I'm A Death Doula. Here's What I've Learned About The End Of Life.

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On a cloudy Friday morning, while idling in Dallas traffic, I noticed a new billboard for a nearby children’s hospital. I couldn’t ignore the irony of seeing a mother holding her newborn baby on the sign while on my way to visit patients who were close to dying.

As a death doula (also known as an end-of-life doula), I spend time with adults in hospice who are in their final weeks, days or hours. It is one of the most vulnerable, gut-wrenching times of their lives and their family’s lives as well.

Many people assume that being around those transitioning to death and their loved ones who are already grieving their pending loss is the perfect recipe for depression and despair. Instead, sitting at the bedside with hospice patients inspires me to make the most of each moment in my own life and makes me more aware of my own mortality. Becoming a death doula has taught me about what to expect at the end of life and given me the opportunity to help others do the same.

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Four years ago, my father was discharged from a Midwest hospital to home hospice care. As he lay in the red metal hospital bed placed in the middle of his family room, the nurse pulled a bottle of morphine out of her bag. She explained its purpose and how much to give him every three hours. My mind raced: Isn’t this a medical professional’s job? Doesn’t she realize I don’t know what I’m doing? What if I give him a dose and he stops breathing within seconds?

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I closed my eyes and tried to control my breathing.

“Let us know if you need anything,” she said on her way out. “There’s a hospice nurse on call 24/7.”

On my dad’s third night home, I spent the evening sitting alongside his bed, my 90-year-old mom in a recliner opposite me. At midnight, a sound in his throat, like rocks tumbling, grew louder. I called the hospice nurse to ask what I could give my father to help him breathe easier. She offered to come to my dad’s house, but she was eight months pregnant and an hour away.

The author and her father, Dr. Joseph Kanarek, in Overland Park, Kansas, a month before he died in 2020. Courtesy of Lisa Kanarek

“You can do this,” she said, her confidence in my abilities stronger than mine. I measured a dropperful of medication to the nurse’s specifications, gently pulled back the side of my dad’s mouth and squeezed the bulb until the liquid was gone.

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At 7:30 that morning, I went upstairs to call my husband while my mom went to the kitchen for a glass of water. When I came back, my mom was standing by his bed. “I think he’s gone,” she said. My dad had waited for us to leave the room to die.

The helplessness I felt at not knowing whether I was keeping my father comfortable during his final hours replayed in my mind like a horror movie. Guilt consumed me for missing his final moments.

The following year, wanting a better understanding of my father’s passing and of death in general, I researched the role of a death doula. Six months later, I enrolled in an end-of-life doula course.

When I shared my plans with my family, I understood their concern about how my new role working with hospice patients would have a negative effect on me. But I wanted to make a difference by providing the knowledge, support and insight I wish I’d had before my father died.

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Around the same time I completed my doula training, my 80-year-old neighbor died, and I adopted her 8-year-old dog, Gaia. The calm husky rolled on her back and welcomed belly rubs from neighbors during our twice-daily walks. She didn’t flinch when a toddler rubbed her ears or rested her head on the sweet pup’s side.

Judging by Gaia’s temperament, I knew she would make the perfect therapy dog. After four training sessions — she already had a few basic skills — we tested to become a therapy animal team. We passed, and months later, I met with hospice patients with Gaia by my side.

The author with hospice nurse Dusty King in 2024 at T. Boone Pickens Hospice Center in Dallas. Courtesy of Lisa Kanarek

Last spring, while spending time with a man in his 80s, with his wife and two sons at his side, I heard a familiar gurgling sound, the same one my father made during his final hours.

“I know it sounds as if he’s in pain, but he’s not,” I told one of the sons.

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“Please keep telling me that,” he said.

I explained that his father wasn’t able to clear secretions from his throat or airway, which produced a rattling sound. I understood his concern and recognized the fear in his eyes. When I was caring for my dad, I assumed he was choking. At the time, I didn’t know that the unsettling noise was a natural part of the dying process.

On a recent Friday, Gaia and I entered a patient’s room that was quieter than the chapel two floors down.

“Have you been talking to your mom?” I asked the family who had gathered around her bed. They were surprised to learn that their mother could hear them. The daughter looked at me and then at her two siblings, her cheeks flushed.

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“I guess we need to watch what we say.”

They didn’t know that hearing is generally the last sense to go.

The following week, I met a patient’s wife and sister-in-law sitting on either side of a man’s bed. They both looked exhausted.

“We don’t want to go home in case he passes away,” his wife said as she petted Gaia.

One of the most surprising things I learned during my doula training is how common it is for patients to wait for their loved ones to leave the room so they won’t witness them taking their last breath. I don’t think most people expect that. On the other hand, some hold on until an unresolved issue is settled. Others wait as long as possible for a loved one to visit them one last time.

Lisa Kanarek visiting a patient in 2024 at T. Boone Pickens Hospice Center in Dallas. Courtesy of Forefront Living

My doula training and working with dying patients has prompted me to consider my own end-of-life issues and wishes: How do I want to be buried? Do I want to die at home or in a hospice facility? Do I want music or an over-the-top party at my celebration of life? (I’d like both.) I’ve compiled a notebook with details about my bank accounts, investments, trust, medical power of attorney and all the information my family will need when I’m gone. I also have an electronic version. Of course, I hope my kids and my husband don’t have to refer to any of the documents for decades, but it’s comforting to know that I’m taking a burden off my family.

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For years, I avoided talking about death, even drawing on my mom’s superstitious ways — she’s convinced that discussing end-of-life issues will summon the Grim Reaper. Being a death doula has changed my view of death — understanding what happens at the end of life has reduced my fear of dying. Meeting patients with less than six months to live has inspired me to focus on life, using their limited time left as a reminder not to take one minute on Earth for granted.

I can’t change my father’s final hours or the desperation I felt not knowing the best way to care for him. At the same time, I’m grateful that I could be with him at his end of life. My training and work as a death doula, along with my personal experience with my father, gives me valuable insight I share with hospice patients and their families. When I meet others in a position similar to the one I was in, I strive to remove the anxiety and mystery around the inevitable. More importantly, I take comfort in knowing that as their loved one faces their final days or hours, they’ll be more prepared than I was.

Lisa Kanarek is working on a book about being a death doula with her dog.

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