When talk turns to the concept of a doula, I find that many people are at least vaguely aware of birth doulas, but the concept of a death doula (or end of life doula) is new to them. I thought it may be helpful to spin a little riff on what a death doula is, what they bring to the proverbial table, and when the right time is to bring them on board.
Back in the day (gather round my rocking chair, children), people used to die at home all the time, surrounded by their loved ones. Maybe a window was cracked open so they could hear the birds chirping, maybe grandchildren could be heard playing outside, maybe something wonderful-smelling was cooking on the stove to help nourish those who were providing care to the dying person. Death wasn’t something scary or never discussed; rather, it was a natural part of life, and while it’s always sad to say goodbye to someone you love, you knew in whatever faith or spirituality that you followed, you’d see them again in some form. Maybe Heaven, maybe Nirvana, maybe in the rain and flowers and trees…or maybe it was just lights out for them and you’d remember them fondly in your own way. In today’s world, more and more we see people never discussing death, and so when it comes for them, they fight it and they ask doctors to help them fight it, and doctors being doctors and wanting more than anything to help their patients live no matter what their prognosis is, will do all they can to help prolong the inevitable. The dying person’s last moments are often in an impersonal place, surrounded by machines and people who never had the chance to know what their favorite color is, or which animal is their favorite, or hear that story about the time they went to that amusement park and won their most cherished stuffie. They die in a place of mental fight and exhaustion and often a slew of pain killers that prevent them from making the most of life. Kindly note that death doesn’t happen until the very end. We are all living up to the point that we are not.
Death doulas seek to help make the process of dying less of a mystery, more of a joyous (or at least a not-scary) transition, and ideally, if engaged early enough, a transition the dying person can make from a place of feeling unburdened and more prepared to step into whatever comes next.
How do they do this? Well, every transition is different, and your chosen death doula will hopefully meet you and your loved one where they are. If I could wave a magic wand, here’s what I’d love to see every time:
1. The doula is engaged early enough to be able to converse with the person who is preparing to die.
2. Conversations will be had around things like life reviews, legacy projects, addressing some of the lingering worries or other mental/emotional/psychological issues that might keep one from feeling fully at peace, and a death plan** is created.
**A death plan is the dying person’s ideal wishes around their last hours. Where do they want to be? Who do they want with them (and who do they NOT want with them)? What does the room look like, sound like, smell like? What can they see and hear and feel? What do they want done following their final transition? Similar to building a wedding plan or a birth plan, these are wishes that all involved will try their best to make happen. Human bodies are unpredictable, though, and should the wish to die at home become a case of dying in a hospital instead, having a death plan still gives some structure around replicating as closely as possible the dying person’s preferred surroundings.
3. The doula will have some longer visits to go over these more administrative-type details, and if schedules permit, the doula would also come perhaps weekly or every other week for shorter visits to check in and offer some support to the dying person and caregivers. This gives the doula the opportunity somewhat settle in with the family and dying person, so that when the transition time comes, the doula is as much a part of the extended family as possible. I will note that this is the ideal, and as part of the ideal, the family/caregivers would click with their chosen doula on a personal level as well. If people feel like they are walking on eggshells or must mask their true selves around the doula, it's not a good fit and a new doula should be sought.
4. When transition time comes (by this, I mean all signs point to the point of death being imminent), the doula would be alerted and might come (if wanted) to help support the family and patient. The time of death isn’t something that can be predicted with surety, though, and asking a doula to come and sit for what may turn out to be days or weeks of time isn’t the best use of anyone’s time. More likely, the family would by this time be aware enough of signs to look for, and often will prefer to take turns sitting vigil or quietly keeping watch over their loved one on their own. It will often become quite evident when death is VERY near, and if the doula is summoned (and is able) to come, that’s a better time to ask for an actual in-person visit.
5. Once death has happened, having a doula nearby can help to give the family a sense of stability and calm. If desired, a gentle washing and dressing or shrouding of the loved one’s body might happen. Calls can be made, either by the doula or by the family. There will be a naturally-felt time for the doula to make their departure, and ideally, this isn’t done in a hurry. When a person dies, society tends to make us feel we must immediately do SOMETHING. But what really needs to happen is decidedly…nothing. Just breathe, and be, and let your loved one have some time to complete their transition and for you to soak in the honor of being able to witness someone passing on.
That’s the ideal. What’s the reality? More often, a death doula isn’t even really considered until we’re closer to #4 above. There is often no time to be able to speak with the dying person, or if there’s time, the dying person may be living with advanced dementia and is no longer able to clearly communicate their wishes. In these cases, the doula and the dying person’s loved ones can do their best in laying out a death plan, and the doula can at a minimum provide some support as outlined in #3 above.
If hospice has been engaged (something I do highly recommend, though do your homework and call several hospice organizations near you to ensure you feel the selected hospice is a good fit for you), you may ask for a patient visitor (usually a volunteer) to be assigned in addition to the RN and personal care aide that will likely be assigned. In some cases, the patient volunteer may have death doula training, but at minimum, these volunteers can simply provide regular visits and be an additional set of eyes and ears to watch for changes and offer support. Respite visits can also be arranged - these are opportunities for a trained person to come and sit with your loved one for a few hours so that you are able to run errands, engage in some needed self-care, or just step outside and catch your breath. These are all small but impactful ways you may find support both for yourself as well as for the person who is preparing for their next adventure.
I hope this helps to shed a little light on what a death doula does. As for the ideal “when” for engaging one, I often tell people that I would benefit from hiring one for myself today. Not that I am nearing my own transition (knock on wood), but the preparation around creating a death plan and pushing me to put some thought behind a legacy project are things I would benefit from right now. You don’t have to be dying to engage a death doula; you may want to engage one early on, just so you’re that much more prepared.
If this sparks any questions or has you wanting to talk more, drop me a line. There’s never an obligation to do more - I’d just love to hear from you!
コメント