Death doulas are supposed to be calm, reassuring, and nonjudgmental, but this one needs to break free and be brutally honest for a minute. Here goes: I’m getting pretty tired of the relentless clickbait and online conversations, even here on Substack, about AI stealing our jobs. The rise of the machines, as portended by countless sci-fi novels and movies, YouTube podcasters, and more than a few conspiracy theorists.

But there is another side of this conversation that’s getting lost in the din. The future of work isn’t just a story about what AI will take from us. It’s also a story about what it may reveal about us, what we value, what we are willing to fight to preserve, and what turns out to matter even when a machine can imitate the finished product.

We all tend to look at the world through the lens of our own experience. Mine happens to be as an end-of-life doula. Which makes this particular question quite literally a matter of life and death.

Yes, I understand the general concern. And it’s not trivial. People I know are losing work and jobs. Some kinds of employment will disappear entirely or change dramatically, just as lamplighters, switchboard operators, and film projectionists have essentially evaporated over the past century. Entire professions may have to reconsider what they do… and why they do it. Very legitimate questions are floating around about privacy, misinformation, concentration of power, surveillance, bias, and what happens when increasingly complex AI systems are put into the hands of people who aren’t particularly comfortable or competent using them.

But underneath much of this is another interesting question, one that I think we’re only beginning to recognize. What happens to our understanding of ourselves when we build something that can do some of the things we have previously considered to be evidence of human uniqueness or superiority?

Philosophers, theologians, writers, scientists, and ordinary people like you and me have been wrestling for ages with just this kind of question: what it means to be human. What’s different now is how many of us are confronting it at exactly the same time, through a device we can actually interact with. Previous generations could imagine intelligent machines, write stories about them, and wonder whether they had consciousness. They could also build machines that were astonishingly powerful, machines that flew in the air and devices capable of blowing things up. But until recently, they couldn’t sit down with something that would discuss grief with them, write a poem, explain a complicated concept, help with a legal question, create an image, brainstorm ten possibilities, and then ask the user what they meant by something they had just said.

This puts a very personal and delicate question on the table: If a machine can do some of the things I do, what exactly makes me valuable as a working professional? What vulnerabilities are exposed?

Even before I became a hospice worker and end-of-life doula, I saw people avoiding hard questions. When I practiced law, some of the firm’s clients would put off writing their wills and advance directives. They couldn’t, or in many cases didn’t want to, imagine themselves becoming old, sick, or dependent on someone else. It was easier for clients to entirely avoid the subject than to contemplate the possibility that the person they understood themselves to be would inevitably change over time. We resist imagining that which threatens our sense of self, whether that is physical decline or intellectual obsolescence.

AI is creating a similar confrontation, on a much larger scale. We’ve spent much of our lives being measured and evaluated as human doings, rather than human beings. We were taught to value ourselves by what we accomplish, what we know, what we produce, and how useful we are to other people. Then along comes a technology that can potentially produce more, know more, and process information faster than we can. That can be terrifying, especially to someone who measures their worth by how productive they are.

But what if we treated this resistance as an invitation to examine what it is we’ve been avoiding? Things like: What happens to my identity as an intelligent person when AI lets anyone keep up? What happens to my job if AI can do my work faster and more accurately? What happens when AI produces visual art and music that is indistinguishable from that created by humans?

AI may be forcing us to look at the qualities we associate with being human. There’s something almost circular about that. We created a technology capable of mimicking astonishing amounts of human output. And in doing so, it made us ask which parts of ourselves were never really about output in the first place.

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Most of us didn’t begin life believing that our worth had to be earned. A baby doesn’t criticize herself for “having done childbirth wrong.” She doesn’t compare her performance to the other babies in the nursery. She doesn’t wonder whether she has contributed enough this quarter.

As she grows, she learns. Don’t touch the hot stove. Stay away from the balcony. Don’t throw your toys. Don’t run over your brother with your tricycle. Eat your vegetables. Be good. Say please and thank you.

Much of this is necessary. Children need to learn boundaries, and some of those boundaries are matters of safety and survival. We also learn that certain behaviors bring rewards, while others make something we want disappear. We get a cookie for being good. We lose television for misbehaving. We get praised for doing the things adults approve of and corrected or punished for doing the things they don’t like. All the while being told that we are “good” or “bad.” Not our actions. Us.

So it’s no surprise that somewhere along the way, many of us start confusing what we have done with who we are. If you measure yourself by your accomplishments, what happens when someone or something takes away opportunities for you to achieve? If your identity is built around what you produce, then a machine that can produce faster, cheaper, and sometimes better is essentially terrifying. You feel diminished and your self-esteem takes a hit. If this is true, then is it any wonder why so many are against AI?

And importantly, death doulas know how to accompany someone whose identity is being stripped away by something they feel they cannot control. We’ve seen that this process doesn’t make them any less human. As someone dies, their life accomplishments become less relevant, while relationships and presence become more important. So we’re the ones who can shepherd someone through a time when AI is making them feel that their old ways of life are dying. We can remind them that their value also includes how they inhabit the world, that productivity was never the full measure of them.

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Another distinction matters here: accumulated information and lived experience. For instance, a person can read a book about performing brain surgery. That’s very different from standing in an operating room with an actual knife and another person’s life in your hands. The first describes the mechanics of an experience, giving the reader an understanding of the skill involved. The second is the skill in practice, which means more than knowing how to do something. It’s the difference between understanding Picasso’s distinctive painting style and actually picking up a brush and painting a Picasso yourself.

AI has extraordinary access to information. It can draw connections among vast amounts of material and offer perspectives that a single human being could never gather in one lifetime. But information alone does not become lived experience. A human being has to carry that knowledge into the world, encounter its consequences, and feel them.

The same distinction applies to emotions. An AI can recognize the language of grief and express condolences in a manner that we might interpret as kind. But AI has never crumpled to the floor upon hearing terrible news. It has never shed tears of joy at a wedding or the birth of a child, or beamed with pride at a child’s music recital. Simply, AI does not have the kind of felt empathy that humans experience.

This matters enormously when one human being sits beside another at the end of life. A death doula doesn’t simply retrieve information about dying. He or she brings a lifetime of felt experience into the room, along with the ability to recognize what another person may be feeling without needing it explained. AI can generate screen after screen of words that a grieving person might find meaningful. But it can’t offer the warmth of a hand held, the steadiness of a person sitting quietly beside a bed, or the reassurance that comes from another human being simply being there.

Ultimately, AI can know a great deal about what it means to die and grieve. What it cannot do is know what it means to be human in the face of death.

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I recently read an article that described bereavement counselors as the “last responders.” I understand the thought, but I disagree with the label. Bereavement support often begins before a death, when families are already experiencing anticipatory grief. So the counselor may enter the picture while the dying person is still alive. More importantly, bereavement counselors are not meant to remain indefinitely. They provide skilled support, help people navigate the early terrain of grief, and then move on to their next client (as they should.) By that point, the support system has ideally transitioned to family, friends, neighbors, faith communities, volunteers, and others who can continue showing up long after the professional has stepped away.

One clarification is important here. Bereavement counselors are not necessarily licensed therapists, and their role can be quite different from that of a mental health clinician. While many bring impressive training and experience in grief and bereavement, their work is more like first aid: providing immediate support, helping someone through a difficult moment, recognizing when something is beyond their scope, and helping to stabilize the situation until any needed additional care is available. Even if bereavement were linear, which it is not, the counselor is not the last responder. Instead, they are one part of a much larger circle of care.

Could or should AI also be part of that circle? Obviously, the answer is different for everyone. A year ago, before I became involved with hospice work full time, I would have responded with an emphatic “no.” Today, I’m more open to how some might find it useful, particularly someone who has no reliable human support network or who has thoughts that they aren’t ready to say to another human being.

For instance, a grieving person may have a thought that feels terrible, selfish, or frightening. They may need somewhere to put the thought before they are ready to bring it into a human relationship. AI is available at three in the morning; it doesn’t need to sleep. It doesn’t have its own grief to manage or its own feelings to protect. It doesn’t have a personal relationship to protect, so it can offer perspective without having a stake in the family drama. AI can help someone find words, consider possibilities, or help someone talk through something that feels too raw to say aloud. It doesn’t need anything from the grieving, and it doesn’t get tired of hearing the same story over and over again. It can take a half-formed thought and help someone examine it from ten different directions.

Real friends and family have significant value, too, even in a digital age. They’re there when the internet goes down… and ChatGPT goes silent. They can drive across town. They can bring soup. They can sit in your house when you don’t want to talk. Unlike AI, they can not only speak the language of compassion, but also embody it, and in doing so share the weight the bereaved carry. They aren’t an outside observer of the human experience. They’re other humans accompanying someone through one of life’s most painful and profound experiences.

Yes, people also have their own lives, needs, and limitations. They sometimes disappoint you. They sometimes need you to support them at the same time that you need them to be there for you. They also grow old and die. But these inconveniences are part of what makes a human relationship real.

At the same time, AI can provide something valuable that is difficult for another human being to offer: perspective without personal entanglement. It isn’t your sister who has been arguing with you about Mom for six months. It isn’t your friend who is secretly hoping you’ll make a particular decision. It isn’t your grieving spouse whose own pain changes what they can hear and how supportive they can be. Sometimes that distance is useful.

That said, therapists, licensing boards, and bereavement specialists have good reasons to be skeptical of AI as a replacement for counseling. Again, having the world’s information at your fingertips is not the same thing as having a lifetime of lived experience in a particular field. A good therapist or counselor develops judgment and pattern recognition by sitting with actual human beings over and over again. They learn when a pause matters, when a statement is a warning sign, when someone needs to be challenged, and when they need to be left alone with a thought. While AI has breadth, a skilled practitioner develops depth.

I have other concerns. AI can also be wrong, and often is. Someone in profound grief may be poorly positioned to recognize when a confident and compassionate-sounding answer has gone off the rails. Not that this can’t also happen when a human is doing the advising, but a human being is ultimately responsible for the advice they give in a way that a machine is not. A counselor can be questioned, challenged, corrected, or held accountable for what they say. An AI can give you a bad answer at three in the morning… and fawningly give you another bad one at 3:05.

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AI is forcing us to examine some of the things we have historically used as evidence of our value. We think, write, create, solve problems, and accumulate knowledge. So does AI. That can feel like a threat if we’ve built our identity on our mastery of these skills. Now that these abilities aren’t exclusively ours, what exactly should we continue to value about them?

What many forget is that proficiency is more than the ability to produce a competent result. We usually think of it as a process: noticing what we do not yet know, practicing, improving, failing, adjusting, and carrying what we learned into the next attempt. That process seems to require some degree of consciousness… or at least an internal experience of intention. A machine may produce the same result as someone who is proficient. But it hasn’t practiced, struggled, improved, or wanted to get better. The output may look the same, but only a human being can have their heart and soul invested in the outcome.

People who have struggled to attain something often come to value the struggle itself. So when someone appears to receive the same benefit without going through that process, it can feel like the other person “cheated.” The venomous online comments directed at people who lose weight with Ozempic are a good example of this. There, the anger isn’t always about the weight loss itself. Sometimes it comes from seeing someone reach the destination by a road you had to walk the hard way. That someone else lost weight while still eating all the “bad” foods and not having to endure hundreds of hours of exercise. I’m not sure whether it’s possible to be jealous of AI. But watching it produce in seconds something that took a human years to learn can still trigger a powerful sense that something about the process is unfair.

I once thought the pandemic might begin a digital-age renaissance. I’d imagined people creating, thinking and loving, now that they’d been given a sudden and unexpected interruption from ordinary life. I was wrong: people self-soothed from their sofa, watching Tiger King and whining about their favorite restaurant being closed.

Maybe AI is the real disruptor. If something else can do certain things better than we can, then what?

Some people are meeting this moment with fear. Some will see AI as a snake in the Garden of Eden, seductively tempting us with knowledge and leaving us to wonder about the price. Others say AI has no power except the power we give it. Both ideas contain points worth considering.

The first human who figured out how to make fire must have been spectacularly excited. Fire cooks food. It keeps people warm. It provides light. It can forge tools. It can also burn down the house and cause permanent harm when it is misused. So with our knowledge of how to create fire also comes the responsibility to use it responsibly. The same is true with AI.

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Walk into a hospice house and you might notice the following: Medical staff come into and out of the patient’s room all day long. Visitors also come and go, sometimes bringing family pets. The kitchen staff leaves out fresh baked goods for patients and their families. Depending on the day, the scent of sugar cookies, blueberry muffins, or chocolate brownies wafts down the corridors. A musician softly plays guitar or flute in a hallway or a bedroom. There also may be a piano in the living room, for anyone willing to work the keys. A family member reads a book or shares a photo album. A volunteer sits next to a bed. While the medical staff uses portable electronics, TVs may be playing, and machines deliver IV fluids, what is most notable about the environment is not the gadgetry. Rather, it’s the human presence.

I don’t believe that the future will require us to choose between humans and machines. There will undoubtedly be places and situations too unsafe for humans where machines can provide care: a war zone, another pandemic, a disaster area, an isolated community, or a situation where someone is dying and no trained human can safely reach them. A robotic death doula might someday provide conversation, music, physical comfort, observation, and connection when a human cannot safely enter the room.

That doesn’t make the machine a replacement for a human death doula, any more than a bomb-disposal robot is a replacement for the human bomb expert operating it. The robot’s value comes precisely from doing a dangerous physical job that a human could do, but shouldn’t have to risk doing. The same principle could apply to end-of-life care. There may be circumstances in which a machine can provide a presence when a human cannot. But that is very different from asking a machine to replace the human experience of accompanying another person through grief, dying, and death.

The goal shouldn’t be to make machines more human. It should be to use what machines can do well to make sure humans can keep doing what only humans can do.

We don’t have to reject technology because it isn’t human. But we do have to become more deliberate about which parts of our humanity we are willing to delegate. Some things will always remain exclusively human: the hand that holds yours, the person who notices the change in your voice, the hug, the look across the room when someone understands without an explanation, the person who has enough life experience to recognize that the thing you just said isn’t really what you meant, the person who knows that fear because they have felt it, the person who has lost someone too, and the person sitting beside you who knows, just as you do, that this life ends.

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In William Shakespeare’s The Merchant of Venice, Shylock asks: “Hath not a Jew eyes? Hath not a Jew hands, organs, dimensions, senses, affections, passions?” He is arguing against the prejudice and dehumanization directed at Jews, insisting that whatever people may believe about his religion or identity, he experiences the same physical and emotional realities as anyone else. He goes on to ask, “If you prick us, do we not bleed?” His argument is fundamentally about shared, embodied human experience.AI can describe bleeding, grief, joy, fear, and death with extraordinary precision, but it does not have the body that bleeds or the life that experiences those things.

