First Vigil, First Death By an End-of-life Doula
A few years before I trained to be an end-of-life doula, I lost both my best friend and my mother within six months of each other. Because my friend, who died first, engaged her illness and death consciously, I had the opportunity to engage far more consciously. I came to realize that I had the capacity to show up, repeatedly, and remain present in the face of such extremity and that this was a gift, not just one I gave, but one that I also received.
Although I had been a primary support throughout her lengthy illness, when my friend Bettina died I was on the opposite coast in the hospital with my mother. Months later, when my mother died, I had just been urged from the room by a well meaning but misguided nurse. I had wanted to be there for each of their final breaths. Still, I knew that being with them for as long as I had was a privilege. The depth of connection available at the edge of life may not heal the body, but it heals the heart and soul. So, it was easy to choose to offer that gift to others.
So, when I first saw then announcement of the End of Life Doula training in the local paper, I thought simply, I can do that. At the training, I felt very comfortable with the in-depth conversations about death and dying. Still, sitting with an actual patient, a stranger, might feel quite different than sitting with a loved one. I wondered how I would fare.
First Vigil, First Night
As I embarked on my first official end-of-life doula vigil, a few months after completing the training at a local hospice, I had an inkling that I might be present for this patient’s death. It seemed unlikely, however, as we had a team of 40 doulas to draw from. I suppose I might have felt overdue, having missed two personal deaths, but that was about me. When you enter a vigil, you do your best to leave yourself aside, so I dismissed the thought. And, while I was curious about witnessing a death, I also feared it.
As I prepared to enter the home of my first doula patient, an elderly woman, I sat quietly in my car and reviewed my course notes. I had made arrangements to go in with an experienced doula for my first shift. Having a more experienced companion eased my fears and calmed my nerves. While she took the lead with the patient and family, I took in the scene and the interactions. The patient had not been eating, drinking, or talking for the past five days and her eyes were partially closed. Her daughter was loving and attentive. We are told that the last thing to go is the hearing, and this seemed evident by the changes in her facial expressions and the movements of her head in response to music and conversation. She was actively dying, but she was not imminent that night. I’m not sure I would have known that, however, so not having the entire responsibility of support for the patient and family rest solely on me allowed me to relax and be present. I watched and waited that first night, staying in the background, on a short three-hour shift.
Preparing Myself
The patient had not died that night or the next, so a few days later, I signed up for another shift, going in for the first time on my own. I wasn’t working at the time, so I took the late night to early morning shift. As I drove to the patient’s home, I played a favorite calming and expansive spiritual CD (Feather on the Breath of God). I had prepped a small go-bag with some frankincense oil, a small votive candle, and a box of matches. My thinking was that I wanted to have them with me in case the patient died and I needed to help wash the body and create a spontaneous ritual. Since the patient was Catholic, I brought along a set of my mother’s old rosary beads and a printout of how to pray it correctly. I also packed mint-scented cream to rub under my nose, in case of unpleasant odors, and a thermos full of hot tea to keep me going. Interestingly, I have never used any of these items, but for the tea, and soon stopped toting them to vigils; I think now that they were transitional objects that helped me prepare my mind for the unknown I would be facing.
I had been a longtime, if sporadic, meditator, but I had a more regular practice at the time. As I arrived at the home, I sat in my car for a few minutes, just watching my breath, calming my thoughts. I had no particular ritual worked out to prepare me, just the belief and quiet counsel to myself, that all I had to do was be present and respond to the moment as authentically as I could.
Multiple Shifts
As it turned out, the second night was not to be my last. While the patient had appeared closer to dying than on my first night, she also seemed to want to savor every last moment of what had been a good life. She did not die that night nor on my third shift a few nights later. So, I signed up for a fourth overnight.
As I said, I had had a thought that I might be there when this patient died, but by this fourth shift, I was not even thinking about it. Over the course of seven days and nights of vigil shifts, she had often appeared close to death but had not let go yet. We surmised it was a connection to her daughter, but the daughter, much as she did not want to lose her mother, was urging her to go. The patient, who was breathing quietly through an open mouth, one of the signs of approaching death, had a strong spirit that was evident even in her now completely unresponsive state. So, I expected to pass another night quietly by her bedside and then leave in the morning.
Nothing To Do
I arrived at 2 a.m. and entered quietly, coordinating via cellphone with the end-of-life doula before me to enter the locked building. For middle of the night switches, when they were necessary, we had worked out this system for entering quietly and not waking the family. That doula took a few minutes to share her observations. Not much had changed during her shift. After she left, I perused the vigil record book to see how the day had gone and settled down in a chair. The patient was in hospital bed, and tonight, for the first time, her daughter was asleep in the room. She was sleeping with her head to the foot of her mother’s double bed, so she could see her face when she woke.
On previous shifts, I had read to the patient from the Bible at the bedside, had spoken to her softly, touched her gently, said the rosary and provided mouth care. But tonight, I merely sat silently, not wanting to disturb her or her daughter. There was nothing to do. The room was still but for the dying woman’s steady, slightly raspy breathing. I sat in the stillness, as I had trained to on meditation cushions, observing. But tonight, instead of watching my breath, I watched hers. Occasionally, I would count her breath, but even that was unchanging. Every time I counted, it was a steady 24 breaths per minute. Eventually, I just listened to her breathing with my eyes softly focused on her face or barely moving chest.
The Vigil Ends
At about 5:30am, I began to mentally prepare for the next doula to arrive at 6:00 a.m. I wrote in the vigil record book beside the bed, describing her condition as unchanged and settled back into quiet concentration. A few minutes later, I heard an odd sound, a quiet click that seemed to come from the dying woman’s throat. I had just leaned forward to better listen when she took a sharp in-breath. Her daughter woke immediately and moved to her side. “She just changed,” I said, feeling a little flustered, as her daughter started to stroke her mother’s face, speaking softly, letting her know how much she loved her and that she would be okay. In the next moment, this woman took her final breath and died, peacefully, with her eyes resting on her daughter’s face.
A Good Death
In the end, 23 end-of-life doulas had attended at this bedside through multiple shifts for over 170 hours in continuous rotation helping this woman and her daughter to experience a good death. In the end, after having missed the deaths of my loved ones, I was with my first hospice patient at the moment of her death. Even though I could not be with mine, as part of a team, I had helped another daughter be present when her mother breathed her last. It was a gift.
Cynthia lives in New Jersey and is an INELDA end-of-life doula.