A Physician Reflects on End of Life Doula Training

by Aditi Sethi-Brown, MD, Hospice and Palliative Medicine Physician

Creative ways of exploring death and dying in our community was the theme of the gathering where I met Grigsby and Anne a year ago. They were a notable couple: Grigsby, a tall, slender, intelligent, poised male - a Yale-trained historian and Jungian philosopher and Anne, a beautiful, eloquent and thoughtful woman – a former counselor. Recently, I had the honor of bearing witness to Grigsby’s dying process, an experience that has deeply impacted my thoughts about end-of-life care. Grigsby chose to consciously approach the end of his life with strength, equanimity, courage, honesty and mindfulness, with little medical intervention from the time of a terminal diagnosis until his death in his own home seven weeks later. As a Hospice and Palliative Medicine physician, I’ve had the honor of supporting many individuals through their dying process, focusing on physical, emotional and spiritual care. However, until my experience with Grigsby’s death and after-death care, I had not fully appreciated what it meant to have “a conscious death” or “a natural death.”

I was between Phase I and Phase II of the Conscious Dying Institute’s Sacred Passage Doula training when I met with Grigsby and Anne, two weeks after Grigsby was diagnosed with an inoperable brain tumor.  I connected with them, not as a physician, but as a friend - essentially as a doula - offering support, love and presence during a period of great uncertainty in their lives.   Grigsby was an active, engaged member of his community and lived a full life. However, his life took an unexpected turn when he presented to his local emergency department for evaluation of increased confusion and difficulty finding words. His medical workup revealed a left frontal mass extending into the corpus callosum, the part of the brain responsible for transmitting neural messages between both hemispheres. After consultations with the neurologists and neurosurgeons, he elected to forego a diagnostic biopsy and any potential life-prolonging measures and return home to prepare for his death. Courage.  The weeks that followed involved deep inner work, contemplation and self-reflection as well as outward attention to details regarding practical and interpersonal matters. Honesty. Grigsby was very intentional about how he spent his time and with whom he interacted in his last few weeks of life. Mindfulness.   As he lost his ability to communicate verbally, he must have felt isolated at times. Despite this, he continued to do the inner work of preparing for his death with great discipline. Strength and Equanimity.

During my time with Grigsby I was aware of the principles taught in the doula training program and how they were revealing themselves in my interactions with Grigsby and Anne.  My medical knowledge and experience were only a small part of my offering to them as they had a Hospice physician and Hospice team to support them already. I was reminded that death does not have to be solely a medical event and that it is a natural phenomenon. I offered an open heart and mind, a safe space to talk about his approaching death, and acceptance of his choices regarding his medical care, including the fact that he was not eager to use pharmaceuticals to treat his symptoms.  The use of complementary and alternative modalities, including essential oils and homeopathy, CBD oil, and acupuncture, served him and Anne throughout his dying process.  I chanted with him, shared Tarron Estes’ Practice for Death Meditation in song, held a fire circle for him with members of his community, and discussed his fears, concerns and wishes with him and Anne.  I cherished my time spent with both of them as they navigated the complexity of their experience.  I completed Phase II of the CDI Sacred Passage Doula Training on Augusta 13th and Grigsby died on August 26th.  He died a peaceful, comfortable death in his own home with Anne by his side. The care of his body after his death, including a home funeral and green burial, was also very intentional and inspiring and deserves its own blog!  

A professor of history and an educator much of his life, Grigsby continues to teach others. He certainly was my teacher during the doula training program and beyond. His life and death illuminate one way to approach death consciously - with attention, intention and honesty.  He faced his fears, confronted his mortality with curiosity, acknowledged and expressed a range of emotions during his dying process, and prepared for his inevitable passage in a way that I hope others can feel empowered and supported to do.

Aditi is a Hospice and Palliative Medicine physician, a Sacred Passage end-of-life doula, and a musician living in Asheville, NC.   She is committed to caring for those dying, engaging in the conversation around death, and exploring the impact of death awareness on the experience of living.