Shylock’s question has lasted for hundreds of years because it gets at something fundamental. We make choices. We create meaning. We form relationships. We suffer losses and celebrate victories. We love people, and people love us. None of that becomes less valuable because a machine can perform something we once considered uniquely human.

And depending on your faith, there is an even older answer to the question of why a human being matters: you are a child of God, created in His image. (Not ChatGPT’s.) Your worth was never contingent upon having some skill that a machine could not reproduce.

Perhaps the strangest gift AI may eventually give us is the realization that we were asking the wrong question. We have spent so much time asking what humans can do that machines cannot. Maybe we should spend some of that time asking what kind of humans we want to be when machines can do many of the things we once thought made us special.

When my grandparents died, I focused on what most families focus on: being present, saying goodbye, and making sure the people we loved were cared for. I knew there were nurses and hospice professionals involved, but I didn’t think much about the people behind the scenes who helped make those final days as peaceful as possible.

Years later, when my mother-in-law was dying, I was the family member with the most flexible schedule, so I offered to sit with her. I didn’t even know the term “vigil sitting” then.

What stayed with me was the quiet skill of the hospice team. They explained what was happening, prepared me for the physical changes I would see, and showed me how simple acts of presence mattered: holding her hand, playing music, reading to her. They cared for her, but they also cared for us.

I didn’t walk away that day thinking I should become a death doula. That realization came a few months later. But when I eventually learned more about hospice and end-of-life work, I recognized something: the way I naturally showed up for people aligned with the kind of care this work requires.

So how do you know if hospice work might be calling you?

You’re the person who stays steady when others are overwhelmed.

Every family has someone who becomes calmer when things become harder. You may not have all the answers, but you can take a breath, listen, and figure out what needs to happen next.

In hospice work, that steadiness matters. A dying person and their family don’t need someone who has everything perfectly figured out. They need someone who can bring a sense of calm into a difficult situation.

You can sit with discomfort without trying to fix it.

We live in a culture that often wants to rush past grief. We search for silver linings, explanations, or ways to make the pain smaller. Hospice asks for something different.

Can you sit beside someone who is hurting without needing to make the hurt disappear? Can you allow silence to exist? Can you simply say, “I’m here”?

Sometimes presence is the gift.

People trust you with their stories.

Have you noticed that people tell you things?

A stranger starts sharing their life story while you’re waiting in line at the supermarket. Friends come to you when they’re struggling with a major life decision. People sense that you’ll listen without judgment.

Hospice workers are invited into some of the most personal moments of a person’s life. The ability to listen with respect and compassion is a requisite.

You notice the needs other people miss.

Hospice care is often found in small details. Whether someone needs a blanket. If a caregiver hasn’t eaten. When a family member needs a quiet moment alone.

This work isn’t only about profound conversations. It’s also about paying attention and doing what needs to be done without fanfare.

Ordinary acts of care feel meaningful to you.

A lot of hospice work isn’t dramatic. Holding a hand. Straightening a pillow. Listening to a favorite song. Looking through old photographs. Sitting quietly in a room when there’s nothing that needs to be said.

If those small moments feel important to you, you may understand something essential about this work.

You can support without taking over.

Hospice is not about directing someone else’s death.

Every person and every family has their own values, beliefs, relationships, and choices. The role of a doula or volunteer isn’t to write the story. Rather, it’s to help create the conditions where someone else can live their remaining life as fully as possible.

You don’t need to be fearless.

People sometimes imagine hospice workers as people who are completely comfortable with death. Most times, that’s not the case.

Many of us are simply people who have learned that fear and compassion can exist together. We can feel sadness and still show up. We can be affected by loss and still remain open to connection.

Your heart stays open.

This may be the hardest quality to define. Hospice work will expose you to grief, pain, and the unfairness of life. These things will unquestionably affect you. The question is whether they make you close yourself off or whether they deepen your ability to care.

Not everyone who’s drawn to hospice work has a dramatic moment of knowing. More often, there’s no single sign or perfect moment of clarity. It isn’t about waiting until you have no doubts. Doubt is part of trying something new. Sometimes, the first step is simply recognizing the ways you already care for others and being willing to follow that path. Even if you didn’t realize at the time that it was leading you here.

But end-of-life work has also taught me that preparation has its limits. That there are times when the most loving thing we can do is remain present without knowing exactly what comes next.

As a planner, I’ve always found uncertainty difficult. I prefer clarity. I like to understand what’s happening and have some sense of what comes next.

This isn’t necessarily a bad thing. The desire to assess a situation can help us advocate, prepare, and care for others well. But it can also create rigidity and tunnel vision. End-of-life work asks something different of us. It requires us to stay present even when there are no easy answers. To be flexible and consider other viewpoints and possibilities.

I learned that lesson again recently through my (former) client S, who spent her career in the helping professions. Dementia has taken many things away from her, but it hasn’t stolen her innate desire to be of service.

S folds dish towels in the kitchen. She brings folded laundry to patient rooms. She notices when someone is having a difficult day and reaches out to place a hand on their shoulder. And she calls me “Kiddo.”

S reminds me that being a helper isn’t just something we do. Rather, it’s something woven into who we are.

When S came off hospice unexpectedly a few weeks ago, I found myself grieving in a way I hadn’t expected. I’d imagined having more time with her. Opportunities to walk her through her final weeks or months. Chances to notice gradual changes and to prepare myself for a final goodbye.

Instead, the timeline changed and the anticipatory grief I had been carrying for years had nowhere to go.

Because S was my only client at this particular facility, I won’t have the opportunity to watch her from a distance as the rest of her life unfolds. I won’t know every chapter that comes next. I’ll have to trust that things are proceeding as they should, even though I’m no longer there to personally witness them.

That’s a hard lesson for someone like me who wants solid answers. But that’s also one reason why I feel this work is changing me.

We often talk about finding our calling as if it means discovering work that perfectly matches who we already are. And sometimes it does. But other times, it asks us to grow in the very places where we feel least comfortable:

• The person who values certainty learns to sit with the unknown.

• The one who wants to fix things finds out that presence is sometimes the greatest gift.

• And the person who wants to understand every part of the story comes to recognize that some chapters will remain unfinished.

This doesn’t mean we have to stop being who we are in order to be a “good” caregiver. Quite the opposite. The very mixture of traits that make us unique is also what allows us to help others in a one-of-a-kind way.

I’ve come to believe that the saying about “helpers receiving more than they give” isn’t just a comforting phrase. And it’s certainly not about “keeping score” or making caregiving transactional. Rather, the gift we receive from caring for others is transformation. And we honor that gift by allowing it to happen.

So maybe personal growth doesn’t require us to change or reject our basic wiring. Perhaps it’s more about stretching and expanding what we can already hold.

Every person we accompany teaches us something. As do the families we sit with and the bedside conversations we have with them. These are also the moments when we realize that while we can’t “fix” anything, we still have a lot to offer.

S can’t do everything she once did. But she continues to find ways to bring comfort and kindness into the lives of those around her. Like her, we can also work with what we have.

It could be that our becoming the person we’re meant to be isn’t about arriving at some special place where we finally have all the answers. Maybe it’s more about learning how to move through the unknowable with more grace.

Not all uncertainty is the same. Yes, some comes as the result of other people avoiding honesty or responsibility. But it can also be the space where we learn patience. Where we discover strengths we didn’t know we had and can practice staying present instead of rushing ahead. And where we become more like the people we were always becoming.

And finally, the same person who can handle uncertainty in other people’s lives can have trouble handling it in their own. I had this exact conversation just today with a spiritual counselor for another organization. He admitted this is something he still wrestles with himself. We didn’t have the opportunity to do a deep dive on why this might be the case, but I have a few ideas.

First, when we’re supporting someone else through uncertainty, we have a role. We have a purpose. We’re the person offering a steady presence: listening, witnessing, and helping someone else find their way through the unknown. We’re not the one waiting for the phone call, opening the email, or sitting across from a doctor begging for answers.

When uncertainty belongs to us, however, that distance disappears. Our own fears, hopes, memories, and assumptions walk right into the room with us. The very skills we use to support others — staying present, making space, accepting what we cannot control — can become much harder to access when we’re the ones facing the unknown.

There’s also something deeply human about wanting a different set of rules for ourselves. We can sit with someone else and say, “We don’t know yet, but we will walk through this one moment at a time.” And mean it. Yet when the uncertainty is ours, a part of us wants a guarantee. We want the answer, the timeline, and the outcome. We want someone else to tell us that everything will be okay.

Perhaps that’s why people like hospice volunteers and death doulas, who accompany others through uncertainty, are not immune from struggling with it themselves, on a personal level. In fact, we may understand the weight of it more deeply exactly because we’ve witnessed so many different ways that a single life can unfold.

The goal isn’t to become someone who never feels fear or doubt. Instead, the point is to recognize that we’re all human beings trying to find our footing in the unknown.

Fabian often jostles for that position. He sees it as his duty to protect me from squirrels and bicycles. (And he’s 100% convinced of his ability to do so.) But I tend to keep him between me and the curb because I know something he doesn’t: the road is a dangerous place when you can’t be seen from the dashboard of an oncoming car.

When I was a little girl, my father also walked on the outside. Between me and traffic. At the time, I didn’t recognize this as protection or love. Instead, I was upset that he never let me had any fun. I also saw it as him warning me that the world was a dangerous place: one that I wasn’t capable of navigating on my own.

But today, I see my father’s custom differently. He wasn’t trying to make me afraid of the world. Rather, he was trying to protect me from the kinds of things that parents worried about in the late 1960s: strangers in vans, hippies, stray dogs, bullies straight out of A Christmas Story…. And hitchhikers.

As a child, I couldn’t possibly imagine that in the future, I’d be the one walking on the outside, watching for danger and making choices for someone who trusted me completely. But that day eventually happened. First, with my own daughter. Then her children.

And today? The little girl who once held her father’s hand has become the woman holding Fabian’s leash, keeping him safe. From birds strong enough to swoop down and carry him off. From red foxes and Maine coon cats. And from all my childhood terrors, including (but not limited to) the following: quicksand, sinkholes, Bigfoot, the Bermuda Triangle, and the atomic bomb.

Maybe that’s how love moves through generations. The protected become the protectors. We inherit the instinct to stand between someone smaller and whatever dangers we believe the world holds.

Quicksand and the Bermuda Triangle don’t keep me up at night so much anymore. But as long as I’m walking Fabian, I’ll still be keeping an eye out for those sinkholes.

Love is also passed from one generation to the next by example. We don’t just inherit eye color or family recipes. We inherit ways of moving through the world.

Some families produce generations of teachers, mechanics, firefighters, nurses, attorneys, or military branch members. Others make volunteering part of family life, bringing children along to food drives, church clean-up days, community suppers, or neighborhood projects. No one needs to announce, “Helping others is important.” Children absorb what the adults around them consistently make time for and value.

End-of-life care is no different. Whether we volunteer in hospice, become a death doula, work as a nurse, or simply show up faithfully for a dying friend, we rarely arrive there by accident. We bring with us a lifetime of lessons about what love looks like in action. Some of those lessons are ones we choose to keep. Others we gently reshape. But almost all of them began long before we ever sat at a bedside.

Every time we pull up a chair, straighten a blanket, hold a hand, or quietly stand watch, we’re drawing on something we first learned as children. We aren’t simply caring for another person. We’re passing those early lessons forward, refining them for the next generation of caregivers, one small act of love at a time.

Some movies stay with us because of the spectacle. Others stay with us because, somewhere inside the story, we recognize ourselves. We see our fears, our loves, our losses, and the questions we carry but can’t fully answer.

What Dreams May Come is the latter type of movie.

Publicity photo © PolyGram Filmed Entertainment / Universal Pictures

Released in 1998, the film stars Robin Williams as Chris Nielsen, a physician whose life is shattered by unimaginable loss. Chris and his wife Annie, played by Annabella Sciorra, tragically lose both of their children, Marie and Ian, in a car accident. Years later, Chris dies while stopping to help victims of another crash. After his death, he enters an afterlife shaped in part by memory, imagination, and love. When he discovers that Annie’s grief has taken her somewhere darker, he sets out to find and save her. The movie was based on a 1978 novel of the same name by Richard Matheson, who also wrote many of the classic episodes of The Twilight Zone.

I first saw What Dreams May Come in a movie theater with my mother, shortly after it was first released. We were both visual artists and we both immediately connected with Annie, an artist herself. I think that what intrigued us was how Annie’s art became the lens through which Chris experienced his afterlife, a reminder that the people we love continue to shape the way we see the world.

This was also a movie that needed the big screen. What Dreams May Come was not simply a visual event. It was a story that could only be fully experienced through the scale, color, and movement of cinema. About fifteen minutes before its end, the film broke. We were offered a refund or the choice to wait while the film was repaired and spliced back together. We waited.

Before exploring what the film says about death, it’s worth acknowledging what it asks us to accept without evidence.

What Dreams May Come presents an afterlife shaped by the life we have lived. Heaven is not one universal place. It reflects our memories, our relationships, and the things that mattered most to us. The film also presents a specific view of suicide, suggesting that those who die by suicide experience a different spiritual reality. It introduces the possibility of reincarnation as well.

While these ideas appear in many religious and spiritual traditions, none of us can know with certainty what happens after death. As a death doula, I’ve learned that uncertainty is part of the human experience. Sometimes the most honest answer is simply: we don’t know.

Humans have always created stories about death because death raises questions we can’t answer. And perhaps that is why this movie has endured over time. Not because it gives us a proven answer, but because it gives us a way to sit with the questions.

Interestingly, the film’s greatest insight isn’t really about heaven. Rather, It’s about grief. Chris and Annie lose both Marie and Ian in a car accident. It’s a loss that violates the natural order of things. Parents expect to die before their children. There’s no preparation for a world where that order is reversed.

What Dreams May Come understands that grief is not only sadness. Sometimes grief expresses itself as guilt.

Annie’s suffering isn’t just that her children and husband are gone. She becomes trapped by the belief that she somehow should have been able to prevent those losses. She believes that if she had driven Marie and Ian to school that day, things would have been different. After Chris dies while running an errand for her (so they can celebrate a special day together), she carries the belief that his death is also her fault. Her hell is not just a place she is sent. It’s a place created by the story she tells herself.

Anyone who has experienced a traumatic loss may recognize that search for a moment when everything could have changed. The mind returns again and again to the same questions: What if I had called? What if I had noticed? What if I had done something differently? The movie understands something important about grief: sometimes the person we have to forgive is ourselves.

It also understands that people do not grieve in the same way. Chris and Annie experience the same losses, but their grief takes different paths. Chris finds comfort in connection and love, while Annie becomes overwhelmed by despair. Neither response is simple. And neither can be measured against the other.

