Illustration by Duncan Robertson
It was the loss of three grandparents in a fleeting five-month period that led Henrico County fourth grade math teacher Emma Kessler not only to examine her own grief, but to look at the deficiencies of America’s 21st-century dying process and do something about it.
“I wasn’t sure how to process my grief, so I decided to take this course,” she explains. “Once I got my certificate, I realized we really don’t talk about death. And it needs to be normalized, especially here in America.”
While there is a proliferation in this country of birth doulas to provide emotional and informational support to women and families during the birthing process, there has been virtually no similar guidance for families facing an imminent death, other than through hospice, which primarily provides medical care. As of this writing, there are about 20 death doulas in the commonwealth of Virginia. Legislators have not filed bills related to the vocation, and the Code of Virginia limits the use of “state-certified doula” as a title to nonmedical professionals who support others during pregnancy.
According to Kessler, death doulas have been common for years in many European countries, where residents tend to maintain a more sensitive and philosophical outlook on dying and embrace death as a natural, human event instead of a medical one. “In America,” she says, “death is about moving quickly — making calls, then cleaning and getting the body out, instead of remaining slow and calm, letting people do what they [emotionally] need to do. It’s too much of a sterile process here.”
Kessler says that her holistic approach is about educating and empowering the dying through decision-making regarding their own care and supporting their caregivers and loved ones in those precious last moments. She eases their anxiety, helps their family understand the experience and encourages the family not to rush the next steps. She agrees that the process of dying can be traumatic — people can fixate on facing a future without a person and wonder how they are going to move forward. “As a result,” she says, “they’re not ‘being present’ for their loved one when death comes.”
The key, she says, is just to stop and be in the moment. That can include holding the hand of the recently deceased or simply sitting in the room with them. “There, [the bereaved] can be present with their emotions, their thoughts and [their] feelings,” Kessler says. “There is nothing that they have to do. They are allowed that time to just be, because that thing that they’ve been worried, scared, thinking and preparing about has just happened.”
Kessler emphasizes that doulas such as herself do not replace hospice or other medical care, nor do they perform specific death rituals, such as last rites. Her duties include educating the family on what they can expect, praying with them and easing the transition of their loved one from this world to the next in whichever faith system they believe. “If the dying person or the family wants me to pray with them, I will,” she says. “If someone wants last rites, I can call the priest, I can call a rabbi, I can assist with any faith.”
Emma Kessler (Photo by Jay Paul)
Sometimes her presence is less spiritual and more practical. She offers limited assistance with advanced directives or with wills, for example. She can also provide short periods of respite for exhausted caregivers. “I say, ‘Hey, do you want to take 15 minutes? Go for a walk? Or get out of the house to get groceries?’ I will sit while they do that. Or I can go get the groceries if they don’t want to leave their loved one.”
While a certification process is not required in the United States, Kessler is an active member of the International Association of Professional Death Doulas, which includes an international certification and even a certification as a doula for pets. “Pets are different, in that people sometimes have to make the call,” she says. “It’s more active. They have to ask, ‘Is it time? Do I put them down?’ I can have that conversation and help them make that decision.”
Another issue Kessler addresses is the sometimes complex family dynamics of dying. “Sometimes family members fully back out. So, I will try to sit them all down and say, ‘Let’s talk about why we’re all here. We’re all grieving differently, but we are here for that one person. We need to see how we can come together in our own ways.’
“Someone may say, ‘I really would like my estranged sister to be here.’ I can’t guarantee it, but I can at least call your estranged sister and see if she’ll show up.”
Kessler hopes to add a type of online message board called a death cafe to her website so that people can talk about their experiences and ask questions. “It’s very important because it’s making death part of the conversation,” she says. “The goal is to make death more approachable and make people more comfortable talking about it.”
Knowing that families suffering through a long illness may not have funds available for extra assistance, Kessler offers all her services free of charge. “I think death is a natural part of life and that people should have access to a death doula without feeling burdened by cost,” she says.
Kessler also stresses that one does not have to be terminally ill to benefit from the services of a death doula, and that she can be available to just answer questions about the death and grieving processes. “Many people have a lot of fear about death and dying,” she concludes. “And I think there’s also a lot of fear of judgment and fear of the unknown. Maybe people feel like they have to tough it out and do it alone, to be a rugged individual … but it doesn’t have to be that way.”
