In 2012, hospice nurse Patricia Cary stands in the chapel of Martha & Mary House, which she founded. “We all need to convey that message to people who feel themselves a burden: ‘You’re not a burden to me; you are a valued, beloved part of our community,’” said Cary, now retired. (Ed Langlois/Sentinel archives)
In 2012, hospice nurse Patricia Cary stands in the chapel of Martha & Mary House, which she founded. “We all need to convey that message to people who feel themselves a burden: ‘You’re not a burden to me; you are a valued, beloved part of our community,’” said Cary, now retired. (Ed Langlois/Sentinel archives)
For hospice staff, who spend more time than anyone with those who are dying, ultimate matters are everyday parts of the job. The nurses and social workers are acutely aware of the transience of life, the challenges of feeling like a burden, the importance of supporting patients and families and the probability of a world beyond.

Accepting vulnerability

Pat Cary, a retired Providence hospice nurse, started Martha & Mary House, a Catholic hospice that operated in Southeast Portland until 2015.

“Dying is a time when people are being asked to empty themselves,” said Cary, a member of Holy Redeemer Parish in North Portland. “One task is helping them accept and live with being vulnerable.”

Cary was young when she cared for her dying aunt, who graciously accepted help even when she missed the bedpan. That was a memorable lesson. By contrast, Cary has seen the anguish that results on all sides when a patient can’t accept help.

Dying people sometimes feel themselves worthless and troublesome to others, Cary said. “We all need to convey that message to people who feel themselves a burden: ‘You’re not a burden to me; you are a valued, beloved part of our community.’ We have to follow up with concrete action — phone calls, visits, Mass intentions, supporting overloaded caregivers, actual caregiving.”

Cary has observed both faith-filled people troubled in their last days and a non-Catholic man who said the Virgin Mary was appearing to him. She has met people whose hard hearts soften as they approach death.

“People do die with grief and unresolved matters,” Cary said. “But some know it’s sacred time and they can accept that.”

Accepting reality

Jo Laurence, a Portland-based hospice chaplain for Providence for the last decade, has learned not to put off important things.

“None of us can assume longevity,” said Laurence, who visits dying patients wherever they are.

Hospice work has made Laurence braver. “When one looks death in the face as much as we do, you have to make a relationship with it,” she said. “I feel stable around death.”

Part of Laurence’s job is to help others embrace reality, whether they are patients or family. To those who seek answers, she often is pragmatic as well as spiritual, explaining that it’s just a fact of nature bodies tire out from age or sickness.

“Then we work with people of all backgrounds and help them connect to something that is bigger and they can hold on to that,” Laurence said.

She is adept at working with people who have all kinds of ways of understanding the larger reality that some of us call God. Others just feel lost, angry and confused at the end.

“We still live in a death-denying culture, and I wish it would change,” Laurence said. “It’s pretty exhausting for everyone.”

Something bigger

Tatiana Avdienko, a hospice nurse for Providence, visits homes in the Portland area. A Russian immigrant and a single mother, she arrived in the United States in 1996 and started her life over. She’d been trained in film and music but was drawn to serving others via health care. She has a spiritual view of existence.

“We are not just bodies,” she said. “We are souls on a journey.”

Avdienko became convinced of this when her ill mother rebounded from death and reported light and joy on the other side.

“There is something bigger than this reality,” said Avdienko, who says hospice is the first job that has left her waking up in the morning enthusiastically. She considers her patients teachers.

Avdienko is a critic of the notion of fighting death. It should be embraced as a thrilling transition, she argues.

She recalls one patient, a 53-year-old artist, who refused pain medications because she wanted to experience death in its fullness. Before she died, the woman reported that she saw people crossing barriers, traveling and laughing — all in a world without gravity.

“I am a supporter of continuous contemplation on death,” Avdienko said. “We are all going to go, but we can go with an open mind.”

Support needed

Barbara Virgilio, a social worker at Mount Hood Hospice, was drawn to the work after losing her father when she was 13 and watching her toddler die of a heart condition 45 years ago.

“I want to make sure people are supported,” Virgilio said. “You learn how to be present with someone who is dying. You have to listen more than you talk. You just let them understand you know this is very difficult.”

Virgilio said hospice work helps her know what matters in life. She has traveled, healed relationships and put affairs in order sooner than average.

“We learn from our experience that the future is not guaranteed for anybody,” she said.

She urges patients to come to hospice on the early side so they get the support that will allow them to have important final interactions.

Virgilio explained that hospice has helped her learn to meet people as they are. She is sad when a dying person does something they don’t want because of pressure from family. On the other hand, Virgilio sees the great love families and friends show.

“It is an inspiration to me to see what people will do for others,” she said.

Visitations

For one nurse, hospice has been an encounter with the immaterial world. Though of a scientific mindset, Lorol Simmons has seen so much that she has no other explanation.

Simmons, based at Sacred Heart Medical Center in Eugene, visits homes of the dying.

She has noticed that most patients experience a visitation of some kind as death nears. They see loved ones who died years ago standing in the room or waiting outside the window. The experiences can be specific. One woman saw a girl, 8 or 9 years old, wearing a tam-o’-shanter and holding a dachshund, standing next to Simmons. Patients see and hear animals, especially cats. These events are never frightening for the patient, Simmons reports.

Often on their deathbeds, patients speak as if about to set off on a trip, asking if their bags are packed or if their coat is nearby.

“There is profound meaning in these simple statements,” Simmons said. “It’s about being comfortable for their next move forward. It’s never scary.”

Some patients detect fragrances or hear music. One woman, who could move only with help and who had not spoken for years, sat upright in bed and declared she was hearing the bells of heaven. It was all silence for others in the room. Saying she was not ready to go, the woman lay back down and died later.

Simmons thinks these experiences, most of which are comforting, must come from God. “I have been around death a long time,” she said. “I have never been afraid of it. I have been curious about it.”