When we met Sam, we began with a simple question, “How can we help you?” As end-of-life doulas, we take the lead from them, meeting them where they are, at that moment in time, while remaining open and willing to explore with them. For Sam, the answer was direct and clear, as he said, “I am ready to be out of this body. I am done. I am fine. Please help my family, they need support.” Our starting point had been succinctly delivered and our initial question answered.
Sam had contacted us for support for the last steps of his process with Medical Aid in Dying (MAiD), which is legal in New Jersey. The strict requirements for NJ Medical Aid in Dying had been completed. Sam had the required medication from the pharmacy and asked if we’d like to see it. As we reviewed the instructions and medications, we asked him if he would be able to drink the required amount of liquid. He had cancer that had spread throughout his body and impacted his jaw, and his pain was unrelenting despite the support of medications. Understanding that our ability to assist him relied on drinking the medication, we kindly asked if he could please demonstrate his ability to swallow with apple juice. He was determined and brave and completed the task with the use of a straw.
We were now in a position to gently move from the physical aspects of support to the emotional and spiritual. We used the next period of time to get to know him, his beliefs, and who he would be leaving behind. Where would he like to take his last breath and who would be present? We are always astounded by grace and honesty that can accompany the dying. Time is of the essence and they, more than anyone, understand this. For Sam, extra words and wasted time no longer belonged to him. He knew that his decision was difficult for his family, although this small nucleus of loved ones supported him. He asked if we could be there to relieve his family of the mechanics of MAiD. Sam didn’t want the responsibility of the timing and mixing of medications to fall on them. He hoped that would free them of a sense of responsibility and allow them to be in the emotions of their loss. We assured him that we would be able to do that for him as well as provide emotional support as needed. FareWell Doula believes MAiD is best approached with two end-of-life doulas working in tandem, as this enables one doula to focus on medications and while the other doula can be more readily available for the client and family.
On the appointed day to take the meds, we returned and met additional family members that Sam wanted present. Everyone was gracious, welcoming, and grateful for our involvement. As we organized ourselves and got acquainted, we suggested that we review the procedures: the timing, taking the medications, and the expectations as well as the myriad of possibilities and variables. As they came to understand that the timing of death is not always exact, they found comfort in our assurances that we would stay with them until Sam had died. We also agreed to make the necessary phone calls that would follow his death.
We brought small notepads, pens, and envelopes with us and placed them on the bedside table inviting anyone who would like to write a small note to Sam to do so. We assured them that the envelopes would stay with him. Offerings such as this are always presented without any attachment to the outcome, as we have learned from the dying, there is no time for judgment or expectations. Thirty minutes later one family member picked up a notepad and began writing, and this prompted a second, a third, and a fourth. Someone asked if they could read their note aloud to Sam and we turned to Sam for guidance. He loved the idea and was able to hear the words of love and appreciation for who he is, what he meant to each family member, and how they would remember him. Those moments were overwhelmingly magnificent. Each envelope was given to Sam after reading. An unexpected and impromptu ritual was performed, one that brought beauty and joy to everyone.
After taking the MAiD medication, it was a few hours before Sam died peacefully. We as doulas will remember Sam for the rest of our lives. We are in awe of his courage and his love and care for his family. We are honored to have been able to play a role in his version of “a good death” and support him and his family in the process.
~ Jeri Glatter