Rachel Friedman | Vox

An end-of-life doula’s advice on how to make the most of your time on earth

2022-08-04T12:55:02-04:00

“I want a party in the woods with an all-night campfire. I’ll be off to the side in a sleeping bag, nice and cozy. There will be s’mores and cocktails. My friends can come and go, saying goodbye however they want, or just sitting quietly with me and holding my hand. Nobody should touch my feet, though. I hate having my feet touched. A playlist of my favorite songs should be on repeat. I’d like to die as the fire burns out at dawn. Lights out and lights out, you know?”

I’m on Zoom and a chaplain from Iowa is describing her ideal final hours of life. We’re training to become end-of-life doulas, and this morning’s assignment is to help each other talk through a final hours ritual. It’s one of many exercises designed to confront us with our own mortality, so we can leave our own feelings about death at the door before we step across someone else’s threshold to help with theirs.

End-of-life (EOL) doulas are at the opposite end of the life cycle spectrum from birth doulas. They provide non-clinical care (emotional, logistical, and physical) and help with planning; engage with life reviews and legacy work; and provide support for family and friends so caretakers can bring their best, rested selves to support their dying loved one.

I knew training to become a doula would change my relationship to death, but I didn’t anticipate how it would transform my day-to-day life. Like others, my smartphone use skyrocketed during the isolation of the pandemic. Even after those panic-inducing first months in NYC, I still found myself using my phone as a constant distraction — lurking on Instagram, clicking every New York Times alert, obsessively refreshing my email like it was a Vegas slot machine.

I didn’t become an end-of-life doula to fix my fragmented focus. I did it because Covid-19 made death suddenly feel very real and very present. But I found that a deep dive into death work profoundly clarified my priorities, and has helped me spend time in ways more aligned with those priorities thanks to the soul-shaking understanding that our time here is truly limited.

Here are three components of EOL doula training that have been useful in my never-ending quest to live a more present and focused life in this Age of Endless Distractions. Think of it as a looking-back-from-your-imagined-deathbed approach to living — which sounds morbid in theory but is empowering and enriching in reality.

Imagine you have three months to live

I’m not going to lie to you: This exercise isn’t going to feel great! Please do it only if you feel equipped to engage with feelings of grief and loss. I recommend having someone you trust read it to you, someone who also has the emotional bandwidth and who is not currently grieving. You’ll need a pen and paper. Choose a time when you’re not going to feel rushed and are in a comfortable space. Take some deep breaths. Settle in. Here we go.

Write down your five most-prized possessions, your five favorite activities, your top five values, and the five people you love the most.

Close your eyes. Imagine you’re at a doctor’s office. You’ve just been given a terminal diagnosis and told you have approximately three months to live. Sit with that news. Breathe. Open your eyes. Cross any four items off your list.

Close your eyes. You’re back home with your spouse or friends or children or pet. You have to find a way to tell those you love: “I’m dying.” Breathe. Open your eyes. Cross another four items off your list.

Close your eyes. You’ve started feeling the effects of your illness. You can’t get around as easily. Your sleep is restless. You’re nauseated from the medications you’re taking. Breathe. Open your eyes. Cross four more items off your list.

Close your eyes. You’re mostly confined to your bed now. Your loved ones have gathered because they know they will soon have to say goodbye. They drift in and out of your bedroom, or wherever you have chosen to spend your final days, holding your hand, perhaps playing music you like or reading aloud your favorite book. Breathe. Open your eyes. Cross four more items off your list.

Close your eyes. You’re in bed, eyes closed, unable to move much or to speak at all. You sense that you’re going to die soon, and you wonder what will happen when you go. What are you thinking about in these final moments? Breathe. Open your eyes. Cross the remaining four items off your list.

Whew. You did it. Make sure to give yourself as much time as you need to regroup before you reenter the “real world.” Sit still. Focus on your breath. Drink lots of water.

