Being present is the best present

How wide, how long, how high and how deep can a person's love be for a dying stranger?

The answer was one that surprised and moved my colleagues and me, when we followed a dying man in the final month of his life, to observe and document the difference volunteers can make to one's last days.

Mr Tay Cheng Tian, 53, was a patient at the Assisi Hospice. Under its No One Dies Alone (Noda) programme, volunteers befriend patients who have few or no family members, keeping vigil round the clock at their bedside so they do not have to die alone.

Their dedication was unstinting.

Mr Tay, who had oesophageal cancer, had been an odd-job worker, a bachelor with just two surviving family members - a brother from whom he was estranged and a sister, who visited him once a week at the hospice.

The Noda volunteers stepped in, helping in simple ways, like wheeling him outside into the garden for a permitted smoke.

They helped in bigger ways, generating the "re nao" (buzz and excitement) he was so fond of. They held a durian party for him, took him on a cable car ride and to the casino. He asked and was taken out to a seafood dinner. His birthday occasioned a disco party with dancing.

They also became familiar with the close details of his life.

Former bank dealer Paul Koh, 63, accompanied Mr Tay to his Choa Chu Kang flat on Oct 14. Knowing the visit would be Mr Tay's last, Mr Koh fought back emotions as he helped his friend pack fresh clothes for the hospice.


Corporate trainer Daphne Lim, 45, and English teacher Jaki Fisher, 39, took overnight vigils, watching over Mr Tay from midnight to 6am, holding his hand when he was in pain, while rain poured outside.

And it was speech therapist Angela Sho, 43, and clerk Madelina Ramamurutan, 66, who changed him out of his hospice clothes into his own after he died.

The volunteers walked, literally, the last mile with him.

As the undertaker wheeled his body out of the room, they went along, walking him up to the van to see him off. And they were there, a stalwart presence, at his wake and cremation.

This choice to look death calmly in the face takes its toll and each volunteer has to process post-traumatic stress in his or her own way.

Why do this week after week, death after death? Why put yourself so close to grief?

For the healthcare professional, this is a gap that needs to be plugged.

Ms Sho, a speech therapist with Assisi Hospice, says she and the nurses are often too busy to sit with the patients and be fully present at every moment. Yet, these are precious moments for their finality.

Others have been shaped by personal experiences. Ms Lim's father had wanted to die at home but died in hospital as the family lacked the expertise to care for him.

Former therapy assistant Shirley Yap, 64, had almost missed being by her mother's side when she died.

Another retiree, former kindergarten teacher Jeanette Wee, 63, had battled guilt over stopping treatment for her dying mother.

Others had gone through the peaceful death of a loved one, such as former banker Helen Lau, 55, and wanted others to die just as peacefully.

Some could relate to the dying. Personal assistant Juliana Chia, 44, was no stranger to depression and had suicidal thoughts, and wanted to be there for those who were dying.

Ms Fisher, too, suffered from loneliness during her teenage years and believes there are times in one's life - such as at birth or death - when one should not be alone.

Singapore needs more volunteers like them. About half of the 82,600 households comprising only of residents aged 65 or older are made up of people who live alone, according to the General Household Survey released last year.

By 2030, the Government estimates there will be 83,000 seniors who live alone.

Said Associate Professor James Low, council member at the Singapore Hospice Council and senior consultant at Khoo Teck Puat Hospital: "One of the greatest fears of some of our elderly folk is to die alone at home and to be discovered days later in their flats by neighbours or passers-by."

Humans are social beings and some sociologists say dying is a social and spiritual experience, rather than a medical condition or state.

The isolation and loneliness near death can be more than just physical, said Prof Low, especially in the setting of an institution where one can still feel alone in the midst of many people in a busy ward.

What I have learnt from the Noda volunteers is that one does not need special skills or to do much.

The volunteers were comfortable with silence - as they held Mr Tay's hand, stroked him and monitored his breathing.

Sometimes, they talked to him or played.

What was most important was their calm presence. It was a gift from the heart which brought solace.

Research shows the power of presence and physical touch. A 2006 US research paper, for instance, found that being present with people in comatose states near death has a positive effect on their heart rate variability, which is linked to emotional well-being.

The strength of this programme also lies in its ability to impact the lives of the volunteers themselves.

Many reported a renewed focus on how to live, in cultivating attitudes such as gratitude, humility, patience and empathy.

One woman stopped buying Chanel handbags and another let go of the hurt and anger she had felt towards her former husband. A retiree went to her family members to say all she wanted to say to them.

Most Singaporeans die in hospitals, though surveys have shown that most want to die at home. Having witnessed the astonishing gifts of the Noda programme, I feel it would be beneficial if more hospices and hospitals identified elderly patients who are isolated and matched them with volunteers.

Assisi Hospice hopes to organise volunteers to be with patients at their homes in future.

This would be more challenging than in a stay-in hospice, where volunteers have the support of trained nurses, said Ms Chee Wai Yee, who chairs the grief and bereavement workgroup at the Singapore Hospice Council.

"It is not easy to recruit people who have an adequate level of emotional maturity and high level of commitment to be activated at short notice, given the general notion that death and dying are subjects to be avoided," she added.

Prof Low suggested starting Noda programme partnerships with senior activity centres or daycare centres first, or using mobile applications or video conferencing systems to at least provide solitary elderly persons with a virtual presence.

Volunteers can and do make a difference in reducing the grief of dying alone.

Many people might not want to be involved, for fear they do not know what to do for the dying. The truth is, they would be doing it already, simply by being there.

A version of this article appeared in the print edition of The Straits Times on December 11, 2017, with the headline 'Being present is the best present'. Print Edition | Subscribe