Inelda's End of Life Doula training contains a three phase model.
The first phase involves summing up and planning. In this phase we facilitate the exploration of meaning in order to help the dying person fully appreciate the richness of his or her life and its impact on others. Additionally we help the dying person take care of organizational details such as living wills etc., and deal with any regrets, guilt or unfinished business that remains troubling. Finally in this phase we help the dying person create his or her vigil which describes the space and interactions he or she wants during active dying. Vigils contain information about where this person wants to die, what sounds they want to hear or not hear, who they want to be there for last breath, whether or not touch is desired and if so what kind of touch, how they want to make the experience personal and if it is their wish, sacred, and what is wanted after last breath etc...
The second phase happens during active dying. During this time we quietly hold the space for all that came up in the summing up and planning phase for all present, and assist in respecting whatever is in the dying person's vigil. We are often asked to help the dying person by implementing the guided visualizations he or she created during phase one. We support all the loved ones emotionally and physically, providing respite to exhausted family members. Often we offer to stay present even in the hours after the dying person's last breath.
In the third phase we help family members and loved ones navigate the transition from life to death by assisting survivors in reprocessing the death experience. Because the lives of all the survivors will always be altered by the death of their loved one, and time is simply not enough to create healing, we normalize the grieving process and assist them in moving through their early grief process.
Erik Erickson, the famous developmental psychologist, identified different developmental challenges across the human life span. The last developmental period he called "Ego Integrity versus Despair" which he saw as occurring during old age as the person quite naturally reflected upon his or her entire life span, reviewed its successes and failures and arrived at wisdom that would then be passed on to future generations.
Over thousands of years in uncountable numbers of indigenous cultures, people have used The Medicine Wheel as a symbolic mirror into which they can look and see things about themselves and their relationships to life that are not ordinarily visible. The Medicine Wheel represents the "circle of life" which has no beginning and no end. On this sacred circle everyone is interconnected. Each person sitting in the circle is equal distance from the center and therefore fully equal. The honor of one is the honor of all. The pain of one is the pain of all. The wheel is made up of the four aspects of the human. Although there are many variations in the teachings, the one I was blessed to learn says that every human who has ever be born or will ever be born is made up of these same four aspects: The Mental in the North, The Physical in the West, The Spiritual in the East and The Emotional in the South.
The East which stands for "spirit" is where we are born and where we live as children. The South which stands for "innocence" is where we grow through adolescence into young adulthood. The West which stands for "introspection" is where we live as adults. The North which stands for "wisdom" is where we are in old age. The elders ("Ego Integrity versus Despair") sit on the North of the Wheel of Life.
As end of life doulas, we believe regardless of age, that when a person has a terminal diagnosis and faces the end of life, he or she automatically enter this developmental phase and faces the challenge of seeing life either as a predominantly positive experience or an experience filled with negative events and failures that lead to a sense of despair.
This is my first of many blog posts about end of life doula work. Should any of you who are reading my first post want to discuss the role of end of life doulas, please don't hesitate to contact me.
With Love,
Ilene
