Facing Death Without Fear

Hospice
Hospice
Hospice

Beverly JeffsSteele in her office at Willamette Valley Hospice. Photo by Diane Stevenson.

JeffsSteele and Keith Seckel, clinical manager, meet with other caregivers at Willamette Valley Hospice to talk about their patients' care. Photo by Diane Stevenson.

JeffsSteele meets with one of her patients, Peg Hill. Photo by Linda Hays, Willamette Valley Hospice photographer.

Beverly JeffsSteele once dreamed of being a nurse-midwife — a guide and aide for the difficult journey into life. But a private tragedy started her on a circuitous path to helping those who have set foot on the still more difficult path out of it.

Seventeen years ago, JeffsSteele’s 18-year-old daughter was killed in an automobile accident when the driver of the car in which the girl was riding fell asleep at the wheel.

I was shocked at how I was treated by people I knew, how uncomfortable they were with my grief,” JeffsSteele says. “It made me aware of how unprepared we are for confronting death — our own or another’s.”

The experience led her to volunteer with her local hospice organization in West Virginia, and now, years of schooling and several jobs later, she is the new medical director for Willamette Valley Hospice in Salem.

We have such an odd outlook on death,” the 52-year-old mused on a recent afternoon. “Death is not seen as normal and natural. We plan for marriage, children, retirement. Nobody plans for dying.

Only 10 percent of us die suddenly; for the other 90 percent, the process of dying involves a stair-step decline. It is helpful for us, and our loved ones, to plan the way we want to spend that time. Pretending that it isn’t going to happen hinders our ability to have a say in the circumstances. We have choices.” 

Willamette Valley Hospice helps people make these last important choices, providing medical services, emotional support and spiritual resources for anyone in the last stages of a terminal illness.

Much of today’s standard modern medical care views death as an enemy and often fights the inevitable with high-tech, invasive therapies until the last moment. In contrast, the goal of hospice treatment is to keep patients at home with family and friends and to improve the quality of their remaining life through palliative care — providing symptom relief, pain management and a treatment plan that respects their desires and needs.

Hospice provides home visits several times per week, 24-hour access to in-home medical care and respite for caregivers. It also offers volunteer support, patient counseling, music and massage therapy, and bereavement counseling for families. More than anything, hospice care is a philosophical choice; many see it as a way of living the last phase of life in comfort and dignity.

We plan for marriage, children, retirement. Nobody plans for dying.

As medical director, JeffsSteele oversees the medical care of all hospice patients. She works to manage patients’ symptoms and ensure their comfort, directs a medical staff of two other doctors and one nurse practitioner, and shares in the on-call rotation. She also is responsible for making sure their patients are appropriate for hospice care and meet the Medicare guidelines for the terminally ill.

Her blond hair in a braid, JeffsSteele is warm and maternal, laughs easily and focuses intently as she speaks. Her looks belie her six grandchildren. “I started really early,” she says with a grin.

Before she accepted the job in Salem, JeffsSteele was medical director of palliative care services for Harrison Medical Center in Kitsap County, Wash. Before that, she supported her three kids by working, variously, in a paper mill, at a ski resort, and as a river guide. She still goes white-water rafting; not too long ago she took her father down the class 4 rapids on Idaho’s Payette River for his 80th birthday. “He loved it!” she says.

After dealing with the grief of her daughter’s death, still thinking of nurse-midwifery, she applied to medical school. She graduated from the West Virginia School of Osteopathic Medicine. “After that, it just snowballed,” she says.

She completed a residency in allopathic (standard) medicine at St. Peter Family Medicine in Olympia, Wash., and a then a fellowship in hospice and palliative medicine at University of Louisville.

At Harrison Medical Center, JeffsSteele started the palliative care program for patients who have life-limiting illness and may or may not be seeking curative therapies. While there, she once interviewed an elderly man who was seeking to end his life through Washington’s Death With Dignity Act. 

I asked him why. He said, ‘I just don’t want to go back in the damned hospital again!’ Through palliative care, we were able to show him that he had options other than hospitalization, and to support him in that. He was able to enjoy the remainder of his life in the home that he loved and die there, without intervention.”

That, JeffsSteele says, is the most important reason for the existence of hospice. 

Seventy to 90 percent of people want to die at home. When people aren’t on hospice and a crisis occurs, 911 gets called out of fear, confusion and anxiety. Dying folks end up in the ER, which is never a good experience, no matter how wonderful the ER is. Hospice gives the family someone to call other than 911, someone who can tell that staying at home is a reasonable choice.”

She believes that people die as they have lived. In her experience, death is a private thing for many. 

If family is not there when a person dies, then the person most likely wanted it that way. I’ve seen families in vigil at a bedside for days, and the one moment they all step away is the moment their loved one chooses for death.”

Others, dying, hold on until someone they have been waiting to see shows up. “I’m not a researcher, but I have seen it over and over,” she says. “I think there has to be something to it.” 

The idea that the dying process is an important part of our lives, or that death could be a good experience, is a novel one to most. But JeffsSteele believes people can die well when facing it head-on, at home, in bed, with family and dear friends. 

I’m not such a giving, altruistic person — I get something back. I get to witness an incredibly beautiful, poignant, sacred thing where everything that is not important drops away and the core of humanity is revealed. It is a wondrous thing to behold. I feel so honored and privileged to do this work.” 

Laura Gildart Sauter volunteers weekly at Willamette Valley Hospice’s Tokarski Home, which provides end-of-life care for those who are unable to remain in their own homes. She writes a column for Salem Weekly and has had her short fiction and poetry published in obscure literary journals.

Diane Stevenson is a freelance photographer and videographer who lives in Salem and specializes in shooting candid portraits and landscapes. On weekends you can find her pouring wine at Left Coast Cellars in Rickreall.