On a Sunday afternoon, Heida Earnest sank into her living room couch at her home in Mountain View, Calif., counting down the days when she would see her father again.

She remembered the last time she saw him, in April at Gulfside Regional Hospice in Florida, fixed to his hospital bed with his muscles eaten away. At 79 years old, he could barely speak, but he was still awake and alert.

It was late June now, and in two days, she would be back at his bedside. She and her husband, Ian, had already booked their plane tickets, and she had scheduled a few days off from work.

But Heida and her husband never boarded their Tuesday flight.

The shrill ring of the telephone pierced the afternoon silence. Heida picked up, and a nurse from her father’s hospice quickly identified herself.

“It’s your dad,” said the nurse. “He wants to talk to you.”

Heida was immediately concerned, wondering why this nurse was talking for her dad, especially after holding a seemingly normal conversation with him the day before.

“Hello, Dad?” she said.
No response.

“Dad, hang on,” Heida said. “Ian and I will be there on Tuesday.”

Again, nothing.

“Everything’s going to be O.K.,” she finished. “I love you.”

The rustling and crackling of the phone on the other side interrupted the conversation.

“Your father just passed,” the nurse said and hung up, leaving Heida to the monotonous dial tone.

She sat on her couch perplexed and, after waiting 10 minutes, called back.

“This is James Hall’s daughter,” Heida said calmly. “Did he just die?”

“Yes, he did, and he heard your voice,” the nurse responded. “Your voice was the last thing he heard.”

A year and a half later, sitting in the basement offices of Stanford Hospital’s Spiritual Care Services, Heida Earnest still finds that call hard to accept. She is a soft-spoken woman with large, bright eyes. As she speaks, her voice barely rises above a whisper, and she pauses occasionally to collect herself.

“It’s a funny kind of a thing, because in your mind you know it’s coming,” she said. “You know it’s coming, but when it happens, it’s always disbelief. It’s very strange.”

After she hung up the phone, it took a few hours for the pain to hit. Then it came in waves — an “unbelievably profound sadness.” Still, she is thankful she was able to talk to her father in his last moments and that he was not alone, but surrounded by nurses and doctors.

At Stanford Hospital, 600 to 700 people die every year. Of those, about five percent die alone — some 40 people left to face death in their hospital beds by themselves.

Sometimes, they are the sick and elderly who no longer have families. Other times, they are like Heida’s father — patients whose families are in some other part of the country and can’t make it to their loved ones in time. Whatever the reason, the patients are left in the care of the hospital, where the hustle and bustle of staff duties can prevent someone from being at their bedside at all times.

So, when Heida uncovered a binder with a new program in the Spiritual Care offices last February, she was immediately intrigued. “No One Dies Alone,” she read, flipping through the hodgepodge of papers on “the dying process” and “providing a caring presence.”

She asked the Reverend Susan Scott, the decedent care chaplain, what it was all about. No One Dies Alone would be a volunteer program launched by Spiritual Care Services in April, she was told, to provide company for patients who didn’t want to face the end of their lives alone. Heida joined immediately.

In the same binder that Heida found on Reverend Scott’s desk was “The Dying Person’s Bill of Rights.” Created by a Michigan nurse more than 30 years ago, it outlines 16 rights that an individual should be afforded while dying. Right #7, printed in bold, is the foundation of Stanford’s new volunteer program: “I have the right not to die alone.”

This idea sat in the back of Sandra Clarke’s mind for 16 years, after she left the side of a dying man as a nurse at Sacred Heart Hospital in Eugene, Ore. The man had asked her to sit with him in the Intensive Care Unit in his last moments, and she promised him that she would, just as soon as she finished checking on other patients. He died before she returned an hour and a half later.

Now retired, Sandra remembers the burden she carried after that night in 1986.

“He asked for dignity and respect . . . and the simple fact that a nurse on duty could not be there for him — I thought this was just wrong,” she said.“If he had needed machines or medication, that would have happened.”

