“What do you do for a living?”It’s a common conversation starter. Fortunately, end-of-life (or death) doula, Melissa Murphy, has found that her response has not killed a conversation yet.
“I haven’t found anybody personally who says, ‘OK that’s nice, I’m going to go over here and talk to somebody else,’” she smiles.
“They actually want to talk to me and they want to tell me a story or share something that’s ‘coming up for me now’ and they just open right up.”
Some readers might be familiar with the term “birth doula”: a trained companion, who is generally not a healthcare professional, but is there to provide physical, emotional and educational support through a person’s pregnancy, birth and even post-partum.
As Melissa sees it, an end-of-life doula provides similar care; and ultimately, encourages people to think about what they would like their death to look like.
“We can’t plan everything obviously, because we just don’t know how it’s going to look really, but we can start to look at it the way that we would give that care to other celebrations like weddings and births,” she explains.
“To not wait until death is on the doorstep or there’s a crisis. Pre-planning can be so, so helpful and bring, I think, a lot of peace and calm to people who are open to it.”
Part of psyche
As she chats from her home in Glengarriff, west Cork, Melissa sips from a Dia De Los Muertos (Day of the Dead) mug, joking that she chose it especially in anticipation of our conversation.
“I don’t know what it is,” she responds of her lifelong fascination with death, “but it’s always been a part of my psyche.”
Raised in Rochester, New York, she recalls a childhood memory of her mother – the daughter of a Derry man – reading the obituaries in the local paper.
“I understand that’s a very Irish thing,” she says, explaining that from a young age, she felt a draw towards old cemeteries and even took an elective in high school on “life and death”.
Indeed, having trained as a clinical social worker, one of Melissa’s first jobs was in a nursing home, where she became fascinated by the work of the visiting hospice team.
“I was just in awe of what they were doing,” she explains; so much so that she soon applied for a job there. Other roles followed, but it was working with patients at end-of-life that proved most fulfilling.
“I remember some of them still,” she says.
Life took an unexpected twist when Melissa – then living in California – signed up for an Irish language class and met her future husband, who has heritage in north Cork and dual citizenship. The couple came on several holidays to Ireland, but after a three-month stint in the winter of 2016, fell in love with a house in Glengarriff and decided to stay.
Initially, Melissa planned to work as a social worker and was in the process of registering in Ireland; but something was missing. “I wasn’t really on fire about doing that,” she recalls.
While attending a talk by a funeral director at a historic cemetery in New York on a trip home, however, she accidentally stumbled on to a whole new pathway.
“She mentioned ‘end-of-life doula’ and that was the first time I’d ever come across that word in 2016. And when I heard it, I felt I was instantly familiar with it. And it’s like, ‘Oh, that’s what I’m supposed to be doing, perhaps,” she recalls of her Eureka moment.
While there is no official licensing, regulation or specific training for end-of-life doulas, Melissa did an introductory training course with the International End of Life Doula Association in 2017 and has continued to study death, loss and grief; for instance, with the Elizabeth Kübler Ross Foundation (Kübler Ross was a psychiatrist and hospice pioneer who came up with the theory of the five stages of grief).
Her first clients were neighbours, but since then, she has worked with people locally and nationally, both in person and online.
Melissa explains that the doula is not there to replace the medical team, priest or solicitor – who all traditionally play a role in end-of-life matters – but to complement their work in a holistic way, through education, pre-planning practicalities or simply being a listening ear, or “holding space”.
Perhaps it’s easiest to explain through examples. One client is a man who has been diagnosed with motor neuron disease. Over eight months, Melissa worked with him to define his wishes; from exploring where he might want to be buried to the atmosphere he would like in the room in his final hours.
“What he would want ideally in the room if possible – personal things, music, books. Literally people he would want to visit, there’s people he doesn’t want to visit,” she elaborates.
“So he wanted to put all this in writing and just be able to share with somebody else, myself, and more importantly his son, so they can be familiar and hopefully advocate for him in case he’s not able to speak for himself.”
Another client, meanwhile, had a very particular focus.
“The thing she was most concerned about was where was her dog going to go,” explains Melissa, “and it was really important to her that he stayed close to the house where she lived.”