When I did a version of this exercise, I was amazed at how real loss and grief felt as I crossed items off my list. (There is nothing quite like imagining your kid’s life without you to bring on The Sobs.) I don’t want to overstate the impact of imagining loss versus actually experiencing it, nor minimize our individual, multi-faceted responses to real grief, but research has shown that stressful life events can change us, and that includes clarifying our values and priorities. Maybe you, like me, tapped into some of that clarity during this exercise.

A few days after I tried this exercise, I rewrote my Top 20 list on a notecard. I keep that notecard by my laptop and look at it often. It has been an unexpectedly powerful reminder of what and who I love, of who I am and want to be. Each day I think about how to fit in as much as I can from this list, even if I only have a few free minutes to myself. It has become the framework that informs my daily to-dos and balance of urgent/important tasks.

Practice deep, active listening

A good deal of EOL doula work is listening work. The deep, active listening doulas are trained for involves holding back our own stories, comments, and feelings. Doulas don’t tell a dying person what to do. They don’t try to fix the situation. They ask open-ended questions and understand that how people move through the dying process is up to them. This kind of listening requires empathy and restraint. It insists on being free from distractions, external (cellphone notifications, I’m looking at you) and internal (like that voice inside your head that wants to judge or give advice).

As the person at a party who makes approximately 30 seconds of obligatory small talk before diving into deeply personal conversations with strangers, I assumed I was custom-built for this part of being a doula. But it can be difficult to stick to open-ended questions, to sit comfortably in silence, or to resist giving well-meaning but unsolicited advice.

So, I’ve been practicing. A lot. This kind of listening has altered what I can only think to call the texture of my time. It has made me more present, empathetic, and curious in conversations and relationships.

The next time you’re having a conversation with someone who is sharing important information or struggling in some way, you might try it. Ask open-ended questions. “How are you feeling about X?” “Do you want to talk more about Y?” Give their answers space and silence to settle.

Reflect back what you think you’ve heard. Be open to being wrong about what you think you’ve heard. Be supportive, but don’t try to fix the situation with advice or talk them out of what they are feeling. Avoid platitudes like “give it time” or “it wasn’t meant to be.” Even “I know how you feel,” well-intentioned though it is, often misses the mark because we mostly don’t know exactly how someone else feels or entirely understand their specific situation.

Of course, not all our conversations require this therapist-like level of restraint, but challenge yourself to consider that plenty of them could benefit from a touch more deep listening.

Legacy projects in the here and now

Doulas often help with legacy projects: autobiographies, letters to loved ones, art projects, and more. These projects memorialize a person’s passions and creativity, values and contributions, and — spoiler alert! — you don’t have to wait until you or someone you love is dying to work on one.

Say you’re an amateur musician. You might already know who you want to leave your beloved instruments to. However, another kind of legacy could be recording a few minutes of playing each week and saving that audio in a digital folder to be passed on down the road.

To start thinking about a legacy project ask yourself questions like what life lessons have I learned so far? What brings me joy? How do I want to be remembered? What do I love to do outside of my paid work? Consider what form best fits your legacy project and spend a little time each week or month on it.

Researchers have found that “mortality legacy awareness” can be a “highly creative force,” and that “focusing on what you would like to leave behind could help you turn something terrifying into a positive motivational tool.”

I’m encouraged by recent shifts in our societal approaches to dying, like the death positive movement, empowering trends in end-of-life care, opportunities for exploration and discussion, a transition away from hospitals and back to dying at home when possible, and the increasing number of end-of-life doulas as a community resource. Still, proactively thinking about our own death isn’t always (ever?) easy. We live in a country that tends to overmedicalize death. We are currently facing unfathomable individual and collective grief over deaths from Covid-19, ever-increasing gun violence, a lack of accessible health care, and a horrifying real-time erosion of human rights. All this in a culture desperately in need of more space for individuals to rest and to mourn.

It’s easier in the short term to distance ourselves from thinking about death. But engaging with our mortality when we have the bandwidth to do so can offer clarity that in the long term infuses our lives with more joy and meaning. You’ll be living life knowing what you want to have accomplished at the end of it. And that, I swear, is the ultimate productivity hack.

