This story is part of Image’s May issue, which journeys through environments that encourage, nurture or require stillness.
While I traveled from my apartment in Los Angeles to B’s house in the woods of Pennsylvania, I realized I knew nothing about death. I prepared myself to meet a shuffling, sick patient, milky-eyed and translucent. More ghost than woman. Instead, B (whose full name is being withheld for privacy) walked down her long driveway like she had been waiting for me, and waved my cab up toward her white stone house. The bird feeders outside the kitchen had just been filled and a swarm of palm-sized birds ate the spilled seed.
When B called me a few months before, I had just left teaching to try freelancing in pursuit of more time to write. Also, I fell in love with someone who had an influencer ex and I felt jealous of how people paid attention to her. In a soup of flimsy and sturdy reasoning, I wanted to be noticed, and when you are a teacher, you are noticed but only as a single frame of yourself. For most of my 20s I taught 12th-grade English, and the longer I did this, ushering these 18-year-olds over a threshold, the more I became exhausted by being the one who stayed behind. You teach them, you know one another, you really do care, and they leave you for good because they must. What I couldn’t have known is that working with B would guide me to becoming a death doula, work where you are guaranteed to be the one who stays behind.
When she first called, B asked me to work as her editor, or ghostwriter. She used the terms back and forth, and I said yes in the way my freelancer friends had taught me to say yes — boldly, with the promise of figuring it out as I went along. Upstairs in her office, she had dozens of legal pads scrawled with poetry, she told me, and she had the idea of turning those notepads into a poetic memoir. She texted me a few pictures of handwritten pages during our call, giving me time to read a poem about swallows flying in loops and another about singing to her first preschool class. B mentioned her cancer once, briefly, opening the window to death just a crack.
As I got out of the cab, B grabbed my suitcase from the trunk, propped the back screen door open, and warned me about the low ceilings. This house was old, like pre-Revolutionary War old, and so as I followed her through the many rooms and up the tight, groaning staircase to my room, both B’s head and mine brushed the ceiling. She talked for a while like this, telling me about the walls and the hiding places that were now sealed. In one of many guest rooms, what would become my room, she mentioned the walls were likely stuffed with old papers and objects. I noticed the way all sound stopped at the door, holding me in a room that had held many lives before mine. In L.A. most things feel new, and maybe destructible, but these walls felt like they might hold forever.
In our first hours, I listened to her talk as she walked around the house and ate tuna sandwiches at her kitchen counter. She started telling me stories, and I awkwardly took out a notebook to start taking notes, and she kept going without pausing, like she had been waiting for this, for my arrival.
As I listened to B’s stories over the year we worked together, I mostly didn’t talk. At first, this felt awkward to me, or maybe even frustrating, because she sometimes repeated herself, or told stories I didn’t think mattered to the arc of the memoir. I wanted to dive deeply into memories that felt shadowy and rich. I wanted her to go back to that one memory she mentioned about the stables, but instead, she told me where every antique in the house came from and what time of year her mother had planted the daffodils. I wanted to nudge her toward the profound, especially as time passed, but I stayed quiet. I kept thinking this was the time, if not the only time, to say the things she needed to say.
This figuring out through observation, I would later learn, is what death doulas often do. A first client visit exists for witnessing, to wait and see what the dying need from you, and to build trust. A doula meets people wherever they are and this includes their use of language. A tenant of doula care is nonjudgmental support, meaning the doula does not impose their values on the way a client chooses to approach their death. Instead, doulas listen with “unconditional positive regard,” a therapeutic approach popularized by Carl Rogers in the mid-1950s. Does the client say “cancer”? Does the client say “death”? No, OK, then what word do they use?
A doula intends to help the dying person make informed choices about their end of life, but sometimes those choices may feel at odds with what the doula thinks is “right.” The client might stay mad at death, at their family, at the world, for as long as they want. They might never move out of denial. They may die without ever saying the word “death.” Or they may die with everyone they love around them. A death doula arrives to accompany the dying person in the distress, the restfulness, the stillness, the pain, the all of it, and to walk them right up to the unknown. Every doula arrives with a set of skills, and mine in this moment with B was to listen, record and write her book.
Both birth and death doulas in the U.S. have had a resurgence of popularity in the last 30 or so years, even though these sorts of care practices are ancient, for people have always been giving birth and dying. Now, there is certainly a feeling of never having been more aware of our mortality collectively — the pandemic, of course, and facing the ongoing existential threat of climate breakdown. Death doulas work in homes, in hospitals, in care facilities — wherever the client might be, all while providing care suited for the whole person. Some doulas might be best suited to offer practical support — tending to the death directives, the scheduling of hospice care, and the logistics for after death. Others might offer emotional and spiritual support in the form of companionship, storytelling and, well, lots of listening. Both birth and death doulas offer something quite practical, while also modeling visions of care. In the case of the death doula, especially, this model of care requires us to prepare for the things that we might otherwise turn away from. And, to stay.
