Putting Life in Perspective:
Stories from a Hospice Volunteer
By Tim Tosta

Every Monday night for more than two years, I have made my way to work at Laguna Honda Hospital’s Hospice for the evening shift, which runs from 5 p.m. to about 10 p.m. The Hospice is an open ward. It contains 26 beds on either side of a single long wide open hall — 13 beds for men and 13 beds for women. I imagine that, on average, some 12 to 15 people die there each month.

Many of you have reacted to my Hospice stories with “What a brave thing to do” or, “I could never do that.” But, I assure you, caring for the dying is extraordinary, uplifting work. Discussion of death is very discomforting to many of us. It once was to me too. Some of you, at this point, may not wish to read further. I appreciate that. For the rest, I want to share parts of this incredible journey. If you know someone that might be interested in what I describe, please pass this on. And, if any of this touches you, please let me know.

In telling these stories, please know that I claim no medical expertise. The stories reflect only what I see, feel and believe.

Laguna Honda Hospital serves the City’s indigent. The Hospice residents consist of elderly, who have outlived their families; new immigrants, who live in San Francisco outside established medical support system; street people, who are often brought in from very harsh living conditions; and just other normal folks with economic circumstances that leave them no care alternative.

When a resident dies, leaving no family, his/her body first is taken to the morgue, then transferred to a facility where the body is cremated and the remains buried. I don’t know where these residents are buried. But, since they have no other family, I imagine no one else will either. Their remaining personal property is either given to the other residents or discarded. I have seen photographs, birthday cards, personal memorabilia — things of meaning to the former resident — collected in plastic bags and discarded.

So, what I will write — perhaps most importantly — serves as a memorial to those extraordinary human beings with whom I have had the honor to attend — over a period of years, months, weeks or even a few short hours. My profound thanks go to each and everyone of them for their contributions to my life. I will pass on to others the important lessons they have taught me about courage and nobility in the face of death.

Ben’s Story

From conversations with other volunteer colleagues, I have learned that, despite years of volunteer experience, very few of us actually witness someone’s passing. On my second night as a volunteer, I had my first such experience.

There are two “Quiet Rooms” in the Hospice, situated adjacent to the common room at the Hospice entrance. Residents who enter a period “active dying” are frequently relocated to a “Quiet Room” for their remaining hours. On that particular spring Monday evening, Ben was on the “Quiet Room” on the left as you enter the ward.

I was advised at our Shift Meeting (held with the afternoon volunteer shift), that Ben’s brother had arrived earlier that day from the Midwest with his wife and teenage son.

At that point in my Hospice experience (some five hours total), I was still quite nervous about my competency as a volunteer. I had mentally run through a check list of my duties and the opportunities available to me for the evening. For some reason, the Monday evening shift at that time had only two, rather than the usual four, volunteers — just Prudence and me. Both of us had only just finished our Zen Hospice Project training. We really had little substantive knowledge to share with one another. But we immediately bonded as hospice volunteers, just because we were so “green.”

Early in the shift, I had passed Ben’s small room where Ben’s brother, his wife and son surrounded the bed. I asked as to whether I could help in any way. They told me that since they had been there for the better part of the afternoon, they wished to leave for a bit to have dinner. They asked if I could sit with Ben for an hour or so until they returned.

I said “Of course.” And, I took the visitor’s chair in Ben’s room, next to his bed.

“Active dying” was then not a term that I understood. It is a period when the systems of the resident begin to rapidly shut down. Their extremities grow cold, from reduced blood flow. Their breathing is usually very erratic and labored. In most instances, you feel like the resident’s soul just can’t wait to leave, but is being held back by the body’s force of gravity. As you might expect, Ben looked and sounded horrible. He had little flesh on his bones. His eyes were deeply receded. His color was a yellow green. He probably didn’t weigh 100 lbs.

I wasn’t used to this. I really didn’t know what to do. So I sat by Ben’s bed and meditated. There is a form of meditation called “Metta,” which consists of being present, focusing on your breath and sending out messages to the universe. You ask that the person for whom you are saying the “Metta” among other things, may be free from harm and relieved of pain. In the long minutes of my meditation, I had difficulty focusing on my breath. I wanted to somehow help Ben through his labored breathing. But I did not know how to. I would take a breath — inhale — and find that Ben was taking nine breaths before my exhale. Then, 13 breaths. Then, four breaths. I counted his breaths, sent out my “Mettas” and tried to stay present.

I don’t know how many minutes went by, but suddenly I realized that I didn’t hear Ben. The room had gone quiet. I opened my eyes and studied him. My first thought was that his breathing had eased — that he had been granted a brief respite. Then, another thought came to my mind. “Oh God! Could he have died?”

I found a line of sight where I could watch the top of his chest, cloaked in white, against the backdrop of the wall, which was then dark with shadow, to see if I could detect any motion. I don’t know how long I sat, hoping to see movement. I couldn’t see any!

I heard one of our nurses coming down the hallway and, in the silence of the room, I gestured toward Ben. My eyes must have said everything. She looked at me and said “He’s gone” and proceeded down the hallway.

In that short time, I had covered an enormous distance of emotional experience. And I found myself ill equipped with what was to come next.

In our training at the Zen Hospice Project, we were taught how to treat the body of the recently deceased. I won’t bother you with the detail now. Suffice it to say, that we honor the resident’s body and, in a case where family is present, prepare it for viewing.

That evening, I did not have the time to properly prepare Ben, because his family returned within minutes of his passing.

The son of Ben’s brother was a teenager with Down’s Syndrome. I was caught off guard. Before I could communicate with anyone, he went into the room and immediately knew that his uncle had passed.

The boy had a complete and immediate understanding of what had transpired. He began to sob. His father and mother joined him, arms embracing at Ben’s bedside. They held one another and cried for several minutes.

Then, Ben’s brother and his family joined me in the hallway. He asked what had happened. I told them. He and his wife looked at me with tears in their eyes and said “Thank you for being here.” Ben’s brother was about my age (I later learned so was Ben, despite his 80-year-old appearance that night).

His brother offered no cues that any contact other than a hand shake would be appropriate. So I offered my hand. He drew me close and again said with tears in his eyes “Thank you.” It was a “hug less” embrace. I knew that I had done something important for them and for Ben. I had been a companion at and a witness to his death.

I learned that night my central purpose as a volunteer. No one ever should die alone, without a witness, without a companion. There may be no science to back up what I believe. But I think that my presence was known to Ben.

Copyright © Timothy Tosta 2006. Used with permission.

Click here to read Tim Tosta’s blog.

Note: My volunteer work is through an organization called Zen Hospice Project. For more information about the organization and how to become a volunteer, please visit http://www.zenhospice.org.