That understanding of grief is personal for me. I grew up in a family that was Catholic in a somewhat lopsided way. We went to church every Sunday. Both my parents were educated by nuns, and my father’s aunt was a nun. We ate fish on Fridays during Lent. I was raised with the belief that suicide was a sin.

At the same time, my mother was fascinated by reincarnation and communication from beyond the grave, especially after her own beloved father died young when I was seven. Faith, mystery, and unanswered questions all existed side by side.

But I was not taught how to grieve. For instance, what I remember most about my maternal grandfather’s death is being scolded for crying. I was told that I was hurting my mother by not being a “good girl” for her. Looking back, I think the adults around me were trying to protect one another from excruciating pain. But the lesson I absorbed was that grief was something to control (or bury), rather than something to express.

At the same time, I saw another side of grief. People sent flowers. They brought food. They asked what we needed. They showed up. That difference has stayed with me.

Grief doesn’t need to be “fixed.” It needs to be witnessed.

That’s one reason Annie’s loss feels so powerful. When Chris dies, she loses more than a husband. She loses the person who shared the same memories of their children. She loses the person who knew the exact shape of their grief.

What Dreams May Come becomes more complicated in its portrayal of suicide. Chris’s love is powerful enough to reach Annie even after she has entered her own version of hell. It’s a beautiful idea. It’s also an idea that requires care.

In real life, love matters enormously. But love alone cannot always overcome depression, trauma, illness, or unbearable psychological pain. We see this in the scenes where Chris visits Annie in the sanitarium where she is admitted after her children die. And we see it again after he finds her again in Hell. Sometimes people are surrounded by love and still become lost in suffering. That doesn’t make love less important; it makes suffering more complicated.

What Dreams May Come was released in a different cultural moment. In 1998, conversations about suicide were often shaped more by shame and moral judgment than by the understanding we have today about mental health and overwhelming psychological pain. Many communities, including many faith communities, have moved toward greater compassion and understanding.

That shift changes how many people experience the film now, especially because of Robin Williams’ 2014 suicide. There are those who saw it before he died and those who came to it afterward. The movie itself has not changed. The frames are the same. The words are the same. Chris Nielsen is still Chris Nielsen.

But we are not the same viewers. Watching Williams play a man who refuses to abandon someone trapped in despair carries a different emotional weight now.

The same thing happens with grief. The loss may be unchanged, but the person experiencing it is not.

One of the most moving scenes in the film is also one of the simplest. When Chris arrives in his version of heaven, he is greeted warmly and enthusiastically…. by his pet Dalmatian. That moment tells us everything about the movie’s vision of paradise. Heaven is not a reward handed down only to humans according to a universal blueprint. It is created from love and transcends species.

And if heaven is indeed shaped by what we love, I cannot imagine mine without one of my soulmates: Fabian the Yorkshire Terrier.

The film also makes an interesting choice about the deaths it portrays. Almost every major human death in What Dreams May Come comes suddenly. There are no long illnesses, no preparation, and no chance for final conversations. The only death that seems to arrive in the natural order of things is the loss of the family pet, Katie, ho was put down due to either illness or old age.

That contrast matters. Much of death doula work exists around preparation: conversations, choices, goodbyes, and creating meaning before death arrives. What Dreams May Come is almost entirely about the opposite experience. Its characters are trying to make sense of multiple deaths that came too soon and without warning.

The film gives us one version of grief. Human beings experience many. We grieve relationships, dreams, health, independence, identity, and futures we expected to have.

When What Dreams May Come was released in 1998, popular culture often approached death through mystery and imagination. Stories asked what happened after we died. They imagined heaven, hell, and the places beyond this life.

Since then, the world has changed in ways few people could have imagined. The September 11 attacks in 2001 forced many people to confront sudden death, public grief, and the fragility of ordinary life. The COVID-19 pandemic brought death into daily conversation on a scale most people had never experienced: isolated deaths, disrupted rituals, overwhelmed healthcare systems, and families unable to say goodbye in the ways they expected.

Our conversations about death have evolved, too.Hospice and palliative care are more widely understood. Advance care planning is more common. Grief is increasingly recognized as something we learn to carry rather than something we simply “get over.” The death-positive movement has encouraged more honest conversations about mortality.

So does What Dreams May Come have the same meaning today that it did in 1998 (or for that matter, when Matheson’s book was published in 1978?) Yes and no.

The theme remains the same. Love survives loss. We search for meaning. We carry those we have lost. But the story continues to live because every person who watches it (or reads it) brings something new.

A person watching in 1998 may have seen a beautiful fantasy about heaven. Someone watching after losing a spouse may see a story about separation. Someone grieving a suicide loss may wrestle with its ideas about guilt and forgiveness. Someone who has loved an animal deeply may find the dog scene to be the most important moment in the film.

Richard Matheson’s story imagined a universe where love shapes reality. Decades later, the story itself has been shaped by the people who continue to watch and read it. And perhaps that is the closest thing to an afterlife that a work of art can have.

The next day, the doctor on duty came in to check on my father, who had been admitted. Dad had paralysis on one side, but his speech and cognitive abilities were fortunately still intact. The MD spent a few minutes examining him. Asking perfunctory questions. Writing a note or two. He lifted my father’s arm about 18 inches off the bed, then let it drop. Thump.

He frowned, then pronounced, “Well, he’ll never use that one again.” And then, as if on cue, he turned around and left the room.

My parents and I stared at the door - and dad’s motionless arm - in disbelief. We understood what the doctor didn’t: that there’s a big difference between telling a patient and his family a professional opinion  and telling them the hardest possible version of it. He didn’t just say, “This is unlikely to return.” He had effectively said, “This is who you are now.”

The stroke had affected my dad’s dominant side. The doctor didn’t know that, because he hadn’t asked. He also didn’t ask what my father did with that hand (writing, intricate scroll saw work), what mattered to him (having two working arms), or what kind of life he hoped to return to (one where he could hug his family and lift his grandchildren). The MD only looked at Dad’s physical limitation and delivered his prognosis as if it were an established fact. He didn’t know my father’s history or his future. He only knew what he observed in one particular moment. He’d assessed only a limb, not a life.

Something changed in my father after that, and it wasn’t just how his body moved. The man who had always made others laugh now seemed buried under the weight of what had happened. I visited him at the hospital nearly every night for a month, until he was discharged.  Not because I believed I could somehow will him into perfect health. Instead, I went to distract him from that inartfully-worded prognosis. To remind him that people don’t all bounce back at the same rate. And to help him remember that he was still here, still loved, and still needed.

The agonizing thing is that the doctor’s prognosis turned out to be accurate: my father never regained meaningful use of that arm. He continued physical and occupational therapy for months after his discharge, to little avail. I’m happy to report that much of his former humor and spirit returned.  But he was a changed man.

I later learned that my father’s experience wasn’t a unique one. The medical profession had already begun wrestling with how to teach communication skills more intentionally and medical education was slowly evolving in response. It was too late to directly influence this doctor’s formal education. But I’d like to think that over the intervening years, he learned from the example of others around him.

Nearly 30 years ago, the Association of American Medical Colleges (AAMC) established the Medical School Objectives Project (MSOP) to better align medical education with societal needs by defining clear, competency-based outcomes for graduating students. Recognizing that communication is a clinical skill that deserves explicit instruction, the AAMC commissioned Gregory Makoul, PhD, an expert in medical communication, to prepare a white paper on the subject. In doing so, they recognized that “interpersonal communication was the lynchpin to medical practice.” They also noted that such communication was not only between the patient and doctor, but could also include the patient’s family and/or caregiver. The MSOP report containing Makoul’s white paper is available at https://gwish.smhs.gwu.edu/sites/g/files/zaskib1011/files/2022-08/msop_iii_report_2.pdf

The MSOP helped elevate compassionate communication from a desirable personality trait to an expected clinical skill. It emphasized patient-centered communication, respect, professionalism, responsiveness to patients’ concerns, shared decision-making, and self-awareness.

Although the original MSOP reports were completed in 1999, the work evolved into newer competency frameworks as medical education changed. Over the following decades, the AAMC updated its foundational benchmarks into a unified set of 17 Core Competencies (for admission to medical school) and Core Entrustable Professional Activities (EPAs; for medical school graduates entering residencies.) These modern frameworks are designed to help medical training keep pace with changes in healthcare, technology, health equity, and patient-centered care.

Measuring direct, nationwide clinical improvements is complicated because the AAMC doesn’t mandate a single curriculum. Instead, individual medical schools adapt the guidelines to fit their own programs. However, a 2019 systematic review (available at  https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0221412) looked at 52 studies involving more than 5,300 physicians and physicians-in-training. About 75% of the communication curricula improved empathy and/or compassion on at least one of a number of measured outcomes. The review identified several teachable behaviors that consistently helped patients feel cared for, such as

• sitting rather than standing;

• recognizing emotional cues;

• responding compassionately;

• maintaining eye contact and other caring nonverbal behaviors; and

• explicitly acknowledging and validating emotions.

The metastudy’s results are encouraging because, like the AAMC guidelines, they suggest that bedside manner isn’t just a personality trait. Rather, it’s also a clinical skill that can be learned.

Helping physicians improve their communication skills isn’t an idea that’s limited to only the realms of academia and research. For example, Stanford physician, bestselling author, TED speaker, and  National Humanities Medal winner Abraham Verghese has spent decades reminding physicians that “the patient is the center of the medical enterprise.” He argues that the bedside is where doctors learn what is most important to the person behind the diagnosis. His central message is that medicine isn’t just about tests and diagnoses. It’s about being present with another human being.

Makoul, the author of the 1990s  AAMC white paper on medical communications, continues his work today. Last month, he published “Human-centered healthcare: An organizing principle for reinforcing the humanity of healthcare.” In it, he notes that “the call for culture change is starkly reflected in every facet of healthcare”, not just clinical encounters. Broadening his earlier views on effective patient-centric communication, he advocates for “human-centered healthcare - that values the humanity and perspective of everyone involved in any aspect of healthcare to collaboratively improve the experience, delivery, and outcomes of care.”  Makoul also shares insights from other healthcare leaders who advocate a 'humans come first' mentality. This new paper is available at https://pubmed.ncbi.nlm.nih.gov/41747569/

His shift is particularly timely as healthcare systems increasingly incorporate artificial intelligence and other technologies. While innovation may transform how care is delivered, healthcare leaders emphasize that the human experience of illness, uncertainty, vulnerability, and healing cannot be automated. The future of healthcare will depend not only on what technology can do, but on whether we preserve the human connection that makes care meaningful.

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One physician’s words shaped my understanding of bedside communication for decades. Watching my father’s face sink as a trusted authority figure shattered his life as he formerly knew it taught me something I’d carry into every bedside conversation I’d later have. And I’m grateful that the medical profession has invested enormous effort into teaching practitioners the value of patient-centric communication. But all of us who accompany people through illness—physicians, nurses, therapists, chaplains, volunteers, and family members alike—carry this same responsibility.

Compassionate communication is a skill requiring ongoing practice, not something that can mastered by the end of formal training.  I was reminded of this a few weeks ago, when I sat for a long time with someone who recently found out that she was going to be a first-time grandmother… and also that she was dying of cancer.  J was working with a spiritual counselor to figure out the best way to tell her family about the diagnosis.  I turned to take a closer look at the framed ultrasound picture that she’d carried to the hospital with her. I read its inscription: I loved you the first time I saw you.

I felt fortunate to be there as J shared with me some happy news, just as she was preparing to tell those closest to her a very different kind of news. Her face beamed and her posture straightened. The energy in the room became more hopeful. I said a silent prayer that J would one day be able to hold her newborn grandchild in her arms.  And I thought of my dad, who would have welcomed a moment like that after his stroke.

The reason for their hospitalization used to be included, but it’s no longer listed. That makes sense from a privacy perspective. Still, it means that sometimes I walk into a room knowing very little about the person I am about to meet. And it’s not unusual for a patient not to understand, or be able to explain, their condition.

Often, when I introduce myself as the Reiki volunteer, I am greeted with a blank stare. Many patients have no idea why I am there or what Reiki is, even when my list indicates that they’ve been told about it and have agreed to try it. So I explain it again: a complementary energy practice using light touch or hands held near the body. Hospital has used it for more than 30 years for relaxation, pain management, and stress reduction. Many find it helps them. And it’s free. Some are curious. Some are skeptical. (One even threw a Bible at my head and called me the Devil’s disciple.) Some simply decide to give it a try.

C was curious. She was a woman in her 70s who had spent much of her life in a helping profession. She was open to the idea of Reiki. But when I entered her room, it was clear that something much deeper was happening.

She looked uncomfortable. Her brow was furrowed, and she shifted restlessly in bed. It seemed clear that she was carrying more than physical pain. What I did not know from my patient list was that about 20 minutes before I arrived, C had been told she was dying.

She asked me if I personally believed in God. As a hospital volunteer, I knew my role. We do not generally discuss our own beliefs with patients because the focus is meant to remain on their experience. I told her that I could connect her with a spiritual counselor if she would like.

That was an appropriate response. It was also not the response she needed in that exact moment. Her face fell. It was as though the system, which was designed to help her, had become one more place where she had to fit herself into the right category before someone could meet her.

My shift had just started, but she didn’t know that. So I told her that it was my break time and asked if I could simply sit and talk with her for a while.

I made a point to take off my volunteer ID and vest. Not because I was stepping away from my role, but for its symbolic value. I wanted to remove any suggestion that she was speaking to a representative of an institution. For a few minutes, I was just a person sitting with another person.

I sat on the edge of her bed and we talked as I held her hand. The conversation went wherever she needed it to go. We spoke about her being a single mother at a time where it was not as socially accepted. We discussed crocheting and knitting. We reviewed the Left Behind movies like we were Roger Ebert.

And yes, we talked about faith. C told me that her lifelong belief system had always been spacious. She had never needed rigid answers. But now, facing death, that openness left her with nowhere to grab on.

She asked me about my own spiritual background. I told her about growing up Catholic, studying Buddhism in college, and spending a summer living in a Buddhist community. C laughed when I told her that my hard-of-hearing mother had a very different interpretation of my plans: when I said I was spending the summer in a Buddhist colony, she thought I’d said “nudist colony.” For just a moment, there was lightness in a room that had recently held devastating news.

After about fifteen minutes, C told me she was ready for her Reiki session. So I put my vest and ID back on. My “break” was over and I returned to my official volunteer role.

During the Reiki session, C fell asleep. Not a surprise: that happens about 75% of the time. But here, C’s body softened. Her breathing became slow and steady. The tension disappeared from her forehead.

Yes, the Reiki likely made a difference. But I’m convinced that the conversation that came before it helped, too. (And yes, I did refer her to the spiritual counselor for followup.)

