How Valuable a Vigil Plan Could Have Been

by Christy Marek

One of the axioms of doula work is that we can offer a service and then have to let go of the outcome. Such was the case with a recent client, Felicia (not her real name), who, when I offered it, told me that she didn’t want a vigil plan. While I make a point of going into all of my sessions with no agenda, creating a vigil plan is generally central to the services I’m asked to provide. In my experience, it is very useful in supporting people as they move through the end-of-life process. But Felicia just wasn’t interested. Though we explored some of her preferences that a formal vigil plan might include—for example, she thought it might be fun to have people play her a song when they visited that reminded them of their times together—she wasn’t into anything very particular.  

Although she didn’t make it a formal request, she did often say she imagined having her husband on one side of her, and her daughter on the other, as she took her last breath. As we delved deeper into her thoughts and feelings about dying, what became clear was her fervent wish that her dying process would be as easy as possible for her husband to bear. He was her primary caregiver and had much experience with death, she told me, both as a seasoned trauma surgeon and in presiding over his own mother’s death a number of years earlier. While she told me she trusted him implicitly to know what to do and to make choices that honored her, she wanted to ease the strain of the experience by refraining from requesting specifics that he would feel beholden to. 

A number of times I tried to find a way to help her understand that having a plan in place would actually accomplish what she most wanted: to ease the strain on him. But each time she declined. 

Eventually, honoring her wishes, I stopped trying—letting go of the outcome. 

Not long after Felicia became very weak and frequently unresponsive, a struggle within the family began. Felicia’s husband, who had accepted my services because his wife wanted a doula, suggested there was no need for me to continue visiting now that Felicia could no longer engage with me in a meaningful way. But Felicia’s youngest sister, Georgia, continued to reach out to me for support over the phone. She shared how hard the family dynamics had become. She told me that in the stress of Felicia’s dying, their siblings began bickering with one another about everything and nothing, in some cases bringing the hot issue of the moment to the bedside, even though Felicia wasn’t often conscious or present. This had been Felicia’s role in life—the mediator, the fixer, the overseer. Felicia and I had often talked about that role of hers in the family; even in dying, it seemed, the family was falling into having her stay in that role.

Felicia’s husband, under enough stress and wanting nothing to do with the family dynamics, would separate himself from the situations as they arose. And Georgia—the youngest of nine—was mindful not to step on toes and was reticent to confront it either. 

A vigil plan could have provided parameters for what was allowed, or not allowed, in Felicia’s space. It would have clearly stated her wishes, and given whoever came to visit a blueprint for how to best support her. This would have taken the decision-making and focus off of them, and put it back on Felicia, where it belonged. Without it, and without the physical presence of a doula or an appointed intermediary to honor the kind of feeling Felicia had hoped for around her, it was up to the family in the throes of grief to figure it out on their own. According to Georgia, because the family was embroiled in old dynamics and roles, no one appreciated how disruptive their conflicts were to the reality of what was happening for Felicia. And with Georgia’s added sensitivity to the feelings of Felicia’s husband, even with my coaching and encouragement, she was unwilling and unable to assert what she knew Felicia would want. 

The bedside of a dying family member can be a pressure cooker that has the potential to bring out the worst in people. Minor differences or issues can get dramatically inflamed, obscuring the true cause of their suffering—the reality that a loved one is dying. Their lives have changed, and they are not in control of any of it. And under it all, under all of the drama, the unskillful and habitual words, the actions and reactions, is grief. This leads to a complicated soup of emotion that makes it so much harder to imagine what a dying loved one most wants and needs. 

So much of the stress people experience at the bedside comes from not knowing what is expected of them, and from not being comfortable guessing what to say or do. The simple beauty of the vigil plan is that it can act as a scaffold of support even in the most dysfunctional circumstances. It offers a framework for how people are invited to behave (and not behave), and specifics for how to interact with the person dying.  

Likewise, a vigil plan can take the pressure off of any one person to be in charge. It speaks for the dying when they are no longer able to speak for themselves. This especially holds true in circumstances when a doula, who typically offers that calm, normalizing presence, cannot be there. It isn’t a set of rules, but rather a loving request from the dying to have their time, space, and process honored.  

It’s uncommon for most people to have the opportunity to be so clear and concise in asking for what they want and need, at any time in their lives. For Felicia’s family, if there had been a formal plan in place, regardless of their dynamics, there would have been her words and wishes to refer to: “Felicia said that she only wants positive energy in the room, so if you’re going to have that discussion, please take it outside.” It isn’t a surefire solution, but I imagine this would have made it easier for both Felicia’s husband and Georgia to take a stand on her behalf. 

While I wish I had found a creative way to help Felicia see the benefit of a vigil plan, I know that ultimately it was up to her and I had to let go. In the end, I feel satisfied that I honored her desires. As it is, I have to trust the situation unfolded as it needed to for Felicia, her husband, Georgia, and the rest of the family. However, I also know that I will keep trying to help my future clients see the great benefit of creating a vigil plan.