Death Doulas Navigate Difficult Conversations and Decrease Fear

By Zita Xavier

Let’s face it. We are not well prepared as a culture to deal well with end of life care and the difficult conversations which must be had. The cultural emphasis on youth and the fear of old age and death pervade even the medical establishment.

In “Clinical Challenges to the Delivery of End-of-Life Care,” the authors wrote:

“Unfortunately, clinicians who are responsible for the treatment of patients at the end of life commonly lack adequate training to help guide end-of-life decisions and to deliver bad news to patients and families. They must also face their own discomfort with discussions about death and deal with poor compensation for the time spent discussing end-of-life care with patients and families.

…..The management of end-of-life care and the process of engaging in difficult conversations are topics that are frequently neglected in medical education….A survey of 1455 medical students, 296 residents (in internal medicine, general surgery, and family medicine programs), and 287 faculty affiliated with 62 accredited U.S. medical schools revealed that only 18% of medical students and residents received formal training in end-of-life care, and over 40% of residents felt unprepared to teach end-of-life care to younger clinicians in training.”[1]

Fear is insidious no matter what our profession. We all deal with it with our friendly vices, our interminable distracting devices, our addictions of all sorts, our self meds or scripts. We’ve found the ways to get through our days. We power through, get snappy with others, and visit the candy bowl. Our sleep may be spotty, the meds don’t always do it, blood pressure rises, heart beats faster, and we need more and more distractions. It goes by many names: nervousness, anxiety, worry—all of it is fear.

The trainings at the Conscious Dying Institute offer the possibility of facing into our own fears of Death, and gaining some resilience to be able to be really present and helpful to others and their families as they pass through their last days. When we are called to the sacred work of being a Death Doula, we are called to confront the Mother of all fears, Death. How can we help those dying to navigate the enormity of their terror once the specter of their own Death is staring them in the face?

Essentially we are called to recognize and be with our own experiences of fear. Rather than run away into our avoidance strategies, most of us can gradually develop the courage and train ourselves to be more intimate with all our fears, from the most subtle anxieties to the most obvious fears.

Please realize that you may need professional support to face into your deepest fears. Get the help you need to be free from the bondage that fear imposes, and take heart. It may be the hardest thing you ever do, but over time it does get easier.

Step 1.  Realize you are human. In your compassionate heart you know all humans experience fear. Open to the possibility that fear isn’t anything to be ashamed of or to beat yourself up about. Breathe.

Step 2.  Get curious. Begin to recognize when fear is arising and name it. Own it. ‘I am feeling anxious, nervous, afraid.’ Breathe.

Step 3. Inject some space between the moment of fear and the habitual avoidance response. Take a breath, or two or twenty. Take yourself someplace safe. Pause. Great. You’ve made it this far.

Step 4. Notice and track the feelings in your body which arise when fear is triggered. Does something begin to twitch? Do you get hotter or colder? What happens with your breath? Is there sweating, trembling, nausea, burping, phantom moving pains, stomach cramps?

Step 5. Notice how the feelings in your body change moment by moment. As you gain some muscle in staying with and observing yourself, you’ll notice the feelings are there, and then, after awhile, they’re not. Mental note: all feelings are impermanent—including fear.

Last Step. Congratulate yourself. Every time you manage to interrupt a fear pattern, smile and give yourself the recognition that you just had the courage to do something very difficult. With humility you will also recognize when you didn’t. Yet as you practice, you will get stronger and stronger until you develop the mindfulness muscle enough to be with yourself in all kinds of situations. This will gradually give you more and more internal freedom and capacity to be with others who are going through the fears of the uncharted territory of terminal illness and dying.

These steps sound simplistic, but for those who practice them, they are anything but easy. Developing mindfulness and being with things as they are is radical and courageous.

It is extremely beneficial to face these fears with others. In the trainings offered by the Conscious Dying Institute, you will sit in an open and safe circle with others who are also called to the difficult and rewarding work of the Death Doula. Having found more work ability with your own fears, you can then offer the possibility of end of life care that is reverent, transforming, and kind.

[1] Prim Care Companion J Clin Psychiatry. 2006; 8(6): 367–372.