Volunteer Interviews

People sometimes express surprise that I want to sit down and have a little chat with them before they're invited to participate in our volunteer training program. In addition to being a hospice requirement, it's also a good idea. Although most people mean well (I say "most," because in the past I'm told we had one person who thought it would be fine to get himself written into the patient's will and stormed out of class in a huff when told otherwise), some have misperceptions about what hospice is, others have grandiose ideas of their contribution, some are there more for their own attention than the patients and families and others need fine-tuning over what's acceptable and what's not in dealing with patients and families.

A lady in one of our training classes piped up to share with the group that after her mother's death, she attended a bereavement group and decided it wasn't for her because the other participants had "needs" that she didn't. She went on to say that a member of the group had apparently had a rather domineering spouse and she had wanted to tell her that she was far better off without him and should be glad he was dead.

Yes, well clearly she has some extensive training yet.

One of the things we're taught is that you'll never change family dynamics and shouldn't try. You can't know a family's years and years of history and/or the triggers that make individuals crazy. Additionally, people choose to stay in situations for any number of reasons and to assume that if the relationship was troubled they shouldn't bother to mourn, is thoughtless at best.

Pre-class interviews reveal interesting things if the questions are crafted to elicit opinions. For instance, there was the one prospective volunteer who, when asked how she might respond if a patient's spouse offered her one of his wife's diamond rings as thanks, thought about it a good long while and finally said that she'd say "no," but if he insisted, she wouldn't want to insult him. - Uh, right.

Evey now and then, I'll end up with a pet therapist who's unhappy because the dog isn't getting enough attention. Once again, the focus is off. If the volunteer is there for people to fawn over the dog, he's there for the wrong reason. Another example of why it's a good idea to try to ascertain someone's interest in volunteering.

We get a few indignant people who feel that if they're willing to volunteer, we should be grateful for their time and that asking them to come in for an interview is way too much. Well, now they know the reason. I find it a revealing and indispensible process.

Dream Visitation

One of our massage therapists, a woman who's also worked with hundreds of AID's patients, was instrumental in helping a young man (a cancer patient) come to terms with his impending death. He had originally told her he never wanted to be taken into one of our in-patient units because he knew he'd never come out again. Near Christmas, he was indeed transported into one of our facilities and the massage therapist made it a point to bring him a small Christmas tree for his room. She wanted to give him hope and to liven his spirit. Elated when his symptoms were sufficiently managed that he was able to go home again, he told her he thought he'd come to terms with the fact that he was dying, that he would be fine and that he'd try to communicate with her once he died. He told her to give him a couple of days to "figure out how it all works on the other side" and then to start looking for a series of numbers in her dreams. It seems he planned to help her win the lottery.

As it turns out, he didn't bring her lottery numbers, but she firmly believes he communicated with her. She had a particularly vivid dream in which she saw him standing in front of hundreds of people but she could only make out the faces of those in the front two rows. They were all the AID's patients she'd worked with in the past. The hospice patient said, "This must be hard for you." She assured him that she was fine.

Yes, maybe it was some nether region of the brain being creative during her sleep state, but I like the story. I choose to think it was communication.

Crowded Quarters

Hospice has many, many opportunities for contemplating the unexplainable. There seem to be lots of patients who see and talk to dead relatives. Family members will often think they're hallucinating and maybe so, but if that's the case, I wonder why it's always dead relatives. Why not their childhood sweetheart or best friend from college? Is the patient the only one who senses them or does the room suddenly feel crowded?

For someone like me who believes that our energy survives but not in the same solid form, how is this possible? And what, exactly, are they seeing? Is Grandma Rose age 92 when she appears to them or 25? Why one over the other? Is it just an image of her face or is she seated comfortably in the rocking chair she inherited from her own grandmother?

There are family members who find such things scary or macabre. I would think it would be comforting to know there are relatives to help make the transition less frightening. On the other hand, the disquieting aspect to the whole thing might be wondering if they only come back at death or if they're watching our everyday behavior, tsk-tsking over every petty argument and uncharitable act.

When it comes to understanding the afterlife, my scales vacillate between feelings of admiration for anyone who claims to have all the answers and incredulity that anyone could possibly think they have all the answers. Any which way I contemplate it, there are things that don't quite fit my view of the afterlife and the dying process. Every incident brings more questions and it's always interesting to take the puzzle pieces, shake them up and see if they'll fall into a cohesive picture.

Planes, Trains, Buses & Taxis

Let a patient start talking about buying a plane ticket, catching a train, calling a taxi or checking the bus schedule and the reaction from the hospice staff will likely be "Uh oh." Unless they really are planning a trip somewhere, when they start talking about traveling, it usually means they'll be leaving in a few days - permanently. It's an odd phenomenon, to be sure, but it's eerily accurate.


