"Most of my friends don't really know I do this. I don't want people to think I do this because I am trying to be a good person. I do this because I get something out of it," says Kitty Peacock, a volunteer at The Washington Home Hospice, a residential care facility for the terminally ill.
Peacock, a former teacher and legislative aide is part of a group of volunteers working at least three hours a week at The Washington Home Hospice, 3720 Upton St. NW. As a volunteer, Peacock is expected to make a one-year commitment and attend twice-monthly volunteer meetings where, as part of a group process, she can discuss her interactions with dying patients and their families.
She also is expected to participate in a "bereavement program" which means maintaining contact with a specific family for one year following the family member's death.
The six-bed Washington Home Hospice -- housed within The Washington Home, a large residential nursing facility -- is staffed entirely by nurses and volunteers trained in terminal care.
The Hospice unit is a pilot project of The Washington Home in conjunction with Blue Cross and the Georgetown University Vincent Lombardi Cancer Center. It currently is the only hospice covered by Blue Cross for in-patient care.
Those are the harder facts about The Washington Home Hospice. What is quantifiable, Blue Cross will study. What is not quantifiable, only the patients and their families, and the staff and volunteers at the Hospice can really know.
The immediate impact of the volunteers on patient services is, of course, obvious. Volunteers are cost-effective.
"This is one significant way of containing cost," says hospice director Carol Ann Bingham. "Most hospices are set up with a tremendous amount of effort from volunteers in comparison to the way health care is generally delivered.
"The concepts that we have are very different, and they involve a lot of time and effort. If we had to pay for all the services the volunteers provided, the cost would be prohibitive."
The impact of volunteers on the patients is more difficult to analyze. Interaction may be direct or indirect and may involve everything from cooking for, to being with a patient at the moment of death.
The volunteers work on a very different basis from the nurses.
"The nurses are fantastic," says volunteer co-coordinator Nancy Critchell.
"They understand the patients both physically and emotionally, but they have different kinds of responsibilities, like medication and so on.
"One volunteer, for instance, came and did belly dances for two patients. The patients loved it. It was totally absurb and bizarre and it was just what they needed."
Many volunteers have experienced the pain of losing a family member or friend. Some have had prior experience with the trauma and fear generated by cancer. Some feel working at the hospice has helped them prepare for their own deaths.
Ginny Sonne, a volunteer who began working at the Hospice after the sudden death of her young sister-in-law, a subject which still halts her voice in mid-sentence, says she feels "impelled forward by something I don't understand. Sometimes, when I leave there, I ask myself what I am doing there. I think I may be preparing for my parents' death.
"Before my sister-in-law died, she went through the whole thing of having her mother die of cancer. Because of her mother, she really felt it was important to become prepared for death. She did a lot of reading and talking about it. It was so ironic. But when she was killed (in a biking accident), there was such a finishedness to it. She was so at peace with herself, I know. I think that is really important."
Says Critchell: "I think a lot of the volunteers are trying to explore or find out more about the experience of death. Also, they're finding out an awful lot about themselves, naturally, in dealing with it."
"In general," says co-coordinator Judy Polk, "I think we are finding out about our strengths. I also find I am learning about weaknesses. There are times when there are a lot of deaths on the unit and I will be reluctant to get involved with the next patient. You want to sort of cover yourself. There has to be time for you to recover."
Both Polk and Critchell have teaching backgrounds and both were drawn to the Hospice through personal experiences.
For Critchell, it was the illness and subsequent death of a student in one of her fifth-grade classes. The student, who was close to her own son's age, had leukemia.
"I had to tell the whole class that he was very sick and possibly dying and I followed his family through the next two years. I became very involved and I read (Elizabeth) Kubler-Ross's book ("On Death and Dying"). While all this was going on, I decided to take a sabbatical from teaching and come here.
"But there is no one thing that brings the volunteers into the Hospice," she says. "People have different reasons and different levels of involvement."
While most of the volunteers are professional women, they vary in ages and backgrounds.
