End of Life Doula Care Services

04/12/2025

01/20/2025

“People like to say that time heals all wounds, but I don't believe it. I remember once Grandpa took me firewood cutting, and as we looked at the rings of the tree together, he pointed out the years where there was drought and the years where there was fire. So while time allowed for new growth that hid the scars of the past, those scars were still there, inside the tree, and part of the tree. I think about how I am like that tree.”
― Kaya McLaren

01/05/2025

An Italian artist surprised with an impressive exhibition titled "Life is short, enjoy it before it melts," where he used ice blocks as the protagonists. The sculptures, created in elaborate and ephemeral forms, were designed to melt slowly, symbolizing the fragility of existence and the need to cherish every moment. The exhibition sought to generate reflection not only on the impermanence of life, but also on the impact of climate change, showing how something seemingly solid can disappear over time.
Credits Conocimientum

12/24/2024

Many of you are finding yourselves with an empty chair at the table this year… some of you have been looking at that chair for many years.

Whether it is a holiday, or any day of the week, staring at the empty chair is not easy. Why not change things up a bit this year and add a place card with their name(s) and a candle, and as you sit down to eat, light the candle and talk about them, share a story and a favorite memory, and find reasons to smile. Invite them to join you at the table this year.

You can do this on special occasions or at every meal. There is nothing wrong with honoring them, wishing they were there, or saving them a seat.

Know that I am holding space for each of you during these difficult times, and that you are not alone.

xo
Gabby
www.thehospiceheart.net

12/24/2024

Caught up in the wonder
Of the magic that you see
Captured by the colours
Of the lights upon the tree
Little bits of ones before
Are sprinkled everywhere
Memories that now sparkle
Like the silver in your hair

12/19/2024

7 days of end-of-life tips

Day # 6
“Should we talk to the kids about death?”

One day I was visiting a patient, an 86-year-old father and grandfather. His daughter, a mother of four kids ages 6, 8, 9, and 13, asked me if she should tell the kids he was dying. They knew he was sick, he had been in bed for several weeks, but only recently was sleeping more and became less communicative. The kids had a close relationship with him and saw him every day. I am not a therapist, psychiatrist, or a social worker and I do not pretend to be, I leave the difficult, in-depth conversations for them because they are trained to handle them far more delicately than I, however I did feel it necessary to address it right there and then because I knew he was close.

I asked her how old she was when she first experienced a death. She told me that when she was about 8, the same age as one of her kids, her grandmother died. The way she found out was when family came over, very dressed up, and left her with a sitter. She asked where they were going and one of her aunts told her that they were attending the funeral. She did not get to say goodbye, she did not get to spend time with her, and she didn’t get to go to the funeral, and it has bothered her for years. So, we talked about that, and what it felt like to not be told the truth or given the chance to say goodbye.

Not all children have the emotional maturity to handle and understand death, so I would not immediately tell you to talk to the kids. I would want my granddaughters there with me in my last days. I would want to say goodbye to them, tell them how much I love them, and leave them with sage advice from a life well-lived. I would want them to have the chance to say goodbye, but to also be given the choice whether this is something they would want to do. And if not, I would respect that.

If we are not honest with kids about death and dying, it could affect the way they view death as adults. Kids are less jaded than we are, less affected by years’ worth of traumatic life experiences, and are more likely to see it for exactly what it is; someone they love is not well and they are dying. And if we give them a chance to say goodbye, perhaps draw them pictures, or call them, or send them letters, maybe they will feel a sense of closure in their heart and not carry that with them for the rest of their life. Of course, this would be an entirely different scenario if it was an unexpected sudden death, that would need to be handled more carefully by someone professionally trained to have those conversations.

The daughter asked if I could tell the kids what was happening, which I agreed to do. I explained that his body was tired, and he had been fighting an illness for a very long time but was not strong enough to fight anymore and he was dying. I explained that he probably couldn’t talk to them anymore, but he would know they were there if they wanted to say goodbye. I was asked four questions:

“Is he in any pain?
“Will he hear me?
“Can I hold his hand, is it okay to touch him?
“How soon is he going to die?”