Melissa also works with people caring for loved ones who are reaching end-of-life. For instance, this might include supporting the person to start talking to their partner about what their wishes might be.
“‘Oh my gosh, we never had any conversations about what he would want or what he wouldn’t want in terms of his medical care; how do I begin to talk to him about that?’” Melissa relates of a recent conversation with one carer whose husband received a terminal diagnosis.
“‘And what are some ways to take care of myself as a caregiver?’ And a lot of time, they know what to do, but they just want to be validated and heard.”
Melissa can be involved in the process as little or as much as the client wishes – for instance, at their bedside in their final hours, if appropriate – but her ultimate aim is to “empower” them to advocate for themselves.
She has noticed that more people are getting in touch at an earlier stage; but that everybody could benefit from starting to think and talk about death more openly.
“It will come – that’s the one thing we know for sure. So I kind of feel we do more harm in not talking about it,” she says, though acknowledges that she herself sometimes struggles with superstitions and can understand the reluctance.
In an effort to encourage more conversation, Melissa has been to the forefront of the “death café” movement in Ireland; running events in Bantry since 2018, when 50 people turned up.
“The coffee, tea and cake is a selling point,” she laughs, but fundamentally, it’s just a chance for people to discuss all aspects of death.
“They can listen and not say a word or they can say, ‘Hi, my name is Melissa and I came because I feel really curious about this subject and we don’t talk about it enough’ or ‘I came because my friend died last year’ or ‘I’m afraid what’s going to happen to me when I die, I don’t know where I’m going’ or ‘I don’t believe in life after death’ or whatever. People just want to talk about it,” she explains, though stresses that it is not a support group.
In Ireland, we think we’re “good” at death due to our funeral traditions, but are there parts we’re not so great at? asks Irish Country Living.
Reflecting on the question, Melissa says the pressure to go “back to normal” after the initial mourning period can be difficult, while others not mentioning their loved one’s name – often for fear of causing upset – is not always helpful either.
“They have already been through the worst thing possible,” she counters. “It’s not going to make it any worse to say, ‘how are you?’ or to say someone’s name or to tell a story about them.”
Starting the conversation
As a doula, Melissa works on a donation basis, but on average this ranges from €50-€100 for a two-hour session, either online or in person. Separately, she works with CoAction West Cork, which supports children and adults with intellectual disabilities and autism.
She continues her journey of “bearing witness” to grief and loss; just this week, she completed a retreat at the concentration camps of Auschwitz-Birkenau, and later this year will travel to India to a town where cremations are carried out on the banks of the Ganges.
How does being so immersed in death impact her daily life?
“I wake up today and I’m like, ‘I’m alive and my husband’s alive and my dogs are alive,’” she responds. “And I just have this sense of, even if things are heavy, I’m able to kind of see and really feel all that I have in a way that I haven’t before.”
That said, she admits that she struggles herself to really believe that one day, she too will die.
“There is a part of me that still goes, ‘I’m sitting talking to you now, but one day I’m going to disappear, not going to be here at all.’ In this body anyway,” she says.
Does she fear it?
“For me, the idea of having somebody die is almost worse than my death myself … but I definitely have my moments,” she says, explaining that her greatest fear is not being “present” or being very ill for her eventual passing.
“I’m the worst sick person!” she jokes.
“When I think about it, I don’t feel afraid,” she smiles. “It really kind of resonates with me that there is something just beyond my wildest dreams, just beyond words.
“There are moments too at the same time where I think, ‘Oh my God, there could be nothing’… But first I choose to think it’s going to be one heck of an adventure.”
How can you start the conversation at home?
“Maybe start with really, really little pieces; like if you only had a couple of days to live, what would be the food that you would have to have or what song, whether serious or as a joke, would you love to have to go out with a bang with?” responds Melissa.
“I think that is the way forward, maybe make it light for people who don’t have to talk about it, it’s not at their doorstep, but they want to start talking to their family. And I think a lot of time it’s like starting the conversation yourself.”
Conversations on grief
Also this week, psychotherapist Claire Forde writes about disenfranchised or “forbidden” grief, while next week, Sarah McIntosh will be delving into the hard financial conversations we should all be having to safeguard ourselves.