'How losing my dad as a teenager led me to a career as a death doula'
I let myself into the house and make my way to the bedroom, where he is lying on the bed. After a lifetime of independence, this man doesn’t want strangers coming into his home to nurse him through the final stages of his cancer. I touch his shoulder and he opens his eyes, a little smile flickering across his face.
He says to me, “I’m dying.”
I reply, “Yes, you are.”
The man takes great comfort in someone acknowledging his reality.
He goes on to die in hospital and I am with him all the way, until his last breath. That’s all he wanted, a companion on that last journey.
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And as a death doula, that is my job – providing spiritual and emotional support for a dying person and their loved ones. I’m different from end-of-life support workers, as I can give continuity of care, unlimited time and get to know my clients closely.
The word doula means a trained companion and most people associate them with birth. But this kind of support can be just as important at the end of life.
Alexandra Derwen, 42, has helped more than 1,000 people in their final moments
Alexandra with her father, who died when she was just 14My clients usually have a terminal diagnosis or simply don’t have long left due to old age. I’ve also worked with parents whose children are dying and people bereaved in unexpected, tragic circumstances, like murder or suicide.
I believe I was destined to do this job. My choice of career was sealed when my dad died from leukaemia five months after his diagnosis, when I was 14. I was with him at the hospital just after he died.
I sat on his bed, touched his face and sang one of my favourite songs, No Need To Argue by The Cranberries, which includes the line, “I knew that I would lose you.”
Afterwards, I lay down next to him and fell into a tranquil sleep for three hours. My dad had gone peacefully and I was by his side.
I was sad that he wouldn’t be around but I wasn’t afraid for him. Death has never scared me. It is the only certainty in life. I’ve always been comfortable with that.
I think whatever a person believes happens after death does happen for them and there is not one truth. I enjoy not knowing.
Reflecting on life
When I was in my twenties, I worked in road safety for the fire service and at a youth group, where death from street violence was a regularity. It meant I was constantly around bereaved people.
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In my thirties, I began volunteering in hospices, sitting with the dying and attending the funerals of those without family or friends.
One day, I came to a realisation. I was familiar with the idea of birth doulas – perhaps I could be a death doula?
But there wasn’t much training on offer for this work and in 2017 I set up my own course, using my experiences and knowledge. It’s still a niche occupation but interest is growing.
When I meet the dying, they usually want to have long conversations about what is happening to them and work through their feelings. Generally, they are scared but they are more accepting of their death than their loved ones.
They want to reflect on their life, telling me about their childhood, their career, the people they’ve loved and even their regrets.
The most common regrets are that they haven’t told people they love them and did not spend as much time as they would
have liked with the ones they care for.
One of the death doula's training sessionsHaving their life acknowledged and mentally putting their affairs in order gives them a sense of completion.
Sometimes, they’ll want to impart the wisdom they’ve acquired and I’ve also helped clients make amends with those
they feel they have wronged.
Loved ones can find it difficult to have these emotional conversations but I can listen without feeling like my world is falling apart. Sometimes, they simply want a shoulder to cry on. We have plenty in place medically for the dying but not much to address their emotional needs. Often, my clients wish to die at home and I’ll transform it into a relaxing space filled with things that matter to them, like photos of their loved ones.
As the end approaches, they sometimes panic and want to go into the hospital. I offer calm reassurance but ultimately support them
in whatever they decide.
I also coach the family on what to expect and I’m there for them afterwards.
There is a very primal sound that often emerges through grief, which is called keening. It’s the same sound you hear at childbirth. Grief
is love – so in a way, it is magical. I’ll encourage them to pause and take a quiet moment with their departed loved one by holding
their hand or giving them a hug.
I know from personal experience how special those hours were for me with my dad.
Relief washed over him
There are some deaths that stick with me. I met a homeless man called John, who was an alcoholic and drug addict. He’d run away from home when he was 14 because he didn’t want to be confirmed as a Catholic.
He had this fear that when he died, he was going to be punished for being bad. I told him we all do bad things but that doesn’t make us bad people. I saw the relief wash over him, and that night he died peacefully in his sleep.
In the months that follow a death, I get asked, “Is it normal for me to feel this way?” The answer is always yes – there’s no correct
way to grieve. I’ll be there for those left behind, to make them a cup of tea or tackle more practical tasks, like funeral arrangements.
'The most common regrets are that they haven’t told people they love them and did not spend as much time as they would have liked with the ones they care for'We live in such a fast-paced world that sometimes we don’t allow ourselves time to mourn but we need to have that outpouring.
I’ll encourage people to set up rituals, such as lighting candles in memory, and rotas so they have friends and family checking in. Too often, people only offer help for that first week and forget to keep showing up.
I’ve supported more than 1,000 people in their final moments so far.
I only charge what they can afford, between £20 and £50 per hour. It can be the person who is dying, their family or even the local community that pays. And I help those without financial stability for free.
At the end of my working day, I’m able to go home and put it to one side. I go for walks in the mountains, practise cold water therapy and speak to my therapist if needed.
Some might view my occupation as gloomy but for me, there’s nothing more beautiful than helping to create that final chapter in someone’s life.
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