These questions alone should tell you how kids between the ages of 6-13 might be thinking. I answered their questions, and I suggested things they could do for him. The 13-year-old chose not to be present but had his mother bring in a drawing he did of clouds and sky, letting him know he would be in heaven, two of them drew pictures and stayed at his bedside most of the time, and the 8-year-old stayed and sat with us until he took his last breath six hours after our conversation. They were prepared for his death, they were given a choice, and they each got to say goodbye in their own way.

I think it is important to be honest with kids when someone is not well and could be dying. The amount of information should be determined based on their emotional maturity. If they are close to them, if this person has been an active presence in their life, then at the very least they should be told and given the chance to say goodbye if they choose too, and yes, even attend their funeral.

I truly believe that if we talked about death and dying more openly, and normalized the conversation, perhaps there would be less fear and uncertainty, and our children would grow into adults that continue the honest conversations with their own children. What a difference this could make for everyone in how we communicate about and navigate death and dying.

Yes, I think we should talk to kids about death. ♥️

xo
Gabby
www.thehospiceheart.net

You can find my book “End-of-Life Tips” here:
https://www.amazon.com/Life-Tips-Gabrielle-Elise-Jimenez/dp/B0C9G8PZZ5

12/17/2024

7 days of end-of-life tips

Tip # 5
“Why are routine medications discontinued, and food/water stopped when someone is on hospice?”

I have heard from several family members who feel as though starting hospice is what ended the life of the person they love, because they died shortly after admission. There are many misconceptions, most of which could have been avoided if better education was provided.

“When my mom started hospice, they immediately discontinued her medications, and she died.” People honestly believe that hospice is the cause of death, something I want to try to change. Forgive the length of this, but I wanted to be sure to provide as much information to truly honor the fear and hopefully reduce it.

When someone is admitted on to hospice, their medications are reviewed by the admission nurse who collaborates with the hospice doctor to determine which ones are no longer beneficial. There is no need for someone to take 5-10 pills if they are not helping in some way, especially if swallowing has become difficult. They might also be discontinued because they are causing symptoms that can be avoided.

Hospice covers most medications which relate to the diagnosis and the symptoms from the diagnosis. If their current medication is not on the hospice formulary, it would need to be paid for out of pocket. The doctor might suggest a different brand that would be on the formulary, to save the family money.

Medications are discontinued because they are no longer providing a benefit, they are difficult to swallow, or they are expensive and not covered under hospice. The doctor discontinues the medication truly for the safety of the patient. If there is a medication the patient or family wants to continue, the doctor might attempt to have it covered, but if it is not and the family still wants it taken, this can be discussed and might be considered.

Another fear about hospice is that food and water is "stopped" and the patient dies from starvation or dehydration. This is one of the things I hear most often. Food and water is not "stopped," we offer an explanation that it is no longer safe, but it doesn’t necessarily happen at admission UNLESS the patient is declining quickly or actively dying. If someone is struggling with swallowing, their safety is of the utmost importance to the hospice team. We would never intentionally do something that would cause or increase suffering. Usually, we try to help the family understand why the patient is choosing not to eat or drink anymore, while explaining how unsafe it can be for them.

There are a few things I look for to determine if someone has difficulty swallowing:

· They might pocket food in their cheeks.
· They might close their mouth refusing food.
· They might shake their head “no” or turn their head away from the food.
· They might cough when drinking liquids.

If any of these are happening, we know they are trying to let us know that they are no longer interested in eating/drinking and that swallowing is difficult and sometimes even scary for them. Most people think that food and water will help keep their person alive longer, perhaps even stronger, but what they don’t realize is that at a certain point the food and water can become more dangerous and could increase their suffering by causing them to choke. Please know that the body does not need food or water when it is trying to let go. In some ways, the food and water can make it harder to shut down, so discontinuing it can make things more comfortable for them. If your hospice team suggests not forcing food and water, it truly is in the best interest of your person.

If they are still able to eat and enjoy food safely, we are not going to suggest you keep that from them. We are not in the business of starving people; we are always putting their safety first and want to be sure that you do not have to witness further discomfort and suffering. What we will also do is educate you on ways to ensure safe eating and drinking, such as making sure they are sitting upright, and offering smaller and easier-to-eat portions.

Education is key and your questions are valid, appropriate, and absolutely should be addressed. As a hospice nurse, I never want to leave someone feeling fearful or uncertain, and I do not want them thinking that hospice ended the life of the person they love.

