What It’s Like to be a Death Doula During COVID-19 Pandemic

On a chilly October morning in Lander, Wyo., Liz Lightner makes a couple of psychological notes as she sits by a stranger’s bedside. The person is 79, has lung most cancers and is in a deep-sleep coma. He’s carrying a blue scuba-diving shirt that’s worn out and appears as if it’s been liked, washed and rewashed for a few years. In addition to the corporate of his cat, the person is alone and moments from dying.

Utilizing solely phrases, Lightner, 49, carries him away from a house that he can’t bodily go away anymore and guides him below the ocean, the place she is aware of he was pleased. She leans her head in opposition to his chest and tells him they’re now swimming collectively within the tropical ocean, the place so many vibrant colleges of fish encompass them. She describes for him the hanging blues and oranges of their fins, how the solar pierces via the nonetheless water and lights up the coral beneath them. She tells him he’s heat, weightless and floating.

Lightner sits beside the person for practically seven hours. Earlier than she leaves, she gently locations his frail hand on his sleeping cat and reassures him that his beloved pet will probably be high-quality when he’s gone. Then she opens a window—a symbolic and religious gesture of passage to no matter comes subsequent.

The person died the following day, which is anticipated in Lightner’s new line of labor. She’s a demise doula, an end-of-life coach who helps the terminally in poor health be at peace with dying—and she or he’s amongst tons of of Individuals who’ve embraced the rising occupation through the pandemic.

Since COVID-19 emerged in early 2020, organizations that help and practice U.S. demise doulas have seen important spikes in membership and enrollment. The Nationwide Finish-of-Life Doula Alliance grew to greater than 1,000 members in 2021, from simply 200 in 2019. Greater than 600 folks enrolled within the College of Vermont’s end-of-life doula program in 2021, in contrast with fewer than 200 in 2017 when this system started. Some coaching teams say enrollment has greater than tripled through the pandemic, as has the variety of folks looking for assist for themselves and others dealing with imminent demise. Pre-pandemic, Merilynne Rush says her coaching group, the Dying 12 months, would get about six calls a 12 months from folks in search of an end-of-life doula. Now she fields three to 4 calls a month. “We’re seeing an enormous flurry of curiosity,” she says.

That’s no shock because the U.S. demise toll from COVID-19 surpasses 866,000. Up to now 22 months, “the notice of demise was in all of our faces,” says Suzanne O’Brien, whose group, Doulagivers, skilled greater than 1,000 folks in 2021, up from roughly 380 in 2019. On the peak of the pandemic in New York Metropolis, momentary morgues, together with refrigerated vans, appeared close to overwhelmed hospitals. On the Web, pleas for funeral help flooded in from 1000’s of households who’d misplaced family members to the virus.

“Whether or not we wished to look away or not, we actually couldn’t,” O’Brien says. That’s pressured many Individuals to reckon with their very own mortality in new methods.

For one, extra younger persons are writing dwelling wills, in keeping with a number of property planners and nationwide surveys. In 2020, a Gallup ballot discovered that the proportion of Individuals who stated they’ve a will elevated solely to 45% from 40% in 2005. However for the primary time, in keeping with a Caring.com survey, folks ages 18 to 34 had been extra seemingly in 2021 to have a will than these ages 35 to 54. The youthful technology was the most certainly to quote COVID-19 as a significant purpose to plan for demise. “For the primary time in a technology, everyone seems to be experiencing the likelihood that demise could contact their lives—not sometime, however now,” says Ann Burns, president of the American Faculty of Belief and Property Counsel.

The Sept. 11 assaults prompted the same uptick in end-of-life planning after Individuals noticed practically 3,000 folks die in at some point, in keeping with Invoice Kirchick, a Boston-based property legal professional. The pandemic was a far better shock to the system. “To some folks,” Kirchick says, “it was a wake-up name.”

For a lot of others, it was a name to motion. After Tracy Yost, who lives in Danbury, Conn., was furloughed from her job as a health supervisor at a retirement neighborhood in 2020, she says she’d name 100 of the residents twice per week to verify in. It didn’t take lengthy to listen to how “wildly remoted” they sounded. On the identical time, Yost’s pals had been saying their remaining goodbyes to their dying mother and father via video calls.

“I simply thought, Oh my God. We have now misplaced our means,” says Yost, 52, who turned a demise doula largely as a result of she feared the pandemic would create a brand new technology of individuals traumatized by demise. “We already stay in a society that doesn’t speak about dying,” Yost says, including that the taboo nature of demise could also be mirrored within the majority of Individuals who don’t have their superior well being care directives so as. With out the pandemic, Yost says she seemingly by no means would have change into a doula.

