the book, you discuss openly how becoming a pediatrician runs in your family, yet you chose to be a geriatrician. What attracted you to this field?

Dr. Dosa: There have been a number of pediatricians in my family. While I love the field, I always felt that pediatricians deal with blank canvases— little patients with bright futures ahead of them but few stories to tell. Geriatrics has always appealed to me on a certain level because of the patients and their life stories. You need only listen to a veteran of World War II to become instantly transfixed. I’m constantly learning from my patients and that makes the experience of caring for them all the more rewarding. Caring for patients with multiple medical problems is also complex and challenging.

On a different level, I’ve also always been fascinated by geriatrics because of the public health questions. We are definitely coming to a crisis point in our society where the aging baby boomers are upon us and our ability to care for them under the current system is severely limited. We are completely unprepared to meet their medical needs and finding ways to provide high quality care under these circumstances is intellectually fascinating to me.

Jen: Playing the cards we are dealt is not easy, especially when a chronic disease is involved. As my readers know, I was diagnosed with juvenile rheumatoid arthritis at the age of eight. You, too, suffer from arthritis. Let’s talk about how you have adapted your successful career to incorporate your fight with the nation’s #1 crippling disease. And, in what ways has it changed your outlook in terms of helping your patients cope with pain and suffering?

Dr. Dosa: I am sorry to hear about your arthritis—I don’t wish that on anyone—certainly not someone in their childhood. There are certainly days when battling arthritis is tough. As you mention, I’ve had inflammatory psoriatic arthritis since my mid-twenties and there have been low points in my life when I’ve let the pain and discomfort get to me. Nevertheless, by experiencing those low points, I’ve also become a better person, and a better doctor. When you have uncertainty in your own health, you become better at prioritizing what is important in your life. Since, I’ve developed arthritis, I can honestly say that I’ve started living my life rather than letting it slip by. As a physician, I’ve also come to understand my patient’s needs better and my patience for their concerns and their uncertainty has also increased.

Jen: MAKING ROUNDS WITH OSCAR centers on your experiences as a physician at Steere House. First of all, what circumstance led to you accepting a position there?

Dr. Dosa: Steere House is just part of what I do—I also do research—but my position there came about because of my interest in nursing homes and their residents. Most of my research focuses on improving the quality of care that we deliver to frail nursing home residents and it has always been important to me to maintain a foothold clinically in the nursing home world. It’s hard to do research when you don’t have that clinical reality check of what life is really like in that environment.

Jen: Tacking onto that last question, please describe for us the role of the facility, its location, and its overall goals in terms of patient care.

Dr. Dosa: I am actually just one of the 4 or 5 doctors on the staff at Steere House. I have no special role there other than the fact that I maintain a handful of patients in the nursing home. The facility itself is located next door to Rhode Island Hospital in Providence, Rhode Island. As a facility, Steere House is clearly a special place. While you can get good and bad care at any nursing home, Steere House is one of those homes where you would want a parent or spouse if push came to shove. They pride themselves on being “more of a home—than a nursing home” and this is exemplified in part by their commitment to animals—they have 6 cats, and several birds—which lend a homey atmosphere to the place. They also pride themselves on their staffing and commitment to providing the best care that they possibly can given the economic realities of nursing home care.

Jen: A question I am sure my readers will want to know, what is the average rate of availability for a room in this facility? And, how has the release of your book affected this wait time?

Dr. Dosa: I’m not sure what the book will do in terms of wait times for “rooms at the inn”, but I know the New England Journal essay I wrote about Oscar in 2007 certainly made a splash. Thankfully, if anything, it has only increased the popularity of the nursing home. Caregivers generally like the idea of animals like Oscar being on the job.

Jen: Without further ado, let’s talk about Oscar as well as his five fellow companion cats. First of all, how did the notion of having animals in the facility come about? And, how do they attribute to the overall well-being of the residents?

Dr. Dosa: Steere House made a commitment to animals many years ago. I’d like to say that they made this commitment based on the benefits of having an animal companion program but truthfully—it mostly occurred due to a cat named Henry. When the current building was being built, an unnamed cat was known to frequent the construction site. Shortly after the building was dedicated, said cat wondered into the nursing home and sat down in the lobby. Despite best efforts, he refused to leave. Eventually, the staff got tired of shooing him out of the nursing home and decided to just let him stay. They named him Henry— after the building’s benefactor and the facility’s animal program officially commenced. We now know from numerous studies that animal companion programs can be incredibly beneficial to nursing home patients—with and without dementia. They help to reduce depression and decrease agitation rates.

Eventually, Henry died—but the nursing home was not the same without him. After a brief mourning period, the nursing home adopted 6 cats to replace the one— Oscar being one of them. I’m often asked how the animals affect resident well- being. I think they just make the place homier. So many of us own pets during our lives but yet we make our health care facilities sterile places. The animals contribute a lot to the patients. Those that don’t have dementia certainly enjoy spending time with the animals. Even those with dementia—who might not be able to tell us—seem to get a lift from having animals around. Perhaps our closeness to animals is something innate rather than learned and therefore impervious to the affects of Alzheimer’s disease.

Jen: Being a cat owner, I can attest as to their innate ability to be able to sense when their owner is in need. Describe for us Oscar’s abilities and how they were discovered.

Dr. Dosa: Oscar was not all that friendly at first. He generally kept to himself choosing to hide in quiet corners or under beds rather than sitting out in plain site. This continued till he was about 6 months. Then his behavior started to change. Occasionally you would find Oscar out in the open—sitting with a patient. It took us all a little time to figure out what he was doing. At first we just thought he was sitting with residents who didn’t bother him. But each time he came out of hiding, the residents that he sat with died shortly thereafter. It was uncanny and definitely eye opening. I’d like to say I was the first one to notice Oscar’s ability but I wasn’t. Truthfully I was one of the last.

