Two nurses, two different worlds, by Joy Shiller Sarah Anne Terrot was one of the original nurses who accompanied Florence Nightingale to the Crimean War in 1854. The following is an excerpt from her diary, describing an experience during the first days the female nurses were permitted to care for patients at the General Hospital in Scutari:
“One poor dying fellow, called Nichols, seemed to be neglected by the orderlies because he was dying. He was very dirty, covered with wounds, and devoured by lice. ... I washed his face and hands, cut his hair, and tried to make him a little less uncomfortable, and he was so grateful, he would scarcely let me leave him ... but I was unable to return to him. I hope someone soothed his dying hours, and that he did not look and call for me in vain” (Richardson, 1977, p. 91).
 |
| Photo credit: Ansgar Photography/zefa/Corbis |
In 1986, Sandra Clarke was a staff nurse in a medical unit at Sacred Heart Medical Center (SHMC) in Eugene, Oregon, USA. The following is her account of an experience she had while caring for a dying patient:
“Stay with me” was the only request this patient made, just after midnight—the start of my shift. He was one of my seven patients, a frail old man, tremulous, and nearing death with a Do Not Resuscitate order. I said, “Sure, soon as I check my other patients.” Complex patients; challenging tasks; time passed quickly. I entered his room ready with a truthful apology and saw his pale, cold hand stretched out from the bed. Was he reaching out for someone who’d care? I’ll never know. He had died, as he feared, alone.
Sarah Anne Terrot and Sandra Clarke were from two different worlds of nursing. One nurse was working in a war zone, the other in a modern hospital almost a century and a half later. Despite their dissimilar worlds, they describe the same sentiment of remorse when they had to leave a dying patient who wanted them to stay.
A program is born, by Sandra Clarke
Haunted by my broken promise, I was determined to find a way to make sure my patients would not be alone during those last vulnerable hours. It became personal. This could have been my Uncle Carl, an ancient cantankerous bachelor; or that ragged homeless woman I occasionally gave a granola bar to in the supermarket parking lot; or, worse yet, my husband, after a catastrophic accident far from home, on one of his frequent business trips.
Where does one find individuals on short notice and at odd hours willing to sit with a stranger who is dying? I asked around at work. The reactions ranged from “What a wonderful idea” to “Nobody’s going to want to do that!” The challenge would entail getting the support of the “wonderful idea” people.
As with many ideas and good intentions, circumstances changed my priorities. I began working in the intensive care unit, where no one dies alone. There, everything is done to avoid natural death and, if death comes, it occurs amidst a noisy crowd of machines and hospital staff.
While I was working in the ICU, my hospital began a pilot program to develop an ethics resource team for staff members. I volunteered. During the training, our pastoral care director overheard me mention my concept. At his request, I wrote a proposal outlining my vision. Shortly after, PeaceHealth, our corporate organization, endorsed the idea and assisted in making it a reality.
No One Dies Alone officially got under way in November 2001. It is a simple, inexpensive plan based on the phone tree concept, whereby hospital employees and unpaid hospital volunteers can become a bedside compassionate companion for those who are dying alone. We put together a guide that explains in detail how to create this program—from the computerized volunteer calendar to what the volunteer might bring to the vigil.
Within six months, the program was generating international interest. It has been featured on television, in several publications and on numerous Web sites. No One Dies Alone was an idea whose time had come. PeaceHealth has chosen not to copyright the guide, which is distributed for only the cost of printing and postage. More than 500 guides have been sent out, as far away as Singapore. We read and hear about programs starting throughout the world.
This program has not only served its purpose to patients and their loved ones, it has brought rich emotional rewards to volunteers involved in the program. The abounding stories associated with No One Dies Alone are heartwarming. During vigils, I have seen a transcriptionist singing quietly, an engineer talking about his fishing experiences with the rugged-looking guy in the bed, and a kitchen worker holding the patient’s hand as though she were a member of her own family. Many of those who have taken part in vigils have said that, because of No One Dies Alone, they have been able to support family or friends through the last hours of a loved one. Everyone involved has been touched.