On a September day in Chattanooga, Tenn., Sara Net, 38, meets with a younger lady in her 20s. The girl is misplaced, scared and confused as her mom nears the top of her decade-long battle with most cancers. Net gently attracts data from the daughter as they speak about what her mom has meant to her at each stage of life. The way in which she cared for her daughter when she was in poor health; the best way they adorned the home at Christmas; the attractive moments that the youthful lady will all the time carry together with her.

One recurring pleased second stands out—the mom and daughter’s shared love of The Wizard of Oz. The dying lady has been sleeping an increasing number of, however when Net places on the film, she smiles and stays largely awake for the movie. The mom and daughter take in their remaining moments collectively on the sofa as Net watches over them. Quickly after, because the mom loses consciousness and enters the ultimate levels of dying, her daughter quietly sings Over the Rainbow.

Earlier than the pandemic, Net’s job description regarded vastly totally different. As a former animal-enrichment coordinator, she spent her workdays arising with artistic methods to entertain the creatures on the Tennessee Aquarium—a job she lovingly compares to that of a cruise-ship director. She’s crammed kiddie swimming pools with colourful plastic balls for the mongooses to dive out and in of. She’s made large turkeys out of building paper and paper baggage, filling them with vegetables and fruit for the lemurs. She’s fed alligators in entrance of stay audiences.

When she was laid off in October 2020, Net says, she confronted low prospects of discovering one other comparable zoo or aquarium job, so she pursued a profession that’s been in the back of her thoughts since her grandmother died of pancreatic most cancers greater than 17 years in the past. She turned a demise doula, in hopes that fewer folks would spend their remaining moments surrounded by panicked family members the best way her 82-year-old grandmother did in 2004. At age 21, it was the primary time Net had skilled such a significant loss. The analysis rocked the remainder of the household.

“I used to be very misplaced in that have,” says Net, who was greater than 1,000 miles away when her grandmother died. “Nobody else appeared to know what to do.” Net needs she and her household may have higher understood the illness, the dying course of and the way a lot time they realistically had left, so they might’ve higher comforted their matriarch. “I promised, it doesn’t matter what, I’d by no means let that occur once more,” Net says.

Earlier than she was laid off on the aquarium, Net saved two reminders of the finality of life on her workplace desk: a pc background picture of the universe and a papier-mâché cranium. “My motto was, the universe is massive and life is brief,” she says.

In addition to a complete lot of compassion, not a lot is required to be a demise doula. Throughout a latest day’s work with a lady who had stopped therapies for breast most cancers, Yost helped her jot down tales to share together with her youngsters about her childhood visits to her household in Italy. When she seen how animated the lady had change into, Yost pulled up Google maps so they might nearly stroll via the identical mountain village the place her grandparents lived. The girl cried because the reminiscences got here flooding again.

“The present of time is what makes doula work so particular and significant,” says Angela Shook, president of the Nationwide Finish-of-Life Doula Alliance.

Since doulas don’t administer or prescribe medicine, the business is unregulated and doesn’t require a license. Most potential doulas take coaching programs that a number of organizations supply in particular person or on-line for as little as $40 as much as $1,000. The teachings are as scientific as they’re emotional. Relying on the programs, which might span weeks, potential doulas usually learn to establish end-of-life levels. They research the ten most typical terminal sicknesses and their main or distinctive signs. They be taught the physiology of how the human physique works, the order through which organs normally shut down. Some programs deal with easy methods to take care of a terminally in poor health little one, whereas others train doulas merely easy methods to speak to households.

Dying doulas typically work in tandem with hospice employees, who’re licensed to offer pain-relief medicine, deal with wounds, monitor vitals and help in different medical duties that the doulas aren’t certified to do. However demise doulas, who’re normally much less restricted by work schedules, step in to fill the emotional voids, says Michelle Thornhill, 52, who has been a demise doula for 12 years.

They can assist write farewell letters or stockpile memos to surviving family members for milestones they’ll miss, equivalent to weddings, birthdays and graduations. They will hearken to somebody’s life story for hours on finish or hear out their proudest moments and worst errors. “I hear tales that perhaps they’ve by no means informed anybody earlier than,” Net says. “I hear tales that will by no means be heard once more.” Upon request, demise doulas can make certain Whitney Houston is taking part in within the background, fill the home with scents of Christmas cookies in the intervening time of demise or discover new houses for pets that will probably be left behind.

In June, Shook says, she helped a lady discover a loving new household for her two cats, which was instrumental to giving her peace. Earlier than the lady entered a hospital for the final time, Shook purchased her stuffed animals that regarded similar to the felines, in order that she’d have them close to as she died. “It’s very human to wish to nurture and help any person via any kind of struggling,” says Shook, who can be a volunteer hospice supervisor in northern Michigan.