"I've come close to using all the emotional resources I've accrued in my life-time," says Janice Carrick, a broadcast technician for the Public Broadcasting System and, at 28, the youngest volunteer working at the Hospice. "Sometimes I feel I've aged 10 years . . . It's rare that you get a chance to try your wings out as a person in a situation like this that is almost unthinkable."
"Cancer -- when you hear that word, everyone gets really scared," acknowledges Critchell. "But I've learned you don't have to die a painful death.
"We were worried at first about being caught in the room with someone writhing in pain, but that doesn't happen. There aren't many of us who could stay if it did. The pain is really controlled. That's one of the important concepts of Hospice."
Kitty Peacock, who is in her 30s and also has taken leave from teaching, talks candidly about her experience with a friend dying of cancer at the Hospice last year.
"A lot of people were turned off by the physical changes she underwent as the disease wore on. I found I wasn't. I've asked myself why I can do this work and I can't answer it. It's something I am just finding out about myself.
"Sometimes the things that happen aren't very pleasant and, if I were to think about it, I would never think I could handle it.
"In dealing with the patients, I am learning I can do what I have to do . . . What I have seen is the spirit of these people coming through when the body is failing. I feel very privileged to be able to take it all in."
To help prepare them, volunteers are encouraged to voice their concerns at initial training sessions, which offer guest speakers such as oncologist Dr. Josephina Magno, and social worker Patti O'Donnell, both of Georgetown University Medical Center, and psychiatrist Dr. William J. Polk of Chevy Chase.
Finding out that the patient's pain can be controlled seemed to be of major importance to most of the volunteers.
"That was the first thing that really relieved me," says volunteer Sonne. "The second thing that really relieved me was that the nurse said most of the people really die very peacefully. That made all the difference in the world to me. While I have had some irrational fears, the horror I had of cancer seems to have dissipated."
On the Hospice unit, the atmosphere is quiet, almost serene. An empty bed is visible past an open door. The blanket and a Dior designer sheet are tossed back; the patient elsewhere. The other rooms are quiet, doors shut.
Beyond the corridor of rooms is the Hospice family room, where families and patients can talk or meet, or families can rest or sleep over if they wish. Off the sun-filled main room are a small kitchen and bathroom. The decor is functional, but brightly colored.
"A lot of times it really is a very cheerful place," says volunteer Carrick. "I know it sounds strange, but it's true. Some of it has to do with accommodations people make to each other, although no one wants to create an atmosphere of false cheerfulness.
"You have to have a good understanding that it's up to the patient how close you can become. You're wrong if you think that just showing up is going to be an immediate carte blanche to extreme closeness with people. You can't force emotional involvement. Sometimes I just provide comic relief."
"Sometimes there are tears and sometimes laughter," agrees Peacock. "Sometimes family members are embarrassed about their tears. I tell them 'Hey, it's all right to cry. This is probably the worst thing you're going to have to go through in your life.'"
"Most patients come from hospitals, which are so rigid," says Sonne. "Hospice is very relaxed. One man had his dog come in. Another man had a Sabbath meal with his family one Friday night.The Hospice really encourages the integration of the outside world."
For the volunteers, there is an apparent undefinable satisfaction they derive from their work; a certain something that paid labor and other activities may not provide.
"If you're not afraid to listen to people's sadness or bitterness, you can have close moments," says Carrick, "but these moments are ephemeral. The next time you come, the person you were close to last time could be withdrawn or comatose."
Sonne says she knows she may face death intimately at the Hospice someday and has worked hard to overcome her anxieties about it.
"What am I going to do if someone dies and I am the only person available? I expect my reactions to be very calm and then to accept it.
"I really am beginning to understand how much we deny death. I feel it's important for the patients to be able to settle with family members, settle on themselves. If they don't want to, it's their choice, but I think that is the best."
In looking at the overall experience of the volunteers, co-coordinator Polk stresses that working at the Hospice means taking emotional risks.
"There's no question that volunteers go through their own bereavement when a patient dies. And there are some patients you get more involved with. Something clicks with the patient or the family. It could be their age of their background or some shared experience. Your feelings are involved. That's reality."
"Your helplessness is something you have to confront when you come here," says co-coordinator Critchell. "You can feel very helpless at times. There are things you can do and yet, in spite of everything, the patients do die."