It used to be that four or five patients would die in a room by themselves each month at the University of Utah Hospital.
Sometimes they were homeless. Sometimes they were estranged from family or had outlived all their closest relatives. Sometimes their family and friends couldn’t reach Utah in time.
U. nurse case manager Jim Geiermann had seen it over and over: “You go into a patient’s room, and they’re all by themselves.”
They won’t be anymore.
A newly formed volunteer group at the east Salt Lake City hospital aims to give those people an around-the-clock companion in their final day or two of life. On a recent evening, Geiermann and about 20 others, many of them hospital employees and medical students, met in the hospital’s Serenity Room to learn how to take part in the program called No One Dies Alone (NODA).
It takes a rotating cast of volunteers willing to carve out three hours of their days — or skip some sleep — to sit with someone who is near death. They hold the dying person’s hand and read to them. They talk about their lives or play music.
Often, the patient is in no shape to respond. But at least, volunteers said, someone is present for those final moments.
“You’re not their nurse. You’re not their doctor. You’re not anybody else — you’re just there for them,” Heather Smith, a social worker, told attendees.
The idea for NODA began with Sandra Clarke, a nurse in Eugene, Ore. She was making her rounds during a night shift when she came upon a man with a “do not resuscitate” order. She could tell he was close to death.
“He could barely speak, and he said, ‘Will you stay with me?’ ” Clarke recalled in an interview years later. “And I said, ‘Well, I can’t right now. I’ve got to see my other patients first. But as soon as I get done, I’ll come back and be with you.’ ”
By the time Clarke returned to his room, the man was dead — with an arm outstretched, as if reaching for someone.
“The sense of frustration and anger was overwhelming,” Clarke recalled. “He had a simple wish that was easily granted, and I couldn’t do it.
“From that moment on,” she said, “it became something important for me — to find a way we could be with patients at the end of life.”
The NODA volunteer organization formed in 2001 and has since spread to hospitals around the country, and even to Singapore.
At University Hospital, volunteers have been active for more than six months, managed in part out of the hospital’s social work and volunteer offices, and by Brian Zenger, a 25-year-old medicine and biomedical engineering graduate student at the U. He said the group recently received approval to expand to Huntsman Cancer Institute.
For those not in the medical field, Zenger said, there’s often a sense of shock — people actually die alone? — followed by a desire to help.
Nontheless, said Zenger, the group is constantly trying to attract volunteers. It currently has about 30, but organizers hope to expand those ranks to between 50 and 100 people to fill the three-hour shifts.
At the recent training, volunteers learned how to be “compassionate companions” during the 24- to 48-hour vigil — how to be present with the dying, but not overbearing. Volunteers are encouraged to offer some of their own personality. Spending time checking emails on a smartphone is frowned upon.
The first thing Zenger noticed on his initial vigil several months ago was how “unbelievably depressing” and sterile the hospital room felt. So he does his best to “screw it all up.” He fluffs up pillows, unfolds blankets, moves things around, turns down the lights. Sometimes, he’ll bring a philosophy book to read aloud.
“To me, it feels like it would be a very spiritual experience, as well as one of service,” said Lisa Browdy, a yoga teacher who attended one of the training sessions.
Browdy, 54, said she began to research issues surrounding death after a close friend died at a young age, and her mother-in-law suffered far too long before dying. She has discussed the process of dying extensively, but she said she’s never stayed with someone as they died.
“I don’t think it’ll freak me out,” Browdy said, “but one doesn’t know until one does it.”
Volunteers learn beforehand what they may witness. Breathing patterns may change; the patient’s eyes may appear glazed; the skin may turn dark as circulation withdraws, Smith, the social worker, told them.
If the dying person is conscious, he or she might speak to people who aren’t there. Patients may talk of “going home” or “waiting for the bus.” They sometimes mention moving toward a light.
“Dying is a journey that each one of us is called to take,” Smith said, reading from the NODA training book. “It is a journey into the ultimate unknown, one that no one else can take for us. It is mysterious for those who remain behind.
“Witnessing this intimate journey for another,” she added, “is sacred work that requires no more and no less than our presence.”