I think a lot about this work that we do as doulas and the sacredness of simply holding space and bearing witness and affirmation as another soul labors out of this life–their soul set free from earthly body. If we are very lucky and gifted with the grace of time between the terminal diagnosis and active dying of a loved one, we can celebrate the life lived and find peace of mind in those “bonus hours,” days, and weeks.
In my personal experience, the gift of bonus hours changed my perception of how the time approaching death can be experienced on both sides of the bedrail. I have seen it work its “magic” time and again in my deathwork too.
In our last conversation, we sat together in the bonus hours—that sacred, often unexpected window of time between a diagnosis and the final transition. We talked about the power of Legacy Work, from transcribing ‘Lasting Words’ to the quiet healing found in an ‘Ethical Will.’ We also explored the Doula’s role as a Gatekeeper, a gentle but firm protector of a loved one’s energy, ensuring that their sanctuary remains a place of peace rather than a revolving door of logistics.
But what happens when the bonus hours end, and the body begins its final, rhythmic retreat? For many, this is where the silence becomes heavy and the waiting turns into wondering. In this post, we step into the Active Dying phase. It is a time that requires a different kind of sight—a ‘Doula’s Wisdom’ if you will—to recognize the body’s subtle language. Today, we’ll discuss how to navigate these final physical hours not with fear, but with a steady, informed presence that honors the soul’s departure as much as we honored its arrival and its journey.”
The Shift
In the beginning, Doula work is about doing (paperwork, cleaning, advocating). In the Middle Space, it shifts to being. We are holding space for the person to exist as themselves—not as a patient, not as a tragedy, but as a human being with a story that is still being written.
Vigil Planning
It remains important to continue to use this period, before active dying begins, to put pieces in place for the things to come. I am a planner and I have the added blessing of having a pretty clear idea of how the dying process will unfold. It is my process to have the answers to the to some questions not only written down, but also pre-arranged. I have seen this strategy lend itself to actuating a calm and peaceful environment repeatedly. No guesswork involved much more focused time for a client and their family to say their farewells unhurriedly. My list of things to know includes:
- If the room were to be silent, would you enjoy music to be playing sloftly? Or would nature sounds or the laughter of children playing outside be more comforting?
- Would you like a visit or visits from a faith leader?
- Do you have a favorite nightgown or quilt you want to be wearing and wrapped in?
- Do you want the windows open or closed?
- Who do you want at your bedside? Who do you not want in the room?
- Where do you want your pets to be? (We encourage companion animals to be allowed into the room as similarly as they are accustomed to being under regular circumstances. Animals understand death. Without the opportunity to process the senses of death, they can experience the senses of loss as abandonment instead.)
From here, we are more prepared for the transition. Recognizing the signs of active dying and how the Doula supports the family through the final hours of the physical journey.
The following is a list of transitions in the active dying process, some may be more subtle than others. The gentle progression of these transistions are merely medical markers. They are the cues for us to tighten the circle, dim the lights, and begin the sacred task of witnessing the untethering–the body’s innate wisdom of letting go:
- The Inward Retreat: Leading up to this time, you may have observed a definitive lack of appetite and thirst. This is completely normal. The body no longer needs sustenance for its earthly form. Insisting on feeding tubes and IV hydration at this time only serves to comfort those in the surroundings. We recommend letting the body follow the natural path it knows instinctively–food and water are for the living world.
- At this time, you will likely notice a profound withdrawal from the outside world. This is not a loss of feeling, but a shift in focus. The soul is beginning to untether from earthly concerns, preferring silence, dimmed lights, and the presence of only one or two “anchor” people.
- RE-patterning of Breath: Breathing begins to tell its own story. It may become very slow, with long pauses or take on a rhythmic, “ebbing and flowing” quality. This is the body finding its own pace for the journey, often more distressing to the witness than to the one traveling.
- The Coolness of the Journey: As the heart focuses its remaining energy on the vital core, the hands and feet may become cool to the touch or take on a mottled, purplish hue. Think of this as the body gently gathering its warmth inward to protect the spirit’s transition.
- “Vigil Sleep”: This is a transition into a deep, non-responsive sleep. While they may no longer speak or open their eyes, the sense of hearing is often the last to fade. This is the time for “heart-speak”—whispering gratitude, giving permission, and simply being a steady, loving frequency in the room.
- The Final Release: The muscles of the throat and face relax completely. The breathing may become shallow and “sigh-like” until it eventually stops. This is the moment the Doula calls the Grand Transition—the physical container has finished its work, and the soul is set free.
Throughout this process, the EOL doula provides the bedside vigil if that is what is wanted or needed. If there are others at the bedside, your doula will offer comfort care all around and will be a continuing source of reassurance, knowledge, and understanding for grieving.
In closing, I share my Gatekeepers Manifesto. In my next post a few days from now, I will share more about the topics of unity, forgiveness, and unconditional love from the perspective of nearing death.
The Soul at Heart Manifesto
We believe that the final labor of a human life is a sacred transition that deserves a sanctuary of protection. As Gatekeepers, we commit to:
– Unity: Holding a space where family friction bows to the singular purpose of peace.
– Forgiveness: Clearing the emotional threshold so the soul may untether without weight.
– Unconditional Love: Offering a non-judgmental witness to the body’s inward retreat.
The Vigil is not a medical event; it is a love brought full circle.
If you are navigating these hours right now and feel overwhelmed, reach out. You do not have to hold this space alone.”
Thank you for reading. I invite you to share your stories. We are made stronger and more unified as humans on this planet when we offer the blessings of shared experiences. End-of-life moments can hold some of our most treasured memories and lasting feelings of love and fulfillment. I would love to hear your stories.
With love, compassion, and comfort for those bearing witness to life’s labor out today,
Carolynn