We are bedside nurses, yet our patients and their families are essentially strangers to us. Even though we hardly know them, we are often taken to the extremes of emotion when caring for them. We are elated with good news, such as a negative biopsy. We feel their sadness when they hear distressing news, such as the reoccurrence of a malignancy. We hold back our tears when we witness a final goodbye. And, we are guilt-ridden when we must leave the bedside of a patient who is alone and dying.
Such was the experience of Sandra Clarke, a registered nurse at Sacred Heart Medical Center in Eugene, Oregon, USA. At the beginning of her shift one night, an elderly man with a DNR order on his chart was alone and dying. When he asked Sandra to stay with him, she promised to return after she checked on her other patients. By the time she came back to his room, he had already died. Remorseful, she resolved to find a way to make sure other patients at her hospital would not have to face dying alone.
No One Dies Alone
She created a program in which a group of trained volunteers called “compassionate companions” would be willing to sit with a dying patient who had no friends or family available. PeaceHealth, the corporate organization of Sacred Heart, endorsed her idea and, in 2001, Clarke founded “No One Dies Alone” (NODA). In 2003, PeaceHealth developed a guide for other institutions to emulate the program.
When Denice Foose, a chaplain at The Methodist Hospital in the Texas Medical Center in Houston learned about it, she felt it would be a most sacred and honorable service to offer dying patients. NODA was implemented at The Methodist Hospital in 2007. The program is employed when a patient’s death is expected within 48-72 hours, provided the patient has DNR or hospice status and has no family or friends available to provide a sustained presence. It has proven to be a godsend to everyone who is either involved in it or witnesses it in action.
At Methodist, those who have been designated compassionate companions are primarily non-nursing employees who have expressed a desire for more patient contact. Some volunteers are members of the community who are not staff members. It is incredible how something that functions so simply and inexpensively can result in such profound positive outcomes.
Every nurse at the hospital is educated about the program. There is also a card on each nursing unit that specifies criteria for activation. When concern arises about a patient dying alone, a nurse notifies the Department of Spiritual Care. If the patient qualifies, preparation is made for an around-the-clock vigil, and an e-mail is sent to the bank of compassionate companions.
Somebody needs to say goodbye
Assignments are made on a first-to-respond basis. The companions, who are provided with a bag that contains supplies such as CDs of comforting music, a Bible and poetry, usually sit at the patient’s bedside for three- or four-hour intervals during the day and six hours at night. Companions involved in caring for these patients have had memorable and heartwarming experiences, and their stories abound with emotion. The following is just one of those stories:
Every nurse at the hospital is educated about the program. … When concern arises about a patient dying alone, a nurse notifies the Department of Spiritual Care.
“M,” a homeless man in his early 30s who was HIV- and MRSA-positive, was admitted to the hospital with multiorgan failure. Unkempt, and with a large green marijuana leaf tattooed on his neck, he most likely was not a person his nurses would have befriended outside the walls of the hospital. They may have even feared him, as he had a criminal history and had spent time in prison. When one of the staff attempted to contact a family member, she was told, before the person abruptly hung up, “We thought he was already dead.” After a series of failed treatments, M was designated for hospice care, and his nurses contacted the Department of Spiritual Care to request the services of NODA. Emma, a college student employed as a unit secretary, and Anh, a young pharmacist, responded.
When Emma arrived on the nursing unit, a nurse graciously greeted her and debriefed her about M’s status. Since he was in isolation, she donned a gown, full-face mask and gloves.
In reflecting on the experience, Emma observed: “The room seemed hot, and wearing the gown and mask made it almost unbearable. He had a sour odor to his body. … I think he was probably craving human contact. … When I put my hands on M, his heart rate increased. He felt warm to the touch, so I asked the nurse if we could remove the compression stockings. She asked the doctor, and we removed them.”
In previous vigils, Emma had read poetry to patients, but she felt poetry was not appropriate for M. Since she had no information about his religious preferences, a favorite hymn or Bible passages, she talked to him and sang children’s songs, such as “Kookaburra Sits in the Old Gum Tree.” At one point, while she held his hand, he opened his eyes and thrashed. She immediately called the nurse, who medicated him for pain. She then requested pain medication for him every time he stirred or she thought he was uncomfortable.
“The nurses … spoke in hushed tones and were reverential of the dying process,” Emma noted. “I expected them to be annoyed at my asking for pain meds so often, but their faces did not reveal anything. [They were] just calm, quiet and professional. They both said, very sincerely, ‘Let me know if you need anything.’”
Emma had been with M for six hours and his death appeared imminent when Anh arrived to relieve her. Emma had been awake all night and needed to go home to study for her college exams, but when she saw the expression on Anh’s face when he entered the room, she offered to stay. Together, they bathed M’s forehead with a cool washcloth, swabbed his mouth and applied Vaseline to his lips. While they were in the process of comforting M, a large, white pigeon appeared on the windowsill of his room. It peered through the window, stayed awhile and then took flight. As it flew away, M’s oxygen saturation and heart rate plummeted. And so it was, early one morning, he died in the presence of not one, but two compassionate companions.
He had been a mystery. No one had answers about who he really was. No one knew why his family did not care about him or when they had last spoken to him. He had no friends who came to see him. Something had obviously gone terribly wrong in his life, but none of that mattered at the time of his death. What did matter was that, in his final hours, two strangers—compassionate companions—assisted by the nursing staff, met his need for human contact and caring connection. In the process, it is hoped that this gentleman sensed the presence of human respect and dignity in the midst of isolation. And the unexpected visit by a white pigeon that appeared on his windowsill brought comfort to Emma, Anh and M’s nurses.
Once again, the NODA program had accomplished its mission. It relieved nurses of the emotional burden of guilt they would have felt, had it been necessary to leave M alone. They had peace of mind while caring for other patients, knowing someone was with him and that he was being treated with tenderness. It changed a situation that could have been emotionally traumatic into one embraced with comfort and closure. The program also provided an enduring memory for those involved in M’s care. They will always remember each other and the reward of providing compassion to a homeless man.
Both Anh and Emma plan to continue volunteering as compassionate companions in the NODA program. Emma spoke passionately when she said, “After sitting with a patient for a while, my heart grows heavy. The weight sticks to me like wet leaves, and it can be hard to detach. Yet, when I talk about the program, people say, ‘Oh, I couldn’t do that. How do you do it?’ But how can you not do it?” RNL
Joy Shiller, MS, RN, CAPA, is a clinical mentor and pre-op nurse at The Methodist Hospital at Texas Medical Center in Houston, Texas, USA.