Over the years, the program has evolved, incorporating ideas from those involved in the program. I have always made it a practice when I am on duty to stop and visit—and also to thank—the compassionate companion at the bedside vigil. One morning, about 4 o’clock, I saw a companion, the mother of six, writing on a note card.
“Catching up on your correspondence?” I asked.
“No,” she replied, “I always leave a personal note when I vigil—just in case they have family somewhere—so they know we made sure their loved one was comfortable and not alone at the end.”
I was so moved by this gesture that the next morning, I contacted the administration and asked if we could supply cards. Now cards, blank on the inside and with our “hands touching” logo on the front, are included in each No One Dies Alone bag used by our volunteers. Sometimes, the cards include a running commentary by many companions. Other times, different companions write notes on separate cards. The following is an example from one of the cards:
“I’ve been sitting with Joe since 11 a.m. When I got here, the harpist was playing beautiful music and the room was peaceful (SHMC has music thanatologists who play harps for the dying). Joe is calm and his breathing is consistent. ... I’ve covered him with an extra blanket and have been wiping his face. He doesn’t appear to be in any pain. Joe passed at 1:55 p.m. He was peaceful. His breathing slowed down and finally stopped. No pain—no struggle. I am honored to be here for his passing.”
Another gift of the No One Dies Alone program is the notes of appreciation from families who are forever indebted to those who sat with their loved ones when they could not be there.
“Dear ALL who attended our beloved dad who passed away. Our family, who lives out of the Eugene area, was relieved to know that our dad was not alone when 'his time had come.' ... We prayed that our Lord would send angels to soothe, comfort and bring peace to dad. Little did we realize how literally our prayer would be fulfilled!
Thank you, angels of No One Dies Alone, and God bless each and every one who sat next to dad.”
The continuation and growth of No One Dies Alone have been gratifying. How many people get to see their dream come true? Being actively involved in a project that rests on the goodness of others is humbling. What people fear most about dying is being in pain and being alone. No One Dies Alone is working to change that for the most helpless of our population. The CEO of PeaceHealth said it best: “We create moments of grace in a world that does not expect kindness.”
The Nightingale vision, by Joy Shiller
Florence Nightingale’s vision for the nursing profession and patient care was incredibly progressive for a nurse during the Victorian era. She was a proponent for evidence-based practice, nursing research and publication, continuing education for nurses, even pet therapy. There is, however, one additional, little-known aspect of her nursing practice that has multiple similarities to the 21st-century No One Dies Alone program initiated by Sandra Clarke.
Every nurse is familiar with Nightingale’s efforts during the Crimean War to improve the horrendous conditions for the British military. However, she was also personally devoted to caring for the most desperately ill and dying patients.
Miss Nightingale knew that the final ineluctable role of the medical assistant is to give solace to the dying and that this too must be well done. To nurse was also to hold a hand, to look with love, and to be there for the dying (Gill, 2005, p. 351).
Akin to No One Dies Alone, Nightingale believed that someone should always be present when a soldier died. This belief became her rule for any patient who came under her observation. If the man was conscious, Nightingale was present (Woodham-Smith, 1983). By her own account, she had "closed the eyes" of hundreds of soldiers (Gill & Gill, 2005, p. 1804). She sometimes allowed Mrs. Bracebridge, a long-term family friend who accompanied the original nurses to the war zone, to take her place if the soldier was unconscious (Woodham-Smith, 1983). Prior to implementation of this practice, this had not been the case. It was said that the British soldier "had been allowed to die like a dog—until the lady of Scutari came along to treasure and care for him" (Gill, 2005, p. 384).