To unencumber relations to focus solely on their dying liked one, demise doulas can assist make funeral preparations and deal with different logistics. In Pennsylvania, Thornhill spends six days per week caring for her 101-year-old shopper, Estella Stackhouse, who has dementia. She additionally helps Stackhouse’s granddaughter and first caregiver by creating care checklists and meal schedules, crafting responses to individuals who name and textual content, and limiting the granddaughter to creating just one necessary choice a day. With COVID-19 lowering the variety of guests Stackhouse will get, Thornhill’s function as a caretaker and liaison has change into extra necessary. “It ranks proper up there with oxygen,” she says.

The impression, and never the pay, is why many are drawn to the work. Some doulas supply their providers without cost, Shook says, whereas some function on a sliding scale based mostly on the shopper’s capacity to pay. Others, together with those that have their very own non-public enterprise, usually can cost $45 to $100 per hour, although costs rely upon many elements, together with location and period of service. Many doulas supply packaged charges that Shook has seen go from $500 to $5,000. “It’s in every single place,” Shook says, including that the prices should not coated by any health-insurance plans.

Net has but to make a revenue after leaving her over-$40,000-a-year aquarium job and pouring about $5,000 into her new doula enterprise, together with prices for coaching programs, workplace area, licenses, promoting, web sites and insurance coverage. However up to now six months, she’s felt her impression, which has helped heal a few of her personal inside wounds from her grandmother’s demise.

The job is usually misunderstood, partially as a result of many really feel it’s a morbid occupation. However demise doulas disagree, saying there’s typically extra dignity within the work than unhappiness. Net says her mom was horrified when she began coaching to change into a doula in spring 2021. “She thought I’d be devastated 24/7 as a result of I’m a delicate particular person,” Net says. However since Net launched her doula enterprise early in June, she hasn’t felt that means in any respect. “I can’t cease folks from dying,” she says. “All I can do is be there to help them.”

Dying is one expertise each particular person has to undergo. However that doesn’t essentially get simpler to simply accept with time, Yost has realized. “Concern is current in any respect ages,” she says. And since there’s just one likelihood to do demise proper, a number of doulas say it’s widespread for private grief and regrets to drive many towards end-of-life work.

In March 2019, Lightner’s father died following issues from a lung biopsy. Earlier than that, he had spent about two months intubated and hooked to a feeding tube and different life-sustaining gear earlier than he was faraway from life help. These months had been difficult for Lightner, who knew her father had not wished that for himself. “We stock guilt and we supply what-ifs,” she says. “Me changing into a demise doula is partially me grieving this loss.”

Each Tuesday night, Lightner nearly meets with a couple of dozen different new demise doulas from across the nation. They assist each other navigate their careers, perceive the logistics of their companies and launch their web sites. However more often than not, she says, they’re spending their weekly Zoom periods working via their private struggles and renewing each other’s hope.

Among the many new doulas are Patty and Greg Howe, a longtime married couple who’re each terminally in poor health. Within the 5 years since Greg was identified with leukemia, the 66-year-old says he has come to a “place of simply full liberation.” His acceptance helped form Patty’s outlook when she was identified in February with liver most cancers at age 69. “We have now the selection to decide on pleasure in every thing,” Greg says. “It remodeled me.”

The Howes have shed what they don’t want, together with most of their materials possessions and any petty issues that after burdened them. They now stay out of a candlelit yurt in Ketchikan, Alaska, as they plan preparations for different terminally in poor health folks to make use of their beachfront home close by as an end-of-life resort, the place they will spend their final moments with their households. For the reason that pandemic, the Howes have immersed themselves in death-doula work, serving to others attain the identical sense of peace.

“It’s virtually like we’ve taken a grasp’s class in demise,” Greg says.

Dying wasn’t all the time so industrialized. Greater than a century in the past, earlier than there have been coroners and funeral administrators, it was regular for households and communities to care for the deceased, in keeping with Nukhet Varlik, a Rutgers College professor who specializes within the historical past of pandemics. Hospice care wasn’t launched within the U.S. till the early Nineteen Seventies, although folks had been nonetheless informally taking over the function of a demise doula. “Dying was revered as a sacred a part of life’s journey, and we’ve utterly eliminated it from our consciousness,” O’Brien says. “In truth, we’re doing every thing to run the opposite means.”

Dying doulas as we speak try to vary that. In January 2021, when a dying man in frigid northern Michigan stated he wished to be again on a seaside however was too sick to go away his home, Shook dipped his hand in a bowl she’d full of sand. She lit citrus-scented candles round him and introduced in a sunlamp to heat his physique because the sound of ocean waves crashed out of audio system within the background.

A month later, when Shook realized a dying lady who liked lilacs wouldn’t stay lengthy sufficient to observe them bloom once more in her yard, she burned lilac candles within the lady’s room, hung giant images of the purple vegetation on her partitions and massaged her palms and ft with lilac-scented oils.

“Dying doesn’t should be this medical occasion,” Shook says. “There’s a number of magnificence.”

Contact us at letters@time.com.