Desert Song
Monday, July 25, 2016
Dying is hard. Death doulas want to help make it easier.
Before he enters the room, Craig Phillips pauses for a deep exhale. “Just to let everything go,” he says. “And to remember that I’m here for them.”
Until he walks in, he won’t know whom, exactly, he’s about to see. Today it’s an elderly woman in a blue hospital gown. Eyes closed. Jaw dropped open. Breathing loud and labored, but regular.
There is a little green circle by her name on the white board in the nurses’ station. Hospice center code for “actively dying.”
“She doesn’t have anyone with her,” a nurse says. So Phillips goes, pulls a chair up to her bed and introduces himself.
“I’m not here to poke or prod you,” he says softly. “I’m just here to be with you. I’m just here to sit with you.”
The work of a death doula–Phillips’s work, now–is primarily about presence. He is there to ease the passage from this world to the next. And he knows that the most valuable thing he can offer anyone taking that most solitary of journeys is his company. So he sits, silently wishing them peace and comfort.
Especially with patients who can no longer speak, Phillips has learned to slip his hand beneath theirs, palm to palm, rather than rest it on top. This way, he says, “you get an understanding of how well wanted you are.” When his grip is returned, he knows that he is welcome.
Phillips operates alone, but he is part of a growing army of volunteers and professionals who call themselves death doulas. (Some, opposed to that term, prefer end-of-life doulas, soul midwives or transition coaches.) And like the childbirth doulas from whom they draw their name, their mandate is to assist and accompany. Their patients’ experience may be quieter, more sorrowful, but it is no less sacred. Or scary.
As the baby boomers move into retirement, fresh consideration is being given to what it means to grow old, which measures to take to treat illness and, ultimately, how we die. There’s a growing recognition among hospice workers and palliative-caregivers that pain management is not enough. That the spirit must be attended to as much as the body. And that the soon-to-be-bereaved need help along with the dying.
It’s out of this recognition that death doulas are emerging. Most say they feel almost inexplicably called to the role. And profoundly touched by it.
On a sunny spring day in Alexandria, Va., 30 women and one man sit in a windowless hotel conference room, having traveled from all over the East Coast and paid $600 to learn to serve as death doulas.
“Our role is to walk alongside [the dying] in their journey,” says Henry Fersko-Weiss, president of the International End of Life Doula Association (INELDA), one of several organizations offering certification in the field.
The weekend-long training will cover the best ways to touch a dying person, when to use aromatherapy and guided visualizations, strategies to relieve overburdened family members, how to organize a “legacy project” to help capture the patient’s life, assisting at the moment of death and helping loved ones process their grief in the weeks that follow.
On the first morning, Fersko-Weiss, a social worker who worked with hospice facilities for decades before creating an end-of-life doula program in 2003, asks each of the students to recall a death that affected them. How it smelled and looked and felt. How it shaped their concept of what constitutes a “good death.”
One woman talked about her daughter’s stillborn baby. “That was the hardest hurt I ever felt,” she said. “I didn’t understand how you could take a baby who was full-term.”
Fersko-Weiss nodded and observed that she may be able to transform her pain into something that could aid dying patients and their families. “If we can touch that place of angst and anguish and despair,” he said, “it may help us to be more present to other people experiencing it now.”
Later, the prospective doulas talk about their reasons for coming. Several had had negative experiences with the death of a close relative. A few were birth doulas who wanted to assist with the exit from, as well as the entrance into, life. One woman had suffered a brain injury and a near-death experience. All said that they wanted to be of service in a way that would make this final transition somehow better for others.
They will be called upon to fill all kinds of roles, Fersko-Weiss told them. Sometimes patients may need help with physical care; other times, families will need assistance with errands or household chores. In all cases it will be a doula’s job to listen, without judgment, to honor the experience of both the dying person and their loved ones, and to facilitate meaningful interactions between them. “As a doula, it’s important to encourage people to say everything they need to say,” Fersko-Weiss explains, “so that they don’t look back and really regret it.”