Compassion doesn’t always look the same. Sometimes, it’s a referral to the right professional. Sometimes it’s merely sitting with someone who has just received news that has changed everything.

Healthcare systems need structure. Volunteers need boundaries. Those protect patients and make good care possible. But caring for another person also requires judgment. It requires knowing when the structure is serving someone and when a little flexibility can help them feel seen. Heard. Understood.

The goal isn’t to break the rules. Rather, it’s to understand the purpose behind the rules. And when appropriate, bend them gently enough that someone in need can still feel and access the human heart providing the care.

Photo by Aziza Berdieva on Unsplash

Shock isn’t simply a delay between understanding something intellectually and feeling it emotionally. And it’s not a message traveling slowly from one place to another. The human body is more complicated than that.

Rather, shock is what happens when reality changes faster than someone can integrate it. The brain may understand the words. The heart may understand the loss. But the body may still be trying to catch up. A person’s identity, relationships, assumptions, plans, and sense of safety may all be asking the same impossible question: “If what’s happening now is true, then how do I live in this new world?”

P was in her late forties when she received a diagnosis that changed the trajectory of her life. She had achieved remarkable success in the arts before marrying later in life and becoming a mother. She and her husband were raising three children together, all still young. She was a soccer mom, a ballet mom, and a theatre mom. And she had the energy, vitality, and outlook of someone much younger.

Then she learned she had an aggressive form of cancer.

This diagnosis didn’t only threaten P’s life. It threatened the future she’d built. And her family’s future, as well.

She talked about it rarely, because she was a private person. But when she did, P didn’t focus only on dying. She talked about the things she wouldn’t see. She worried about not being there as her children grew up, got married, and had children of their own. She worried about leaving her husband to raise their children alone. She was concerned about what her diagnosis might mean for other women in her family: was inheritable?

We often think of grief as something that follows a loss. But humans also grieve possibilities. We grieve the birthdays we may not attend, the conversations we may never have, and the versions of ourselves we may never become.P’s grief wasn’t a failure to accept reality. It was evidence that she had a future she loved.

One of the most important things that caregivers can understand about shock is that it’s not a sign of weakness or a moral failure. It isn’t proof that someone is handling a situation badly. Instead, shock and grief are part of the human experience, because attachment is part of the human experience.

The same capacity that allows us to be devastated by loss also allows us to experience deep joy, belonging, and love. The shadow exists because something meaningful is casting it.

When someone is in shock, there can be a powerful urge to help them leave that place quickly. We want to reassure them, to offer meaningful solutions. We want to say something that will make their pain smaller.

But sometimes, the most loving thing we can do is resist that urge. A person in shock is not a problem to solve. They are a person whose world has shifted.

This is where the practice of nonjudgmental presence becomes more complex than it first appears.

Nonjudgment doesn’t mean passivity. It doesn’t mean watching someone move toward danger and saying, “That is their journey.” And it doesn’t mean refusing to act because we are afraid of overstepping. But it does require discernment.

A nonjudgmental caregiver learns to notice the difference between a person experiencing pain and one who has lost the ability to care for themselves. Between withdrawal as a temporary protection and that which becomes dangerous isolation. Between a person making choices that others find uncomfortable and someone who is unable to make choices safely.

A passive witness watches; an active one pays attention. An active witness notices what is said and what is not said. They listen without immediately filling silence. They understand that their own discomfort isn’t the issue. They remain close enough to recognize the difference between when presence is enough and when action is needed.

Moreover, they don’t fight against another person’s feelings; instead, they protect the person having them. They protect that person’s right to grieve in their own way and at their own pace. They protect them from being rushed into decisions before they are ready, from being spoken over or reduced to a diagnosis. But they also protect them from harm when protection is needed.

I learned something about this distinction when I was diagnosed with malignant melanoma while my daughter was a teenager. The fear that gripped me was not primarily about my own death. Rather, it was about what would happen to my daughter if I were gone. I was a single mother at the time and her father had been minimally involved in her life up to this point. I worried that if I died, he might seek custody and she would lose stability and support.

I shared this with my parents. They understood immediately. They assured me they would fight “tooth and nail” for her. They couldn’t promise me that nothing bad would happen. They couldn’t erase the uncertainty. But they gave me something I desperately needed: the knowledge that the person I loved most in this world wouldn’t be left alone.

My daughter responded to my diagnosis differently. She pulled away. She began, in her own way, preparing for a future without me. I understood that she was protecting herself. I also understood something else: that she was a child and that she shouldn’t have to become my emotional support system.

So I watched. I paid attention to her grades, her disposition, her friendships, and her involvement with others. I stayed connected with her teachers. If I had seen signs that she was no longer functioning or was in danger, I would have stepped in. But I never assumed that her way of coping was wrong simply because it was painful to me.

Years later, I was fortunate enough to see the future I once feared losing. My daughter became an adult, married, and had children of her own. P was not that lucky.

Psychologist Pauline Boss’s work on ambiguous loss speaks to this experience of grieving what has changed before there is a clear resolution. Viktor Frankl wrote about the human search for meaning even in suffering. Palliative care voices such as Ira Byock have reminded us that dignity and relationship remain central even when circumstances cannot be changed. None of these ideas remove suffering. But they do help us understand it better.

For caregivers, the challenge is to resist the temptation to measure progress by how quickly someone appears “better.” The person who acts reserved may not be failing. The person who asks the same questions repeatedly might not be refusing reality. The person who cries isn’t necessarily falling apart.

Instead, they may be integrating. They could be rebuilding their understanding of a world that no longer looks the same. There is no universal timeline for that work because there is no universal human life. The goal isn’t to pull someone back into the life they had before. Rather, it’s to stand beside them as they discover how to live in the life that remains.

But publishing that writing? That meant inviting other people into the middle of something I was still living. Something I wasn’t quite ready to do. Not because grief should be hidden, but because I wanted to better understand my own situation before asking anyone else to witness it. That meant fully living the messy parts - totally unfiltered - in private.

Part of my hesitation was practical. After all, recruiters and future employers can Google. They’re on LinkedIn. They can also think, Oh, get over it already! It’s only been a few months. Were you this big a drama queen at your last job? I worried that people would see this as the story of someone who was wallowing in self-pity over something that wasn’t a “real” loss. Asking others to see value in her where she wasn’t able to do so herself. And the ugliest thought: Someone so fragile that she might be a risk to hire.

But most of my reluctance to post from the trenches of unemployment has been psychological. Looking for a job at an age when many are thinking about retirement is challenging enough without putting myself out there for public scrutiny. Also, sorting out my feelings about everything was tougher than I thought it would be. At first, I dismissed what I was feeling. This can’t be grief, I told myself. No one died. But grief doesn’t appear only after a death. People grieve after a devastating diagnosis, before the outcome is even known. They grieve futures they expected to have, but will not. People even grieve joyful transitions—the end of being single after a wedding, the end of life as a couple after a baby arrives, the loss of one identity as another begins.

By not giving myself grace, I had inadvertently turned grief into a competition. Into something that had to be earned. No one would tell someone grieving the death of a spouse, a child, or a parent that they hadn’t suffered enough to deserve compassion. We understand those losses. We instinctively make room for them. But with smaller losses, such as a job loss, we often become much harsher with ourselves. I was telling myself that because other people were facing illness and death, I had no right to struggle. That just wasn’t true. And in concluding that my job loss was smaller than someone else’s death loss, I’d forgotten that “smaller” is not the same as “insignificant” or “unworthy of recognition.”

As I revisit my earlier essay today, I realize that I’m not so much grieving the loss of somewhere that I thought I belonged as much as I’m grieving the loss of a version of myself. For years, if someone asked what I did, I had an easy answer: I help people feel generous, connected, and that they’ve made a meaningful difference in the community. My work wasn’t just how I earned a living. It was part of how I understood my place in the world and how I helped make it a little bit better. Without this work, I’m finding myself asking an uncomfortable question: If I am not “her” anymore, then exactly who am I?

I don’t have that answer just yet. And that’s OK because this experience has helped me live with uncertainty.

But perhaps what surprised me most about my period of unemployment was how invisible and lonely job loss can be. When someone dies, people generally recognize that you are grieving. They send cards. They bring meals. They ask how you are doing. When you lose a job, the expectation is often that you’ll be sad for a day or two, then move on. Sometimes people act as if unemployment is contagious—they respond as if standing too close to someone who has lost a job might somehow threaten their own career path and sense of security. While it’s relatively easy to connect with other job seekers online, the loneliness compounds because often the only thing I have in common with them is unemployment. (And most of them aren’t 63, trying to deny ageism exists while at the same time wondering why the ATS spit out that “we appreciate the time you spent applying, but…” automated email so quickly.)

I don’t have a tidy ending for this, because things are still unfolding in real time. Life is moving forward and don’t know who I’ll be on the other side. That’s not necessarily a bad thing. Until then, I continue to use my doula tools to treat myself with the same gentleness and compassion I’d treat a client.

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My new day job starts tomorrow. I’m very excited about it — and grateful — because it provides the exact experience I’ll need someday for my dream retirement job: creating and running a company offering death doula services.1 This new opportunity will also allow me to contribute to the end-of-life space much more meaningfully and on a greater scale than I did before, giving me a clearer sense of purpose and value.

So how will my new role change the content on Heart Grown Threefold? First, I’ll have many more experiences from which to draw, even when I’m supporting someone else’s work at the bedside. (With an eye towards HIPAA’s Safe Harbor requirements, I’ll continue to eliminate “all explicit data points connected to the patient, their relatives, employers, or household members.”) I’ll also be exposed to situations, systems, and challenges that I might never have encountered in my former role as an individual volunteer. And perhaps most importantly, I’ll be closer to the conversations that shape how we care for people at the end of life. I hope you’ll stay with me as this next chapter unfolds, because I think we are only beginning to understand what it means to truly support people through dying.

Researchers and philosophers have explored this experience through the lens of authenticity. Authenticity is often described as a sense of alignment between who we are at our essence and the world we experience around us.

One form of this is place authenticity: the feeling that a particular landscape, building, community, or culture resonates with us in a way that feels unexpectedly personal. Another is personal authenticity: the feeling that we are recognizing something essential about ourselves. A vocation, creative pursuit, way of living, or role may feel less like a choice and more like something we were always meant to grow into.

Both types of experiences raise an intriguing question: How do we recognize what belongs to us?

Authenticity Through Various Lenses

Some people interpret moments of authenticity through a spiritual or metaphysical lens. They may describe them as past-life memories, soul connections, or a sense that something has been carried across time. Psychiatrist Brian Weiss, whose work focuses on past-life regression, suggests that some experiences of unexplained familiarity, deep connection, or recognition may reflect memories or impressions carried across lifetimes. From this perspective, a powerful sense of belonging in a place one has never visited may not be coincidence, but a form of remembering.

Others argue that such experiences of authenticity and belonging may arise from memory, symbolism, or the brain’s remarkable ability to create meaning from experience. From this perspective, the feeling of recognition may be real without necessarily being evidence of a previous lifetime.

Carl Jung suggested that human beings share deep symbolic patterns, or archetypes, that can be activated by certain places and experiences. A lifelong connection to an ancient culture, for example, might reflect a powerful relationship with themes such as ritual, mystery, transformation, or creativity rather than a literal memory of another lifetime. And James Hillman explored a related idea through his metaphor of the “acorn”: the possibility that each person carries a unique pattern of potential and is naturally drawn toward experiences that help that pattern unfold. In this view, we are not necessarily remembering who we were; we may be recognizing something about who we are.

Cognitive scientists offer another explanation for this sense of recognition. Our brains are constantly absorbing information, noticing patterns, and responding to subtle cues before we are consciously aware of them. What feels like remembering may sometimes be the mind integrating years of impressions, interests, and associations into a powerful feeling of familiarity.

At the same time, some researchers have argued that not every experience fits neatly into conventional explanations. Psychiatrist Ian Stevenson investigated cases of children who reported detailed past-life memories and concluded that some cases raised questions worthy of further study. His work does not prove reincarnation, but it represents one of the more serious attempts to examine whether consciousness and memory might extend beyond what we currently understand.

While these perspectives don’t all agree, they share an acknowledgment that human beings sometimes experience forms of recognition that feel larger than ordinary preference. And like many people, I’ve often experienced this kind of alignment (and sometimes, lack thereof).

Familiarity at an Egyptian Temple

I’ve loved ancient Egypt since childhood. It was my favorite subject in Geography and Social Studies and that fascination stayed with me for decades. Visiting Egypt was a lifelong dream, an especially ambitious one for someone who’d never travelled internationally until her mid 30s.

So when I first entered the Karnak Temple Complex around 2000 or 2001, I expected to be amazed. Maybe even overwhelmed by the size and spectacle of it all. I certainly didn’t expect it to feel so familiar, much less so intimate.

Walking through the temple, I was surprised to find that I immediately knew my way around. I felt connected not only to the architecture, but to the people who had lived, worshiped, and created there thousands of years earlier. It felt less like meeting a distant civilization and more like rediscovering a place that had always held special meaning for me.

Was it merely the result of years of fascination finally meeting reality? Was it the emotional power of standing in one of the world’s great sacred spaces? I’ll never be sure. But the experience definitely felt authentic.

What stays with me about this experience isn’t the question of whether I was remembering a past life or simply responding to a place that held deep personal meaning. It was the feeling of being welcomed without having to prove anything. I didn’t have to earn my connection to Egypt through expertise, education, or experience. I simply arrived and something in me recognized something in it. Perhaps that’s part of what we mean by authenticity: the rare moments when the world outside us aligns with something true within us.

Coming Home to a Canadian Shrine

A different kind of recognition happened when I visited the Sanctuare Sainte-Anne-de-Beaupré in Quebec. As an adult, I toured the site for the first time (or at least the first time I consciously remember.) Beneath the main sanctuary of the basilica, I discovered the Immaculate Conception Chapel (also called the Marie Chapel). I immediately recognized it. For years, I had dreamed about a chapel with this same feeling and configuration. Same colors. Statues. Standing there in awe and reverence, I experienced the same comfort of reencountering something I already knew well.

My mother doesn’t believe I had ever been there as a child. She might be right. It’s also possible that another image, building, or memory contributed to my dream chapel. But the feeling itself was unmistakable. Belonging. Safety.

What matters most about this experience isn’t proving where the image came from. Memories are complicated, dreams borrow from countless sources, and our minds are constantly creating meaning from what we encounter. What matters is the sense of belonging it created. The chapel offered a feeling that many of us spend our lives seeking: the experience of being received rather than evaluated. Perhaps authenticity isn’t always about finding something new, but about encountering something that allows us to recognize and accept a part of ourselves that’s been there all along.

