by Sandra M. Clarke, CCRN
Ms. Clarke is nursing supervisor, Sacred Heart Medical Center, Eugene, OR.

One rainy night at Sacred Heart Medical Center, Eugene, OR, 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.

Since that night I have on occasion mentioned to peers and administrators my idea for putting together a group of volunteers made up of hospital employees who would be willing to sit with the alone and dying. Usually this is met with, "Good idea,"  and sometimes, "I already give this place enough of my time!"  For 16 years my vision quest remained only conversation.

The past 14 years I have worked where no one dies alone. 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.

The medical community has begun to focus on the need for specialized end-of-life care. Sacred Heart Medical Center has been proactive and innovative on this front. We have unit-based ethics resource teams in ICU and oncology. These teams are made up of staff nurses who teach, review patient care, and assist other staff with complex ethical concerns that surface. We have protocols for palliative care and comfort care. We have music thanatologists on staff who play for dying individuals.

In this climate, during casual conversation with another nurse, our pastoral care director, Bob Scheri, overheard me talking about my old idea for employee volunteers who would attend the alone and dying. Bob asked me to write a proposal, which he would take to PeaceHealth corporate headquarters for consideration. In six months an ad hoc committee, composed of various department heads and myself, created a complete program based on a simple plan without creating a new department and minimal financial impact. Bob Scheri deemed it a "virtual department."

"No One Dies Alone" as 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.

What is satisfying for me is that my original plan, formed only in my mind, is essentially intact. Today, with computer technology, some things have been streamlined. No One Dies Alone has its own web page on the Sacred Heart/PeaceHealth home page where employees from any department can sign up. It includes a patient confidentiality agreement and a volunteer agreement that states that no one will be expected to perform their own job while acting as a "compassionate companion." There is an orientation packet for volunteers. Once-a-month hour-long orientation sessions are held to answer questions and explain what might be experienced.

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.

At Sacred Heart Medical Center an estimated three or four people a month die who have out-lived their family members, or have alienated themselves from friends and family through lifestyle choices, or have had a catastrophic event while passing through Eugene. My goal is that not one of these persons will die alone.

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."

I am not an especially pious person. I do have a strong belief in human rights, particularly when a person is most vulnerable. No One Dies Alone has been a profound professional and spiritual experience. It gives both job satisfaction and a raison d'etre. It is a plan which could be readily implemented in any hospital. In time, it may be true that, No One Dies Alone.