Craig Phillips’s path to end-of-life doula work wasn’t straight, but he thinks he was always inching toward it. He grew up in Wilkes-Barre, Pa., next-door to a cemetery that served as his playground. In college, he had a chance meeting with Elizabeth Kubler-Ross, the famed psychiatrist whose groundbreaking work shaped our modern understanding of death. And all through his life, Phillips has had an intense awareness of his own mortality.
At 61, he has the look and presence of a yogi, but he spent most of his adult life in the corporate world. Several years ago, his sister called, saying that her ex-husband was suffering from advanced ALS and living in a facility very close to Phillips’s Baltimore home. So Phillips went to see him. And kept going, two or three times a week, for the last 2½ years of the man’s life.
“I’d bring him flowers,” he recalls. “I’d tell him stories. I’d take oil over and rub his feet, stuff like that. Just devoted myself to him. And it was a beautiful thing.”
A man in Phillips’s running club mentioned volunteering as a death doula, so when he retired last fall, he linked up with Gilchrist Hospice Care, which serves more than 750 patients daily in the Baltimore area and established its own end-of-life doula program in December 2009. It has since grown to more than 150 volunteers.
After 20 hours of training in January, Phillips spent a morning shadowing a mentor doula at Gilchrist’s facility in Towson. “We walked into a patient’s room, and she said, ‘Isn’t this person beautiful?’ I could see that they were. And she said, ‘Yes, all my patients are beautiful,’” he recalls. “You walk into a room and there’s someone there with their mouth open, looking very near death. Perhaps no teeth in their mouth and a three-day beard or whatever. And I look at these souls and they’re beautiful. It’s the oddest thing. Their guard is down. They’re just who they are in their most real, beautiful state.”
Several days a week, Phillips spends time volunteering either at the Towson hospice center or at patients’ homes. He has helped long-term-care patients communicate with a letter board and even washed a dog for a family that needed assistance with the chore. On his weekly visits to an elderly man who was still alert, Phillips brought videos of the patient’s favorite big-band performances.
But with many patients, Phillips just sits, quietly meditating and sending good wishes. He tells them that they are safe. And that they are not alone. One woman was unable to speak, but when he said goodbye after three hours, “she mouthed the words ‘Thank you’ and held out her hands like I was dear to her,” he says.
The work has also produced an unintended side effect. It has pushed Phillips’s awareness of mortality even further to the forefront of his mind.
And happily so.
“The more immediacy, for me, that I have of this,” he says, “the more appreciation I have for every day, every minute.”
Saturday, July 23, 2016
Friday, July 22, 2016
Why We Don’t Follow Through on What We Set Out to Do and What to Do About It
By the summer of 1830, Victor Hugo was facing an impossible deadline. Twelve months earlier, the famous French author had made an agreement with his publisher that he would write a new book titled, The Hunchback of Notre Dame.
Instead of writing the book, Hugo spent the next year pursuing other projects, entertaining guests, and delaying his work on the text. Hugo’s publisher had become frustrated by his repeated procrastination and responded by setting a formidable deadline. The publisher demanded that Hugo finish the book by February of 1831–less than 6 months away.
Hugo developed a plan to beat his procrastination. He collected all of his clothes, removed them from his chambers, and locked them away. He was left with nothing to wear except a large shawl. Lacking any suitable clothing to go outdoors, Hugo was no longer tempted to leave the house and get distracted. Staying inside and writing was his only option.
The strategy worked. Hugo remained in his study each day and wrote furiously during the fall and winter of 1830. The Hunchback of Notre Dame was published two weeks early on January 14, 1831.
Human beings have been procrastinating for centuries. Even prolific artists like Victor Hugo are not immune to the distractions of daily life. The problem is so timeless, in fact, that ancient Greek philosophers like Socrates and Aristotle developed a word to describe this type of behavior: Akrasia.
Akrasia is the state of acting against your better judgment. It is when you do one thing even though you know you should do something else. Loosely translated, you could say that akrasia is procrastination or a lack of self-control. Akrasia is what prevents you from following through on what you set out to do.