Sense of Unease at a Maine Campground

But authenticity isn’t always a feeling of attraction; sometimes, it’s just the opposite. When my family was checking out camping areas in Maine for an upcoming vacation, we found a beautiful campground deep in the woods. On paper, it seemed ideal. But in person? The closer we drove, the more my mother and I both felt that something was wrong.

Neither of us could explain why. The place felt unsettling, as if it carried a painful history. I became so upset that I started to cry. I begged my father to turn the car around. My mother calmly agreed and we left.

That experience taught me that authenticity isn’t always a feeling of “yes.” Sometimes it’s a strong “Hell to the no.” The important question wasn’t whether my interpretation was correct. The point was that something about that specific environment made me feel unsafe and my parents honored that feeling.

And it’s stayed with me because instead of feeling welcomed by a place, I felt a strong sense that I should leave it. We never learned whether anything terrible had actually happened there. But the experience reminded me that our minds and bodies are constantly taking in information, often before we can explain what we’re noticing. Authenticity isn’t always a pull toward something that feels familiar or beautiful. It can also be the recognition that a place, a person, or a situation isn’t right for us. The wisdom, then, isn’t in obeying every feeling without question, but in being willing to listen, investigate, and respond with care.

Authenticity in End of Life Decision Making

When families choose caregivers, physicians, treatments, hospice providers, or long-term care communities, they’re often navigating a storm of information. They compare credentials, outcomes, costs, recommendations, and medical options.

Those things matter. But so does discernment. I want to be clear that discernment isn’t the same as following a feeling blindly. Instead, it’s the practice of listening to multiple sources of information.

The head asks: What are the facts? What does the evidence tell us? What questions still need answers?

The body wonders: Do we feel safe? Do we feel rushed, dismissed, or unheard? Does something feel out of alignment?

The heart inquires: Does this honor the person we love? Does this reflect their values and dignity?

Discernment comes from bringing all three together.

For example, a caregiver may have excellent credentials, yet something about the relationship may feel wrong. A facility may look beautiful online, yet the atmosphere may feel impersonal. A doctor may be highly respected, yet a patient may leave appointments feeling invisible.

The opposite can happen too. Someone walks into a room and feels a quiet sense of trust. A nurse sits down instead of standing in the doorway. A caregiver learns the person’s routines, stories, and preferences. A hospice team creates space for both comfort and grief.

Often, what we’re acknowledging isn’t anything supernatural. Rather, we’re recognizing higher, very human qualities. Kindness. Presence. Safety. Respect. Dignity.

At the same time, we should be cautious about how we interpret the input we receive. Not every powerful feeling of recognition is necessarily truth. Belonging can guide us, but it can also be seductive. That is why discernment matters.

Perhaps authenticity isn’t about proving that we have been somewhere before as much as it’s about recognizing where we can be fully engaged in the present. Somewhere where we truly belong, without feeling like we somehow have to “earn” it.

André is an Idiot is a one-of-a-kind documentary about a man dying of Stage 4 colon cancer. But just calling it “about cancer” is doing the film a disservice, because it tries to be much more ambitious than that. Rather, it’s about what happens when a mind that refuses containment meets a body that suddenly insists on it.

This is your spoiler warning. Not because the plot twists—there aren’t any—but because once you see it, you don’t really get to unsee the way it stares unflinchingly at death and keeps cracking jokes anyway.

The Mind That Won’t Stop Spinning

André Ricciardi is the kind of person who talks like his thoughts are trying to escape custody. Fast, outrageous, associative, funny in a way that occasionally makes you worry for the people around him.

Of course, he works in advertising—one of those industries where absurdity is a feature, not a bug. His ideas are so extreme they mostly offend everyone, except perhaps the executives at Fox. And then cancer arrives. Suddenly, even advertising looks like background noise.

He puts it plainly: once you’re diagnosed, nothing else feels consequential. The punchline writes itself.

Love, Improvisation, and the Life That Was Already Strange

André’s life with his wife Janice doesn’t fit into a tidy narrative arc either. It begins with a green card marriage and evolves into something real. It also somehow includes a winning strategy on The Newlywed Game that sounds like it was invented by a chaotic philosopher: if in doubt, choose kindness. If still in doubt, pick the answer whose first letter is later in the alphabet.

André and Janice build a family. Two daughters grow up describing their relationship with him as “more cerebral than parental,” which is probably the most diplomatic way imaginable to say : this man is not like other fathers. One daughter recalls him reading her Helter Skelter aloud in a hospital room while nurses move in and out like background extras in a film that doesn’t know what genre it is.

The Body Starts Keeping Receipts

The film tracks André’s decline in increments: one year after diagnosis, two years, the slow rearrangement of his face into something hollowed and unfamiliar.

There’s no soft-focus metaphor here. Chemo takes his hair. His body shrinks into something almost skeletal. At one point, he gets out of bed and looks like he wandered out of The Machinist. The film’s director shared that André wanted him to keep shooting, no matter what. And so he did.

He jokes constantly—about hangovers preparing him for chemo, about absurd medical detours, about anything that keeps him from sounding afraid. But the film never lets humor fully erase what’s happening. It just lets it sit beside it.

Control as a Survival Strategy

Right after diagnosis, André does something very human, very revealing, and very him: he makes a film about it. And to accomplish that, he reached out to his close friends, filmmaker Tony Benna and executive producer Lee Einhorn.

As Benna explained to NPR earlier this year, ( Director Tony Benna chats about the documentary, ‘Andre Is an Idiot’ : NPR ) “at very least, if I could just capture his crazy, funny, irreverent stories for his family, it would be a legacy I could leave for his daughters, for his wife. And so I went into it without the whole idea of having to make a full feature. I just thought if we can just start capturing these stories, we’ll see where it goes.” The result? A movie that went on to win multiple awards at the 2025 Sundance Film Festival, where it debuted.

And that title? As André himself explains in the film: “When I told my mother that I had colon cancer, the first thing she said was, ‘what a [expletive] idiot.’ She said that is the easiest cancer to stop. All you need to do is get a colonoscopy. And I may still defeat it, but if I don’t, she’s right. I’m a [expletive] idiot.”

The “idiotic” result is loud, chaotic, MTV-edited, stop-motion animated, sometimes vulgar—basically André’s brain rendered in real time. It’s not just documentation. It’s containment. If he can shape it, he can survive it. At least emotionally.

The Myth of Routine (and Its Collapse)

Early on, André describes life post-diagnosis as almost boring. He empties the dishwasher. He lies on the sofa. Etc, etc, etc.

There’s a Buddhist echo here. Before enlightenment: chop wood, carry water. After enlightenment: chop wood, carry water. Except André’s version doesn’t stay calm. It fractures. The mundane becomes haunted by the knowledge that it is temporary.

The Dark Comedy of Facing It Directly

The film refuses to look away from the grotesque details of the dying process, but it also refuses to treat them as purely tragic.

André’s long, bushy hair falls out. He shapes it into little animals and “releases” them. He likens chemo to a long hangover. He explores cryogenics and builds fantasies around control. He gets a “death yell advisor.” He even entertains a project called Who Wants to Kill Me?, where the audience votes on creative death methods instead of cancer deciding. It’s funny in the way people get funny when the alternative is silence.

But Janice is careful to point out something sharper: even in chaos and absurdity, André is still guarding the most vulnerable parts of himself. Humor is not total surrender. It’s selective exposure.

A Family Tries to Keep Up

A significant part of the film is not André, but the people orbiting him—especially his wife and siblings, who try to narrate someone who resists being narrated.

There’s a recognizable ache here if you’ve ever had someone in your family who is brilliant, unpredictable, and impossible to summarize. The kind of person who pulls everyone into their orbit whether they consent or not. André doesn’t just live his experience. He expands it outward until everyone else is part of it.

When Real Life Won’t Cooperate With Casting

At one point, André’s father refuses to appear in the film, saying he’d prefer to undergo chemo himself than appear in front of the cameras. Harsh. So André hires a stand-in: Tommy Chong. Yes. That Tommy Chong.

André and Tommy film scenes of stereotypical father-son interactions. They have heart-to-hearts. They play baseball. And they do some unconventional things, too, like smoke weed together. Because if reality won’t participate, André will cast around it. It’s funny until it isn’t. Then it’s funny again. Then it’s something else entirely.

What André is an Idiot Is Really About

By the end, it becomes clear the film isn’t about one man dying. It’s about the ecosystem around him:

• the strong wife steadfastly loving someone who won’t totally reveal his inner fears to her

• the daughters (Tallula and Delilah) translating an untranslatable parent

• the filmmakers trying to capture a person who refuses categorization, and

• the audience, who can’t turn away from this slow-motion crash.

André is an Idiot is also about denial vs. clarity. Humor vs. avoidance. Control vs. collapse. And the strange idea that maybe speaking about death—loudly, badly, messily—is its own form of resistance and memory making.

André once says something close to this idea: he doesn’t want to disappear quietly. He wants to be witnessed. If people keep speaking his name, maybe that’s a kind of continuation. A death yell, not a whisper.

The Part Where I Should Tell You to Get Screened

Normally this is where a writer turns evangelical about colonoscopies and early detection.

I can’t quite do that cleanly here. Because at 63, I haven’t been screened either. So instead of advice wrapped in moral certainty, maybe it just lands as this:

Don’t be careless with your body. Don’t be arrogant about time. Don’t assume you’ll get a warning before the warning becomes irreversible. Don’t be André. Don’t be me. Take the flipping test.

Die How You Want to Die

André is an Idiot is not really just a movie about a man who died. It’s a unique video memoir about what happens when someone refuses to become smaller in the face of something designed to erase them. It’s loud. It’s chaotic. It’s uncomfortable. It’s funny in ways that shouldn’t work.

And yet it resonates.

As of June 2026, André is an Idiot is available on Netflix.

There are moments when the dying person is awake and their breath is so light it’s almost hypothetical. You’re not watching a chest rise and fall; you’re watching for something much more subtle: a shoulder to move, a small flap of skin at the neck to shift.

Then they fall asleep and snore like a linebacker.

Families sometimes read this change as drama. And sometimes it is. Often, however, it’s just the body doing what it needs to, to move the process along. Airways relax. Pain meds and anti-anxiety meds shift the rhythm of the breath. The pace of inhales and exhales gets irregular—loud, quiet, paused, then a rally. It’s hard to predict which breath will be the last, so the caregiver can become hypervigilant.

Recently, a chaplain/pastor visited my client F, whose age had crossed into triple digits a few months earlier. (Marked, fittingly, by a commemorative fleece blanket and festive banner over her bed.)

In nursing homes, spiritual counselors are part of the support team. Their role is comfort, not conversion. They meet residents wherever they are and offer steady, non-directive presence: listening, sitting with fear, sometimes prayer or ritual if invited.

Compare this to the work of a church leader, which is longer-term, centered on a specific tradition, and focused on teaching and guiding within that framework. In the outside world, the distinction matters a lot. But at the bedside? Things converge around whatever meaning the patient already carries and everyone else adjusts to that shape.

I asked the pastor a few questions to help me better understand her role in this new-to-me facility, where I was still getting to know all the faces. She replied only that she was with a “Christian church,” so I let the conversation flow back to F.

The pastor then told me that F had previously told her that she was ready. Ready to die. Ready to see her deceased loved ones again. Yet F had been actively dying for more than a week and the nursing room staff was trying to figure out who or what else she still needed to let go.

She then asked if she could pray with F. I stepped out of the room to give them privacy.

When I came back later, the pastor was still there… and visibly moved. She told me that F’s breathing changed right when she’d said “Amen.” She took this as a sign. A confirmation that F had heard the prayers and embraced their meaning. It clearly mattered to her that F wasn’t just dying, but dying well. That she wasn’t afraid. That her faith was intact, intact enough to carry her through the last moments without doubt or hesitation. The change in breathing reassured the pastor that F’s faith had held.

Part of me wanted to see it that way too. And part of me knew it might simply be timing.

I’ve seen breathing change as death draws closer. It changes during prayers, yes. It also changes during conversations, silence, medication adjustments, sleep… and absolutely nothing at all.

So the question that stayed with me for days after my visit with F wasn’t whether the pastor was wrong. It was: “Is coincidence the enemy of faith—or is it a wider version of it?”

Many of the top thoughtleaders of modern times—across psychology, philosophy, and contemplative traditions—have wrestled with this question. They don’t necessarily agree on doctrine, but they converge on an uncomfortable conclusion: that faith that depends on certainty doesn’t hold up well.

William James tackled this directly in The Will to Believe. James argued that when evidence can’t settle a question—and questions of ultimate meaning rarely can—we don’t live by proof. We live by choice. The mistake isn’t finding meaning in ambiguous moments; it’s confusing meaning with verification. For James, faith doesn’t fail because things can be explained. It fails when we expect explanation to do faith’s work.

This is where William James’s idea of overbelief is useful. James understood that there are moments when the facts run out but life doesn’t pause to wait for better evidence. The breathing changed; that part is observable. What comes next—the meaning we attach to it—is something we supply. Overbelief isn’t about being irrational; it’s about how humans bridge the gap between what we can know and what we need in order to keep going. The trouble starts only when overbelief masquerades as proof, when a story that steadied us quietly hardens into a rule about how faith is supposed to work. In rooms like this one, overbelief can be compassionate and sincere—as long as we remember it’s a layer we add.

Buddhist nun Pema Chödrön comes at the same issue from the another direction. She warns against what she calls ground-seeking—the urge to latch onto signs, certainty, or spiritual reassurance when things feel unstable. Interpreting coincidence as confirmation can be comforting, but it can also be an attempt to make uncertainty go away.

In When Things Fall Apart, Chödrön notes, ““Letting there be room for not knowing is the most important thing of all. When there’s a big disappointment, we don’t know if that’s the end of the story. It may just be the beginning of a great adventure. Life is like that. We don’t know anything. We call something bad; we call it good. But really we just don’t know.” From her perspective, faith—or practice, or trust—has less to do with securing meaning and more to do with staying present when meaning refuses to tidy itself up.

James and Chödrön land in the same place: coincidence isn’t the problem. But needing coincidence to behave the way we want it to is.

And there’s another point that’s hard to ignore. The pastor’s relief rested on seeing something—on having her time with F confirm what she hoped was true. But the Christian tradition the pastor represents carries a more demanding standard. Jesus Christ was explicit about this, blessing those who believe without seeing, without waiting for proof to arrive first. His reminder to Thomas (John 20:29) isn’t for the ones who get the sign; it’s for the ones who don’t—and who trust anyway. This raises an uncomfortable possibility: perhaps the sign (the change in F’s breathing) mattered not because faith requires it, but because the pastor did.

And there are another risks with signs. If every meaningful moment has to be unmistakably supernatural, what happens when nothing special happens? When the breathing doesn’t change? When the prayer doesn’t line up perfectly with the physiology? If meaning only counts when it’s dramatic, then ordinary moments start to feel like failures.

