No One Dies Alone program ensures a human touch at end of life

Babies don’t enter this world alone. Hospital patients nearing death without family should have at least one person nearby to hold hands with before they die.

That’s one motivation shared by volunteer coordinators Tracy Roundy and Connie Christilaw in Providence’s 10-year-old program, No One Dies Alone. Volunteers do two- to four-hour shifts at Providence Sacred Heart Medical Center or Holy Family Hospital in vigils over a few days, but often less.

Hospital staff contact the program’s coordinators after they see signs that a death is imminent, typically in the next 48 to 72 hours.

“We’re sitting with patients who don’t have family either in town or no family at all, or they’re estranged,” said Roundy, also a clinical trials management system trainer.

“Sometimes, we don’t know anything about this patient. It could be a homeless gentleman. We’re sitting with them and giving them comfort all the way to the end.”

As a retired nurse and former Spokane deputy coroner, Christilaw has seen much death. She’s also a volunteer in the hospital’s neonatal intensive care unit around newborns, as witness to both the start of life, and, with No One Dies Alone, the end. “Talk about powerful,” she said.

She considers it an honor to be with people when they die.

“They are alone except for us,” Christilaw said. “We’re strangers when we get there. That’s hard, but yet, it’s also incredibly rewarding to be with a person at passing.

“People ask if it’s depressing or morbid; it’s not. It’s an honor to be there at the end. It honors their life and their existence.”

Hospital chaplains are spread thin helping all patients, and the nurses having to make rounds appreciate the volunteers, both women said.

Christilaw said she’s often advocated for a short, symbolic gesture when someone passes, similar to when a baby is born and the hallways ring with a chime.

“For decades, I’ve said we need to have something go overhead when a patient passes, either a soft single chime or something to honor the end of a life, not just the beginning.”

More volunteers are needed, but the coordinators said they know this isn’t for everybody. Many people have never witnessed death or birth. Volunteers often have ties to health care or teaching, but others are college students or from other varied backgrounds.

Before COVID, the program had about 56 volunteers, but that fell to 20. A recent two-day training added more people, and Providence now has about 31 volunteers who cover 15 to 20 vigils a year.

In 2021, MultiCare began a No One Dies Alone program, after Valley Hospital Intensive Care Unit nurses felt distraught over multiple COVID-related deaths and wanted to bring something positive. MultiCare has 21 volunteers.

“We thought, what can we do to help with such loss, to help create something out of such a terrible situation?” said Brittany Zimmerman, an ICU nurse who spearheaded MultiCare’s program launch.

Similar to groups nationwide, MultiCare asks volunteers to do vigils at hospital bedsides if dying patients have no relatives who can be there.

But MultiCare has added other aspects, Zimmerman said.

“If patients have families who can be there intermittently, we also have a family packet we can give them with grief counseling recommendations, numbers for mortuary places and information on frequently asked questions after a loved one dies,” she said. The packets can help relatives relax and focus on the patient.

“We also give handmade quilts from both volunteers and staff members.”

Christilaw said the vigils aren’t meant to be a respite for family members who can be there but don’t want to.

While volunteers don’t provide any medical care bedside, they can offer comfort such as mopping a brow, giving a sponge with water or calling a nurse. Often, there’s a lot of hand-holding, if the patient wants that touch.

The patients often are unresponsive, but the volunteers can tell the dying individual knows someone is there.

“You can see flinching sometimes,” Christilaw said. “Every patient is different.”

Some patients pull away to avoid touch.

“Other patients will reach out and want to grip harder or they’ll squeeze your hand. When we wipe faces, they’ll flinch or look relieved. We just have to be very responsive to what that patient needs, and even without words, they can let us know.”

In training, volunteers are told not to feel guilty if they’ve sat for a while, take a break and return to find the patient dead. Christilaw and Roundy say they’ve witnessed that some people seem to wait to be alone for the end.

Roundy said that happened during a 30-minute window with her grandmother.

“I was there with her all weekend,” she said. “That half an hour when I wasn’t there, she passed away, but I think it was that she didn’t want anyone there.”

Christilaw has a reputation that, when she does vigils, more people seem to die on her watch. She’s nicknamed “diva of death” for a good reason, Roundy said.

At a vigil start, Christilaw settles bedside and immediately rests a hand on a patient, telling them, “It’s OK. I’m here. You’re not alone.”

Several times, the patient seemed to relax and die shortly afterward, she said. One man instantly took a deep, last breath after hearing her say, “You’re not alone.”

She’d just hung a sign outside the door with only an image of hands being held to let staff know she was there. Just after he died, a nurse walked over to announce a move to a comfort care room.

“I said, ‘Probably not; you better put your stethoscope on him,’ ” said Christilaw, who has done more than 50 vigils. “She goes, ‘You just got here,’ and I said, ‘I know.’

“Literally, what happened next is I heard the baby bell chimes, and I felt his soul leave the room. In 38 years of nursing, that has happened to me only twice. I’ve been around death hundreds of times. I literally felt his soul leave the room.”

The other time happened when she was a Navy nurse and cared for a baby who died, she said.

While death can happen within minutes of volunteers arriving, other times, it can be days. Some people have done vigils for years and never had a patient die on shift.

Sometimes, the phone rings and a volunteer will hold the phone up to the patient’s ear, so a relative who lives across the country can say goodbye.

“We always assume they can hear,” Christilaw said. Visual cues can help. One woman held a frayed blue collar in her hands. Bedside, she had a picture of a black Lab, so Christilaw talked to her about that beloved pet.

Roundy said volunteers learn the importance of letting patients know someone is there. She once sat with a man who had a criminal record, but that didn’t matter.

“Part of our training is letting them know it’s OK to go; we’re here with you and you’re not alone,” she said.

“We’ll be here through this process, just giving them that comfort by holding their hand.”