She vowed to ensure that this same situation would never happen again, and in 2001, she launched the first No One Dies Alone program with Sacred Heart. From the start, Sandra never intended the program to provide medical attention to its patients. Instead, she focused on the basic human needs of individual patients, with care as simple as waiting at the bedside or providing a hand to hold.

After establishing the first No One Dies Alone organization, Sandra developed an extensive manual, teaching other hospital staffs how to start programs of their own. She did not copyright the material and name in order to allow for open dissemination, and she has shipped more than 1,500 copies around the world — from Alaska to France to Singapore.

Seven years later, a copy found its way into the hands of Susan Scott. After receiving approval and structuring a program around Clarke’s manual, Scott began Stanford Hospital’s No One Dies Alone program in April.

No One Dies Alone volunteers are strictly on call — they sign up for two-hour shifts in which they are available during the week and are only called if the program receives a patient. Heida signed up for any open 3 p.m. shift on weekdays, so that if she were called, she could make her way to the hospital quickly from her job at Stanford’s medical library. She didn’t expect that she would be phoned within weeks of signing up.

On a late April afternoon, she entered a first-floor hospital room to find a woman, eyes shut, propped up in a hospital bed. Light flowed in through an open window, basking her in a warm light as she lay peacefully. A woman singing and playing a Celtic harp accompanied the patient.

Heida placed down her things, including a program-provided bag filled with poetry books and a music player, and glanced at the patient with whom she would be spending the next two hours. Remembering her training, Heida introduced herself even though the patient kept her eyes closed — she never opened them in those two hours.

Penny Barrett, a long-time volunteer with Spiritual Care Services, had sat with the patient some eight hours before Heida on the inaugural shift of the program, and had given the woman a nickname.

“There was nothing scary about it, the patient had a great sense of peace and innocence and there was a childlike characteristic for a person in her 90s,” Barrett said. “Her hair was short and . . . I thought of Peter Pan.”

Gathering herself, Heida read through Peter Pan Lady’s files, reciting her name and diagnosis. There was nobody in the area to look after her because her family lived on the East Coast.

Heida sat in a bedside chair next to the woman and clasped the woman’s hand in her own. As doctors moved in an out of the room, and the Celtic harp player left for other duties, Heida remained the one constant.

Since Peter Pan Lady, Heida has sat with three other patients, each with a unique nickname and experience.  There was Mr. Verbal, a man transitioning to hospice care, who couldn’t stop talking — a rarity given that most of the patients in the program no longer have the capacity to speak.

An atheist, Mr. Verbal questioned Heida, a devout Catholic, about her religion. He wanted to know where she had traveled and what she did for a living. But their conversations were broken by bouts of sleep that overcame the patient.

“I don’t know why I keep falling asleep the way I do,” he said before nodding off.

Then there was Thirsty Woman, hospitalized in Stanford’s ICU. Heida spent two hours with her on a Saturday night holding a pink sponge that she used to soak in water and dab the mouth of the patient. Thirsty Woman could barely speak.

“For the whole time, I just gave her water,” Heida said. “She just drank and drank and drank.”

Her most recent patient was Big Man, an unresponsive man suffering from heart disease. She spent most of that time working with a new volunteer who had just joined the program.

It’s been a month since Heida sat with her last patient, and she doesn’t often think about any of the patients she’s been with. The volunteers are not expected to dwell on the subject of their previous patient’s conditions and are not usually notified if a patient they had been with has died on a later shift. Despite the intimate nature of the program, volunteers are expected to maintain a certain emotional distance from their patients, especially after leaving the room.

But by sitting with fellow human beings in their last moments of life, how could one not develop a personal connection to the dying? Isn’t there at least a sense of wanting to know? Heida only heard of Thirsty Woman’s death through Reverend Scott.

When asked if she knew whether Mr. Verbal or Big Man had died, she whispered, “I don’t know.”

— Part two will run in tomorrow’s issue of The Daily.