End-of-life work lives in that tension. It perseveres steadily through times of uncertainty and doubt.

I don’t think the pastor was wrong to see meaning in what she witnessed with F. Humans are wired to make meaning. And sometimes, that meaning shows up not because it’s provable, but because we need it.

Ultimately, the strongest belief system isn’t necessarily one that needs confirmation. Sometimes, it’s the kind that can sit in a room with a changing breath and let the moment be what it is.

(And F? She passed away a few days later. I wasn’t there, but I understand she just drifted off. The pastor’s visit may indeed have made a difference. Helped the process continue. Since no one will ever know for sure, we’ll just have to take it on faith.)

Lately, I’ve been gravitating toward movies that are unapologetically formulaic—the kind where you can see the ending coming from a mile away. When the world feels unstable and unresolved, I enjoy taking refuge in a story that’s predictable, comforting, and offers closure. Especially one that’s accompanied by a warm blanket and a large bowl of buttered popcorn.

I recently rewatched The Last Word (2017), starring Shirley MacLaine, and this time I watched it through a lens I can’t turn off anymore: that of a death doula.

The film showcases MacLaine as Harriet Lauler, a wealthy, aging advertising executive who commissions her obituary while she’s still alive. On the surface, it looks like vanity—one more attempt by a controlling woman to manage her image. But that’s not quite it.

Harriet isn’t trying to control how she’s remembered. She’s trying to control the inevitable handoff.

That moment when a life stops belonging to the person who lived it and becomes a story told by others—one that may be bowdlerized, misunderstood, or quietly erased. Harriet understands this pattern: she’s already seen it played out in her professional life. Death is the final place where authority evaporates, and Harriet knows it. The obituary is just the object she grabs on to, to steady herself.

I see this constantly in my work. People don’t just fear dying; they fear losing authorship. They fear that the meaning of their life will be decided without them, or worse, decided badly. This is one reason why so many spend their last years creating their memoirs.

Amanda Seyfried plays Anne Sherman, a newspaper obituary writer who is used to shaping final narratives without resistance. Her subjects are dead; they can’t argue. Harriet is very much alive—and she argues plenty. What follows isn’t really about journalism or legacy management. It’s about friction. About what happens when someone is forced to see herself through other people’s eyes while there’s still time to respond.

At first, Harriet treats the obituary like PR. She wants admiration, affection, and a tidy highlight reel. Instead, she’s confronted with a trail of strained relationships, professional resentment, and an old black-and-white videotape. People admired her brilliance, yes—but they also feared her. Resented her. Felt flattened by her.

Harriet rejects the obituary Anne writes and decides to change the narrative. She doesn’t become nicer. Instead, she becomes more honest—about who she was, what she lost, and what might still be salvageable. That shift—from managing perception to meaningfully responding to reality—is what makes the film so engaging to me.

It also echoes end-of-life work.

I’m about 20 years younger than Harriet, but I faced many of the same challenges she did when I started my professional career. It made me brittle in some places, defensive in others. So watching how Harriet resolves the unfair things that have happened to her, as her life draws to a close, is like getting a visit from the Ghost of Christmas Yet to Come.

The movie shows Harriet drinking heavily as she revisits old wounds and unfinished business. She knows the clock is ticking and that she could die of heart failure at any time. When fear is loud and defenses are worn down, people reach for whatever helps them stay present without being overwhelmed. For her, it’s copious amounts of alcohol. Unlike Harriet, I don’t drink; my default coping mechanisms are trying to help others and writing essays here about my steep learning curve as a caregiver. (Admittedly healthier for the liver, but still ways to distract myself from the real issues.)

The film’s handling of estrangement is especially sharp. Harriet’s relationship with her adult daughter, Elizabeth, is not healed in any cinematic sense. There is no big apology. No forgiveness arc. No sentimental bow. Harriet even brings two other people - including Anne - to what Elizabeth likely expected to be an intimate reconciliation. As if it were merely a routine work meeting.

This is what estrangement often looks like at the end of life—not reconciliation, but triage. Old injuries. Competing versions of the past. Love, duty, resentment, and regret sharing the same small room. I am blessed to have a close relationship with my daughter, but I have a sibling I haven’t spoken to in four years. And I’m OK with that.

As Harriet’s focus shifts from how she’s perceived to what actually matters, her actions become less abstract and more relational. She listens. She responds. She starts making choices that are specific and concrete, not merely symbolic. She doesn’t have to tell people anymore how strong and brave she is, because she now fully embodies these strengths.

For instance, Harriet orchestrates the removal of the “L” from the sign of the advertising firm she built and was later forced out of—literally severing her name from what the company became without her. It’s petty, theatrical… and brilliant. The firm’s partners threaten her, while its rank-and-file employees clap, laugh, and cheer her on.

Back at her house, in the aftermath—sparks still flying, adrenaline still humming—Harriet dances like no one’s watching. Then she leaves a few letters where they’ll later be found, sits down… and quietly dies. Given the film’s opening and the fact that it opened only a year or so after medical aid in dying became legal in California, we’re left to wonder whether Harriet’s timing was coincidence or choice.

MAiD isn’t legal in my state yet. But in my experience, some people appear to choose the moment of their death by sheer willpower. They wait for someone to arrive. Or to leave. They hold on until a hard thing is finally said—or they decide that it doesn’t need to be. It’s relational closure.

At Harriet’s funeral, we learn how deliberately she distributed her considerable assets. She leaves money to help save the struggling local newspaper at which Anne works. She donates her home to the town to become a public library, conditioned upon books being organized alphabetically rather than by the Dewey Decimal System (honoring a nine-year-old girl’s offhand remark that most other adults would have dismissed.) Harriet’s impressively curated record collection goes to the independent radio station where she DJ’d, where it will be used, shared, and loved.

These aren’t random gestures; they’re thoughtful responses. Proof that Harriet was paying attention. That she had been listening to people all along, even when no one thought she was capable of it.

Then Anne stands at the podium and reads the revised version of Harriet’s obituary. Halfway through, she stops, realizing that it doesn’t fully capture the curmudgeonly woman she’s actually grown fond of. She puts it aside, to speak directly from her heart. She reminds everyone that Harriet didn’t really hate people—she pushed them. Challenged them. Saw what they were capable of becoming and refused to pretend otherwise. Sometimes that made her unbearable. Sometimes it changed lives.

Shortly after Harriet’s funeral, Anne does something quietly radical. She quits her job. Not with a standard letter of resignation, but by writing an obituary for the person she used to be.

Because people don’t just get one life in this story.

In my work, I see this again and again: the obituary isn’t the point. The story that matters doesn’t get written at the end. It gets lived earlier—when someone stops managing appearances and starts engaging honestly. When the focus changes from how others will describe us to how we were actually there when it counted most.

No one gets the last word at death, no matter how well you think you’ve prepared for it. But you do get many chances to change the story before then.

And that, it turns out, is the part that counts.

###

Leave me a comment below with your favorite death-adjacent movie. My next essay in this series will likely discuss What Dreams May Come, starring Robin Williams.

Due to usage restrictions on photos from the actual film, opening image was created with ChatGPT.

My higher self would say yes. It would offer something lofty and aspirational about being kind all the time, to everyone—not just the people on the client list.

While noble in theory, that viewpoint is also wildly unrealistic. Real life is messier than that. We get tired. Hungry. Overwhelmed. And sometimes—especially when someone else strikes first—it’s hard not to react defensively.

P was controlling long before dementia, and even more so now that she lives in a nursing home. In her earlier life, she held real power—someone whose approval opened doors and whose disapproval could quietly shut them. She was known for her discernment, her intellect… and her sharp tongue.

Today, P repeats the same nonsensical phrase over and over and grows impatient when others don’t immediately understand her. This former authority figure is quick to reprimand a fellow resident who drops food at breakfast—while she herself is wearing an oversized bib.

I should feel only compassion for how disorienting this all must be for her. But here’s the complication: decades ago, P treated me cruelly, telling me I was talentless at something that was core to my identity at the time. The details aren’t relevant here. The important thing is that she never apologized. Never backed down. Only doubled down when I asked for clarification. I worked hard to recover from her words. I even proved her wrong, gaining proficiency — and eventually expertise — in the very skill she once tore me apart for.

Still, every once in a while, P gives me a smirk that my insecurity reads as I remember you.

Rationally, I know this is unlikely—many days, she doesn’t even remember her husband and children. But something tattooed itself on my nervous system thirty-five years ago: a reflexive need to prove that I am not “less than.”

Recently, I’ve realized that this woman has become my spiritual practice. Her merciless feedback once motivated me to grow in my avocation; now she may be teaching me how to better serve. And crucially, my higher self and day-to-day self don’t feel quite as misaligned.

You have a lot of excuses why, especially if you haven’t spent much time around death. You don’t know what to say. You’re afraid you’ll say the wrong thing.

Most of us aren’t taught how to sit with grief. So when we don’t know what to do, we do nothing. Just when someone really needs you to do something.

Sometimes, it feels safer to give someone grieving space than to risk increasing their pain. But often, when you pull back rather than lean in, what you’re really trying to avoid is your own discomfort. What often looks like kindness or caution is sometimes something else: an attempt to protect your own comfort, identity, and/or emotional equilibrium.

You still think of yourself as a kind person. And you probably are. But you’re also an absent one. Now, more than ever, the bereaved needs your support.

Looking at Grief From the Inside

When there’s loss, there’s a hole left behind. You’ve probably felt it in some area in your life. Job loss. Breakup / divorce. Loss of health or mobility. Natural disasters. Loss of dreams and goals. Such loss can include any significant transition, separation, or shift that disrupts your life, identity, or sense of security.

Grief from a death is different from other losses because it is completely permanent and cannot be undone. This absolute finality shocks your brain, which is wired to keep you connected to the people you love. Because you can never see or talk to them again, your mind and body go into a state of panic trying to find them. Death also changes your entire future, forcing you to adjust to a world without that person in it.

Life continues, but the grieving person feels fundamentally altered. Ordinary tasks take effort. Emotions arrive in waves, often without warning. There’s a quiet fear that talking about the loss will make others uncomfortable—so many people in

mourning say nothing at all. And when others do pull away, that fear of causing discomfiture feels confirmed.

Social Awkwardness and Performative Mourning

Again, avoiding the performative aspects of mourning doesn’t make you a bad person. What matters is what you do with that feeling.

For example, I can hold someone’s hand as they take their last breath. I can watch skin mottle during active dying. I can sit for hours at a bedside talking with family.

But I struggle with wakes. With open-casket makeup that tries too hard. With funeral-parlor small talk that flattens a life into trivia:

“How did you know him?”

“Oh, you bowled together on Tuesdays?”

And I especially struggle with watching people leave a graveside service and immediately pivot to their next errand.

People expect the death doula to know just how to act, what to say, after someone passes. But the truth is that we fumble and bumble just like anyone else. We’re all works in progress.

The good news is that acknowledging this discomfort and awkwardness is the first step toward transforming it into authentic presence. By leaning into the unease rather than running from it, you shift the focus away from your own anxiety and back to the person who needs you most.

How Ego Threat, Identity, and Self-Protection Come Into Play

Most of us want to alleviate the pain of others. And we especially don’t want to cause them more pain when attempting to do so.

We often forget the many, many times we stepped up for others, because doing the right thing is simply the standard way that good people go through life. What we do tend to remember, though, is something that happens far less frequently: our own missteps. The awkward thing we said. The moment we froze. We replay it for weeks. We beat ourselves up. We wonder if we should apologize. It’s a wonder we don’t want to put ourselves in that position again.

It’s perfectly understandable. But that doesn’t always make it excusable.

Some people actively avoid situations that challenge their identity as a strong, capable person. That’s where narcissistic grief can sneak in. Not through cruelty, but through self-protection.

Supporting a grieving person can unexpectedly reopen your own unhealed wounds. When their situation closely tracks your past losses, your might instinctively blur the line between their current reality and your personal history.

It’s important to keep these experiences separate. Recognize that while your feelings are valid, this moment in time is theirs. By stepping back to process your own triggers in private, you help ensure that your support remains a safe place for their grief.

When Grief Comes Out Sideways

Many people constantly scan their surroundings for danger and feel safest when others act in an expected manner. However, a grieving person is dealing with intense pain, which can make their behavior less predictable. For someone trying to be supportive, this unexpected behavior can feel unsettling.

Grief doesn’t always look like tears. Sometimes it shows up as irritability, anger, numbness, or a hair-trigger response. What you’re seeing from them is not a verdict on your character; rather, it’s pain and exhaustion.

A grieving person might cancel plans at the last minute. Forget to say thank you. Speak sharply and then withdraw. None of that means you did something wrong. It means they’re depleted.

If someone who is grieving snaps at you, try not to judge or take it personally. If anything, they need validation that what they’re feeling is normal. While you may have known loss in your own life, you haven’t known this loss. Their loss. No one else has. And that needs to be acknowledged. You can’t possibly know how they’re feeling.

When You Are the Sensitive One

Some people feel everything deeply and visibly. If that’s you, your job is to manage your reactions without outsourcing that work to the bereaved.

It’s too much to ask someone who is mourning to help you regulate your feelings about their loss.

Your feelings are real. They’re just not the same as the bereaved person’s feelings.

If being close to grief overwhelms you, it’s okay to step back and self-regulate. Just don’t disappear. Send a card. Send flowers. Drop off a meal. Leave a note that says “I’m thinking of you.” Small acts still count.

Turning Your Discomfort Into Something That Actually Helps

Being there for someone in grief means parking your ego at the door. It means resisting the urge to make their pain about you.

Here are five ways to do that.

1. Name to yourself what you don’t understand—and stay anyway.

Sit in a place of stillness and identify the feelings that are holding you back. Fear? Anger? Obligation? Let them float by without grabbing for them. The goal is to get to the point where you can say, “I can’t imagine what this is like for you, but I’m here and I care.”

2. Let their story be the only one in the room.

More specifically, avoid the reflex to answer their pain with your own experience. Even well-meant sharing can hijack the moment. Responses like “That sounds incredibly hard” keep the focus where it belongs.

3. Ask how to help—and be ready when they don’t know.

“What would be most helpful right now?” is a fair question.

If the answer is “I don’t know,” offer specifics:

“Can I put the dishes away?”

“Would it help if I took out the trash?”

“I could bring a casserole or some baked goods.”

If they still can’t decide, don’t push. Say, “That’s okay. I’ll check in again in a few days.” And then do. Remember: it’s not their job to help you feel useful.

4. Make room for whatever emotions show up.

Tears, anger, silence, repetition—none of what the bereaved is feeling is wrong. And you don’t need to fix it or smooth it out. When something feels pointed at you, remember: This isn’t about you—even when it feels like it is.