I truly hope that this information is helpful.

xo
Gabby
www.thehospiceheart.net

For all of my tips, you can find my book “End of Life Tips” here:
https://www.amazon.com/Life-Tips-Gabrielle-Elise-Jimenez/dp/B0C9G8PZZ5

12/17/2024

7 days of end-of-life tips
Tip #4
Can they hear you? Yes!

When my parents died, a few years a part, I was present for both, but only physically. I didn’t know what to say or do and no one was there to guide me. 30+ years later I am a hospice nurse/end-of-life doula and what I do best is prepare people to be at the bedside of someone who is dying.

I always encourage people to say “the things” because I believe if they are said, maybe they will carry less regret on their grief journey.

If I knew then what I know now, I would have sat at their bedside and at the very least, said goodbye. I have spent all these years wishing I had said so many things.

The first advice I want to give you, is to not wait for the bedside to “say the things." Say them now, when you have a chance. Imagine if you didn’t have years’ worth of held-onto feelings in those last moments, and you could instead simply use that time to say I love you, thank you, and goodbye.

The question that I am asked quite often, is “can they hear me?” I have heard that the hearing ability is heightened at the end of life, but I don’t think that is why they hear us. I think it is our love for one another, our history, our life experiences, our spiritual connection, and the magic and wonder that happens at the end of life when two people have to say goodbye. They hear us because they feel us and they know we are there, and somehow everything we think, feel, and say is handed over to them. I think they need to hear those last words as much as we need to say them, so that is enough for me to be absolutely certain that whatever is said moments before last breaths are taken, are without a doubt heard. Trust that.

While I wish everyone said “the things” way before they find themselves about to say goodbye, I will always encourage people to say whatever they need to before last breaths are taken. I imagine their words as a take-away, a beautifully wrapped gift for the person who is dying to take with them when they go. Sometimes there is history that is not pleasant, perhaps years of disconnect prior to this bedside moment, which means there are years of unsaid words that there will never be enough time for. But what if you apologized, forgave, or made amends and the comfort that might bring. And if the damage and pain is too deep, what if you simply wished them peace, and said goodbye. This is not a moment to make up for lost time, it is a moment to let go and say goodbye, for you and for them.

I believe that people who are dying need to know a few things; that the people they love will be cared for well, that their name will always be said, and that their legacy will be carried on for many lifetimes. And they need to know without any doubt, that they were loved. Imagine if we just said those things.

When you ask me if they can hear you (us), especially when they are non-verbal and cannot respond, my answer will always be yes. You may not get a smile, or opened eyes, you may not hear words in response to yours, or feel a tightly squeezed hand… but I can assure you that whatever you say will be received and it will be the last gift you give them.

But how can I be sure? Because when I was at my brother’s bedside for the 18 days he was in the ICU, I apologized over and over for wasting so much time holding onto anger from a fight we had many years before. The day before he died he woke up. They took him off the ventilator and off oxygen and he was awake. I asked him if he knew I was there and he said, “I’m sorry too.” He heard me.
That’s how I know for sure that the words that you say will be heard.

So, if you find yourself at the bedside of someone who is dying and you love them, let them know, and tell them their life mattered, wish them a safe journey, and say goodbye, because they deserve that. They hear you. I believe this with every ounce of my being.

xo
Gabby

For all of my tips, you can find my book “End of Life Tips” here:
https://www.amazon.com/Life-Tips-Gabrielle-Elise-Jimenez/dp/B0C9G8PZZ5



12/17/2024

7 days of end-of-life tips
Tip #3
Visions, Voices, and Visitors

Pretend for a moment that anything is possible, and our role is not to prove someone wrong, but to instead support them if it brings them comfort. Let’s place scientific proof, endless data, and opinions of others aside for now. These are just my opinions, what I have witnessed, and how I feel about this topic personally.

I visited a man a few weeks before he died. He told me that his dogs, both of which died years ago and years apart, had started to visit him. His question was, “does this mean I am close to death?” I first asked about the dogs, their names, and how it felt to have them there. He was so pleased they were there, and he told me that they didn’t get along well when they were alive and the older one died a few weeks after he got the second, so they didn’t have a lot of time together, but now, as they lay on his bed, they were the best of friends. I explained to him that it is my opinion that when someone is near death, they are more open, perhaps spiritually, maybe intuitively, to welcoming the things we cannot see or hear. I told him that from my experience it doesn’t necessarily determine his timeframe, but that it was my opinion he was close. On the day he died, I was there with him. I asked him if the dogs were there; he patted the bedside (as if to pet them), smiled, and said, “yes.” He died about an hour later.