Thanks to INELDA for their fantastic end-of-life doula training. The 20 favorites exercise is my abbreviated version of the loss exercise found here.

Rachel Friedman is the author of And Then We Grew Up: On Creativity, Potential, and the Imperfect Art of Adulthood and The Good Girl’s Guide to Getting Lost. Find her on Twitter @RachelFriedman.

The 30-something life crisis

2020-01-23T10:49:22-05:00

Thirty-somethings today are less happy than their predecessors, possibly because adulthood milestones are converging in a unique-to-this-cohort way. | Shutterstock

“I know I’m getting older because my Kindle is turning into a self-help library,” says comedian Ali Wong in her Netflix special Baby Cobra.

My own early-30s self-help library was brimming with advice: on how to get my finances in order, make relationships work, and get comfortable with uncertainty. When I was 33, a divorce and an up-and-down writing career had left me wondering what my personal and professional future held.

My friends and I all seemed to be taking stock — considering having kids or feeling exhausted by new parenthood, searching for meaning in careers or seeking balance after working nonstop in our 20s — and speculating all the while thanks to social media if others were enjoying happier relationships, better jobs, and fitter bodies.

This is expected, of course. You make a plan for your life, and then life gets in the way. What is new is that we’re less happy than our 30-something predecessors, possibly because this taking-stock moment is happening during a decade when adulthood milestones — and lack of milestones — are converging in a unique-to-this-cohort way.

It’s true we already have the quarter-life crisis — I’d had that post-college “what now?” moment after quitting music school and backpacking abroad on a shoestring budget. But at 33, I was past the average age of this “real world” rude awakening. In my 30s, I knew who I was and what I wanted, but that didn’t mean everything had gone according to plan. Not by a long shot. And I wasn’t quite old enough for a midlife crisis (if it even exists). Maybe I was having a bit of both kinds of crises, another convergence of sorts.

“Adult” milestones in your 30s seem far more consequential

In our 20s, living in New York City, my friends and I were focused on our careers. We thought we had plenty of time to marry and pop out a kid or two. In our 30s, though, something shifted. Suddenly we were discussing parental leave policies and the cost of preschools over brunch with the same horrified enthusiasm once reserved for retelling bad dates.

I was 25 when I married, an outlier given the age at first marriage has “accelerated sharply, reaching a peak age of 29.1 for men and 27.8 for women in 2013,” according to historical demographer Steven Ruggles. However, the average age for a first divorce is 30, so at least I was right on track there.

While the age at which someone has their first kid varies based on geography and education, in cities like New York and San Francisco, that age is 31 and 32 for women, respectively. For American men, it’s 30.9. So, it’s safe to say that more 30-somethings than ever before are newlyweds and new parents in their 30s.

There are upsides to waiting to marry and have kids, of course. In my early 30s, I wasn’t sure if I wanted to have children. Even at 34, when I had my son, I was on the younger side of my soon-to-be-procreating NYC friends.

But for some, there can be complications to waiting. Clinical psychologist Caroline Fleck says she sees many patients who are dealing with fertility issues. “The resources for supporting families through these physically, emotionally, and financially demanding treatments” are lacking and she often sees “men, women, and marriages hanging on by a thread.”

Then add economic pressures to relationship and biology ones. The median age of a first-time home buyer is 32. (It was 29 in the 1970s and ’80s.) That is, if you can afford to buy a home given student debt, the gig economy, and rising house prices. Tara Genovese, a counselor in Chicago, notes that for 30-somethings who came out of college during the recession, “economic milestones have been pushed back.”

And then there are the more nebulous anxieties of our 30s. Nearly every therapist I spoke with over email or phone talked about unmet expectations.

“One of the main words I listen for in a session is ‘should,’” said Megan Bearce, who sees many 30-somethings. “I should have a child, I should be married by now, I should love my job.”

