COLORADO SPRINGS, Colo.—Ann was not going to make it.
After a fiery car crash, the young woman was taken to Penrose Hospital. Her husband couldn’t be with her because he was being treated at a different hospital for his injuries.
That’s when Jill Clark’s phone rang on a July night. She volunteers for the hospital’s No One Dies Alone program.
“I nervously began asking questions, then stopped, realizing the questions were pointless, of no worth,” Clark said. “I was being called to be with someone who was dying and being present was the purpose.”
While hospices have long had volunteer vigil programs to comfort the dying, most hospitals do not, perhaps because it’s seen as an admission of defeat for an institution committed to saving lives. Penrose is rethinking its posture toward death with No One Dies Alone.
Clark was the first volunteer to be called, and on the drive to the hospital, her mind raced. The founders of the program had an image in their minds of elderly, homeless John Doe patients who had no family, not young mothers. And would she be in the way in a critical care environment?
“The medical staff was flying in and out of the room—equipment, tubes, bags of fluids, machines and pumps were everywhere,” she said, “but they graciously made room for me to hold Ann’s hand and speak into her ear.”
Clark said the environment in the room changed the moment she walked in.
“All of a sudden, we were treating the whole person,” she said. “We were doing everything medically we could do, and everything personally we could do.”
Dr. Roger Nagy, medical director of trauma, dimmed the lights. “He started using her name and talking to her. And the nurses started talking to her. It was really beautiful,” Clark said. Penrose could not release the patient’s full name because of health privacy rules, and her husband is not yet ready to discuss the crash.
“As soon as Jill came, a weight was lifted off me because I knew she was there. And I could just focus on the medical side,” Nagy said. “We could work on the clinical side and Jill was there to concentrate just on the human side. From my perspective, it was wonderful.”
Clark sat with Ann for three hours. She held her hand, talked to her, and tried to comfort her as the medical staff worked to keep her alive. Finally, Ann’s husband came in, still barely able to walk. After he recovered from the shock of seeing his wife’s condition, Clark put Ann’s hand in his and slipped away.
Shortly thereafter, Ann slipped away as well.
No One Dies Alone began in July.
Penrose-St. Francis Health Services Chief Nursing Officer Kate McCord heard about the program at a conference and got the ball rolling.
Palliative care clinical nurse specialist Ginny Vravick and chaplain Theresa Gregoire worked to make the program a reality.
The criteria for the program is imminent death, a do-not-resuscitate order, and no family present.
A team of 45 volunteers has mobilized to sit vigil with patients. So far they have sat with five dying people at the hospital.
The idea of sitting vigil isn’t new. Most hospices have similar programs.
But moving that hospice idea into a hospital setting is new to Colorado Springs.
The nonprofit Pikes Peak Hospice & Palliative Care began its vigil program about five years ago, and the program served 48 patients in 2009.
The hospice’s rules are looser, as its team of 74 volunteers also uses the vigil program to serve families who need a break.
“Death is like a bookend to birth. And, if possible, you should have a presence to be with you,” said volunteer and former hospice nurse Susan Conde.
She realized the importance of a vigil program when her father died in 2001 in hospice. “My father died in the middle of the night here (in inpatient care),” she said, “and we weren’t with him, but it was comforting to know the nurses were with him.”
Hospice volunteer Mark Szabo has sat with many people during the last hours of their lives. He holds hands, reads sacred texts, massages feet, performs aromatherapy and a relaxation technique called reiki, anything to soothe and comfort.
“Some people are confronting their fears of death at death, so they’re terrified of it,” Szabo said. “Other people have accepted they’re going to die and are peaceful with the outcome.
“It’s a privilege to be there and to do the little things.”
His memory is particularly sharp of one elderly grandmother.
Her family said their good-byes and left the room, most of them unable to watch the final hours. One daughter decided to stay with Szabo, and she passed the time telling stories about her mother as they each held one of the older woman’s hands.
The woman opened her eyes in response to one story and looked at her daughter, he said, then she settled in peacefully and died about 15 minutes later.
“She squeezed both of our hands and just passed,” Szabo said. “Tears were going down my face along with her daughter’s. It was a beautiful moment.”
While that’s a natural approach for a hospice program, accepting death is much harder in a hospital setting.
“A hospital is curative,” said Vravick, the head of palliative care at Penrose. “When people are dying, that’s a defeat. We didn’t fix them.”
Nagy is one doctor who is trying to change that way of thinking.
“This is a natural process. We’re not going to get out of this alive,” he said. “So, how do we meet the needs of something that is inevitable?”
Vravick thinks that will be one of the major questions in health care in coming years, as an aging population faces mortality.
We’ve improved the birth process, improved in wellness and preventive care, so how do we improve death?
Facing that is a sea change in thinking for doctors and nurses who are trained to keep people alive, who often think of death as a failure. No One Dies Alone is an attempt to turn that thought on its head.
“Death is not a defeat,” Vravick said, “but can be beautiful.”
