Pamela Crowder-Spikes' sister-in-law was dying, and they needed a notary. Death doula Tonya Fortune Smith saw the family's Facebook post in late December 2021 and dropped her holiday plans. She headed to the family's Charlotte, North Carolina, home and found an overwhelmed husband, two frightened teenage children and a frail woman in pain. Immediately she got on the phone to set up palliative care and hospice, then started setting up legal documents and an end-of-life plan.
"She just swooped in and saved our lives," Crowder-Spikes said. "I will be forever grateful to her."
A month later, in Greensboro, North Carolina, another death doula intervened in another crisis. Hospice staff were over for the first time and a pharmacist was treating Holly Broadwater's mother, Hedy, when Broadwater's aunt collapsed to the floor.
Broadwater close to panicked. Death doula Raylene Driver Hill reminded her to breathe. She sat with Hedy while Broadwater accompanied her aunt to the hospital.
"She took charge of what I needed," Broadwater said.
Hill and Smith are two members of a growing profession: death doula. As the more familiar birth doulas nurture families at the start of life, death doulas nurture at the end. They bring information, support and peace to dying.
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To be sure, the role isn't new. "Being a death doula has gone on since the beginning of time," National End-of-Life Doula Alliance president Ashley Johnson said. But as a profession, it's emerged in the last five years, surging especially with the pandemic.
"It made people face mortality," Johnson said. In 2019, the alliance had about 350 members. Now it has over 1,300, with 30 to 40 membership inquiries per month.
Usually, personal experience triggers the professional decision. Hill's father died in 2020. "We were totally unprepared. We didn't know any of his information. We didn't know what he wanted," she said. She decided to spare other families the confusion and chaos at the most upsetting of times.
Death doulas provide a range of services. They may sit bedside vigil with a dying person, the same way birth doulas help at delivery. They help people plan for their own deaths - both legal elements like choosing health care proxies, and emotional elements like writing letters to those left behind or listing the people they don't want at the funeral. Death doulas navigate hospice, burial, organ donation, funerals - that entire world of complicated and often expensive services.
They educate, telling families what the last hours look like. Most of Hill's clients have never seen someone die. They think it will be messy and dramatic. "You kind of build this image from what you've seen on TV," she said. Where she lives, many don't know that you can die at home or say no to the doctor: "A lot of us were raised in the generation where the doctor was like God."
Afterwards, doulas support the grief that friends may feel too awkward to address.
For all this work, death doulas may get paid - from $30 to possibly $100 per hour, Johnson said. However, the field is not federally regulated or covered by health insurance, though the national and international end-of-life doula associations offer professional certifications. Doulas do a lot of unpaid work, stepping in when someone in their community hits a crisis. Both Hill and Smith have full-time jobs.
Their overarching goal: a good death.
A 'houseful of people' at the end
For Broadwater's mother, Hedy Davis Broadwater, a good death meant being at home, lavished with all the things she loved.
Shea butter rubbed into her skin. "Golden Girls" on the TV over soft gospel music. Her pretty lime-green gown and burgundy bedsheets. Broadwater's chicken salad and old-fashioned salmon croquettes. And a houseful of people - nephews, children, grandkids playing in the hallway. After Hedy died, Broadwater and her sister bathed their mother with her favorite Dove body wash.
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Through those weeks, Hill "was just always here. Or she was on the phone," Broadwater said. Afterwards, grieving, she would apologize to the doula for taking up her time. "Honey, you are fine. This is what we do," Hill said.
The end-of-life plan eased Broadwater's caregiver guilt. That day her mom had trouble breathing, should she have called 911?
"What did your mom say?" Hill reminded her.
"She said no."
Broadwater couldn't sing Hill's praises enough. "This death doula thing, I hope it hits every family," she said.
Giving them their roses now
After leaving a client's house, Smith meditates and prays in her car. At home, she washes her clothes and hair, and takes a bath in Epsom salts. "It's almost like getting death off you," she said. She asks her women's prayer circle to keep her lifted up. It helps that her husband got certified as a death doula as well and shares the load.
The work requires and creates intense compassion. Dying is "really one of the most intimate experiences," said Smith, the Charlotte death doula. "So much beauty in it and so much sadness."
At the same time, it's important "to see the end of life as something worth celebrating," Smith said. One way to do that is a live farewell - a wake the dying person can attend.
When Tommy Parham Jr.'s doctors said there was nothing more they could do, Smith, a childhood friend, raced to put together a recorded Zoom celebration of his 42 years.
"I had never heard of anything like that," said father Thomas Parham, 79.
Tommy's family propped him up in bed in his hospice room. Together they watched two dozen members of his community, many accomplished Black men like Tommy, share their love.
His pastor reminisced about their shared love of classic hip-hop. A friend sang an original R&B song: "Won't you please come down and give our friend a helping hand? Lord, he needs you right now." Friend Duane Reed praised how just a few days before, Tommy had admired the beauty outside.
He was grateful to know that Tommy was alive to hear his thoughts. "We're not giving a person their roses later. We're giving them their roses now," Reed said.
Heavily sedated, Tommy couldn't say much in response. But he smiled, especially when his high school basketball coach held up a jersey and said they were retiring his number.
"That smile on him, that's all we needed," his father said.
Now that his only child is gone, Parham likes to watch the video. "Just whenever. It's raining outside, I can't go outside, I just watch it," he said.
Providing families with that kind of peace is what drives Smith.
"Death touches everybody. Death does not discriminate," Smith said. "Make it serious, make it laughable, find the joy, find the heartache."
Danielle Dreilinger is an American South storytelling reporter and the author of the book The Secret History of Home Economics. You can reach her at firstname.lastname@example.org or 919/236-3141.
This article originally appeared on USA TODAY: What's a death doula? Growing profession provides peace, plans