Almost three years ago, I packed up my four children and drove to Oregon to help care for my father. His melanoma had metastasized to his spinal fluid, and everything that could be thrown at it to kill it, had been. There was nothing left, but to wait. Probably only weeks were left.
His decline was gradual, over the course of about three and a half months. During that time, I discovered another purpose to my doula training and work.
The end of life is much like the beginning. It is mainly about waiting, comfort and support. There isn’t anyone who can do the dying work, except the dying. Those in attendance find themselves with not much to do but wait. At the most, we bring comfort through physical touch, slow conversations, and just quietly being present. It is so much like waiting while a woman labors. The main difference being that we are on the wrong side of the veil. We do not get to see our loved one birthed into the next life. It is all darkness on this side.
I have never been so grateful for my training as a doula. Everything I learned is very nearly directly applicable to the dying process. Here are 5 things I learned while doulaing my dying father.
1. Pain can be a normal part of the process.
Granted, the pain of death was not something I believe that we were ever designed for. It is often pathological, but it is also a natural part of dying. As in labor, it is a signal that something needs to change. Perhaps a massage will alleviate it. Perhaps a dose of morphine will help the man laboring to die to rest a little easier. Pain also allows and invites loved ones to minister to the dying simply by being present, holding a hand, or stroking the hair.
2. The same comfort measures used in labor often work well for the dying.
Massage. Gate control. Supporting the five senses. Medication. Acupressure. Essential oils. Music. Bathing. Hydration. Light snacking to their level of hunger if it exists at all. The dying, much like the laboring woman, do not need much food if any. It’s important to follow their lead. All these techniques we learn in our doula training are applicable to the dying one. Of course, some causes of death render certain massage strokes unbearable, much like transition may do in a laboring woman. It’s all about trying different things, and allowing the dying to accept or refuse it without taking it personally.
3. Holding space is the foundation for dignity.
We know as doulas that a mother’s pain level, or even the kind of birth she has will have little bearing on how satisfied she is with her experience. What matters most to her is that she is the decision maker and that she feels supported throughout the process. We as doulas hold the space for that to happen. We are constantly directing attention back to the laboring mother: “How do you feel about adding Pitocin to the plan? Would you like time to talk about it?” It’s the same with the dying. They often struggle to decide, and just need the space to settle in with what they want. This gives them the dignity they deserve as a human being while they go through an undignified, and often painful process.
4. Writing an end-of-life plan is much like writing a birth plan.
It’s written before the active dying really begins, much like a birth plan is written prenatally. It outlines the dying person’s desires, wishes, and medical decisions ahead of time, so that if and when they become incapable of decision-making, those who are caring for him can use it as a guide to know what he would most likely want to do. Unlike a birth plan, it is a legal document, and only power-of-attorney can override it. The principle is the same, though. And as a doula, upholding these desires came naturally to me.
5. Dying doesn’t look at all like what is portrayed in the media.
Birth in the media is always an emergency, there is a lot of screaming and hating of husbands, and demanding of drugs. It’s almost never clinically accurate or true to life. It is the same with death in the media. Death in the movies is always grand or gory or like watching someone fall asleep. Watching my father die was none of those things. There is no way to portray the sights, smells, sounds, or the heaviness of the room where the dying man lies. There are as many ways to die as there are to give birth. As beautiful as Dad’s final moments were, as dignified and peaceful as it was, I found death itself to be ugly. Just as I find birth to be beautiful, in spite of the “mess” and the pain and the noise and the smells. Death and birth are studies in contradiction. They are each a paradox. And both are sacred.
I loved being with my dad while he lay dying. I felt honored, privileged, and blessed to witness a man’s leaving of this world to enter the next. For Dad, to live was Christ, and his death was gain. Every time I enter the sacred birthing space of another woman, I am reminded of the gravity of life, and how important it is to have dignity at both birth and death. As a doula, I now know that I have the skill and compassion I need for either. If I weren’t a doula, or pursuing midwifery, I think I would want to be a hospice nurse. But that is an entirely different post for a different day.
Thanks for sticking with me. I know this is a tough subject, but it’s close to my heart, and it was time to write about it. How have you experienced death or birth in your life? Have you seen both? Are there other parallels you noticed?
Grace & Peace,