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I pause at my client’s door to take a deep breath and center myself. This threshold represents more than just personal space in a nursing facility—it is also a threshold between the living and the dying. My client Jack (not his real name) is in the final stages of active dying. He’s elderly with no living immediate family, and has no support outside of medical staff, to usher him through the death process. I’ve been contacted to do a bedside vigil during his last hours so that Jack will not die alone.

A trained end-of-life companion, also known as a death midwife or doula, is not a job for everyone. Encounters with sadness, anger, confusion, panic, and, of course, death are a given. There can be prolonged hours, if not days, of sitting at the bedside of a client. Rarely are they alert and oriented, so much of that time is spent sitting quietly in vigil, or perhaps reading aloud or playing soft music. If brought on board early enough, a death midwife can create a detailed plan for that time with the dying. But either way, you are going to lose every client, and each loss will hurt in its own special way. The work is, however, highly gratifying and immeasurably appreciated. Those without friends or family no longer have to face death alone. And for those with folks around, being an extra pair of hands means that caregivers can go to work with less fear, or can get out to purchase groceries or take a shower. 

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There is currently no national regulatory body that certifies death midwives, however, after completing a training program, doulas have the support of The National Hospice and Palliative Care Organization. To find a training program that’s right for you, try the International End of Life Doula Association (inelda.org), Doulagivers (doulagivers.com), Beyond Hospice (beyondhospice.com), or the National Home Funeral Alliance (homefuneralalliance.org). Training generally entails learning the basic language of death and dying, learning active listening, recognizing the stages of death, vigiling, and ritual/spiritual work, and can cost in the hundreds to the thousand-dollar range. Rates for death midwife services vary depending on what’s offered, from around $25 to $100 an hour, and some doulas charge flat rates when round-the-clock care is needed. Finding clients can be a challenge, since many don’t know this option exists. Joining an organization like the National Home Funeral Alliance, which offers a state-by-state listing of end-of-life companions, will help get you started. If you’re contemplating the work of death midwife, consider volunteering with your local hospice organization. The training is not as intensive, but it’s free and you’ll get an idea if this work is for you.

By Kris Bradley

Illustrated by Natalia Bzdak 

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This piece originally appeared in the January/February 2019 print edition of BUST Magazine. Subscribe today!

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