AURORA, Colorado (AP) – Ashley Scott describes the emotional side of her work as a deadly doula, like a fountain in the middle of a lake.
Her job is to help a dying person get through an experience that is so intimate, common, and yet largely taboo in American culture. Scott wants people to feel comfortable, safe, and cared for in the last moments of their lives.
“You pour out this energy, love, compassion and space for them to absorb it all,” she said. “I really didn’t realize how much energy it took until my last client.”
The client, a woman who had outlived her husband and daughter, stood there wary when Scott first arrived at her home.
“I know who you are,” Scott recalls her words. “I was waiting for you.”
This gave Scott, who has worked in the hospice for over ten years, chills. She took care of many dementia patients and Alzheimer’s patients, and for some reason, while excitement and surges of energy may be common before death, it was different. According to her, the statement seemed “very informative.”
The woman’s room was disheveled, stuffy, and had a daytime TV show, so Scott said that she put her to bed, played some instrumental music, rearranged the furniture a bit, opened the window and dimmed the lights. She rubbed the woman’s hands and face for comfort.
“In those five hours, we were able to hold that space for her and help her enter the active transition period of dying,” she said.
Until that day, the woman had been in the hospice for over a year.
Scott officially began her journey as a death doula a year ago, but caring for people at the end of their lives has been a passion of hers ever since she started CNA at a nursing home.
“It was so wonderful, I wanted to help and be there, but mostly just to prepare and honor the shell that this person had,” she said of the first death she experienced as a hospice nurse. “After that, it was like if someone was on edge, I had this suspicion of magnetism. I want to make sure that they take care of them, they are comfortable, that they are loved and appreciated in the last days, because this is their most vulnerable point in life. “
Throughout her career in nursing homes, Scott said she knew there was something missing in caring for the dying. There was no one to “hold the space,” a phrase that many end-of-life caregivers often use when referring to the work of the death doul.
It wasn’t until a friend sent her a link to a Zoom workshop on deadly doulas last May that it all came together for Scott, 32, and living in Aurora with his fiancé. She is part of a growing number of workers seeking to make death more comfortable.
Doulas, by a vague definition, tend to perform all the duties of a dying person that are not performed by medical personnel. In many ways they are equivalent to a wedding planner, but for the last moments of life.
They can help arrange funeral services, help complete legacy projects, make sure the aesthetics of the place of death are exactly what the client wants, and help family members deal with the post-death situation of a loved one.
“We treat death like fast food,” Scott said. “And it should be treated like a five course meal.”
For people who work in hospice, the arrival and growing popularity of the death doula is welcome, and it is changing the approach and culture to the experience everyone will have.
– Developing care
Caitlyn Van Woolkenburg, volunteer coordinator at the Namaste Hospice in Denver, jokes that she is a little protective of Scott, who first began volunteering for her doula services in November.
Van Woolkenburg said she doesn’t want Scott to overwork or burn out because it is becoming apparent how much doulas are needed to care for the hospice. Before Scott, the organization consisted of nurses, social workers and volunteers, but after working with Scott, they recruited five more doula volunteers.
“Some of us in the hospice are used to ordinary death,” Van Valkenburg said. “They make us think again about making it unique.”
Scott arrived in Namaste after two waves of the COVID-19 pandemic, but it “felt like a fresh start,” Van Woolkenburg said. For months, hospice nurses struggled to care for patients, some of whom were in nursing homes or nursing homes. In the early stages of the pandemic, Namaste workers were sometimes not even allowed to enter the premises and had to look for ways to comfort their dying patients from their bedroom windows, by phone, or via a computer.
“It shook us to the core,” she said.
Nurses and social workers had to get creative, Van Valkenburg said. They donated over 150 radios to their patients and installed aromatherapy diffusers in wards whenever possible to make the atmosphere as comfortable as possible.
This winter, adding doulas to their grooming model helped caregivers “fully present,” she said.
While neither private insurance nor Medicaid covers the cost of doulas, as does end-of-life care through hospice, Namaste wants to eventually be able to pay for their doulas. At the moment, they voluntarily provide their services, mainly to meet requirements through certification programs.
Scott started his own private doula practice called Benevolent Care, where scheduling services can range from $ 70 for one hour of Death Day planning to an extensive package where Scott is available 24/7. She said that she usually calculates these costs on an individual basis.
“Everyone is so different and I don’t want to deny them,” she said.
While doulas are not in the medical profession, Nancy English, an assistant professor of palliative care at the University of Colorado Anschutz Medical Campus, says they definitely play a role in hospices.
“We need to consider death as important as birth, it is the transition from one state to another. We know that this is a major transition, even if we do not know what will happen next, ”she said. “The doula of death helps us make it more sacred.”
English said she recently took a course on lethal doulas, and while she has no plans to practice as one, she wanted to see how this could help her prepare students to provide more comprehensive care.
“Doula can take the time to actually address some of the issues that were fragmented upon leaving,” English said. “I think nurses are as creative and caring as a group and they want to do it, but you have one patient who dies in this bed and the next patient is coding. It’s just a difficult role. “
English, who worked as a hospice nurse for many years before becoming a professor, said the workload defies the individual attention and comfort that a doula can provide.
Scott said that she believes her experience as a hospice nurse has helped her become a doula because she understands medical jargon and struggles not to be able to comfort each patient as much as they may need.
It is also good for families of people in hospice care.
“Imagine that someone is on your side, someone is really close to you, walking next to you in this process,” she said. “Someone you could call, who was with you, who saw certain things that you might have missed, and you can call them and just get confirmation.”
“You are attracted to it either because you have curiosity or experience,” she said.
The moment Scott learned of the existence of the doula of death, she said she knew it was for her. This is generally the case for most people who work in end-of-life patient care, said Cindy Kaufman, president of the Colorado End of Life Collaborative.
“You are attracted to it either because you have curiosity or experience,” she said.
Kaufman and a small group of other doulas worked together because they saw the need for a common place for the people working in the field. Somewhere they could connect services if they were needed, or just have a support system. The community has grown steadily over the years, but Kaufman said she did notice the surge about three years ago.
This is due in part to the growing pro-death movement, she said, thanks in large part to Los Angeles-based writer, activist and undertaker Caitlin Doughty. In 2011, Doughty founded a collective called the Order of the Good Death, which became the basis for much of the crusade to see death in a brighter light.
Since then, the death doula has grown in popularity, according to Kaufman. There is no exact way to tell how many doulas there are in Colorado because they tend to work in their private practice or volunteer like in Namaste.
The movement has also created death cafes — groups where people can gather to talk about all aspects of death — all over the country. English opened a death cafe in Denver in 2014, which before the pandemic used to gather on Sundays at the Torn Covers bookstore. For the past year, she has led a small group on Zoom.
“They were wonderful,” the professor said, echoing Kaufman that Westerners are starting to see death in a different way.
Kaufman, English and Scott say they are seeing a shift, and perhaps the pandemic – the collective experience of sudden death – could move even further.
“A lost life is a lost life and we have to respect that, and during COVID, we didn’t,” Scott said. “We have failed to honor the process of dying. It literally just happened, and I think that’s what really drew me to becoming a doula. We must respect this process. ”