Jen: In the beginning, you were Oscar’s Doubting Thomas. Naturally, being a physician you needed concrete evidence in order to prove Oscar’s abilities. Please describe for us your “Ah! Ha!” moment when you finally realized that Steele House’s very own cat was indeed special.

Dr. Dosa: The “ah ha” moment for me came during a time when there were two patients in their final stages of dying at opposite ends of the unit. We all thought one of those patients was going to go first and some people on the unit became upset that Oscar’s streak of predicting deaths was going to end. One of the aids went looking for him and found him with the other patient. She picked up the bewildered cat and brought him down to the other room so he could “be with the sicker patient who was going to die first”. As soon as she put him down, Oscar looked at everyone like they were all crazy and sprinted back to the first room.

Oscar was right….the other patient died later that evening faster than any of us could possibly have predicted. The “sicker” patient rebounded and lived several more days. Nevertheless, 4 hours before the patient finally died, Oscar walked into the room and curled up next to him.

Jen: Every main character needs a great supporting cast in order to perpetuate the story. Let’s talk about your proverbial right arm, Mary. In what ways are she and Oscar alike? And, how do both of them attribute to your success in making Steere House a better place?

Dr. Dosa: Mary was very much the glue that held the third floor together for many years. I use past tense because, unfortunately, Mary has moved on to a different nursing home. We all definitely miss her at Steere House. Having thoughtful caring nurses like Mary is critically important in any care environment—I dare say even more important than having a good doctor. When Mary said something about a patient, I learned to trust her without question. She was also the maternal figure on the unit—the patients on the unit were all her “children.” Family members also came to rely on her to be their loved one’s advocate when they were not around. Some have speculated that Oscar is just patterning behavior. If so, then he learned from one of the best in Mary.

Jen: As you explain in the foreword, some of the names of patients described in the book have been changed in order to protect their privacy. The story that touched me the most was the Rubensteins’. At the point when Ruth could no longer recognize her husband due to her advanced stage of Alzheimer’s, Frank chose to never return to Steere House. Is this common? And, how do you help patients’ families come to terms with harsh realities of the disease?

Dr. Dosa: Frank and Ruth’s story comprise one of the emotional backbones of the book. Perhaps the book’s denouement occurs when Frank leaves the nursing home despite his staunch advocacy for his wife to that point. I think that this episode in the book says more about the horrors of Alzheimers than any other. Many caregivers talk about the notion of death before physical death. Jack McCullough uses the phrase “The Woman upstairs who looks like my mother.” Other characters in the book talk about the need to embrace the new normal. Unfortunately, this is what Alzheimer’s does and caregivers come to the realization at different speeds. Some caregivers adapt to this reality better than others.

My sense is that Frank left because he could not bear what the disease has done to his wife. As long as there was an ounce of recognition, Frank could continue to remain her staunchest ally. When that recognition faded, perhaps it was time for Frank to simply let go. As I say in the epilogue of the book—the final act of love is “letting go.” Some people just do this in different ways.

Jen: Without getting into the pros and cons of health care reform, in your opinion, what is missing in terms of essential care needed for patients suffering from Alzheimer’s?

Dr. Dosa: Our health care system does a terrible job of caring for patients with chronic diseases like Alzheimer’s. We have a system that is based on acute care. Doctors are reimbursed for doing things—rather than limiting treatments, even when the latter is the better option. We also buy into the myth of the acute care hospital: when we are sick acute care hospitals can make us better. Unfortunately, that is sometimes the worst place to go if you are a patient with dementia. Hospitals are just plain understaffed, and even at times uninterested in adequately caring for patients with dementia. Their chief goal is getting patients in and out (to maximize revenue) and patients with dementia take longer to get better. So if you are an Alzheimer’s caregiver, my advice to you is to become an advocate for high quality care. Seek out the doctors who will tell you how it is—rather than the doctors who seem to disappear when there are no more procedures or tests to do. Make sure your parent or loved ones gets the attention they deserve when they are admitted to the hospital.

Jen: Finally, how is Oscar doing today? Has his sudden stardom changed the way in which he lives? And, have the two of you bonded in your own way?

Dr. Dosa: Oscar is doing fine—I left him the other day sitting on a window looking at the world go by outside. I truly think that is his favorite activity (other than perhaps lying down in a sunbeam). I don’t think that his stardom has affected him in any way—but I will say that our relationship has improved. Recently—he even let me hold him when a photographer came to snap pictures—a far cry from my first experience with him when he bit me. Perhaps I am finally getting over that fear I had of cats growing up 🙂

Jen: I must admit. As a reviewer, many great books come across my desk; however, MAKING ROUNDS WITH OSCAR is in a class all by itself. Thank you for sharing your extraordinary story with my readers. And most especially, thank you for giving those suffering with Alzheimer’s a voice with which to be heard.

Dr. Dosa: Again, thank you for taking an interest in the book. I hope readers will come away from this book embracing the mystery of Oscar and what he does. In the end, I suppose it really doesn’t matter why he does what he does. The important thing is that he does it and his presence serves as a comfort to caregivers at difficult times in their lives.

Of all the interviews I have done to date, I have to say that this one touched me the most. I hope you agree. Please stop by our local library branch or favorite book store today and pick up a copy of MAKING ROUNDS WITH OSCAR. In the back of the book, there are some invaluable words of advice for helping families cope when a loved one is diagnosed with Alzheimer’s.

Better yet, how would you like to win your very own copy? Enter our contest and you could be one of five winners.

What was the name of the very first cat to live at Steere House?

Later this month, I will be bringing to you my interview with Maria Murnane, author of the hilarious debut novel PERFECT ON PAPER. You won’t want to miss it!

Until next time…Jen

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