I have witnessed many people seeing friends or family members that have died, people they didn’t know, one even told me Jerry Garcia played music at her bedside. I have only witnessed one person fearful of what she saw, because it was so startling to her, but soon after, she found comfort in the visits from the stranger. People who can verbalize and are alert and oriented, share their stories with me and I sit almost child-like at their bedside, eager and excited for every word. I see the comfort this brings, but I am also curious and I want to learn more. In many ways it is a hand stretched out, as though someone is saying, “I will take your hand and join you on this next part of your journey so you do not have to do it alone.”

Some people are no longer verbal, but I can tell they either see or hear something by the way they gaze (usually at the wall or ceiling), with glazed eyes and appear peaceful. Family members worry, they don’t understand, most cannot accept it to be true, so they want to talk them out of what they see or hear and convince them they are wrong, or even medicate them out of their “hallucinations.” I can appreciate the discomfort the unknown can bring, so I always take time to help those at the bedside feel a little more accepting, and hopefully less fearful.

I have learned that some people can have these visions or hear voices months before they die, some it only happens hours or days before, so this cannot be predictable. Most people do not struggle or feel fear, and find comfort, safety, and peace with the presence of the visitor(s). I always encourage families to just listen, and ask questions like, “what do they say?” or “what are they wearing?” If you leave the door open for them to trust you with what they see or hear, they will be more inclined to include you, and trust me, you want to be included.

There is a darker more uncomfortable aspect to this, which some of you might have witnessed. Terminal delirium is a real thing, hallucinations can happen, and fear is difficult to watch. This is that time when it is so important to talk to the doctor and ask what you can do, and most times, medication is key, so my advice is to trust that. Our role as a bedside guide, in any capacity, is to relieve fear, so be sure to honor them by being their fierce advocate.

Whether there is a curtain, a veil, or a sparkly silk cloth that comes between us and whatever is waiting for us on the other side, if someone hears a comforting voice or sees an outstretched hand offering safety on their journey, I believe our role is simply to thank them for being there, and feel comforted that someone you love has a companion to take those next steps with.

Instead of questioning or correcting, ask questions and offer them a safe place to talk about the mysteries and magic of the dying process.

xo
Gabby
www.thehospiceheart.net

For all of my tips, you can find my book “End of Life Tips” here:
https://www.amazon.com/Life-Tips-Gabrielle-Elise-Jimenez/dp/B0C9G8PZZ5

12/17/2024

7 days of end-of-life tips
Tip #2
Medications

I will start by saying that I am not a big fan of medication. And what I mean by that, is that it is not usually my first go-to because I would like to think there are other things we can do first to try and relieve distress, discomfort, and/or suffering, such as repositioning and verbal or tactile stimuli. However, having said that, medication is important to have on hand and will oftentimes be the difference between pain and peaceful.

A comment I hear often is the connection between hospice, morphine, and death. I have heard people say that their loved one died when they were given Morphine. I have not been in your shoes, I wasn’t there when this might have happened, so I can only speak from my own experience and from what I have seen.

The medications commonly used at the end-of-life are Morphine and Lorazepam (Ativan). There are many others, but for now I will start with them. I am not afraid of these medications because I have seen them work effectively and I rely on them. I am not concerned about someone becoming addicted, and while I respect your fear, I encourage you to remove that from the things you are afraid of. If someone is at the end of their life, becoming addicted would be the last thing I want you to worry about.

I find that pairing medications like Morphine and Lorazepam can be very effective, but this too scares people. I take time to explain the “why,” and say “they are good friends, they play nicely together.” What this means to me, is that when given together they can provide more comfort and relief. For instance… if there is pain, it can increase the agitation/anxiety- if there is agitation/anxiety it can increase the pain. If Morphine and Lorazepam are given together they can often simultaneously reduce both (most of the time).

More is not always better. Our bodies react differently to medication, so we cannot assume that what worked for one person will work for another. This also means that we tolerate doses differently as well. For instance, one person can take Lorazepam and feel relaxed and calm shortly after, another person might sleep for an entire day, and someone else might not feel any relief or it will only last 30 minutes. This cannot be predicted.

