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As I arrived at the Balm of Gilead, a palliative-care unit on the fourth floor of Cooper Green Hospital in Birmingham, one of the nurses was blowing her nose. Arnold Smith (not his real name) died that morning. Three nurses had gathered behind the nurse's station. "When people die, it is not unusual to find the leadership team in the nurse's station in a huddle, crying and praying," says Edwina Taylor, R.N., nurse practitioner and go-to person at Balm of Gilead. "Our faith holds us up."

Palliative care is not hospice care, though the two can easily be confused. Hospice care typically takes place in the dying person's home, or in a home-like setting. According to the National Hospice Foundation (NHF), it is a team-oriented approach of medical care, pain management, and spiritual support that is tailored to the patient's needs and wishes. Hospice care, the NHF says, upholds "the belief that each of us has the right to die pain-free and with dignity."

The same can be said of palliative care, with a notable difference: through pain and symptom control, palliative care readies dying patients to move from impersonal institutional settings into the gentler environment of hospice care—whether at their home, in a nursing facility, or, if necessary, in the palliative-care unit itself. Dr. Amos Bailey, Balm of Gilead's former medical director, highlights the point that "75 percent of the people who die in the United States die in medical institutions." Fifty percent die in hospitals, another 25 percent in nursing homes. These "institutional" deaths are often painful, lonely, and isolated.

Palliative care is trying to change that picture. One might think of it as the meeting ground between hospice and institutional medical care. Situated on-site in a hospital, a palliative-care unit is a clearinghouse of sorts through which dying patients in the hospital, who have not received hospice care, get their symptoms stabilized and are then released from the hospital to die—not lonely, isolated deaths, but in a more personal, compassionate setting. Once patients have been through a palliative-care unit like Balm of Gilead, they are channeled seamlessly into the care of a local hospice.

Balm of Gilead refers terminally ill patients from all parts of Cooper Green Hospital—patients with AIDS, cancer, cirrhosis of the liver, heart and lung failure—to one of the 15 area hospices in Birmingham. Palliative care is still up-and-coming, but more medical institutions are recognizing its merit. Like hospice, it "addresses physical, spiritual, social, and emotional suffering through symptom control in those four areas for people who have a disease that man cannot cure," says Edwina Taylor, and it makes hospice care an option for more and more patients who might otherwise die alone in a sterile hospital bed."

Despite the soon-to-double number of aging Americans, most don't want to think or talk about how to die. There are now 40 million elderly people in the United States. In the next 30 years, with the aging of the baby boomers, that number will double. One third of those 80 million deaths will involve a chronic illness of some sort. Every chronic illness will require decisions, either on the part of the patient or the family. If present trends persist, most of these people will not have thought through end-of-life questions.

According to a national survey taken by the National Hospice Federation in April 1999, Americans are more likely to talk to their children about drugs and sex than about how they want to die.

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October 22 2001, Vol. 45, No. 13