Your First ‘End of Life Doula’ Vigil

by Janie Rakow

The first vigil for an End of Life Doula is always intimidating. Armed with knowledge and training, most End of Life doulas are apprehensive about their first patient visit. Classroom training is fine, but meeting the patient and family for the first time can be downright scary.

What is a Vigil?

A “vigil” is when an End of Life Doula sits bedside with the patient and family during the “active” dying phase. My role as an End of Life Doula will typically begin far in advance of the actual vigil. Usually End of Life Doulas will meet with the family weeks prior and work on a “vigil plan” determining how the patient and family would like the process to evolve. Would they prefer to be sitting outside in the sunshine ? Do they want fresh flowers surrounding them? Candles lit? Soft music playing? Surrounded by photos of their loved ones? Each patient’s vigil plan is unique and customized to their preferences.

Your Presence

So what are some basic things to remember for your doula visit? First, relax. The family and patient are most likely anxious, exhausted and distraught. Your presence is a calming force in the midst of the storm. I always introduce myself to the family, and then go directly over to the patient. Even if the patient appears to be in a morphine haze, I speak gently into their ear. I remind them who I am, and why I am there. I assure them that I am there to help, and I will explain everything I do before I do it.

The next step is to sit with a family member and find out if a vigil plan was done. If so, I read through the End of Life vigil plan and glean as much knowledge from that as I can. If not (and many times this is the case), I ask the family, or the patient, to tell me about what is going on. I ask if the patient is in any pain; have they slept; has there been any change in the last few hours; what type of medication are they taking; do they have any concerns that I can help them with?

If the patient is agitated or their pain is not controlled, I will ask the family if they want to reassess the meds and call the hospice nurse. The goal is to stay ahead of the pain and for the patient to be comfortable.

Create the Space

If the patient is resting comfortably, I’ll sit next to them and try to have a dialog with them. If the patient or family has indicated that they like gentle touch, I will ask them if I can massage their hand or head. I usually play soft music in the background. I will look around at family pictures, and bring the pictures to the patient’s bedside and ask them who the family members are. If the patient is unresponsive, I will often ask the family members to tell me stories about the patient. Most family members love to talk about their loved one.

Sometimes all that is required is a quiet presence. Sitting bedside and taking your cues from the patient or family is often all that is needed. Family members can be exhausted mentally and physically. They may appreciate a break and some quiet time. As an End of Life Doula, we try to create the space for the patient and family to relax and allow things to unfold as they were meant to.

So, for your first End of Life Doula vigil, just remember to bring an open heart and a calming presence. Hold the space for “a good death” with grace and compassion. That is when the magic happens.