Two decades ago, a long-term patient at Greater Baltimore Medical Center was astonished at the quality of care he was getting. His principal nurse wasn't just cheerful and knowledgeable. She also seemed to be taking care of him day and night.
Then he realized his caregiver was not one person, but two: Tina Maggio and Gina Ranieri, identical twins who were taking their shifts back-to-back, just as they've shared nearly everything important in their lives.
"He thought we were some kind of super-nurse," Tina said in the pair's office at Gilchrist Center, the acute-care hospice they've served for 16 years.
Maggio and Ranieri-Bender, as Gina is now known, are nurses and clinical managers at the Towson facility, where they handle patients and their families in a field that has mushroomed in size since the 1980s but remains shrouded in mystery.
"They tell me they've found their true love: making the end-of-life [experience] what people want it to be," said Michelle Sullivan, the center's associate clinical director for inpatient units. "They're passionate about meeting that need. The fact that there are two of them makes it all the better."
A day with the 46-year-olds offers a glimpse at the possibilities of hospice, an industry that served just 25,000 Americans in 1982 but reached 1.65 million in 2011.
"Back in the 1980s, doctors were less comfortable saying, 'It's time [for end of life],' but that's less true today," said Gina, the twin with the shorter hair. "And once people began living longer, more were dying in hospitals. Nobody liked that. Word of mouth [about hospice] spread."
Smartly dressed in bright sweaters and scarves one recent morning, the twins talk their profession at warp speed, completing each other's thoughts as often as not.
"People always ask if this work is depressing. But dying is part of life. It happens every day. We enjoy being able to help people with the transition," said Tina, the younger of the two by five minutes.
"We don't just 'dope 'em and kill 'em,'" Gina added. "We offer so many services the public doesn't know about."
Tina and Gina Ranieri grew up in Harford County, the daughters of a banker and a real estate agent. No one in the family worked in health care, but they got what amounted to a grounding in hospice values.
As members of a sprawling Italian-American clan, they started attending relatives' funerals at an early age. Afterward, both noticed, there was usually a big party. "It's a culture that celebrates [at funerals]," Gina said. "We learned that death wasn't something you have to whisper about."
After sharing nursing classes at Towson University and graduating with BSN degrees in 1984, they landed jobs in adjacent wards at GMBC. (One doctor took a year to realize that they were two separate people.)
Nurses are crucial in a hospital setting, they learned, but both felt it was hard to "get to know the people under all the tubes and wires," Tina said. After a beloved grandfather died a lonely and painful death, they came to the conclusion that health care should mean more than trying everything possible to keep a patient alive. When Gilchrist opened in 1996, they made the switch.
Their new field focused on "caring, not curing," in the words of the National Hospice and Palliative Care Organization, on providing "medical care, pain management, and emotional and spiritual support expressly tailored to a patient's needs and wishes"
The twins learned early on how different that would be.
Their first patient at the Towson center — a 34-bed acute-care facility, which generally admits patients who are within a week of death — collected toys from McDonald's Happy Meals. Tina and Gina made sure she was surrounded by the prizes.
Over the years, they've done everything from blow-drying patients' hair and supplying a gut-churning sandwich to making sure a 30-year-old cancer patient got to go to his first rock concert.
"Our patients are living," Tina said. "They know they have only a certain amount of time [left]. We always ask, 'What can we do to help you live life to the fullest?'"
Death, they've learned, is a natural transition, one with clinical, social and spiritual elements. Family members, for instance, are likely to agonize as much as the patient embracing the transition, Gina said. A caregiver can offer a shoulder to cry on, information on legal and financial choices, or just a forthright, informed sense of how near the end may be.
Someone approaching death, the twins said, might experience less steady breathing or lower body temperatures or begin withdrawing from family, and loved ones often appreciate the "courageous conversations" that clue them in.
It's also important, they said, to honor death's less tangible dimensions, such as when dying patients speak in metaphors — often announcing that they need to put on new shoes, catch a plane or just "go home" — or speak aloud to deceased loved ones they believe are welcoming them.
"We don't know if that's a real experience, but we see that again and again," said Gina with a smile. "If it's a comfort to the patient, we support it."
Their office is a place of organized chaos, where nurses stop by for advice, phones ring to announce new admissions (with 20 to 30 deaths per week, there's lots of turnover) and Tina and Gina tap into the latest information on their laptops, all while finding time for the personal visits they make to every patient.
The scenes can be hard: the time the cancer-stricken young father dictated letters he wanted his daughters to read at key milestones in their lives, or the dying mother who asked Tina and Gina to make plaster molds of her hands so her preschool children would have something to remember her by.
The twins, like everyone in those rooms, broke down in tears.
If you want to know why patients and their families deluge Gilchrist with letters of thanks about the sisters, look no further than the way they view such moments.
"If you can't show your feelings at a time like that, you might be in the wrong field," said Tina. "This work isn't for the squeamish."
Gina, of course, agreed.
"It's a privilege to be there," she said.
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