End-of-Life Choice, Palliative Care and Counseling

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No One Dies Alone program offers comfort to the end

By Thomas Curwen
The Los Angeles Times
July 5, 2012

Barbara Farkas is certain about what happens after death. It is the end, she says; there is no heaven, no hell, no journey that lies ahead. Her conviction hasn’t changed, no matter how many times she has sat with the dying.

Holding Taylor Hall’s hand, she could tell he would be around for a while. She felt his grip and looked into his bright blue eyes. He was getting a fairly light dosage of morphine, at least for now, she thought.

Hall had been admitted to the hospital two days earlier, consigned to a hospice room, and as soon as Farkas got the news, she scheduled time to keep him company. They were strangers, but that hardly mattered. Aside from a few friends, he had no one in his life.

“Are you thirsty?” she asked. “Shall I wet your lips? Would that feel good?”

Hall turned to face her. He was 57. His short cropped hair, bushy mustache and eyebrows reminded her of her uncle John. He was delirious either from pain medication or his tumor — she didn’t know — but he managed to speak.

“Thank you, ma’am.”

His room had a sliding door that was open to a courtyard, and a breeze pushed the curtains out, breaking the twilight inside with a thin sliver of light.

He lay elevated on the bed. A loose bandage covered the left side of his neck where the tumor, a nasopharyngeal cancer, had broken through the skin. An IV line entered his left wrist.

Farkas, 68, leaned close and moistened his lips with a green swab. She noticed that he was missing a few teeth.

Her life was so different not so long ago when she worked for a manufacturer of semiconductors in Torrance. She was on the phone all day with clients, processing international shipments and expediting orders.

She had a reputation, she says, for being outspoken, and if she exploded at someone, it was only in the course of doing the job. She was under pressure and had a sales quota to make. Then in April 2009, she was called into the human resources department. She was one of 28 employees let go in a downsizing.

After 30 years on the job, staying at home wasn’t an option. Her husband, a high school teacher, had no intention of slowing down. Volunteering seemed to make sense, so she signed up with Little Company of Mary Medical Center in Torrance and twice a week drove from her home in Gardena to escort patients and assist the nurses.

When she heard that the hospital was starting a program called No One Dies Alone, she was intrigued. A few years earlier, she regularly visited a friend who was dying and felt good for being able to help with his care and comfort him.

Today she is one of 32 volunteers who attend to patients as their schedules allow. Since signing up two years ago, Farkas has sat with at least 30 patients, and the experience has changed her, she says, leading her to discover patience, calm and compassion she didn’t know she had.

“Do you want to listen to music or do you just want to rest?” she asked Hall.

His words came out as a hoarse, indistinguishable whisper. She fiddled with the CD player, and Glenn Miller started to play.

“I don’t think you like swing music,” she said. She had heard that he was a fan of the Rolling Stones.

Despite the open door, the room smelled foul, the result of bacteria and necrotic flesh around the tumor, but Farkas was not bothered. She once sat with a woman with ovarian cancer who needed to be bathed twice a day. The nurses wondered how Farkas could stay in that room for four hours straight. She said she got used to it.

She has seen how tenacious life can be. Without food and on only pain medication, patients endure. Death comes slowly, and she recognizes its onset: dehydration, incontinence, congestion and the panic that sets in as breathing becomes more difficult.

Hall, whose last job was at a car dealership a few years back, had been in a residential care facility in San Pedro and then in Long Beach as his cancer advanced. In May, he was discovered unconscious and taken to St. Mary Medical Center. Doctors stabilized him, but he was too fragile for treatment.

He is divorced, his parents are dead and he is estranged from his brother, so he put a friend in charge of his health, and together they decided that he should enter hospice care.

“How do you feel?” Farkas asked, trying to maintain a conversation. “Do you want me to let you sleep?”

No One Dies Alone was started in Oregon in 2001 when a dying man asked a nurse to sit with him. She agreed but first needed to make her rounds. When she returned, the man was dead, and the nurse resolved to enlist volunteers to stay with patients who were alone and close to death.

