By Maisha Hasan, Local Journalism Initiative Reporter
The slight hiss of the breathing tube, mentioning do-not-resuscitate between coffee pours, and looming silent anticipation are the stock and trade of Patti Broadfoot’s career as a death doula.
Broadfoot is a part of The Collaborative Doula Collective, an organization that connects people to doulas of all kinds across Ontario.
The job title is one most people are unfamiliar with, and is even sometimes met with fears of ill omens, which is a far stretch from the reality of this work.
“Being a death doula is a grassroots kind of thing that happened long before medicalization. We have birth doulas, and there is that other end of the spectrum — death,” Broadfoot said. “We’re all going to die, although it seems to be a surprise for a lot of people. If we can make that journey that much easier for the person themselves as well as the family and friends that support them, then why not?”
Between travelling to the UK for courses in social work and palliative care and taking complementary courses at Western University, Broadfoot spent time volunteering in hospices. She credits much of her experience and growth to those environments. Broadfoot now has five years under her belt as a certified death doula, but some 20 to 30 years in her overall experience with end-of-life care.
Broadfoot’s path to becoming a death doula was shaped by losses in her own family. Experiencing deaths that felt poorly supported left her with questions about how end-of-life care could be handled better, inspiring her to help others navigate death with more understanding and intention.
“We assume that the people caring for us know how to do this, knowing what happens to the body and what you can see and experience as the person is dying. I remember one friend who was dying of cancer, and oftentimes, a person will have that resurgence before death within 24 hours. Everybody, and even some of the medical staff, went, ‘Wow, you must be doing really great. ’ It was actually that last little hurrah moment before death. Education and understanding all of it is important. The more we know, the less our anxiety goes up,” Broadfoot said.
In tandem with education on end-of-life trajectories, Broadfoot also tries to find solutions to the answers desperately needed for the person on their deathbed.
“I had a client who had excruciating pain. It wasn’t a type of diagnosis that would have excruciating pain; the team couldn’t figure out how to manage his pain. Nothing was working. [I got] curious; what I discovered was he had ‘total pain,’ not just the physical pain. There’s emotional pain, there is so much that encompasses pain,” she described.
It turned out it was this client’s emotional pain and questions about his life’s course that were contributing to the “total pain” he was experiencing.
“I found out he grew up Catholic, and his family would have been really honoured if he had become a priest. [Instead] he proceeded to sample every kind of religion, and did a lot of travelling too, to explore other religions. Here he lands, at the end of life, and starts questioning, ‘Did I end up with the right religion? Should I have stayed Catholic?’” Broadfoot continued.
The solution for his total pain, like its source, was similarly non-medical.
“We arranged for a Catholic priest to come and chat with him. Sure enough, within 24 hours, his pain went way down. I couldn’t solve his existential question, but I could help put him on the path to discover his pain. It’s not about us fixing them. Everybody fixes themselves when it comes to that kind of stuff,” Broadfoot said.
Broadfoot usually takes on clients one at a time, as per her operating style, with each client being unique in terms of age, health, life, and predicted time of death, of course.
Her goal, ultimately, is to help her clients have a “good death,” a phrase constant in Broadfoot’s line of work, which feels like an oxymoron in itself. A death doula cannot guarantee a death will be painless. Neither can they guarantee what waits on the other side. All they can do is chart what is possible.
“A lot of people don’t know what support is out there. What does a good death look like for me? What can I advocate for? What can I do? What can’t I do? How can we make [plans] happen?” Broadfoot said.
While the exact definition of a good death might vary person by person, discussions with a death doula can help best understand what is most important for each person. Having good pain and symptom management is a commonality, along with emotional and spiritual support, and coordination of services.
Misconceptions persist. Some believe death doulas hasten death, when studies show end-of-life care can actually prolong it. Another assumption is that doulas only serve the dying themselves.
“Another misconception might be, we’re only for the [actively] dying person. We actually support them months and years in advance. I’ve also worked with [young people] whose parents died in a traffic accident. They had to make some really serious decisions about their parents before death, while they were on life support. What would they want? And they’re like, ‘I don’t know what they want,’” Broadfoot said.
Of course, Broadfoot isn’t immune to the amount of loss that surrounds her. After all, her job is making connections with people whose funerals she may end up helping to plan.
“Do I sit and cry sometimes? Absolutely. It’s a loss. It’s also a very important part of self-care, and having that [death doula] community, to say, ‘Hey, I’m feeling kind of crappy today. Anybody want to chat?’ Or, you know, the self-care things, what I need to do on a daily basis that helps keep me from burnout or compassion fatigue,” Broadfoot said.
The task is a challenging one — to care and to lose over and over again — but it is overwhelmingly rewarding, said Broadfoot.
We all die, and Broadfoot encourages everyone to lean into those conversations.
“Often, I work with a family, they set a date and a time, people get so focused on that date and time [that they don’t think] ‘How am I going to actually enjoy and make some memories?’ We can provide those around us with good memories of our death. One family I worked with went for a drive to Grand Bend, sat on the beach, had a picnic, went and visited lots of their favourite spots, and had a big celebration in the morning. They had mimosas and good food. It was this wonderful moment together, making some really great memories, before that death happened,” Broadfoot said.
When it comes time for a death doula for Broadfoot herself, she jokes that with the community she has, she is well set for life — or rather, death.