5. Be the one who’s still there after the attention fades.

Grief doesn’t end when the cards stop coming. For many people, that’s when the loneliness sharpens. Checking in weeks or months later says, “I didn’t forget. You’re still not alone.” Being consistent matters. That way, the grieving person will know that you’re still there for them.

A Few Parting Words

You don’t have to be comfortable with death to be kind around it. You just have to be willing to stand close to something painful without making it about yourself.

People in deep grief won’t remember everything you said. They will remember whether you stayed, whether you listened, and whether you kept the focus on them.

Showing up—imperfectly, without needing credit—is how support actually works.

When you stop managing how you’re seen and start attending to what’s needed, grief stops being a test of you and becomes a relationship again.

Image by Pexels from Pixabay

In the Western medical care system, treatment has a nucleus and outer margins. At the center sits allopathic care—diagnosis, intervention, and (sometimes) cure. Mostly via drugs and surgery. Allopathic medicine is largely evidence-based. (But evidence-based medicine is a standard it continually works toward, not a label every intervention automatically earns.)

That nucleus isn’t fixed, however. Practices that begin at the margins sometimes move inward as evidence accumulates, mechanisms become clearer, or outcomes become harder to ignore.

Alternative medicine sits far outside that always-changing nucleus. It is defined less by what it does than by what it replaces: it is offered instead of allopathic care, often with its own explanatory system and claims of sufficiency. Once a practice asks someone to delay, refuse, or abandon standard medical treatment, it has crossed into alternative medicine, regardless of how gentle or well-intentioned it sounds.

Complementary medicine occupies the space in between. These are practices used alongside allopathic care to support comfort, coping, or quality of life, without claiming to diagnose or cure disease. Their distance from the nucleus of allopathic care depends on the specific protocol: what claims are made, how risks are handled, whether boundaries are respected, and whether coordination with traditional medical care is encouraged.

So the distinction isn’t really about what the practice is—it’s about how it is used, what it claims, and what it displaces. A practice becomes complementary when it supports the nucleus without challenging it, and alternative when it pulls people away from it.

Some people turn to non-allopathic practices when traditional medicine doesn’t have all the answers. (Or has an answer that the patient refuses to accept.) Fear of illness, anxiety about dying, or the difficulty of letting go can make less conventional approaches feel appealing—they offer a sense of comfort, control, or gentle support that allopathic care alone sometimes cannot provide. One of these practices is Reiki, a non-invasive Japanese energy work treatment intended to reduce stress and manage pain.

Three things to consider when considering a potential treatment are what works, what people feel works, and what is being sold as if it must work. The same touch or practice can be honest support in one setting and manipulation in another, depending on whether the goal is comfort or conversion. This is exactly why clarity about intent becomes a legitimate ethical line.

Reiki is complementary when it’s used alongside allopathic care, with clear boundaries: no diagnostic claims, no promises of cure, no pressure to abandon medical treatment, and an explicit focus on comfort, stress reduction, and symptom relief. In that form, Reiki behaves like other supportive modalities such as music therapy, or guided imagery.

But Reiki drifts toward the fringe when the practitioner frames it as sufficient on its own, claims it treats disease, or wraps it in unverifiable spiritual explanations that substitute belief for care. Same hand positions, totally different ethical category.

I learned Reiki several years ago and have practiced it consistently since then. In my own experience, the most consistent results showed up not as dramatic cures, but as reduced agitation, easier regulation, and faster settling. At first, my brain insisted that any positive outcomes had to be placebo. (Real changes that come from belief, expectation, or the care environment, not from the treatment itself.) Then I watched the work produce tangible changes in people who couldn’t possibly convince themselves it would help—babies born to drug-addicted mothers who became calmer and began to thrive, developmentally challenged adults who healed more quickly and required less medication. Something was clearly happening. The harder question was whether those results were statistically meaningful or simply the most compelling anecdotes stitched together after the fact.

Naloxone and the Placebo Effect

I’ve become even more fascinated by the placebo effect after learning that the drug naloxone—an emergency medication used to reverse opioid overdoses—can sometimes reduce certain kinds of placebo pain relief. If placebo effects are partly driven by the brain’s own opioid system, then blocking that system can also reduce the relief people experience. But that raises a bigger question: what, exactly, are we measuring when we say “placebo works”?

I’m not a trained medical professional, so digging into the published research was daunting. I wasn’t necessarily looking for things to be dumbed down so much as explained in a way that doesn’t require a medical degree to follow. Here’s a simplified version of what I learned.

The brain is made up of billions of specialized cells called neurons. These neurons communicate using chemical messengers called neurotransmitters, which pass signals through receptor sites on other neurons. These signaling systems are essential for everything from movement and mood to pain perception and emotional regulation.

One important system involved in pain relief uses the body’s own opioid-like chemicals, including endorphins. These can bind to mu-opioid receptors, which are also the same receptors activated by opioid medications. When those receptors are activated, pain can feel less intense and distress can soften.

Naloxone works by blocking mu-opioid receptors, preventing opioid drugs from activating them. This is why it can rapidly reverse an opioid overdose. In some studies, naloxone has also reduced placebo-related pain relief that appears to involve this same opioid pathway, suggesting that expectation and belief can, in certain contexts, recruit real biological pain-regulation systems.

At the same time, placebo effects are not driven by a single mechanism. Research suggests they can also involve other pathways—such as dopamine-based reward systems, conditioning, attention, and changes in how the brain processes incoming pain signals. In other words, placebo is not one thing; it is a collection of overlapping brain responses shaped by context, expectation, and experience.

Real pain medications are also not all the same. Opioid drugs act primarily on the same mu-opioid receptors, which is why naloxone can block their effects. Non-opioid pain medications, like acetaminophen or ibuprofen, work through different biological pathways involving inflammation, peripheral nerve signaling, or other central mechanisms, and are not affected by naloxone in the same way.

Much of placebo research uses three-arm studies: an active drug group, a placebo group, and a no-treatment group. This helps researchers separate the biological effects of a medication from expectation effects and natural variation in symptoms over time. It also reflects a limitation in the field: there is no ethical way to simply “turn off” most brain systems in humans to isolate each pathway cleanly.

The takeaway is not that placebo is fake or that belief is medicine on its own. It’s that expectation, context, and meaning can meaningfully influence how pain is experienced—sometimes through measurable biology, and sometimes through mechanisms we are still working to understand.

When Things Work Even When You Expect Them Not To

Placebo science shows us exactly what belief can do - and just as important, what its limits are. That matters when we turn to therapies like Reiki that claim they don’t rely on belief at all. If benefit appears even where expectation is minimal or absent, then belief alone cannot fully account for the outcome. The question then becomes whether a similar outcome can be produced under conditions where belief is neutral - or absent entirely.

Reiki itself is gentle and follows a clear, hands-on or near-body method to support energy. It’s even used as a complementary practice for pain and stress management at places like the Cleveland Clinic, Brigham Women’s Hospital, and the Memorial Sloan Kettering Cancer Center. Trained reiki practitioners are also skilled with the delicate life energy of a dying person.

Even so, many MDs are skeptical of Reiki because they feel the practice lacks a measurable mechanism, reproducible evidence, or standardized outcome; in their view, its effects are mostly subjective and context-dependent. From a biomedical perspective, it reads to them as ritualized placebo because there’s nothing to test in a lab or dose precisely. The invisible, unquantifiable energy of Reiki can also feel amusing—or frustratingly unscientific—to them because it operates entirely outside the frameworks they rely on and have spent years learning. Others shrug it off, knowing that reiki is unlikely to harm a patient unless that person rejects all allopathic treatment in a belief that reiki alone can heal them.

So I keep practicing Reiki, even with that little voice in my head suggesting that maybe any kind person with enough love could have achieved the same results. Does it matter whether it’s the energy itself or simply the placebo effect at work? Ethically, I suppose it does—because using Reiki responsibly means knowing its limits and ensuring that it complements, rather than replaces, conventional care. People’s well-being is at stake, so honesty about what we know—and don’t know—is part of that responsibility. Proving that Reiki works beyond observation and experience remains a challenge, but that doesn’t mean we shouldn’t use it. Rather, it means we must use it responsibly and alongside conventional care where appropriate.

So what does all of this mean for someone choosing care at the end of life? It means asking different questions than we ask when cure is the goal. Not “Will this fix the disease?” but “Does this ease suffering, respect reality, and stay honest about what it can and cannot do?” Practices like Reiki belong in the conversation when they are used in a complementary manner. With clear boundaries, informed consent, and alongside allopathic medical care—not as substitutes for it.

Image by Sponchia from Pixabay

There are several reasons for this. The resident’s levels of pain, breathing discomfort, agitation, or anxiety need to be continually assessed. Comfort medications, like morphine, may need to be administered more frequently, sometimes every few hours or more often. The dying need to be repositioned in bed every few hours to prevent discomfort and skin breakdown. Staff need to provide the resident with mouth care care, hygiene, and secretion management. They also need to support and communicate with family members who may be present around the clock. And they need to respond to changes that can occur rapidly (and sometimes unexpectedly) as death approaches.

This doesn’t mean that every actively dying resident requires constant one-to-one nursing care. But the amount of attention a dying resident requires is often higher than for stable long-term residents.

A fully staffed nursing home can still become strained if an unusually large number of residents are dying at the same time. Staffing plans are generally based on expected averages. But reality doesn’t care about spreadsheets and schedules.

Here, the facility wasn’t understaffed for an average day; but it was arguably overwhelmed for this one. So the call went out for volunteer vigil sitters. I was available to pick up some shifts and I did.

Vigil sitters can help a facility with those at end of life in several ways. They provide a calm presence so a dying resident is not alone. They can notify nursing staff if the resident appears uncomfortable or changes suddenly. They companion the dying by playing music, holding a hand, or simply sitting quietly with the resident. And their presence allows nurses and aides to attend to other residents.

It’s important to note that vigil sitters do not replace skilled nursing care. They do not assess medical conditions, administer medications, or make clinical decisions. Their role is companionship, observation, and emotional support.

Companioning one dying person at a time is a lot. But having to split my time between multiple clients is exponentially harder. I admire the facility’s staff for how well they can do just that. I always ask to be placed in the area of greatest need, prioritizing someone who has no family members or other guests visiting at the time. That’s how I met K.

Even though she was drifting in and out of consciousness, I introduced myself. It’s not just a social nicety. There’s scientific evidence that hearing may remain functional or partially functional very late in the dying process, even when, like K, a person appears unconscious. But there’s no way of knowing with certainty that hearing is the last sense to go, compared to sight, sound, touch, and smell. Even so, staff and people like me often assume that a dying person may still be able to hear and understand some of what is being said around them.

I spent most of my visit watching K’s chest rise and fall as she slept. I watched for any signs of discomfort and promptly notified staff when K started moving more restlessly, winced, or showed other signs of pain. I read a lot. Mostly to myself, but also aloud when it appeared that K might be alert enough to hear what I was saying.

K was in a shared room and there’s some etiquette that goes along with that. It can be emotionally challenging because you’re balancing the needs of your client or loved one with the privacy and comfort of the roommate and their visitors. You need to be present and supportive while also being mindful that the room is shared space.

For me, this means speaking in a quiet, calm voice and trying to keep our interactions from dominating the entire room. Respecting the roommate’s privacy. Avoid looking at their medical equipment, discussing their condition, or involving them in conversations unless they initiate contact. Stepping out of the room if I need to use my phone and generally avoiding speakerphone conversations. Keeping the volume down for any played music or tv usage. And being considerate about lighting.

But messing up these well-intentioned plans was Judgy Cat. Not a real cat, of course. One of those life-sized, battery-operated cats designed to provide comfort and companionship, especially for people with dementia, Alzheimer’s disease, loneliness, or anxiety.

Meet Judgy Cat. (To preserve patient privacy, image created with ChatGPT.)

These stuffed critters are eerily realistic. They typically purr when petted, as well as meow and make other cat-like sounds. They move their head, paws, or body slightly. They respond to touch and sound/voice. And they provide comfort for residents who previously enjoyed caring for pets but can no longer safely have a live animal.

Many nursing homes, memory-care units, and hospice programs use them because some residents find them calming and engaging. Studies and staff observations have reported benefits such as reduced agitation and anxiety. Increased social interaction and conversation. Improved mood and sense of purpose. Not every resident likes them, but for some people they become a cherished source of companionship.

If you’re not a “cat person”, they can be really creepy. (Especially this one, whose face was stitched into a permanent expression of disapproval.) And K clearly loved hers a lot. Its fur had been hugged into a matted tangle. It smelled vaguely of chocolate pudding. And it was omnipresent. With fresh batteries.

I always enjoy when a client’s children drop by unexpectedly. In a matter of minutes, the person in the bed becomes less of a stranger. I learn who took the photos taped to the walls, why certain trinkets occupy every flat surface in the room, and which stories have been told so often they’ve become family history. Listening to the children talk, I can place my client inside a larger life—one that existed long before this room. And in an instant, the stranger I was assigned to sit with starts to feel more like a good acquaintance with whom I’m spending time again.

Today, I had the privilege of meeting K’s daughter, D, who was eager to talk about her mother. As oldest daughters, we bonded instantly. D talked about K as a young mother. About later moving away, but still staying close. I could tell that she was filtering what she should share and what needed to stay private and close to her heart.

D was telling me one of those stories that made us both laugh. Then, from the top of the bed, we heard “My sweet baby girl.” And a frail arm reached out to D. K’s maternal instincts had broken through dementia. Broken through active dying. It was time to create more family history.

D rushed up to K and held her mother’s hand. I gathered up my belongings to give them one-on-one time. As I left, I looked over my shoulder to see K stroking D’s face, saying the same line over and over again. My sweet baby girl.

And Judgy Cat, who would annoyingly meow every time K or I moved a fraction of an inch? He remained silent the whole time. (I would say “inexplicably,” but I’ve learned by now to sit with things I don’t fully understand.)

For a moment, I was transported to my own mother’s deathbed. Holding her hand, when neither of us knew if it would be for the last time. Mom didn’t have time to say it aloud as she drifted off into a morphine-assisted nap. But I’d like to think her last thought as she fell asleep that day was the same as K’s: my sweet baby girl.

Thanks for the memory, K.

The story continues.

H slept through the night, most likely assisted by the amount of morphine she was being administered to help manage pain. It was now the weekend and I arrived at the long-term care facility at noon on Saturday for more vigil sitting.

It was a typical early Spring day. Sunshine contrasted sharply with cold temperatures, making sunglasses a necessity. As I walked towards the building’s entrance, I noticed that the grass was beginning to green. I also spotted several birds hovering around a nearby feeder. The timing of my arrival coincided with the start of a large national political rally. So while thousands gathered only a short distance away to protest for a better life, I was helping H end hers in a peaceful, dignified manner.