Another component of Nightingale’s activities during the war is also similar to No One Dies Alone. She personally sent letters to families and sweethearts of deceased soldiers, recording any final words and explaining the circumstances surrounding their death. She also sent any personal possessions and paid for the postage from her own funds. The following is an excerpt from a letter that Nightingale wrote to a bereaved mother of a deceased soldier:
“He was always conscious and remained so until the very last. He prayed aloud so beautifully that the Nurse in charge said, 'It was like a sermon to hear him.' … He knew me and expressed himself to me as entirely resigned to die. He pressed my hand when he could not speak. He died in the night. ... He was decently interred in a burial ground we have a mile from Balaclava. One of my own Sisters* lies in the same ground, to whom I have erected a monument. [The “Sister” was Elizabeth Drake, one of Nightingale’s best friends, who died of cholera.] Should you wish anything similar to be done over the grave of your lost son, I will endeavor to gratify you, if you will inform me of your wishes. With Sincere Sympathy, I am Truly Yours, Florence Nightingale” (Cook, 1939, p. 141).
Toward the end of the war, Nightingale became increasingly involved with administrative duties. Her Aunt Mai, who later joined her after Bracebridge returned to London, actually wrote some of the letters, which Nightingale signed (Vicinus & Nergaard, 1990). Still, her heartfelt feelings were reflected, and patients' relatives and friends were reassured that their loved ones were attended in their final hours.
Nightingale also received letters from families and friends of deceased soldiers. The following is one from among a bundle of personal papers she retained after the war:
“My Dear Miss. I feel the loss of my poor son’s death very keenly, but if anything could help my grief it is the thought that he was looked to and cared for by kind friends when so many miles away from his native land” (Cook, 1939, p. 141).
Again, here is the philosophy and essence of No One Dies Alone—the comfort of this grieving mother in knowing that another human being was present at the time of her son’s death, when it was impossible for her to be there for him.
The two worlds merge, by Joy Shiller
One of the basic tenets of nursing has always been to provide comfort to the dying. Whether the situation is that of Sarah Anne Terrot in the midst of a horrific 19th-century war or that of Sandra Clarke in a modern Oregon hospital, it is unsettling for any nurse when a patient dies alone. With No One Dies Alone, nurses and loved ones can have peace and reassurance in knowing someone will always be there. More than 200 hospitals have now adopted the program, and it is certain that many other hospitals will emulate them.
In the 21st century, the little-known Nightingale practice of caring for dying patients during the Crimean War has resurfaced and blossomed into a formal program. The elements of No One Dies Alone, such as the bedside vigil and correspondence to and from bereaved loved ones, are strikingly similar. In the same manner that PeaceHealth cherishes and retains those letters of gratitude from patients’ families, so did Nightingale. They were among the few treasured items she brought back with her to England.
So often in history, people become heroes after their death. This was not the case in the life of Florence Nightingale, nor will it be in the life of Sandra Clarke, for they both “created moments of grace in a world that does not expect kindness.” RNL
Co-authors Joy Shiller, RN, BSN, MS, CAPA (left), and Sandra Clarke, RN, have never met. Shiller is a pre-op nurse on the day shift at Texas Medical Center. Clarke is an administrative supervisor on the night shift at Sacred Heart Medical Center in Eugene, Oregon. The hospital where Shiller is employed had implemented No One Dies Alone. After recognizing the program’s similarity to the efforts of Florence Nightingale, she contacted Clarke. The manuscript was written as a result of numerous interchanges via e-mail, postal service and phone conversations. Unexpectedly, the No One Dies Alone program has provided two nurses who would have never worked together another special gift.
References:
Cook, E.T. (1936). A short life of Florence Nightingale. New York: MacMillan Co.
Gill, G. (2005). The extraordinary upbringing and curious life of Miss Florence Nightingale. New York: Random House.
Gill, C.J., & Gill, G.C. (2005). Nightingale in Scutari: Her legacy reexamined. Clinical Infectious Diseases, 40, 1799-1805.
Richardson, R. (1977). Nurse Sarah Anne with Florence Nightingale in Scutari. Chatham, UK: John Murray LTD.
Woodham-Smith, C. (1983). Florence Nightingale 1820-1910. New York: Atheneum.
Vicinus, M., & Nergaard, B. (1990). Ever yours, Florence Nightingale, selected letters. Cambridge, MA: Harvard University Press.
