Comfort and Caring at the End of Life: Baylor's Doula Program

Abstract

I magine yourself alone in a hospital room. Your trusted physician has just left after telling you that things are not working out the way he had hoped. Th e treatment options have been exhausted and you have weeks, perhaps months, to live. Your spouse or life partner died a year ago. If you are lucky enough to have supportive friends and family, you do not want to burden them with long hours at the hospital and add to the stress in their lives. All of a sudden you are fl ooded with a myriad of emotions, decisions, and questions that need to be addressed. Despite the frequent visits from nurses, technicians, doctors, and therapists, your room feels empty and cold. You dread the long night ahead. You begin to wonder what death will be like and who and what you will need to get through the time you have left. You’re overwhelmed and feel very much alone in the journey you are about to make. Out of a fi rm belief that no patients at Baylor University Medical Center in Dallas should have to struggle with this experience or die alone, Baylor’s Supportive and Palliative Care Service developed and implemented the Doula to Accompany and Comfort Program. After reading a 2004 New York Times article, “In Death Watch for Stranger, Becoming a Friend to the End,” by N. R. Kleinfeld, one of the team members brought the concept of a doula program to the weekly team meeting for consideration. Th e term doula has been around for centuries. In ancient Greece, it was used to describe a household servant. It can also mean an individual trained to provide comfort and support to women during labor and childbirth. More recently, it has been associated with those trained to provide support at the end of life. In 1998, the Shira Ruskay Foundation in New York sponsored a conference on end-of-life issues and care. Dr. Sherwin Nuland, professor of surgery at Yale University School of Medicine and author of How We Die: Refl ections on Life’s Final Chapter, spoke of the Yiddish and Hebrew word for funeral, levaya, which means “to accompany.” Dr. Nuland emphasized the importance of accompanying the seriously ill through the dying process. Phyllis Farley, chairman of the board of the Maternity Center Association in Manhattan, suggested that well-prepared volunteers could make a signifi cant diff erence to those who would otherwise die alone. Her suggestion, as well as her assistance in gaining funding for the pilot program, birthed the From the Supportive and Palliative Care Service, Baylor University Medical Center at Dallas.