I have also witnessed pain increase when medication is given, which is why I like to wait to see how a medication works before immediately giving another dose. Each body reacts differently, therefore it is important to determine whether an increase or reduction of medication is needed, or perhaps changing to a different medication.

Constipation is a common side effect when using opioids, but what I also look for is the dry eyes, the dry mouth, and the reddened and warm cheeks because this can be very uncomfortable for someone who is dying. This is where you come in… offer a cold compress on the cheeks and forehead, or wetting eye drops for the eyes (check with the doctor first), and even just one drop of water is comforting to a dry mouth, but please always be mindful of their swallowing ability and that the head of their bed is elevated. If they are alert and oriented, I suggest sugar-free sucking candies or watermelon… both comfort a dry mouth.

Can someone die after taking these medications? Yes. Did you or your doctor or nurse end their life by giving it to them? In my experience I will say no. When someone is suffering and given medication, they might die shortly after. My rationale for this is that the medication allowed them to stop fighting so hard, and give into what was already happening to them, allowing their body to let go. Their diagnosis and disease process ended their life, the medication just gave their body permission to let go with a little more peace and grace.

If you are afraid of the medications being prescribed for someone you love, ask for more information. Not only are you this person's advocate but you will carry this memory with you for the rest of your life and you need to know that you did right by them. And if you are the doctor or nurse suggesting a medication, please offer as much education to the family, allowing them to feel confident with what is being suggested. Education is so important, and can relieve fear.

I think it is very important to respect that medication can be scary, and most people equate it to addiction and death. I alway do my best to remove these fears, making sure they feel confident and comfortable with what is being given, and how their person is being cared for.

xo
Gabby
www.thehospiceheart.net

For all of my tips, you can find my book “End of Life Tips” here:
https://www.amazon.com/Life-Tips-Gabrielle-Elise-Jimenez/dp/B0C9G8PZZ5

12/17/2024

7 days of end-of-life tips

I will be posting a new end-of-life tip every day for one week. Each tip will hopefully help to clear up some of the misconceptions or fear that you might have. I have chosen the topics based on the questions I am asked most often.

End-of-Life Tip #1 The Death Rattle
(Note that this doesn’t always happen)

I want to (in my terms) explain the "death rattle", which by the way I think is an awful term, and I wish they would call it something else. Note: some call it "terminal secretions," which I don't think is any better... but it is what it is.

I have come to believe that the sound bothers us more than them, and while there is no actual proof of that, in those last few hours to days when they have become non-responsive, I believe they are less aware of the sound. It usually happens at the end of life because our ability to swallow is reduced and we are unable to cough or bring secretions (saliva/phlegm) up or down so it hovers there and will sometimes make a loud vibrating sound, that sounds like rattling, or gurgling.

Please do not rush to get a suction machine or medications like Atropine. First try to gently reposition them on their side. Sometimes, that alone can move the secretions just enough to quiet the noise... which again bothers us more than them. Repositioning is oftentimes the remedy.

If the secretions are filling their mouth, even spilling out, a suction machine is useful, but I want you to imagine what it must be like for the person lying in the bed. The noise is awful in itself, but the suctioning tool is so uncomfortable, and when you are dying, that is the last thing you want happening to you. Try and use mouth swabs to remove the secretions manually first... please... it is so much gentler and far kinder.

Medications like Atropine are often effective, but usually more effective when the secretions are pooling in the mouth. A suction machine is also helpful in that same way. Neither are very helpful when the secretions are down the throat and just hovering there. This is why I believe repositioning is the best first thing to try.

My hope in sharing some of these tips/tools is to relieve your fear, and to help you be better prepared for what happens when we die. To be present for someone when they are dying, means to witness the ways our bodies shut down. It can be messy; it can even be a little scary... but our bodies know what to do and the things we experience are a natural part of the dying process.

Sometimes, I just lean in and I place my hand on their back and rub it gently, whispering, “it's okay, I am right here, I’ve got you,” making sure they know they are safe, and not alone. And that comforts them. Trust your words, your heart and your touch... it is amazing what comfort these can bring.
❤

xo
Gabby
www.thehospiceheart.net

For all of my tips, you can find my book “End of Life Tips” here:
https://www.amazon.com/Life-Tips-Gabrielle-Elise-Jimenez/dp/B0C9G8PZZ5