Entering H’s room, I was pleased to find that she had been changed into clean daytime clothes. She lay quietly, not moving at all at first. The entire room felt sacred yet still a little unfamiliar, like walking into someone else’s church. Even though it only had been less than 18 hours, H’s appearance had changed dramatically since I last saw her. She looked even thinner, with large hollows in her cheeks. Her lips were extremely dry and looked crusty at the edges. Her hands and arms seemed more fragile than yesterday: they were starting to feel cold to the touch as her body conserved energy to keep her heart and lungs going. Her breathing was becoming more irregular and she’d transitioned to full-force death rattles. Her eyes were glazed and half-open, almost like she had one foot in this world and the other in the next. While each death is unique, there is still a recognizable progression most take. And at this rate, it appeared that H didn’t have much longer to live. So I tried to make that time as high quality as possible for her.

Starting with the music. (Since hearing is reportedly one of the last things to go.)

The room’s mini-speaker was playing the hits of the 1990s, likely the selection of the aide who had helped her get ready for the day. It didn’t strike me as the type of thing that someone like H - a former church organist - would typically listen to. So I turned the device as low as possible before opening a Spotify list on my iPhone. Selections by Arvo Part, Max Richter, and George Winston would be her soundtrack of the next few hours.

H waved her hands about, reaching out, then retracting. Were these random movements or was the gentle instrumental music truly touching something inside her? Might she be directing her congregation’s choir? Or was she reaching out to greet a long-departed loved one only she could see?

Later, I read H a guided meditation. The ones I use are intentionally ecumenical because I don’t want to press my own religious beliefs or faith systems to on anyone else. You can find it and others here: https://heartgrownthreefold.substack.com/s/worksheets

At the end of my shift, I chatted with the new volunteer assigned to relieve me. And I realized that I’d never heard H’s voice, seen her eyes open, or spent a moment with her where she wasn’t on painkillers. It saddened me, so I can only imagine what it must be like for her family.

A quick aside on the use of morphine near end of life. Often, family members worry that their loved one will become addicted to painkillers and that it will impact their ability to spend lucid time together. In reality, when morphine is used appropriately in hospice care, the goal is comfort, not sedation or addiction. Properly dosed pain control often improves clarity by relieving distress, allowing people to be more present, not less, in their final days.

I leaned over and said goodbye to H. One of those goodbyes that might be the last one. It’s interesting how easy it can be to bond with someone who was a total stranger only a day or two ago. And I felt privileged to spend even this brief amount of time with her, during one of the most vulnerable points in her long life.

As I left, I did what I usually do: overthink about worked and what didn’t. I ruminated on how I could do things better next time. Maybe H really did like 1990s pop music. I made a mental reminder to ask the nursing team before automatically assuming that H - or any patient - would have preferred contemporary classical ambient music. Maybe H didn’t like having a stranger stroke her hand gently. Maybe she thought the guided meditation was too woo-woo. Maybe, maybe, maybe….

After a vigil, it’s easy to replay every moment and wonder what you “should have done differently.” But presence is the work: showing up, staying, and bearing witness. This is what matters most, even when it feels like you didn’t “do” anything at all.

My next shift was on Monday. Again, I could see the difference in H over the past few days. As people approach death, their extremities often become cold. This is because the body redirects blood flow to vital organs. It prioritizes the brain, heart, and lungs because they control consciousness, circulation, and breathing. Blood flow is pulled away from the skin and extremities to support those core systems for as long as possible, which is why hands and feet grow cool first. H’s arms and legs were still quite warm. But her breathing was more labored, with a greater amount of time between breaths. It was clear that H was going to exit life the way she may have lived it: on her own terms.

H passed on Tuesday, I was notified on Wednesday. My supervisor made sure to let me and the other vigil sitters know how grateful the family was for our presence when they were unable to be there. And then the other volunteers started sharing stories about interacting with H’s loved ones. It reminded me that the dying process isn’t just about the dying person: it’s also an important transition for their family and friends, too.

What stays with me about my time with H is not a single moment, but the understanding that showing up—again and again—matters. No one—not medical staff, not volunteers, not family—can know exactly when a life will end. That uncertainty is just one thing that gives time with the dying its value and importance.

Photo by Nathan Dumlao on Unsplash

There’s also a recurring impulse in these sections for some readers to demonstrate that they understand the topic more deeply than the expert guest being interviewed. It makes me wonder about the way we look for approval in these spaces, and why even strangers on a screen can feel like an audience we need to impress. (And yes, I’m aware of the irony of responding to a comment section observation — on another platform — with something that turns it into a longer reflection of its own.)

One of the hundreds of commenters to this particular podcast joked that Buddhism was simply the art of being satisfied with the unsatisfactory, They then “clarified” that the practice was “really” about the art of transforming dissatisfaction and suffering into gratitude/contentment/love.

I humbly disagree.

Turning dissatisfaction into a more desirable outcome sounds uplifting, but it treats Buddhism as an emotional makeover culture. It isn’t that and merely cultivating comfortable feelings not what it teaches.

Rather than turning difficult experience into something more desirable, Buddhism starts by being honest about what it calls suffering, dissatisfaction, or unease. It points to how often we meet life through craving, a persistent impulse for things to be other than they are, and how that habit shapes our experience. The shift it invites is not the transformation of suffering into a better feeling, but a loosening of that grasping itself. When that grip softens, what changes is not the fact of difficulty, but our compulsion to resist it or turn it into something else.

This distinction matters, especially in end-of-life contexts.

When someone is dying, trying to “find the satisfactory” or “turn this into gratitude” can become a kind of spiritual bypass. Buddhism encourages something much harder: learning to tolerate the groundlessness of letting go. Of letting the heart break open without rushing to seal it with meaning.

In Buddhist thought, the full arc of life is not something to be managed away or selectively celebrated. Birth, sickness, old age, and death are understood as natural, inseparable aspects of being alive, not as failures of planning or attitude. Paying attention to these cycles matters because denial is what creates unnecessary suffering.

When we pretend that youth should last, health should be permanent, or death should be optional, we quietly turn natural phases of life into personal failures. Aging becomes something to hide, illness something to battle with moral urgency, and death something to postpone at all costs. That framing adds fear and judgment to experiences that are already tender, and it often isolates people precisely when they most need companionship.

But that doesn’t mean that Buddhism, end of life care, and the longevity movement can’t still meet. Trying to maximize health, strength, and clarity is not the problem. In fact, it can be a form of respect for life. The problem comes when self-care turns into refusal. When staying well at all costs becomes a way of denying that life ends at all.

Death doula work sits in the same space as Buddhist practice as life draws to a close. It doesn’t try to “fix” the moment or steer it toward a better emotional outcome. It honors and respects the circle of life.

That’s also why people like Pema Chödrön feel so steady in the presence of death. They’re not trying to avoid it or turn it into something more manageable. They’re willing to stay with it as it is, without adding anything on top of it. That kind of presence doesn’t make death easier. It just makes it real.

Photo by Jose Luis Sanchez Pereyra on Unsplash

Part of an occasional series on how death is portrayed in modern cinema.

“Men are supposed to be made out of steel or something. I just sat there. I just held Shelby’s hand. There was no noise, no tremble, just peace. Oh god. I realize as a woman how lucky I am. I was there when that wonderful creature drifted into my life and I was there when she drifted out. It was the most precious moment of my life.”

- M’Lynn Eatenton in Steel Magnolias

I was still in my 20s when the film Steel Magnolias - the movie version of Robert Harling’s hit play - was first released in 1989. The story centers around a close-knit group of outspoken Southern women who navigate friendship, life’s daily judgments, and devastating loss while showing that love and loyalty outlast everything else.

The husbands in Steel Magnolias mostly hover at the edges, remaining secondary. They have the kind of nicknames you’d typically hear once you cross the Mason-Dixon line, like Spud and Drum. (Ouiser’s dog is even named Rhett.) The women carry the vast majority of emotional weight of the plot. And they are undeniably judgy. About hair, weight, men, choices, lifestyle choices. Their judgement is sharp. Sometimes mean. Often unsolicited. (By today’s standards, a lot of it might get side-eyed or rewritten.)

To be fair, much of their disapproval happens in low-stakes places—the beauty shop, the kitchen, casual conversation. It’s a way of sparring, bonding, establishing pecking order, burning off anxiety. No one is ever truly cast out for making the “wrong” choice. The judgment might be noisy, but it’s not decisive or final.

And when it actually counts—hospital beds, gravesides, real loss—the critiquing evaporates. That’s not an accident. The women may disagree loudly about how someone should live, but they are absolutely clear about how someone should be held when things fall apart.

It fascinates me how deeply this story lands with Yankees like me. It’s drenched in Southern manners, accents, and beauty-shop rhythms—and yet it has been beloved far beyond its roots. I think that’s because beneath the regional flavor is something universal: women who show up for each other, speak honestly, and stay.

Many people look for themselves in the books they read and the movies they watch. This is likely because stories are low-risk mirrors: we scan them to see our fears, hopes, and identities reflected back. So we can make sense of who we are, or who we’re becoming, without having to live it first. When the film first came out, I was closer then to the younger women—especially Shelby Eatenton-Latcherie (Julia Roberts), she of the wide smile, big hair, feisty personality, and youthful hope that true love could outrun biology and bad luck. At the time, I was the single mother of a six-year old. Not being there for her, not getting to see her blossom into everything she was capable of, was the worst thing I could imagine.

Today, nearly forty years later, I really don’t see myself so much in Shelby — or in shy, awkward outsider Annelle Dupuy Desoto (Daryl Hannah). I don’t see much of myself in Shelby’s mother M’Lynn Eatenton (Sally Field) or warm salon owner Truvy Jones (Dolly Parton) anymore, either. Maybe it’s that I see them struggling with experiences that I could teach a masterclass in: loss, endurance, resilience, and the challenges of long-term relationships, to name just a few. At some point, I started understanding that Steel Magnolias wasn’t only about Shelby’s tragedy, but also about what’s holding everything in place when the unthinkable happens.

So what I pay close attention to these days is Ouiser Boudreaux’s (Shirley MacLaine) crankiness and devotion to her uncontrollable, mangy dog. She may no longer bother being pleasant, but she still cares deeply about those around her. Then there’s widowed Clairee Belcher’s (Olympia Dukakis) easy confidence, the kind that lets her buy a radio station and stroll into a locker room full of men a third her age without missing a beat. They speak bluntly because they no longer see a reason to soften what they stand for. They don’t manage their tone for anyone else’s comfort. And they tell the truth even when it stings. They’re teaching me how to become a crone.

M’Lynn’s breakdown after burying her daughter Shelby is perhaps one of the most accurate depictions of grief ever put on screen. This is even more remarkable considering that there are accounts from cast members that the movie’s director, Herbert Ross, could be difficult on set. But what many wrote off as just arrogance or “artistic temperament” was actually much more. Ross was actively grieving his first wife, ballerina/producer Nora Kaye, who had died of cancer in 1987, shortly before filming began. They had been married for 28 years. This did not go unnoticed by his second wife, socialite Lee Radziwell, who he married in 1988 shortly after Kaye’s passing. . (Radziwell was quoted in a 2013 New York Times Magazine article as saying “Herbert had been married to the ballerina Nora Kaye until she died, and unbeknownst to me was still obsessed by her. It was ‘Nora said this, Nora did it like that, Nora liked brown and orange.’ “)

The charged atmosphere on the Steel Magnolia’s set, as reported in IMDB and elsewhere, sits in stark contrast to the cemetery scene itself (which was reportedly captured in a single unbroken take—an uninterrupted emotional release that gives it its raw, almost unbearable intensity.)

M’Lynn starts out trying to hold everything together, because that’s what strong women are expected to do. Then, it becomes too much. Her friends see her struggle and come over to support her. They stand a few feet away, giving M’Lynn room to express whatever arises next. Her breathing breaks. The anger explodes. She rages at the injustice of a parent burying a child. Disbelief, fury, guilt, desperation—all of it shows up, fast and unfiltered.

As a death doula, I recognized every beat. Grief doesn’t move in a straight line. It ricochets. It gets loud. It doesn’t care who’s watching. The scene would be almost unwatchable if it weren’t for what happens next.

After M’Lynn cries out, “I don’t think I can take this! I just wanna hit somebody.. till they feel as bad as I do!! I just wanna hit something! I wanna hit it HARD!“, Clairee suggests that her grieving friend hit Ouiser in the face. She even pushes Ouiser right in front of M’Lynn. The other women are shocked, but Clairee continues: “Ouiser, this is your chance to do something for your fellow man! Knock her lights out, M’Lynn! “

The scene is surprising and funny, because it’s wildly inappropriate. And yet it somehow works. Humor doesn’t erase anyone’s pain; it just interrupts it long enough to keep the friends grounded. The women don’t shut M’Lynn down. They don’t try to fix her. They let her fall apart—and then they crack the pressure so no one breaks. They even laugh for a brief moment.

We know this scene wasn’t added for Hollywood effect because Steel Magnolias was directly drawn from the real illness and death of Harling’s sister Susan. Like Shelby, Susan Harling Robinson was diabetic. And like Shelby, she chose to have a child despite the risks posed by her condition. Both paid the ultimate price. The cemetery scene was there in the stage play. And Harling carried it over — nearly word-for-word — to the big screen.

In a recent article in People Magazine, Field discussed acting in that iconic scene. She noted, “It takes a part of your soul. It costs you. It cost every one of us. And we get a great deal of return from it because we learn from it. We were certainly bonded in it, holding each other’s hands the whole time. But it’s not just a job.”

It took me decades - and repeated viewings - to even begin to understand what goes into being a Steel Magnolia. As I understand it now, it’s about truth spoken inside relationship. It’s about knowing you can be blunt, cranky, grieving, trying out new personas, struggling with your marriage… and still held by the group.

But perhaps no one explains it better than Harding himself, who said in a 2012 interview with Garden and Gun Magazine, “When I was young, often sent to pluck a few magnolia blossoms for my mama’s floral needs, I learned that, while gorgeous, they are fragile and bruise easily—qualities often attributed to Southern women. My extraordinary life experiences with my sister and mother showed me that the women I’ve known are indeed gorgeous, but their lives can be fragile. But if you look underneath, you realize they possess a tensile strength stronger than anything I could ever muster. I wrote of their strength, joy, and laughter that rang out no matter what life threw at them. After my sister’s death, the only way I could deal with it was to celebrate them. When the play was finished, I needed a title. In my head, I heard that grand dame’s voice and the way she pronounced “steel magnolya.” It seemed right. My mother, my sister, my aunts, the neighbor ladies—I still hear their glorious voices all the time. I hope I always will.”

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To read more about the “real Shelby,” visit The Heart Behind Steel Magnolias: A Tribute to Susan Harling Robinson — Sharon Playhouse.