NHPCO team member and non-practicing but Certified Death Doula Elyssa Katz recently sat down with Nicole Fisher, full-time Death Doula, to learn about the path she took to become a death doula and how she practices today.
Becoming a Death Doula
Elyssa Katz: How did you first learn about death doulas?
Nicole Fisher: One year into the pandemic with a forced break from my old life, I began to be interested in what a new career might look like. I lost my mother 16 years ago; over the years, I’ve had many seeds planted in my life about good and bad deaths. During the height of the COVID pandemic, I was reaching out to my more senior friends, just checking in to see how they were doing alone. One of those friends was on the board of End-Of-Life Washington and I looked at its materials. As soon as I read an article about the work of a death doula, I knew that this was the new focus I wanted in my life. From that moment on, my goal was to become a death doula.
Elyssa: What made you naturally interested in that death doula role?
Nicole: As I mentioned, when I was in my thirties my mom was diagnosed with terminal cancer. From her, I learned how to die well—no fear, no anxiety. There was sadness across our family, of course, but my mother never let us see any other side except for love and acceptance. I learned that death is not a bad, sad, or scary thing, just the next stage in our life. I metabolized that in a society where no one could talk about it. Death and birth were this balance I was fascinated by and wanted to talk about but didn’t always feel comfortable doing so. Today, I continue to think and talk about it, nonetheless! I’ve watched as my friends’ parents have gotten elderly, sick, and died, and so many have died in a way that was not good for them or their families. It was that strong knowing that my experience was a positive one and seeing that there were other ways to do this that I needed to share. It seemed preachy at the time, but I realized the death doula role allowed for the perfect opportunity—I’d have credentials and a platform, even if only to help my family, friends, and neighbors.
Death Doula Certification and Training
Elyssa: Once you knew you were going to take the next step, how did you identify and choose where and how you would complete your death doula training?
Nicole: I went online and researched in the U.S. and Canada, and because of COVID, all the training was online. I live in Canada, and that’s primarily what I’ll be speaking to, so be aware that laws for a death doula are different in the U.S. versus in Canada. End-of-Life Doula Association of Canada identified different programs to become certified and I focused on a local college here in British Columbia. I found one of the most highly-rated programs at Douglas College. The program was wonderful, and I learned so much about end of life and how to help others facing death and dying.
Elyssa: Once you completed training, it was time to start thinking about how the role of the death doula fits in with your interests and skill set. How did you determine what you would focus on and offer as part of your practice?
Nicole: I’m still learning my language and my field. I thought I was so focused when I finished my death doula course, but I went straight into a business course with non-doulas and it helped me think about what my business would look like as an independent consultant.
There’s an incredibly vast area that one can work in as a death doula. Where I’m located in British Columbia, there are more death doulas than anywhere else in Canada, so I tapped into that amazing community right away. A local group recently re-branded Death Doula Network International has been instrumental in meeting peers in the field.
In this community of death doulas, I discovered that some doulas work only with children, others were newly certified like me, and some have been practicing for 30 to 40 years and are regarded as gurus in the community. I met a death doula from India who tapped into the Indian community by honoring and recognizing their specific traditions and religious practices around death and dying.
I have not found my niche yet, but every time I tell someone what I am doing, they want to learn more. They are amazed that it is a profession and often remark that it’s a needed skill. Increasingly, I’m drawn to spreading information rather than sitting vigil at besides. I’m interested in the death positivity movement, and potentially changing laws to empower death doulas. I want to help get information out—writing about, sharing, and fostering our community. In North America and in Europe we’ve medicalized death, and very few people die at home though a majority desire to do so. I want to talk about how to help change that.
How Does a Death Doula Help Patients and Their Inner Circle?
Elyssa: How do you see a death doula, specifically your services as a death doula, helping patients and their loved ones on their journey?
Nicole: Death doulas fill in the cracks where the medical system and families can’t support patients. At times, that is reducing the fear of death in the client, allowing the client to drive the conversation. Often with seniors, adult children are making decisions on their behalf—they’re doing what they think their patients want, but it’s not always on point. The death doula can listen and build steps to achieve clients’ wishes before they die.
Elyssa: How did you set up your practice to begin accepting clients? How did you get the word out about your services?
Nicole: I needed to establish a legal business in Canada and ensure that it was a clear business concept. I read and heard that many people didn’t have a clear path from the get-go, so I wanted to be sure of what it was my services would be. During this process, the existing death doula community in my region was a great resource to test the ideas I dug into. I’m currently in the process of creating the business name and website, and then I’ll be pressing go.
Elyssa: Without disclosing any identifying information, would you mind sharing how you’ve helped your clients? What guidance they were looking for and what forms of support you provided?
Nicole: A couple of cases come to mind. Neither person has died, but both have fears.
One woman is in her seventies, and she was terrified of dying despite not yet being sick or facing a terminal illness. Her choice of meeting, during COVID times, was to go for a walk and have a coffee. She and I have been talking through different activities, readings, and books to help her work through her fear. It took a year, but she did her homework and finally got to a place where she is far less fearful. She has a plan in place and has acted through advance care planning, updating her Will with her lawyers, and having conversations with her adult children to let them know not only her wishes, but also where everything important is located. She is clear and comfortable with her decisions. It is rewarding to see her less fearful, more in control of her future, and empowered with the choices she has made for her end-of-life wishes.
Another client is also a woman in her seventies who is facing a decrease in quality of life due to several diseases. I’ve spent a lot of time with her, and few family members are comfortable discussing death with her. Recently she whispered to me “Nicole, can you tell me—when do they know I’m ready for palliative care?” I understand she does not want to upset her children by talking about death, and as a death doula, I am grateful that I am there for her to discuss these topics that she is curious about. An end-of-life doula is in a unique position to be a compassionate listener.
This won’t be the path for everyone, but this client chose to have a conversation with her entire family about Medical Assistance in Dying (MAID), which is legal across Canada. With her illnesses, intolerable suffering, and now mental suffering due to her limited quality of life, she wanted to have the option to end her life with dignity. She applied to the MAID program, was approved, and then signed a waiver that allowed the doctor to perform the procedure if her health declined to a stage where she was unable to provide verbal consent. This gave her peace of mind.
Elyssa: Is there anything I haven’t asked about today that you would like to share or discuss?
Nicole: With COVID, North America finally started talking more openly about death. I don’t want this window of opportunity to close. Let’s keep the conversation going and help our community feel more comfortable talking about and preparing for our end-of-life, so that we can keep living without fear.
Thanks to Nicole for sharing her experience as a Death Doula with us. You can learn more about what a death doula is and consider how to discuss what types of care work for you.
