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Q & A
Q&A: Comforting patients in final hours Bill Fentum, Sep 19, 2008
Denice Foose
Seven years ago, a Catholic hospital in Eugene, Ore., launched a program that was so simple, it’s hard to believe no one had thought of it before: If terminal patients are facing their last hours with no family or friends around, why not have a volunteer sit beside them to provide spiritual comfort?
Methodist Hospital in Houston, Texas, adopted in 2007 the “No One Dies Alone” program, now called Compassionate Care for the Dying. United Methodist laywoman Denice Foose is the hospital’s bereavement coordinator who supervises volunteers. She talked recently with staff writer Bill Fentum.
How did the program begin at Methodist Hospital?
We ran it as a pilot project for several months. Before that, I thought the only people who were at risk of dying alone were those who had no family at all. But the first patient we helped was a 60-year-old man who had traveled 140 miles to Houston for heart surgery. Things didn’t go well for him, and it was clear he was going to stay here and die. There was no way for his elderly parents to come, so our chaplains stayed with him. It was great for his mother, 94, to be able to call and say, “Can you read Psalm 91 over him? Can you tell me what he’s doing?”
The next patient was Bishop Peter Dabale, the United Methodist bishop of Nigeria, who died at the hospital from liver cancer. He had been flown here for diagnosis and treatment, but things deteriorated quickly. Again, there was no family around. His daughter was a student in the U.S., at Duke Divinity School, but she couldn’t get here immediately. We bridged the gap until she arrived.
So it helps families as well as the patients themselves.
Yes. It gives a family a sense of comfort to know, “OK, I’m trying as hard as I can to get there. But if I don’t, they’re not just going to be in the room alone.” And it’s good for the staff on the floor. There’s nothing worse for nurses than to know that Jane is dying in Room 9, but they have other patients to tend to. It relieves the stress for them, at least a little.
Did it take you long to get volunteers for the program?
Not at all. My first thought was to recruit people from local churches. But right away, more than 70 staff members stepped up to help. A lot of the hospital’s senior executives do it because they say, “All I do is crunch numbers all day, I’m never around patients anymore. This puts me back in touch with why I got into health care in the first place.”
Now we have about 150 volunteers, about 90 percent of them on the staff. And we still get four or five calls a week from people wanting to get involved or other hospitals wanting to start their own programs. I’m also hoping to get it started in nursing homes and homeless shelters.
Are people trained before they sit with patients?
Yes, we train them one-on-one for an hour or two, enough time for us to get to know them better and see what kind of background they have in health care. You really need the person to be a presence in the room more than anything else. Most patients are non-responsive in the last 24 to 72 hours. We’re there to hold the person’s hand or wet their lips—or play music if that might comfort them. We try to find out as much as we can about each patient, including their religious preference, either from family or from papers they filled out when admitted.
One gentleman’s spirituality was Native American. With his family’s help we were able to provide readings and play music that was meaningful for him. His mother told me, “We’ve been to five different hospitals, but no one attended to our spiritual needs like this hospital.” That’s what it’s about, for us.
How long does each volunteer sit with a patient?
We like to schedule them in three-hour shifts, but it can vary. Several people take six-hour blocks, from midnight to 6 in the morning. But anything over three hours can be pretty taxing, so we try to limit the shifts.
How do you know if a volunteer is ready for the stress?
One thing we look at is the person’s age and whether they have any experience with the death process. Some volunteers in their early 20s have never had a death among their family or close friends—period. I would never stick them in a room all night by themselves with somebody who's dying. Early on, one young volunteer was so full of anxiety about being left alone with a patient that he started to upset the nursing staff. That’s the last thing you want.
Also, we need to know about their motives for volunteering. Are they driven by a sense of compassion or curiosity? That’s more often a problem with outsiders, but even with staff members, the nature of their daily job may not lend itself to bedside care. Their main experience may be with answering phones or transporting patients.
Why did you change the name of the program from “No One Dies Alone”?
The reality is that for all our best intentions, some people may still die alone. Because the family has gone home for the night, perhaps, and the patient rapidly declines. Whatever the reason, I would hate for that to happen and then hear a family say, “But you advertised, ‘No one dies alone’!”
I understand that you also send a letter to each family after the death.
Yes, that’s part of our 13-month bereavement program, something we do after any death in the hospital. Our chaplains remain available to families, to listen and offer spiritual and emotional support. And we do the same for hospital staff when they lose loved ones. There are several different types of intervention, whether it’s grief-support groups or just helpful hints about how to tell the difference between normal and not-so-normal grief. They can reach us by phone or e-mail, 24/7. We’re a faith-based hospital, and one of our core principles is to provide a caring, spiritual environment.
That’s also why we started our Patient Partner program. Volunteers, again mostly from our staff, buddy up with patients who are expected to be here two weeks or longer. They can run up to the patient’s room during lunch, or before or after work. They’re simply there to socialize; to talk about whatever the patient wants to talk about.
In one case, a man from New Jersey was here on vacation when he suffered a massive heart attack and had to be hospitalized for a couple of months. He was a big NASCAR fan, so his partner actually went out and researched NASCAR so they’d have something to talk about. In another situation, I partnered with a lady who had just been told she had only three months to live. Her husband and family wouldn’t hear of it—they wanted her to keep up the fight. She just needed someone who would talk with her about dying. Our partners play a lot of different roles.
Denice Foose
The next patient was Bishop Peter Dabale, the United Methodist bishop of Nigeria, who died at the hospital from liver cancer. He had been flown here for diagnosis and treatment, but things deteriorated quickly. Again, there was no family around. His daughter was a student in the U.S., at Duke Divinity School, but she couldn’t get here immediately. We bridged the gap until she arrived. 
