July-August 2015 | Featured Article

At Suburban Hospital, No One Dies Alone

Staff members volunteer to be with dying patients who have no one with them

Patricia Gabriel, a clinical nurse educator at Suburban Hospital, volunteers with the No One Dies Alone program, which provides dying patients with a companion in their final hours. Photo by Michael Ventura.

Patricia Gabriel was sitting at her desk at Suburban Hospital in Bethesda one day last year when an email popped up in her inbox: A patient was dying. Could anyone come and sit with him?

Gabriel, a Bethesda resident who serves as a clinical nurse educator for the hospital’s emergency, trauma and pediatrics units, scanned the open time slots for sitting with the patient and noticed one in the late afternoon.  

In the fall of 2013, she’d signed up as a volunteer with No One Dies Alone (NODA), a national program that aims to provide dying patients with a companion in their final hours if they don’t have family or friends nearby. Though many nurses and other clinicians volunteer with the program, the role doesn’t involve medical care. Instead, volunteers promise to bear witness to a patient’s final moments. They read to the person or play music. Sometimes they are silent, simply holding the patient’s hand.

Gabriel, whose children are grown, didn’t have to be anywhere after work that day, so she replied to the email, saying she would report to the patient’s room that afternoon. She knew nothing about the man she was going to see, aside from the fact that he was just days or hours from death.

When Mary Aguilera-Titus (left), a massage therapist at Suburban, told hospital chaplain Barbara McKenzie about No One Dies Alone,  McKenzie loved the idea but wondered if employees would volunteer their free time to help. They did. Photo by Michael Ventura.

Suburban Hospital chaplain Barbara McKenzie’s phone rings during the week whenever a doctor or nurse determines that a patient is very close to dying. At night or on weekends, McKenzie; Mary Aguilera-Titus, who was instrumental in bringing the program to Suburban; and chief nursing officer Barbara Jacobs receive notice via pagers. Then one of them sends an email to NODA volunteers, such as Gabriel, and builds a round-the-clock visiting schedule based on the responses.

“If there’s a longer projection of death, we do work on moving the patient out of the hospital and into a hospice facility,” Jacobs says. “NODA really works with patients who we believe will die fairly soon. And this is one area of medicine where we’re really playing a guessing game. Often, our best guesses are not right, which can make it hard for a patient’s family.”

In some situations, the patient’s relatives live far away and can’t be there; other times, the patient is alone in the world and never receives any visitors. Volunteers sat with one Suburban patient, a man in his mid-50s, so his wife could get home at mealtimes to feed the couple’s kids. In another case, the wife of an elderly patient was having trouble getting to and from the hospital to see him—they didn’t have family in the area—so NODA volunteers stayed with the man when she couldn’t be there. One morning, Aguilera-Titus sat with him for a few hours, then another volunteer came on her lunch break. When the man’s wife arrived, Aguilera-Titus checked in on her throughout the afternoon. The man died later that day.

“We had a lovely interaction with his wife, who was so grateful,” says Aguilera-Titus, who lives in Silver Spring. “It was just the two of them—they didn’t have a big circle of supporters around them. We became that circle for her.”

Milton Alcazar, a service desk analyst for Suburban’s IT department, sat with a dying patient for the first time last fall, reading to the man and holding his hand. Photo by Michael Ventura.

A nurse named Sandra Clarke founded NODA in 2001, after an experience she had with a patient at Sacred Heart Medical Center in Eugene, Oregon. The patient was one of seven people Clarke was caring for that night. He was elderly, ill and had a “Do Not Resuscitate” order. He asked if Clarke would stay with him, and she assured him that she would sit with him as soon as she checked on her other patients. By the time she returned, he was dead. “I felt awful,” Clarke wrote the following year in Supportive Voice, the newsletter of Supportive Care of the Dying: A Coalition for Compassionate Care. “It was okay for him to die, as it was his time—but not alone.”

Aguilera-Titus, a massage therapist at Suburban who volunteers for Montgomery Hospice and often works with terminally ill patients, had heard about the NODA program while taking a course in 2009 on being a companion for the dying, and thought it could serve an unmet need. She brought the idea to Suburban in 2011; Holy Cross Hospital in Silver Spring also has NODA volunteers.

McKenzie loved the idea. As chaplain, the Burtonsville resident is accustomed to being with patients in their final hours. But she wasn’t sure how many hospital staffers would be interested in volunteering. She wondered if nonclinical workers would be comfortable around death. And she wasn’t sure if clinicians would be able to turn off their instinct to treat or help patients—or if employees would be willing to fit another obligation into their busy schedules.