If people are “hoping to get married and start a family, or be at a particular place in their career, their 30s is usually when they imagine they will do so,” says Los Angeles marriage and family therapist Saba Harouni Lurie. “For those who achieved certain goals or benchmarks, they can be surprised if they are not as happy as they had anticipated.”

Lurie gently framed this gap between expectations and reality as coming as a surprise. But I and many of my friends were often struggling with something more akin to failure when it came to feeling like we weren’t living up to our potential.

The pressure to search for happiness in your 30s

Happiness peaks at different ages, depending on the study. For instance, psychologists look at raw data, University of California, Riverside professor Sonja Lyubomirsky, who studies happiness, told me. “Those studies show people get happier with age,” she said. “Economists would say it’s a U-shaped curve, with the lowest dip around 45-50. They are controlling for lots of variables, like wealth, for example.”

Happiness itself is a slippery concept. In one of my favorite studies, people in their 30s and 70s were asked what age group was happier. Both groups answered the 30-somethings, but when the researchers asked each group about their own subjective well-being, the 70-somethings scored higher.

“I find people to err systematically in predicting their life satisfaction over the life cycle,” says economist Hannes Schwandt. “They expect — incorrectly — increases in young adulthood and decreases during old age.”

For Americans, happiness has become the ultimate self-help project, which only adds to the pressure of our 30s. Thanks to a wise therapist friend who suggested it, I spent a lot of introspective time in my early 30s focused on deconstructing various abstract happiness clichés (pursue your passion! never give up! fail forward!) and replacing them with more concrete and specific definitions of personal and professional fulfillment.

There are positives when it comes to being in your 30s. It’s a more “empowered age” than your 20s, says psychotherapist Alyson Cohen. We’re clearer about what we want and more “equipped for the struggle,” as Lurie eloquently put it.

I like how therapist and coach Shoshanna Hecht sums up being in your 30s: “Whereas in the 20s, the cynicism for what’s possible hasn’t yet set in, and the ‘I know who I am and so don’t give a ____’ of the 40s hasn’t yet arrived.”

So what to do? In our 30s, we are perhaps finally old enough to heed some good life advice. Don’t compare yourself to others. Practice gratitude. Embrace the beautifully messy, ordinary adult lives most of us lead. Don’t adhere too rigidly to any one vision for your life. Be flexible and adaptable. Figure out what you want versus what you think you want and adjust accordingly.

But we need to go beyond self-actualization solutions for this overwhelming decade. We are living in an era of what journalist Barbara Ehrenreich calls “relentless optimism.” Ehrenreich dismantles the self-help premise that “The real problems in our lives are never discrimination or poverty, bad relationships or unfair bosses … but our own failure to … think positive or practice mindfulness, to ‘take personal responsibility’ or ‘count our blessings.’” She argues instead that many of the problems we face require policy solutions, not positive psychology.

We also need to intervene earlier to teach our kids that failure is a necessary and valuable part of growing up, because by our 30s we will inevitably have faced some setbacks. I’ve realized that how we handle those moments — whether we choose to see failure as evidence that we are screw-ups rather than as natural, or even admirable, consequences of taking risks — makes all the difference in being mostly dissatisfied versus mostly fulfilled. I admit I have no idea how we tackle the social media nonstop comparison problem, but we all know we’ve got one.

I’m 38 now, and there have been more plot twists in the last five years than I could have ever imagined: both significant failures and substantive successes. Maybe it’s because my (hopefully) “don’t give a shit” 40s are looming, but I take it more in stride now than I did in the earlier part of this decade.

“Welcome to middle age!” a friend recently emailed me in response to some of these 30-something musings. “Isn’t it nice to realize that the stakes aren’t quite as high as they once seemed?”

Nice, indeed.

This essay is inspired by the author’s new book, And Then We Grew Up: On Creativity, Potential, and the Imperfect Art of Adulthood.

Rachel Friedman is also the author of The Good Girl’s Guide to Getting Lost: A Memoir of Three Continents, Two Friends, and One Unexpected Adventure. Find her on Twitter @RachelFriedman.