FORT WORTH -- The patient was only in her 40s, but addiction and homelessness had taken a toll. She was dying alone in her room at John Peter Smith Hospital, no family or friends at her bedside.
She asked for staff Chaplain Tyrena Hallett, who had visited the woman throughout her hospital stay.
Could you be with me when it happens? she asked Hallett.
Of course, Hallett told her.
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"When it came time, I sang to her," Hallett said. "I just felt fortunate that I could be there."
Dying without the presence of loved ones is a sad but familiar occurrence at public hospitals, where some patients are homeless or separated from relatives by international borders. Their lonely deaths have prompted Hallett and other JPS officials to launch a new project called No One Dies Alone.
They are putting together a group of employee volunteers to sit with patients in their dying hours, a practice they hope to start next month.
"The greatest fear for a lot of people is to die alone or feel abandoned," said Chaplain Dann Baker, JPS director of pastoral care and ethics. "Just to have someone there, to know that someone cares, can mean a great deal."
JPS has five staff chaplains who do their best to comfort patients and families, he said. But about 470 patients die in the hospital each year, not counting those in the emergency department and trauma ward, and chaplains cannot spend as much time with everyone as they would like.
Each month, two to four of those patients die without family or friends present, Baker estimated.
The No One Dies Alone initiative is patterned after a program started by a nurse at an Oregon hospital. An elderly man had grabbed her wrist and asked her to stay with him while he died. She was busy and told him she would come right back.
When she returned, the old man was gone.
"It really impacted her, and we're using what she started as a guide," Baker said.
Many people are fortunate to die surrounded by loved ones, feeling their touch and love, Baker said.
Some families bring mementos from that person's life, photographs of children or familiar music. Baker recalled playing Etta James' song At Last for his own sister as she died of cancer in hospice care.
At JPS, families bring in everything from rosaries to pictures of a dying patient's beloved Harley-Davidson, Baker said.
"Often they stand around telling stories, maybe crying," he said. "Then someone tells a funny story about how that person irritated them and all of a sudden, everyone is laughing. It seems sort of incoherent at first, then you realize that's just how life is. "
But other patients are far removed from family. Some have fallen into homelessness or have deliberately cut off contact with relatives. Some have families in Mexico or other distant places who cannot afford to travel.
They often die alone, their room silent.
Some patients die too quickly for their families to reach them. JPS has a viewing room just off the morgue so people who arrive afterward can still see their loved ones, Baker said.
Feeling as though they are taking part in the experience can help assuage their grief, he said.
"Just last week, I had a family member call me who couldn't get here when their loved one died," Baker said. "They wanted to know if I was able to pray for them or do anything. I was able to share what I did do and the fact that I was present.
"It seemed to comfort to them even though it was still tragic and sad."
The cost of the new program is minimal because it relies on volunteers, Baker said. Dr. Geno Tellez, a JPS trauma surgeon, donated money for a CD player and some music to play in the rooms of dying patients.
Organizers hope to start with 20 volunteers and create an on-call list, Hallett said. Volunteers would likely be asked to sit with patients in two- or four- hour shifts.
The program focuses on patients who are likely to die within 24 to 48 hours, Baker said.
A hospital social worker and case manager are among those helping build the program, Hallett said.
Watching a patient die affects those who are present, Hallett said. But for her, she said, it's not in the way some might presume.
"I consider those last conversations holy ground," she said. "Because you really get an opportunity to hear their last thoughts, even if they are expressing fears.
"I feel lucky that I can be there for them in that moment."
Alex Branch, 817-390-7689