She floated the idea in meetings and put a notice in Suburban’s in-house newsletter. Roughly 30 employees went through the daylong training session to become volunteers. Nineteen of those employees came from nonclinical departments, she says, including information technology (IT), food services and human resources. NODA volunteers companioned their first dying patient in February 2013, and have sat with 15 patients since then.

“Part of my job is being a witness to important life milestones,” McKenzie says. “We’re always with another person at the beginning of our lives. I believe it’s important to bear witness when someone is transitioning and passing on, too.”

NODA volunteers usually know very little about the patients they sit with, often nothing more than a first name or initials. They say it’s irrelevant—their job is to be with the patient, not to get caught up in the person’s past. That was the case for Gabriel when she left her desk on the first floor of Suburban Hospital last spring and walked upstairs to meet her patient in his private hospital room. The elderly man couldn’t speak or open his eyes, as is the case with most patients NODA companions. Gabriel sat down and introduced herself. “I told him that I was there to be a support to him so he would have someone with him on his journey,” she says.

It was a warm, sunny afternoon, and Gabriel described the view from his room in detail. “It’s a beautiful day. There’s a blue sky,” she said. “The sun is shining. There are leaves on the trees.”

Then she reached into the bag of materials that NODA provides for volunteers: An MP3 player with various musical choices, books of poetry, and spiritual readings from multiple faiths.

She played classical music at first, but after a few minutes she turned on big band tunes, thinking that the patient probably had been a teenager in that era. The television was on a channel showing waves crashing on a shoreline. The room was a comfortable 70 degrees. Gabriel noticed that it felt calm and peaceful. She sat by the man’s bedside and held his hand. “It has always been my practice to talk to patients, whether they’re responsive or not, and I do think that there was a perceptible relaxation of his body when I first spoke to him,” she says. The man died the following day, with another volunteer by his side.

Gabriel, a nurse for 40 years, says she has seen plenty of patients face their final moments alone. “In health care, you’re always being pulled in many different directions,” she says.

“There are patients who want you to stay with them, and the best you can usually do is to say that you’ll make it back as soon as you can.”

During the NODA orientation, volunteers learn about their duties as “compassionate companions.” They’re told that they can read to patients, play soft music for them, and light an electric candle. They also learn what death looks, sounds and smells like, such as the “air hungry” gasps a dying patient may experience. Volunteers say that far from being frightening or sad, the experience of sitting with a patient feels peaceful and sacred, a time when the world stops as they behold something important and special.

“I think when we stop and sit with someone, especially an individual you know precious little about, you’re kind of enveloped in the mystery of this person and of this life,” Aguilera-Titus says.

For many, the desire to volunteer stems from a personal experience with death. Gabriel’s father died when she was a teenager. Other family members were home, but no one was in the room with him at the moment he passed. Aguilera-Titus lost her father 12 years ago, and two of her sisters died of breast cancer in the summer of 2006.

“It’s one thing to know on an intellectual level that death is a part of life,” she says. “It’s another when your world gets turned upside down by personal grief and loss. Every time I’m with a patient, I stop and think: This is someone’s loved one, and is just as important as my own loved ones.”

Milton Alcazar, a service desk analyst for Suburban Hospital’s IT department, lost his father in December 2013. His mother and sister were present for what they said was a peaceful passing, and Alcazar traveled to Bolivia for his father’s burial. Still, the regret of missing his father’s death weighed on him. “Even though I know it’s not possible to make up for the moment when I was not there for my father, I felt like volunteering to be there for someone else’s family member would be a good thing to do,” he says.

The first time Alcazar sat with a patient, one evening after work last fall, he found himself with an elderly man who seemed restless. Alcazar had been reading Scripture, but he stopped and laid his hand on the man’s shoulder. “When I did that, he took a deep breath and got very calm,” Alcazar says. “I think that’s when he knew that somebody was with him, and I think it made him feel more at ease.”

Alcazar spent the rest of his two-hour shift reading to the man in a quiet voice, and reassuring him by holding his hand. “It made me feel very close to him,” he says.

When the next volunteer showed up to relieve him, Alcazar didn’t want to leave. “I really just wished I could be there with him longer,” he says. On his hourlong drive home to Centreville, Alcazar didn’t listen to music like he usually does. He drove in silence, he says, his mind lingering on moments from throughout the night: what it felt like to lay his hand on the man’s shoulder, the sound of the man sighing in what seemed like peace. When Alcazar arrived at work the next day, he learned that the man had died early that morning.

“It makes you stand back and look at how precious life really is,” Alcazar says. “It was humbling.”

Amy Reinink is a frequent contributor to the magazine who also writes for Runner’s World and other outdoor publications. To comment on this story, email comments@bethesdamagazine.com.