I realized I could do something about that.

With my mother’s death, my life as I knew it was over. I couldn’t go back to Yale, since I was now Kieran’s guardian. I needed a job, and I found it working at the same hospice where my mother had been. At first, the director hired me out of pity, just so that I could pay bills. As an academic I had no practical skills, so I ran the reception desk and acted as girl Friday and visited with the patients. It was that, the visiting, that I was particularly good at. I liked collecting their stories, mining their histories, putting together the pictures of who they used to be. It was, after all, what archaeologists do. One day the hospice director suggested that I might have a future in this field. I took online classes to get my MSW and became a hospice social worker. I was responsible for getting DNRs signed, for asking about funeral home arrangements, for ascertaining if families were strapped financially. I supported both the patient and the caregiver, who were each carrying such heavy loads. I used to think of my job as taking those massive backpacks off their shoulders for an hour and giving them that time to get squared away before they had to pick them up again. But one hour was never enough, and there were elements of the job that chafed—like having too many patients and endless paperwork; or having to smile through a hospice doctor’s terrible jokes (“Rectum? I hardly knew him!”). Or the way patients had to be recertified at ninety days to make sure they still met hospice criteria…while those who didn’t make the cut were still ill enough to need care or help to process what was happening to them.

After almost a decade of hospice work, I heard about a course called Intro to Death Midwifery. It made sense to me—just as we have birth midwives for the transition from the state of being a single person to becoming a mother, why not have death midwives for the transition from the state of life to that of death? I called up, but the course was full. I told the instructor I would bring my own snacks, my own chair, if she would just let me be a fly on the wall. From the very first words of the instructor—that death doulas hearken back to a time when people didn’t die alone—I was enthralled. Doula is Greek for “woman who serves”—and just as birth doulas know that there’s discomfort and pain that can be managed during labor, death doulas do the same at the other end of the life spectrum.

I started my own business as a death doula five years ago, and it’s still something that most people have never heard of. There’s a National End-of-Life Doula Alliance, NEDA, which creates core competencies and has a proficiency assessment for doulas to pass, but it’s still pretty much the wild west of caregiving. Medicare doesn’t cover my services, and what I do means different things to different people. God knows there’s a need—the “silver tsunami” of baby boomers are aging and have busy kids who can’t be caregivers or children who don’t live nearby. Society is culturally shifting, and there’s a need for support. Plus, there’s a rise in the consciousness movement that reinforces we are only on Earth for a short time.

Doulas don’t perform medical tasks—I’m not covered by liability malpractice insurance. I work in homes, nursing homes, inpatient hospices, assisted living facilities. Whereas the hospice model is a team, the doula works solo, doing all but the medical care. I can be with a client round the clock, but I don’t have to be. It’s really up to the individual, and it may change as the illness progresses. I listen. I keep caregivers calm. I make sure someone isn’t alone if they don’t want to be. I gather information and share it—about funerals, or what to expect during the dying process. I anticipate what is going to be needed and create a plan for it—such as a vigil, or a church memorial service. I provide referrals to chaplains or doctors. I’ll give physical and emotional comfort through foot massage, chakra cleansing, visualization, meditation, guided breathing. I may help a caregiver with a basic daily task—brushing teeth, showering—but that’s an individual preference, too. I’ll get dry cleaning, groceries, or take a client to a doctor’s appointment.

Although I work in tandem with hospice professionals, I also know that some care isn’t medical—it’s holistic, and spiritual—and I provide it. Maybe that’s creating a home funeral, or assisting the families in washing and laying out the body. Maybe it’s arranging for acupuncture for pain relief, or giving business advice on selling a car that’s sitting in the garage and hasn’t been driven since 1970. Sometimes I help families wrap up the affairs of the deceased, taking social security cards and bank information and encrypting and destroying them when I’m finished. A death doula is one-stop shopping; I am a general contractor of death. The way I describe it is like this: if you want butter pecan ice cream at 3:00 A.M. and you’re on hospice, you might be able to ask a volunteer to get you some when he or she next visits. If you hire a death doula, and you want that ice cream at 3:00 A.M., she’ll get it for you. And if you hire me, I will already have it waiting in the freezer.

After nearly thirteen years of end-of-life work, I know that we do a shitty job of intellectually and emotionally preparing for death. How can you enjoy life if you spend every minute fearing the end of it? I know that most people—like my mother was—are afraid to talk about death, as if it’s contagious. I know that you are the same person when you die that you were when you were alive—if you are feisty in life, you’ll be feisty at the end of life. If you are nervous when you’re healthy, you’ll be nervous on your deathbed. I know that people who are going to die need me to be a mirror—to look in my eyes and know I see who they used to be, not who they are right now.

After thirteen years of this work, I thought I knew a lot about death.

I was wrong.

* * *

—

I FALL ASLEEP in Meret’s room and stay there all night. In the morning, Brian and I move in a careful ballet. We speak only when necessary, and even then it’s in details rather than emotions. He is leaving today to give a keynote at the Perimeter Institute in Waterloo, Ontario, on his work in quantum mechanics, and it is a Big Deal. Fifteen years ago, a theoretical physicist who believed in parallel universes was considered fringe, and now less than half of the scientists in his field cling to those older beliefs.

I’m grateful that he’s taking a business trip, because it prolongs the inevitable. I do not go into the shower until Brian is downstairs making coffee; in the kitchen, we try not to look each other in the eye, saying all the right things so that Meret will not think that there is anything strained between us. He doesn’t want to push me, because he is afraid of the outcome; I don’t want to be pushed for the very same reason. So I pour Brian a to-go cup; he kisses Meret on the top of the head and grabs his overnight bag; he leaves for the airport just before Meret does to catch the bus that will take her to STEM camp.

For the first time since I’ve come back home, I am alone in the house. With a deep breath, I let go of all the studied pretense, bury my face in my hands, and wonder how to go back to normal.

Suddenly, the front door opens again. I call out, “What did you forget?”

But it isn’t Meret, like I expect. Brian is standing at the threshold of the kitchen, holding his keys like an afterthought. “You,” he says. “I forgot you.” He walks in and sits down across from me at the table. “I can’t do this, Dawn. We have to talk.”

We already did, and look at where that got me.

“I don’t know what you expect me to say,” I tell him.

Brian looks down at the table. “You don’t have to say anything. You just have to listen to me.”