As B was dying, so was my grandfather. He happened to live a few counties over from her in Pennsylvania, and though his house wasn’t quite as old as hers, it groaned in the same way. He had a long driveway. I would often go from one home to the other when I flew out to work with B. The night he died I woke up with his hospice nurse in the middle of the night because I had a dream that a dark, warm shadow moved through the house. The next morning, the nurse moved slowly and expertly around his body; every detail became an object of sacred, slow attention, though she had clearly cared for the dying and the deceased countless times before. I didn’t know what to do, so I noticed the weird details: a cardinal outside his window and the way his hair sat on his head like white feathers. I felt myself starting to write the scene in my mind, with my own careful attention, to hold the details in place. I did not feel at peace, but instead was trying to figure out how I felt.
With his death, as in moments with B, I felt the urge to offer more knowledgeable support, to hold my discomfort with more sturdiness. When I returned home to L.A., I began a death doula training. I assumed we would focus on concrete skills, like pain management techniques and how to coordinate with hospice, but mostly we investigated our own deaths — own fears and beliefs around death — to show up for the dying more fully. In one class we wrote letters to loved ones articulating what we most admired in them, as though we would never see them again. We imagined our last dinner, selecting the menu, the guests and the soundtrack. Later in the training, we decided on the exact treatment of our bodies should we no longer be able to communicate verbally. We listed who we wanted in the room when we died. I became an eager student of my own death, intrigued by it even, and comforted by letting myself imagine what I would miss about this life.
Transitions and transformations can be fraught, even torturous. As a death doula, a big part of the work is sitting in that liminal space rather than running away from it. It’s about staying still in moments of discomfort and trusting that the threshold is a place of potential.
As the dying approach the end of life, the body begins to detach from the world. They enter into a long sleep, have less interest in food, in speaking, everything slows. B’s house always had a feeling of remoteness and remove from the rest of the world. Its silent thick walls, its long driveway, our strange work. When I arrived, everything slowed, profoundly. I didn’t look at my phone for days, and when B napped, I spent time among her things so I had the feeling of getting to know them. I thought about her objects and her writing — where would any of this end up?
B grew up in this part of the country, and she moved to live closer to her doctors and to be buried by the Quakers. She made this last joke just once. Everything about B started a bit closed off but became soft, messy and even silly. Her kitchen had slate stone tile and an antique wooden table in the middle with drawers all around it. The knobs felt like a thousand hands had worn them soft over time. One drawer was filled with linens hand-painted with birds. On top of the table her purse flopped open and from its mouth spilled curling checkbooks, loose cash, half a muffin in a napkin and bottles of Chinese herbs. A bundle of lilies in a vase sat in green water, petal-less. In the front hall oil paintings stacked against a wall, waiting to be hung. Each one was something related to a bird — a nest, a wing, an egg, a flock. In the living room her blankets made a body-nest on the sofa, layered with old tissues and legal pads scrawled with poems and open pens bleeding ink stains. In another sitting room, a silk chair that somehow looked both new and old, strewn with patches of different upholstery fabric. We picked out a fabric for this chair on my first visit, though it never got reupholstered.
It was in these rooms that my job imperceptibly developed a shape.
I can’t stop thinking about the stillness of a house where someone is dying and feeling the urge to be prepared. What if we all knew what to do? What if we could face the dying and stay? And, in the act of gathering the tools to give that person a dignified end, could they learn to welcome death as an expansion of life? A doula teacher of mine often says, “How we live is how we die.”
On my last day working with B, she mostly slept. She cared little about the editing decisions and told me to decide. Still, we didn’t talk about death. We spoke of her pain a bit and what sort of lunch she would be willing to eat. When she was awake she gave me a lot of advice about marrying the right person and how teachers are always teachers, no matter how hard they try to get away. While she slept on the couch the house felt still, except for the groaning of its walls. I made noise intentionally to feel less alone, making broth in the kitchen and shuffling through her bookshelf. When she woke up we sipped some broth together and the day ended. Before bed she told me how to finish the book, mentioning the possibility of her not being around, and recited a list of people who would need to be sent a copy.
In the middle of the night, a bat got into my room. It flapped and flew and I screamed. My scream woke B and she rushed into my room. She opened the window, and we stood, laughing in the dark.
Nicole Stanton is a writer, teacher and death doula making home in Los Angeles.
