There is a spiritual connection in hospice, dealing with death and dying, forty-plus hours per week. We who are in the field see it often, but there are times when we hear it firmly from the patients and families whom we serve. Let me share the most recent event on Memorial Day, 5/29/2023, week.

Seven days a week (I volunteered to work the weekend), I saw my patient with glioblastoma stage 4 brain cancer while transitioning (the period of in and out of consciousness) towards actively dying and was still able to express himself. On Sunday’s visit, he’s up possibly 30 minutes out of the day, eating bites and sips, and able to communicate clearly.

According to his loved one, Sunday evening, around 3:00 PM, he (the patient) started having terminal restlessness… Monday, 5/29, in the morning, between midnight and 4:00 AM, the patient (who was sleeping in his bed) shared, “There are all these people surrounding the bed, young and old…” …. “There is a stairway leading upwards with a blue light shining…” He tells his loved one he’s walking to the light and raising his hands towards the light… and then hears a voice, “YOU MUST REPENT TO ENTER!”

Then he shares the words “two days” with his loved one. Exploring what those two words meant leaves the loved one wondering what will happen in two days.

On Monday, 5/29, I arrived at about 8 AM, and when we returned to the patient, he was able to wake up and talk lightly. I expressed a desire to have a conversation with God. I shared with the family that, based on the presentation of the patient (the holistic phrase I use that considers the velocity of downward changes, complexion, mottling, etc.), it is very feasible that the patient will die in two to three days.

Wednesday, 5/31… two days later, the patient died. Two days!

I don’t know if the gentlemen made peace with God; the patient and family blessed me as much, if not more, than I may have blessed them in my service to all of them. I know God is real, heaven is real, hell is real, and there’s evidence for those with eyes and ears to see and listen.

Resources

The National Academy of Elder Law Attorneys (NAELA) is dedicated to improving the quality of legal services provided to older adults and people with disabilities

Articles on Advance Directives

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

CaringInfo – Caregiver support and much more!

The Hospice Care Plan (guide) and The Hospice Care Plan (video series)

Understanding Palliative Care: A Guide to Common Questions and Answers

Bridging the Gap: Palliative Care’s Role in Supporting Rare Disease Patients

Comprehensive Guide to Financial Assistance for Hospice and Palliative Care Patients

Surviving Caregiving with Dignity, Love, and Kindness

Caregivers.com | Simplifying the Search for In-Home Care

Geri-Gadgets – Washable, sensory tools that calm, focus, and connect—at any age, in any setting

Healing Through Grief and Loss: A Christian Journey of Integration and Recovery

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Caregiver Support Book Series

• Beyond the Living Will: Creating Effective Advance Directives
• Daily Hospice Care Planner: Organize, Communicate, and Provide Consistent Care
• VSED From a Hospice Nurse Perspective: Voluntary Stopping Eating and Drinking, a Way to Choose
• Hospice Medication Handbook: A Caregiver’s Guide to Comfort Medications
• Nourishing Hope: A Caregiver’s Guide to End-of-Life Nutrition
• Palliative Care vs Hospice Care: Making Informed Decisions
• Palliative Sedation: A Compassionate Approach
• The Caregiver’s Lifeline: Self-Care in End-of-Life Care
• The Hospice Journey Handbook: Your Complete Guide Through the Hospice Experience
• Understanding Breathing at End-of-Life: A Family Guide to Comfort Care
• Understanding Your Rights in Hospice Care: A Guide for Patients and Families
• Validation and Compassion: A Guide to Connecting with Terminally Ill Loved Ones
• When is it Time for Hospice?: A Compassionate Guide for Families and Caregivers

VSED Support: What Friends and Family Need to Know

My Aging Parent Needs Help!: 7-Step Guide to Caregiving with No Regrets, More Compassion, and Going from Overwhelmed to Organized [Includes Tips for Caregiver Burnout]

Take Back Your Life: A Caregiver’s Guide to Finding Freedom in the Midst of Overwhelm

The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself

Dear Caregiver, It’s Your Life Too: 71 Self-Care Tips To Manage Stress, Avoid Burnout, And Find Joy Again While Caring For A Loved One

Everything Happens for a Reason: And Other Lies I’ve Loved

The Art of Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death.”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side, A Guide for Caring for the Dying at Home

Compassion Crossing Academy — Free and paid online courses are available to teach caregivers, nurses, social workers, chaplains, end-of-life advocates, and educators, including death doulas, how to confidently coordinate complex care.

