Support and Care Through Life’s Final Chapter
Every person and family approaches death differently. My role as an end-of-life doula is to listen, guide, and offer support — practical, emotional, and spiritual — through each stage of the journey.
1) DIAGNOSIS
A person and family receive a terminal diagnosis and enter into a new reality. They may individually experience shock, depression, denial, anger, anxiety, or withdrawal. They are also forming a new group for a new purpose. The Doula, person and main player(s) in the inner circle agree on a care contract. The Doula: Assesses acute physical issues, advocates for medical assistance Uncovers any safety concerns with the patient or the environment, and mitigates Maps out inner circle and additional support system, establishes relationships, and begins to suss out capacities and roles. This generally takes a few days to about a month.
2) New Normal
Person and family/friends settle into a journey of terminal illness, with formal hospice care or informal palliative care. The Doula guides and supports the person and the inner circle as they: Process this new reality and their reactions to it Do meaningful work on legacy and relationships Plan for any practical tasks regarding dying, mourning, and re-entry after the person’s end of life. The Doula fills a variety of roles in this phase, including guidance, education, companionship, empathy, family systems work, and project management. More tactical tasks may involve professionals providing their expertise, and there may be occasional contact with the broader community. The Doula continues to center the work on the patient and their needs/wishes. This is the longest phase, and the timing is variable. Hospice organizations work with patients considered as having less than six months to live.
3) TRANSITION
The person is now actively transitioning from this world to what’s next. Getting ready to take flight is hard work for soul and body, and the process can be stressful for the inner circle, as well as members of the broader community who visit. The Doula guides and supports the person, the inner circle, and others at the bedside as they: Witness and manage any physical symptoms and changes in the person at life’s end Say goodbye, find closure, and meaning Experience a variety of emotions such as anticipatory grief, love, anger, fear, exhaustion, acceptance, both individually and as a group Create dying and bereavement rituals; finalize plans for official mourning. The Doula cares for and advocates for the patient and their wishes/needs, and also provides small acts of caring for the inner circle. The Doula continues to provide emotional support, companionship, and guidance, now particularly modeling the skills of listening, presence, empathy, and forgiveness. This phase is generally a few hours to a few days.
4) New Normal
Post death, the inner circle and community enter into a formal mourning period and active grieving. If needed, the Doula can continue to provide support and guidance during this phase. The Doula advocates for friends, family, and community to take the time needed to grieve, and to treat themselves with kindness as they move back into the mainstream.
“Humans Are Mortal.
There, I Said It.”
Each person reaches the end of life, and then they transition to what’s next. While that person’s body breaks down, their soul expands and ultimately flies free. It is an intense individual effort but includes family and friends, just as birth does.
It’s a very important time, filled with so many emotions and practical details. Nowadays the process is often hidden away in hospitals, with beeping machines and healthcare workers. But dying is a human event, not a medical one. The precious human dying, and their friends and family, could use some support.