Everyone will find themselves in a situation where the information in Joellyn's class will be of excellent use, even in improved personal self care. This class is a gift and an awakening to an aspect of healing that is of immeasurable value.
– Paula A.
THE MAKING OF A DEATH MIDWIFE
Hospice Volunteer Eases the Way as Patients Let Go of Life
By Elizabeth Simpson,
The Virginian-Pilot
Photos by Bill Tiernan, The Virginian-Pilot
St. Pierre talks with patient Vernell Williams and her daughter Ann Willis. The hospice volunteer calls her job "death midwifery."
JOELLYN ST. PIERRE wends her way past lifesavers in white coats and green scrubs who bustle in the hallways of Sentara Norfolk General Hospital. Urgent voices crackle over the intercom. Monitor alarms blare. A groan spills out from a room along the way, and nurses hurry in to adjust tubes and check IVs.
It's the usual full-court press against death. Once a week, St. Pierre moves calmly through all this with a different kind of remedy.
The woman in the deep purple shirt speaks in a soothing voice. She holds a hand and rubs a forehead. She crafts a place of peace.
It's her mission as a hospice volunteer.
"Hello, Mrs. Williams," she says as she enters Room 513. "My name is Joellyn, and I'm going to spend some time with you. I'm going to play some music, and we're going to try to create some sacred space. There's not a thing you need to do. Not a thing."
Ninety-one-year-old Vernell Williams is doing all she can today anyway:
Breathing.
Out of St. Pierre's black bag comes a CD player, upon which she plays discs of soothing sounds. Birds singing. Trickling water. Soft strains of a piano and strings.
St. Pierre calls her work "death midwifery."
Just as babies need help coming into the world, she believes people need comfort and guidance going out. Death is something many people recoil from, strain against.
St. Pierre spends time with patients and their families, sometimes hours at a time, soothing them, rubbing their hands, stroking their faces.
Simply being there.
Joellyn St. Pierre is moved to tears as she talks quietly with patient Vernell Williams, 91. During her visit, St. Pierre played music, prayed and talked to Williams as she slept.
Her first patient today is Williams, whose eyes are closed. Every breath looks to take her full measure. She tugs in a breath of air with all her might, only to face finding another when she's done.
"Gugg-gugg, un-un-un." Her chin dips in as she takes the next breath. "Gugg-gugg, un-un-un."
St. Pierre puts her hand gently on Williams' arm, and leans down to speak:
"Hospitals can be noisy and stressful. I am going to try to change the energy in the room."
St. Pierre walks around the room, the palms of her hands facing outward, her eyes closed. She turns to each wall, then the ceiling, in her endeavor to channel good energy.
Often the patients she works with have no one else. But in this case, Williams has a daughter, Ann Willis, who is smoothing her mother's brow.
Willis has met with the hospital's social worker and decided on end-of-life care, withdrawing the feeding tube, making sure her mother is comfortable through this final verse of life.
"I tell her every day, 'I love you. I thank God for you,' " Willis says. "I tell her, 'Thank you for everything.' I said it to her yesterday. I do love her. But I have to love her enough to let her go."
St. Pierre puts her hand on Williams' shoulder and rubs her forearm.
"Let all the sounds of the hospital fade into the background."
She slowly moves her arm up to Williams' face and begins stroking her forehead with a gentle caress.
"Will you be able to tell if she can hear?" Willis asks St. Pierre.
"Always assume she can hear you," St. Pierre says. "Always say what you need to say to her."
"I kind of wanted her to be awake for this," Willis says. "She was at 7. She was wide awake."
This is difficult, Willis says, this seeing someone you love through the work of death, not knowing the hour or the day when it will come.
"It's hard on me, but the Lord will bring me through," she says.
There's a term for the medicine St. Pierre dispenses: palliative care. She's part of a relatively new team here, made up of doctors, nurses, social workers, chaplains, whose aim is not to cure but to comfort.
It's not always people at the end of their lives. Sometimes it's a person with a chronic disease or an illness that's especially painful. The team helps them and their loved ones understand the various options - dialysis, respirators, tube feeding - and work through whether they want them.
They do all they can - whether it's medicine or a cool hand on the forehead - to ease their pain.
Williams' struggle to breathe comes in waves, almost like contractions, and St. Pierre works through them like a birthing coach.
"Let my words count as your own," St. Pierre says.
"I am safe. No matter what I'm hearing, or what I'm feeling, I am safe."
Williams breathes easier for a moment.
"Your family loves you. They also know it's very hard to stay in your body, and that's OK. Just relax and flow, flow into the stream, ease into it effortlessly, surrounded by love. Always surrounded by love, just like flowing on a stream, feeling warm water surround you, going into the arms of God."
More than an hour later, St. Pierre leaves the room, takes a break, then goes to the sixth floor with Megan Zieger, a social worker on the palliative care team.
St. Pierre stands outside a door there and closes her eyes a few moments. To be "fully present," she must clear her mind, remove her thoughts from the last patient.
Inside the room is someone very different from the last. Rather than a gray-haired elder at the end of a full life, here lies smooth-skinned Eazy Baker, 26 years old. He is on his side, a blue ventilator tube stark against his white pillow.