Why would Victor Hugo commit to writing a book and then put it off for over a year? Why do we make plans, set deadlines, and commit to goals, but then fail to follow through on them?
One explanation for why akrasia rules our lives and procrastination pulls us in has to do with a behavioral economics term called “time inconsistency.” Time inconsistency refers to the tendency of the human brain to value immediate rewards more highly than future rewards.
When you make plans for yourself–like setting a goal to lose weight or write a book or learn a language–you are actually making plans for your future self. You are envisioning what you want your life to be like in the future and when you think about the future it is easy for your brain to see the value in taking actions with long-term benefits.
When the time comes to make a decision, however, you are no longer making a choice for your future self. Now you are in the moment and your brain is thinking about the present self. And researchers have discovered that the present self really likes instant gratification, not long-term payoff. This is one reason why you might go to bed feeling motivated to make a change in your life, but when you wake up you find yourself falling into old patterns. Your brain values long-term benefits when they are in the future, but it values immediate gratification when it comes to the present moment.
This is one reason why the ability to delay gratification is such a great predictor of success in life. Understanding how to resist the pull of instant gratification–at least occasionally, if not consistently–can help you bridge the gap between where you are and where you want to be.
Here are three ways to overcome akrasia, beat procrastination, and follow through on what you set out to do.
Strategy 1: Design your future actions. When Victor Hugo locked his clothes away so he could focus on writing, he was creating what psychologists refer to as a “commitment device.” Commitment devices are strategies that help improve your behavior by either increasing the obstacles or costs of bad behaviors or reducing the effort required for good behaviors.
You can curb your future eating habits by purchasing food in individual packages rather than in the bulk size. You can stop wasting time on your phone by deleting games or social media apps. You can reduce the likelihood of mindless channel surfing by hiding your TV in a closet and only taking it out on big game days. You can voluntarily ask to be added to the banned list at casinos and online gambling sites to prevent future gambling sprees. You can build an emergency fund by setting up an automatic transfer of funds to your savings account. These are commitment devices.
The circumstances differ, but the message is the same: commitment devices can help you design your future actions. Find ways to automate your behavior beforehand rather than relying on willpower in the moment. Be the architect of your future actions, not the victim of them.
Strategy 2: Reduce the friction of starting. The guilt and frustration of procrastinating is usually worse than the pain of doing the work. In the words of Eliezer Yudkowsky, “On a moment-to-moment basis, being in the middle of doing the work is usually less painful than being in the middle of procrastinating.”
So why do we still procrastinate? Because it’s not being in the work that is hard, it’s starting the work. The friction that prevents us from taking action is usually centered around starting the behavior. Once you begin, it’s often less painful to do the work. This is why it is often more important to build the habit of getting started when you’re beginning a new behavior than it is to worry about whether or not you are successful at the new habit.
You have to constantly reduce the size of your habits. Put all of your effort and energy into building a ritual and make it as easy as possible to get started. Don’t worry about the results until you’ve mastered the art of showing up.
Strategy 3: Utilize implementation intentions. An implementation intention is when you state your intention to implement a particular behavior at a specific time in the future. For example, “I will exercise for at least 30 minutes on [DATE] in [PLACE] at [TIME].”
It seems simple to say that scheduling things ahead of time can make a difference, but as I have covered previously, implementation intentions can make you 2x to 3x more likely to perform an action in the future.
Our brains prefer instant rewards to long-term payoffs. It’s simply a consequence of how our minds work. Given this tendency, we often have to resort to crazy strategies to get things done–like Victor Hugo locking up all of his clothes so he could write a book. But I believe it is worth it to spend time building these commitment devices if your goals are important to you.
Aristotle coined the term enkrateia as the antonym of akrasia. While akrasia refers to our tendency to fall victim to procrastination, enkrateia means to be “in power over oneself.” Designing your future actions, reducing the friction of starting good behaviors, and using implementation intentions are simple steps that you can take to make it easier to live a life of enkrateia rather than one of akrasia.
