The poem, titled "The Ship," tucked away in the No One Dies Alone (NODA) orientation packet, begins with the lines "I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean." The ship and its journey are a metaphor for encroaching death, a moment when life-sustaining treatments give way to comfort care. The alarms and bells of monitoring medical equipment are turned off and replaced with poems, passages, and musical pieces. This anonymously written poem characterizes death as a sort of passage from one place to another, where it exclaims, "There, she's gone!" As the ship dips beneath the distant horizon and asks, "Gone where?" it reveals, "Gone from sight, that is all." The ship still sails. It's that time upon the water, still in view, while slowly dipping into the horizon, that the NODA volunteers are a beacon. In a patient's final days, volunteers become stalwart lighthouse operators tethering the dying to the earth.
Larry Cothrin, Director of Pastoral Care and the NODA program, says the program is about dignity in death. Most importantly, he says the program is about offering commitment and presence when life circumstances might, without intervention, result in a patient dying alone. He says that the NODA vigil is a ministry upholding one of the many tenets of "The Dying Person's Bill of Rights." Near the center of the page, the seventh declaration in the Bill of Rights reads, "I have the right not to die alone." The guidance is designed specifically with the dying's dignity in mind, reminding us caretakers and volunteers of a person's wholeness until their death and of all the life that preceded the vigil. Volunteers, or "Compassionate Companions," arrive at the very twilight of a patient's life, at a point where patients are officially in a comfort care status. To begin a vigil, the patient must be in an Allow Natural Death (AND) and Do Not Resuscitate (DNR) status, must be expected to pass within 48-72 hours, and extubated. Rev. Cothrin says that patients are unable to speak in most cases. However, sometimes patients can communicate with their NODA volunteers, leading to illuminating conversations about their interests, life, and hints of their humor.
Throughout the hundreds of entries in the Compassionate Companion journal, themes appear, connections that tie volunteers to each other and volunteers to shared patients. Repeated, in precise penmanship or hurried scrawl, are hints to the importance of the NODA ministry. Volunteers describe the program as a blessing and share how proud they are of fellow volunteers, admiring "the courage and willingness to sit with dying people." Some volunteers end their written praise with drawings of small hearts beside their signatures. Other volunteers share their own testimony, highlighting an aspect of NODA volunteering that repeats: a catharsis. The program offers an opportunity to right something in their own history, like a moment when they couldn't be there for a dying loved one. For example, one volunteer wrote about not being able to be beside their late husband when he passed. Another wrote about a comatose grandmother who passed after several years. Somehow, through their volunteering, they're closing a circle, channeling their presence into a dying stranger with all the familiarity of a lifelong loved one. Some shave their patients' faces, caress their brow as they sleep, or whisper prayers over their bed. In reading through the journal entries, there are rarely statements about any patient's passing. Instead, the name is suddenly different as one entry moves to the other. The only continuity resides in the signatures of repeat volunteers.
A book of CDs, relics and indications of the NODA program's hodgepodge of over-time donations, rests alongside a host of end-of-life artifacts. The supply bag items are available should the patient or the volunteer need encouragement or a way to pass the time. Including the albums above, the CDs include Beethoven as performed by Wilhelm Kempff, Brenda Lee's Gospel Favorites, Soul's Desire's Passion Praise & Worship, The Ladies' Country Gospel Favorites, and some Spanish artists, including Los Buhos and their Tres Cruces, mostly Christian praise music accompanied by some secular instrumental classics. A blue, plastic rosary and an embroidered devotional scapular, primarily worn by Roman Catholics, Anglicans, and Lutherans, are tucked into the mesh netting in the top of the supply bag. Books, including the Holy Bible (in Spanish and English), Ruth Fishel's Time for Joy: Daily Affirmations, One-Minute Prayers for Women, Words of Encouragement: Faith, Love, Hope, the Christian poem book Wings of Faith, and The Collected Poems of Emily Dickinson.
"There are several reasons why people might be alone at the end of their life,” Rev. Cothrin says after asking him about the kinds of patients that find themselves in these vigils. "In my experience, they're typically people that are estranged from their family due to something they've done or something that's been done to them." Others are travelers, far from home and family. Some have nearby family members, but they struggle to stand beside their dying loved ones in their final hours. Instead, they choose to remember them as they were before they became sick. "Some are homeless," Rev. Cothrin says, "with no form of ID, so we don't even know their name." In these stories lie the essence of the NODA program: that dignity should be granted to every dying person. The homeless, the nameless, and the troubled all deserve to die beside someone who cares; that love might come from a stranger, a Compassionate Companion, or someone who would want to be treated with the same level of dignity should they ever find themselves in a similar situation. NODA becomes an extension of our Service is Our Passion motto, that through generosity, commitment, and grace, we serve our patients to their final breath.
And so, the poem "The Ship" ends with, "And just at the moment when someone at my side says, 'She's gone,' there are other eyes watching out for her coming and other voices ready to take up the glad shout, 'There she comes!' And that is dying." As we dip beneath this earthly horizon, perhaps our tall masts rise in the distant line of another, somewhere painless and restful, where that deeply held breath is finally exhaled, where we say, in that same breath, "I have arrived."