A patient who's been mostly unresponsive for days or one who's been talking nonsense will suddenly begin to ask anyone who'll listen to call a taxi because they want to go home, or will tell family members they need to hurry so they don't miss the next bus. Where the family will likely think they're hallucinating, the staff will nod knowingly.


The interesting part for me is how the mind uses symbols. Why don't they see the same narrow corridors and beckoning white lights as the people who have near death experiences? Perhaps because although they intuitively know they're dying, the path or road has yet to be revealed. All they know is that something is changing and they're embarking on a journey. The journey starts with the mode of transportation, I guess.

To Preach or not to Preach

My pet peeve involves the people who want to volunteer at hospice because they've decided it's their calling to save people before they die. For the life of me, I don't understand why they can't see how offensive that is. If they were dying and someone of another faith waltzed into the room and proceeded to preach to them, I dare say they'd be offended.

Although I grew up Methodist, I've strayed rather far from there in the ensuing years, mostly because I've found that so many religions exclude everyone from other faiths. That's not for me. As long as someone is trying to be the best they can be, I don't care what religion they've chosen and see no reason to convert them to another. That, I realize, is heretical to many but, working in hospice, I see good people, not good religious people. It has colored my view.

It's been my experience that the most intolerant people are the religious ones, often seeing themselves as being a special group and everyone else as godless, or confused, or less than. Conversely, the people who seem the most accepting of others label themselves as spiritual, not religious.

Our own Spiritual Care department is great and they are careful to honor each individual's preferences. Perhaps because they interact with all the faiths, they've learned to appreciate them. Perhaps they're just extraordinarily tolerant. Whatever it is, they're most assuredly different from so many of the people who go through our volunteer interview process and when questioned about how they see their spirituality fitting into hospice, reply that that's their primary reason for wanting to volunteer. They are then indignant when told they can't pray over the patients - no, not even the ones who are unresponsive.

Yeah, I know what you're thinking and if I end up in hospice, I hope they don't tell you what room I'm in!

Pet Therapy

I'm not sure why it took me almost two years to realize that some of our pet therapists had a limited view of why they were there, but now I'm determined to rectify the problem. It's twofold, I think: (1) Since pet therapists in past training groups were not given a focus, they arrived at the conclusion that they were strictly there for people to pet the dog - not an unreasonable conclusion, I might add, because they were given all the statistics about lowered blood pressure, lowered heart and respiratory rates and better sleep patterns in patients following a pet visit. Since the focus was put on the pet, the volunteer's involvement in the process became superfluous. He or she saw himself as accompanying the dog. (2) I don't believe it's conscious, but even with all the training about active listening and good communication skills, it's still daunting to walk into a stranger's room and start up a conversation with patients and families, any of whom might be depressed, or angry, or distraught, or just plain uninterested. It's easy to arrive at the conclusion that standing in a doorway for a few minutes while everyone oohs and aahs over the cute puppy and dutifully pats him on the head constitutes a successful visit. Again, not unreasonable. The dog is happy, the patient and family are smiling and everyone seems more relaxed.

However, I thing the difference in the focus - from accompanying the dog, to using the dog as the entree into the room - is potentially huge. In the latter scenario, the volunteer takes over once the interest in the dog gets him into the room. Then if the patient wants to reminisce about the dog he took on a fishing trip to Montana twenty years ago, the volunteer should be prepared to sit down, get comfortable and use those active listening skills he learned in the volunteer training classes. The conversation doesn't need to include the disease process in order to be doing something positive for everyone in the room. Maybe the half hour spent reminiscing about a happy memory is enough to take the focus off the elephant in the room so everyone can relax a bit. Now that, it seems to me, is a much more satisfying and meaningful visit, fitting the description "therapy" more accurately

Why Hospice?

During my first Volunteer Training program, everyone in the room was asked to tell why he/she chose hospice as the place to volunteer. I can't remember anyone deviating too far from the response, "I want to give back" or "I want to help others." Me, too. However, over the years, I've thought about that question a lot. I've come to realize that it's a rare case indeed when the giver continues to give without getting something in return. The question for me then became, "What am I taking away from this experience that keeps me coming back?" I mean, why not Goodwill or the Salvation Army, or working with children or animals? Why the dying?

I decided that in addition to all the surface reasons - hoping to relieve suffering, lessen anxiety -for me, the underlying reason I was drawn to hospice was to make sense of the dying process, to come to terms with it before I was forced to come to terms with it. I don't want to be afraid to die and I would probably never have realized this had I not gone through my mother's death about 8 or 9 years into my volunteer experience. It was revelatory to discover that, despite her strong religious beliefs, it turned out she was scared. Death isn't necessarily just an avoidance of physical pain and it doesn't just affect the person who's dying. Subjectively, I knew this, but it's a whole new ballgame when it's one of your own.

So who knows? My perspective may change again before I'm done but delving a little deeper has made my experiences a little richer.