The program was picked up by other hospitals around the country, and began at Little Company of Mary in 2009.

“We instinctively know that people at certain times of their lives shouldn’t be alone,” said Denise Hess, the hospital’s chaplain for palliative care.

Hess, who meets with patients and schedules the volunteers, says No One Dies Alone benefits not only the patients but also the nurses, who find it a relief to know that someone is watching their most vulnerable patients.

When Farkas went through the training — a day-long seminar that included a session with a computerized manikin that could breathe and speak and replicate various stages of dying — she was concerned that she would become too emotional.

She surprised herself by enjoying the time with the patients. Each shift is unpredictable. Each shift leaves Farkas with the feeling that she has been useful.

“I find it meaningful to show them that someone cares about them,” she said.

Keeping vigil is sometimes as simple as holding a hand. Sometimes it means rubbing feet or talking or reading aloud. In instances where patients are asleep, too close to death to respond, Farkas sits silently beside them, a book in hand. Few are as responsive as Hall.

“We enter this world surrounded by people,” Farkas said, “and we should leave it in the same way.”

Only one patient has died in her company. She was reading the New Testament to him, and she heard him stop breathing. Being there at that moment wasn’t as distressing as she thought it would be. Not knowing him eased the sadness.

She had heard some volunteers talk about how the experience has brought them closer to their faith, but faith has never meant that much to her. Raised Methodist in Indiana, she stopped going to church when she was 12. Her husband is Catholic, and they baptized their daughter. For a while they attended Mass, but she went for her family’s sake, not her own.

She stroked Hall on his arm, tracing a circular pattern on his skin, something she learned from being a mother. Her daughter said the gesture always soothed her.

Farkas’ mother was in this facility two years ago. She had broken her hip, and after being discharged, was taken to a rest home in Lomita where she died. Farkas wasn’t with her at the time.

She sympathizes with families who can’t be at the hospital when a relative dies. Some live too far away or can’t take time from their jobs or find their estrangements, no matter the circumstances, too hard to bridge. For others, death is just too painful to watch.

When she hears friends say they’d like to die at home, she tells them what a burden that can be, especially for children, needing to prepare meals, arrange baths and administer medicines.

As food carts rattled down the hall, a call-button trilled from the nurses’ station, and an alarm from a bed sensor in another room went off. Farkas finds facilities like this depressing and wonders if she might end up in one. She hopes to die in her sleep.

When the lunch tray arrived, she fed Hall a puree of bread dressing, glazed carrots and roasted turkey, and when he was done, she gave him a drink of water and stroked his ear and cheek. She leaned over him, her head just a foot from him. A slight smile traced across his lips.

“Good thoughts?” she asked.

For Farkas, to sit with the dying is like looking at a Rorschach, each patient a shadowy impression open to interpretation. She had heard that Hall played golf. She thought he must have been well liked.

As children’s voices drifted in from the courtyard, she closed the sliding door and curtain. A nursing assistant came into the room to change and bathe Hall, and Farkas helped as she could. The sudden attention agitated Hall.

“I’m going to go with you right now,” he said, making little sense. “Please, I told the nurse I would be right back. Please.”

Farkas reassured him and, afterward, took a cool wash cloth to his forehead.

“Oh oh,” he said, wrapping his hand around her thumb.

The hospital grew quiet, except for the hum of the building and the ticking of the wall clock.

“You’re a good hand-holder,” she told him.

He yawned.

At 2 p.m., she tidied up the wrappers from the moisturizing swabs. Her two-hour shift was over, and as the next volunteer stepped into the room, Farkas said goodbye.

Walking toward her car, she was surprised by the bright light of the afternoon. The fog had rolled back, and the leaves of the liquidambar trees lining the sidewalk shimmered in the breeze.

Some day, she thinks, she would like to go to Italy with her husband. That’s on her list of things to do before she dies, but for now she needs to schedule her next shift.