A heartfelt approach to end-of-life support.
A small television murmurs softly in the background, playing reruns of familiar Channel 8 shows featuring the antics of Mark Lee and Henry Thia. In the room, a fan provides a gentle breeze over 95-year-old Mdm Pay, who lies peacefully in a hospital bed, dressed in a sepia-toned printed outfit typical of her generation.
She is gently awakened as Nurse Amy Lim, alongside volunteers Rachel and Linda from Vigil Angels, begins the delicate process of caring for her. Equipped with a basin, towels, and essential oils, the trio moves with intention, speaking in soft tones that reflect the reverence of the moment.
My morning began on a chill, rainy note as I arrived at HCA Hospice’s office in Woodlands. Upon my arrival, Nurse Amy welcomed me warmly and led me to the meeting room to await the other volunteers.
The Unique Role of Vigil Angels
In addition to her duties as a nurse educator for HCA, Nurse Amy and her colleague run Vigil Angels, a volunteer program inspired by No One Dies Alone (Noda), which originated in the United States. Noda engages volunteers to provide companionship to dying patients in hospice care who have limited family support.
In contrast, Vigil Angels operates in the homes of patients who have chosen home hospice care, with HCA as their provider. When referred by their HCA nurse, the Vigil Angels visit to perform a thorough and often final cleaning for the patient. This process encompasses washing the patient’s hair and body, dressing them in fresh clothes, tending to their dressings, and changing the bed linens—all without any extra charge.
“We are deeply mindful of the spiritual state of the individual we’re attending to,” Nurse Amy emphasizes. “Some patients will respond sharply to my questions, asking, ‘What do you think? Can I be good? With a terminal illness, how can I possibly be good?’”
With over thirty years of nursing experience, primarily in obstetrics and gynecology before transitioning to palliative care, Nurse Amy realized that this field has much more complexity than she initially anticipated.
“I thought that working in end-of-life care would be straightforward,” she reflects with a chuckle. “I believed there wouldn’t be much to worry about, but I soon learned how much there is to grasp.”
While Nurse Amy’s compassion is evident, she often encounters the reality that even innocent questions can sometimes feel insensitive to patients in palliative care.
The Importance of Vigil Angels
At HCA, Nurse Amy radiates warmth and calmness, characteristics that reassure those around her, despite her daily encounters with death. While many patients prefer to pass away at home, this decision brings its own unique challenges for both caregivers and the patients.
“One research study indicated that cleanliness is paramount for both patients and caregivers,” explains Nurse Amy.
As patients enter a frail state, communication becomes challenging, which adds to the anxiety for caregivers. “When a patient is moved, even the slightest action may elicit discomfort,” she notes. “Caregivers worry: ‘Am I doing this right?’”
As patients approach the actively dying phase, their caregivers’ anxiety naturally heightens. “When you’re overwhelmed with anxiety, it’s difficult to remain calm,” Nurse Amy points out. This is where Vigil Angels step in, providing care that minimizes pain and maintains dignity for the patient.
“Image and self-perception remain important. Everyone values their appearance,” Nurse Amy states. She recalls instances with cancer patients whose conditions have altered their appearance, leading to feelings of despair. “Everyone deserves to feel comfortable and clean,” she asserts.
Unlike Noda volunteers, who may have multiple interactions with dying patients, Vigil Angels typically serve each family only once. This makes each visit particularly meaningful.
Preparing to Meet the Patient
As I enjoy my tea at HCA, volunteers Rachel Leung and Linda arrive. Nurse Amy opens a suitcase filled with essential products for the day’s tasks, including oils, bath products, and hospital underpads.
Before leaving for Mdm Pay’s home, Nurse Amy briefs Rachel and Linda on the specifics of the case. Mdm Pay, diagnosed with advanced lung cancer, is receiving home hospice care, having chosen not to pursue treatment.
After a short drive through a quiet residential area adorned with vibrant gardens, we arrive at Mdm Pay’s home. The entrance features a brass gong and a traditional Chinese garden table, creating a welcoming atmosphere.
Nurse Amy greets Mdm Pay’s granddaughter, Ying Jie, who is accompanied by her mother and aunt. As a practice, Nurse Amy learns as much as possible about the patient, from personal history to cherished memories.
“I’m entering a very intimate space. To maintain dignity and humanity, it’s vital to understand the patient’s life story,” she explains. “Knowing their journey allows me to honor their existence during this final stage.”
Engaging with Mdm Pay’s Family
The family shares heartwarming anecdotes about Mdm Pay, detailing her resilience and nurturing nature. These stories evoke laughter and fond memories, creating a cathartic atmosphere. Nurse Amy actively listens, nodding in understanding, as she gathers insights into Mdm Pay’s character.
In a poignant moment, the family discusses Mdm Pay’s declining health, bringing tears to their eyes. Nurse Amy comforts them, recognizing the emotional weight of caring for a loved one nearing the end of life.
Meeting Mdm Pay
With a gentle touch, Nurse Amy introduces herself to Mdm Pay, ensuring the family feels included in the process. As she prepares to begin, she outlines potential scenarios, including the possibility of the patient passing during their session. For now, Mdm Pay is stable, allowing the care to proceed.
Dressed in PPE, Nurse Amy and her team spritz the room with essential oils, creating a soothing environment for Mdm Pay. The process begins.
A Comforting Touch
Moving deliberately, Nurse Amy, Linda, and Rachel first remove Mdm Pay’s clothing, covering her with a towel to maintain her dignity. They carefully wash her hair, gently massaging her scalp to ensure comfort.
Mdm Pay’s face is cleansed, and as the process continues, her family is encouraged to observe. The team’s methodical approach creates a calming atmosphere, while they remain attuned to any signs of discomfort.
As they progress, they prepare to clean Mdm Pay’s mouth, using a gentle sponge and mouthwash to ensure her comfort. The team is careful to respect her limits while providing essential care.
After two hours, they prepare to clean her back, supporting Mdm Pay gently while checking for any wounds or pressure sores. Each touch is intentional, with the team utilizing a blend of essential oils to enhance the experience.
The Final Touch
The session concludes with the cleaning of Mdm Pay’s hands and feet, as the team teaches her family how to provide massages that promote relaxation. The experience is holistic, focusing on comfort and connection.
Once dressed in a fresh outfit, Mdm Pay appears rejuvenated. Her family, visibly uplifted, expresses gratitude for the transformation that has taken place during the visit.
“The hallmark of palliative care is sensitivity to the patient’s needs,” Nurse Amy reflects. “Understanding what matters to them allows us to provide the most compassionate care.”
Farewell
As the team packs their supplies and gently tucks Mdm Pay in, we bid farewell to her family, who feel uplifted by the experience.
Nurse Amy acknowledges the privilege of caring for those at the end of their journey. “Caring for someone who is dying is a profound honor,” she states. “It’s a blessing to accept death as part of life.”
Just two days later, Nurse Amy shares that Mdm Pay passed away peacefully at home.
