Saturday, April 02, 2005

Dying, but not alone

While thousands attend the passing of the Pope and Terry Schiavo, Ann Althouse thinks of those dying with no one near:
I imagine them watching the TV reports, seeing all the people lavishing care on these two souls, and feeling terribly sad and lonely. These throngs of people standing in high-profile vigils could disperse and go individually to thousands of bedsides and visit those who suffer in isolation.
A Eugene nurse has started a program that puts volunteers at the bedside of dying patients. It's called "No One Dies Alone." She writes:
One rainy night...I had a brief encounter with a man whose name I cannot recall; a man I shall never forget. He was one of my seven patients, near death and a DNR. During my initial rounds, he asked, barely audible, “Will you stay with me?” He was so frail, pale, old, and tremulous. I said, “Sure, as soon as I check my other patients.”

Vital signs, passing meds, chart checks, assessments, and bathroom assistance for six other patients took up most of the next hour and half. When I returned he was dead. I reasoned he was a DNR, no family, very old, end-stage multi-organ disease; now he was gone, and I felt awful. It was okay for him to die, it was his time - but not alone.

I looked around, scores of people were nearby providing state-of-the-art patient care. For this man state-of-the-art should have been respect and dignity...

Speaking with nurses from other ICUs, there seems to be an unwritten universal protocol for the patient who is dying without the presence of friends or family. One’s other patients’ care will be taken over by nearby nurses. Rituals of passing are acted out: I’ve seen nurses quietly singing, holding the hand of the dying, and, in other manners of behavior, showing care and respect while an individual passes on to death. Nurses know the awe of being present at the birth or the death of another human. I believe awe and privilege is an innate human response at these times, the very essence of humanity...

“No One Dies Alone” has been up and running since November 2001. It is still a work in progress with a few things that need to be tweaked, but overall it fills the void for which it was intended...

A staff nurse generally initiates “No One Dies Alone” by calling pastoral care or, after 5 pm, the nursing supervisor. The person who has signed up for that date is called. It is totally a volunteer program, and no minimum or maximum time has been set. The“compassionate companion” is provided with a parking pass and a meal ticket. We have a gym bag with a CD player, various CDs, a journal, and a Bible. We emphasize that any religious behavior will be initiated by the dying patient and not by the companion. Staff and the “compassionate companion” use an evaluation form in an ongoing effort to improve the program.

The reasons individual employees have volunteered are fascinating and as varied as their departments. Hospital carpenters, administrative heads, maintenance workers, nurses, secretaries, and kitchen workers have come forward. Some come from large families who cannot imagine someone being alone; others are alone themselves. One nurse from the cardiac cath lab has seen many die in spite of the high tech environment and care. He wanted to experience once again “why I became a nurse in the first place—to care for those who can no longer care for themselves.”
Other hospitals have adopted her program. (See this article, which links to the program's manual.)
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