In March, he was beaten and left for dead on a street in Norfolk. He suffered a severe brain injury, and he's been on life support since. Family members disagree about whether to keep him alive on machines or let him go.
For now, the whooshing of the ventilator is constant. A piece of gauze covers a mangled ear. A band holds a trachea tube in place. Beige liquid food in an IV bag on a pole seeps into his veins.
His knees are pulled toward his chest, his hand is gnarled into a fist.
While St. Pierre sets up her CD player, Zieger tends to him.
"Eazy, I'm going to wash your mouth," Zieger says. "I talked to your grandma earlier. She misses having you at home. I am going to get some Vaseline and put that on your lips. "
His eyes are open.
"I see you looking at me," she says.
Palliative care is less focused on technology, more on touch and comfort. Zieger has given patients manicures, massaged their feet, put cool cloths on their foreheads.
"People will say, 'How can you do this kind of work?' " she says. "It was difficult in the beginning. I can't cure them. I can't make them better. But I can make it easier. I can hold their hand and not say a word."
St. Pierre comforts 26-year-old Eazy Baker. In March, he was beaten and left for dead on a Norfolk street.
St. Pierre begins the music and moves to the side of the bed Eazy faces.
"Hello, Eazy. Don't worry about anything. I am just going to play some nice, relaxing music. Let it wash right over you."
The 51-year-old woman squints her crystal blue eyes slightly, as if to look deep inside him. She moves slowly, even in turning her head, and smiles comfortingly, like a mother consoling a child.
She runs her thumb across his forehead, caresses the spot between his eyes.
"It's OK. Don't be afraid. You're safe."
Then she rubs each eyebrow. He closes his eyes.
"Nice and easy. Just like your name. You're all right. Just let go."
There are some who might dismiss her actions as new-age nonsense.
Not Dr. Marissa Galicia-Castillo, medical director of palliative medicine at Norfolk General.
"Some people have not had someone to hold their hand," she says. "That's a powerful contribution in terms of a person's sense of well-being. It doesn't have to be a complicated procedure. It's being there and having that feeling of presence that goes a long way."
St. Pierre trails the back of her fingers against Baker's cheeks.
"I know you're having a hard time. We all want what's best for you. We want healing for you, whatever that is. It's OK. Your family will miss you. It will be very hard to say goodbye. I'm telling you, reminding you, you're never alone."
She rests her hand on his closely shaven head, puts her other hand against his heart.
"Just relax. There you go. Let go."
Facing death has not always come naturally to St. Pierre.
She grew up in Chicago and took to the stages of New York City when she was still a teenager.
She sang and danced on Broadway, in dinner theaters, in nightclubs throughout her 20s. In the 1980s, many of her friends began dying of AIDS. A pianist she worked closely with for seven years disappeared one day in 1991 without a word.
He hadn't told anyone he had AIDS. St. Pierre tracked him down in Michigan. She was terrified of hospitals but somehow talked her way into the intensive care unit to hold his hand the last four hours of his life.
She watched the vital signs of the 41-year-old man go flat on the monitor. She felt his hand turn cold. Then she felt an electrifying sense, like thousands of buzzing bees, in her hand.
She believes it was his spirit leaving his body.
"It felt like I died, too. I didn't know that kind of loneliness. I thought, 'What is this? What is death? What is the point of living?' "
She didn't want to be blindsided by such an experience again, so she took classes about death and dying. She took ministry courses, delving into different religions' views on life and death. She took home-health-care classes. She worked for support groups for people with AIDS and in home-based hospice programs.
She saw both her parents through death, dancing with her mother in the last days of her life, ordering her father pizza as a last request.
"It's an honor to be right at that precipice we call death. To be with someone at that moment,... that's as close as we can get, and that's profound."
A year ago, a Sentara social worker asked her to join the palliative care team. She was used to helping people through death at home. The chaos of a hospital would be a challenge, but one she accepted.
"I didn't choose this work," she says. "It chose me."
Baker lingers in what is known as a "persistent vegetative state." Experts will tell you he can't respond to anything around him.
"But when his eyes connect with mine," says St. Pierre, "I feel there's a connection. He's there at some level. I always treat people that way. I do not treat them like there's nobody home."
She has the sense he feels trapped. She tells him that what happened to him that March night was wrong. She hums a soothing tune. She looks deeply into his eyes with her own soul-searching ones and gives a beatific smile.
She considers this work of "good exits" an honor more than a service.
"I don't try to force my way on anybody. I try to use language they are comfortable with. I work within the framework of their belief system."
One client asked her to turn off the darned music and sit quietly with her. In another case, St. Pierre held hands and sang hymns with family members while a patient's breathing tube was removed. Another wanted to be alone.
She takes her cues from them.
"I want to thank you for having me be here with you, and remind you that no matter what you are experiencing, you are safe," she says to Eazy. "No matter what, you are never, ever alone."
She puts her hand on his heart.
"It's OK."
Warming lights cast a rosy glow across his sheet-shrouded body. Wisps of oxygen from the ventilator float behind him like clouds.
His eyes are open, inches away from St. Pierre's.
Then they close.
She pulls her hand away slowly, pulls up the bed rail, touches his hand, turns off the music, packs her bag and moves quietly out of the room.
"Goodbye, Eazy."
Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com