Bridges to Eternity: The Compassionate Death Doula Path book series:

• Becoming a Death Doula: Foundations and Practice
• Becoming a Death Doula: Business Growth
• Becoming a Death Doula: A Complete Guide to Starting Your End-of-Life Doula Practice (Foundations and Practice and Business Growth combined)
• Death Doula Intake Guide: A Practical Framework for First Conversations, Safety Checks, and Forms
• Carrying Loss Forward: Coaching Clients Through Grief and Integration
• Crafting Meaningful Legacies: A Guide for End-of-Life Professionals
• Crucial End-of-Life Conversations: A Compassionate Guide for End-of-Life Professionals
• End-of-Life Doula Care Planning: A Complete Guide to Compassionate Care
• Vigil Planning Guide: Creating Sacred Space in Life’s Final Chapter

Find an End-of-Life Doula

• Compassion Crossing, LLC, provides on-site services in Madison County, Kentucky, and offers virtual options if no local provider is available.
• Hospice Buddy: Although Jamie Haberman, RN, CHPN, isn’t a certified end-of-life doula, her virtual services are very valuable.
• The National End-of-Life Doula Alliance (NEDA) Directory
• Death Doula Directory
• The International End-of-Life Doula Association (INDELA) Directory

Currently, there is no official organization regulating end-of-life doulas (EOLDs). Keep in mind that some listed EOLDs in directories might no longer be practicing, so verifying their current status is essential.

End-of-Life Doula Schools

The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:

• The International End-of-Life Doula Association (INELDA)
• University of Vermont. End-of-Life Doula School
• Heart Bridge Holistic Training and Mentorship
• National End-of-Life Doula Alliance (NEDA): It is not a school, but it provides a certification pathway.
• Compassion Crossing Academy: While it’s not a dedicated death-doula school, it offers distinctive classes that can help a death doula expand their business. It’s a valuable resource for those eager to grow and deepen their knowledge in this meaningful field.

Remember that there is no official accrediting body for end-of-life doula programs. Certification only shows you’ve completed an unaccredited program and received a graduation certificate. It’s advisable to have discovery sessions with any death doula school you’re considering — regardless of whether it’s listed here — to see if it meets your needs. Also, ask questions and contact references, such as former students, to assess whether the school gave you a solid foundation to start your own death doula practice.

Death Doula Alliances and Collectives

• Bay Area End-of-Life Doula Alliance
• Chicago Death Doula Collective
• Death Collective North Texas
• Florida End-of-Life Doula Alliance
• Midwest End-of-Life Doula Collective
• Minnesota Death Collaborative
• Philly Death Doula Collective
• Santa Fe Death Doula Cooperative
• Sarasota Area End-of-Life Doula Collective
• Virginia End of Life Doula Collective

Please note that some members listed in a specific collective or alliance might no longer be active.

End-of-Life-Doula Articles

Holistic Nurse: Skills for Excellence book series

• The Nurse’s Guide to Motivational Interviewing: Empowering Patients to Make Lasting Health Changes
• Validation in Action: A Nurse’s Guide to Compassionate Communication
• Compassionate Care in Conflict: A Nurse’s Guide to Managing Combative Patients
• Dementia Staging Mastery: A Nurse’s Guide to Dementia Assessment
• Clinical CBT Applications: Essential Strategies for Modern Nursing Practice

Empowering Excellence in Hospice: A Nurse’s Toolkit for Best Practices book series

• Art of Hospice Prognosis: Essential Skills for Clinical Assessment and Family Communication
• Beyond the Hospital: Navigating a Career in Hospice Nursing
• Breath of Life: Managing End-of-Life Respiratory Symptoms
• Care Plans for Hospice Patients: A Comprehensive Guide
• Clinical Pathophysiology: A Reference for Hospice and Palliative Nurses
• Compliance-Based, Eligibility-Driven Hospice Documentation: Tips for Hospice Nurses
• Conversations at the End: Guiding Families Through Final Days
• HOPE in Practice: Implementing Patient-Centered Outcomes in Hospice Care
• HOPE in Action: A Practical Guide to Hospice Assessments
• HOPE Assessment Tool Updates & Version Tracking (free webpage that provides the latest CMS updates to HOPE)
• Hospice Clinical Pharmacology: Critical Thinking for Comfort-Centered Care
• Hospice Tools of the Trade: Essentials for Hospice Nurses
• Mastering Dementia Admissions: Essential Guidelines for Hospice Eligibility
• Mastering Hospice Eligibility: An Essential Guide for RNs and Clinical Managers
• Mastering Hospice Recertifications: A Comprehensive Guide for Nurses
• Mastering the Hospice Item Set: A Comprehensive Guide for Nurses and Managers
• Medication Reconciliation in Hospice Care: Maximizing Quality of Life
• The Art of Hospice Visit Planning: A Clinical Guide to Patient-Centered Care Frequency
• The Complete Hospice Visit: A Nurse’s Guide to Excellence
• The Hospice CoP Handbook: Meeting Federal Mandates from Admission to Audit
• Regulatory Updates to The Hospice CoP Handbook (free webpage that provides the latest conditions of participation updates)
• Time Management for Hospice Nurses: Practical Strategies for Rural Practice
• Whispers of Time: Understanding the End-of-Life Timeline

The best symptom management book the author has read: Notes on Symptom Control in Hospice & Palliative Care