physician, nurse, psychotherapist, chaplain, social worker, certified nurse assistant, massage therapist, etc...
Will the roles become all mixed up?
No. The doula role is specific. So are the other roles which have a specific training and license or certification, i.e: physician, nurse, psychotherapist, chaplain, social worker, certified nurse assistant, massage therapist, etc...
What we can do and should do is clearly state our role as a doula is (xyz) and our (abc) services are that of (abc role). It is realistic to approach this service with all of who you are AND as an end of life doula. The combination is unbeatable for a unique and beautiful experience.
Let's not forget what we are doing here... empowering our communities to die well in this modern age. We each have a powerful combination of talents, and it is within this truth that we are serving each other. We are doing so within the construct of a doula role (see the National End of Life Doula Alliance) AND bringing our own special gifts and expertise to the table ... all of them!
Get cozy and enjoy ♥
Deanna: "Dr. Jackie, please tell us your story of how you chose hospice as your specialty area as a doctor."
Dr. Jackie: As a family physician, I have always cared for people from birth until death….cradle to the grave some people say. In the first half of my career, I was privileged to assist at hundreds of births and found the intimacy and intensity of emotion in those moments to be invigorating and sustaining. As the years went by and as my patients aged, I found that I was attending to more people toward the end of their lives where a similar sacred and intimate connection occurred. It was that connection, soul to soul that I found so profound.
Of course, like many in this field, I had a personal loss that influenced me as well. In 2004, my mother died at age 67. I spent the final 5 days of her life sitting vigil at her bedside. It was shortly after this that I decided to pursue board-certification in this newly emerging sub-specialty of Hospice and Palliative Medicine.
Deanna: "Did you know when you were little you wanted to be a doctor? What dreams did you have back then?"
Dr. Jackie: I come from a medical family so yes, probably from a young age I began working toward a career in medicine. However, before starting medical school, I did struggle with the decision to continue down this path. I questioned my motives…did I really want to be a doctor or was I just following what others in my family had done. I worried that I wouldn’t be able to be the kind of mother I wanted to be while working so many hours. As it turns out, I married a man who stayed home with the children. Also, while the children were very small, I was able to work part-time. “Stay-At-Home Dad’s” and “Part-Time Doctors” were pretty much unknown when I was trying to make this decision. Of course, like so many things in life, it all worked out and I feel blessed to be able to do this work.
Deanna: "What brought you in to the end of life doula realm of the death positive movement?"
Dr. Jackie: In 2011, I attended a series of intense and transformative training retreats at The Metta Institute in northern California entitled “Mindfulness for End-of-Life Practitioners”. This program was run by Frank Ostaseski, a Buddhist teacher and founder of The Zen Hospice in San Francisco. I learned how to connect with my dying patients in a new and deeper way…soul to soul.
Deanna: "Tell us about your services. Are you what they call a concierge physician? What is that if so?"
Dr. Jackie: Technically, I am not a concierge physician. I am a home visit based palliative care physician with a tiny solo private practice. The term concierge has come to mean how services are paid for. A concierge physician bills insurance and in addition, charges a fee to be more readily available to people. In contrast, I am “off-the-grid” as far as insurance goes. I am cash based and therefore work directly for my patients, not for their insurance companies. I like to say this allows me to practice “pure doctoring”. I do have an informal mechanism to discount my cash prices for people when needed.
Deanna: "Why you are choosing to serve people in this way instead of through hospice."
Dr. Jackie: I was a Hospice Medical Director for over 10 years and during that time, hospice changed. Financial support for hospices has not increased to accommodate all of the new regulatory burdens imposed by Medicare. This means that hospices have to do more with less and struggle to serve people in the same way we did 10 years ago. I do still believe strongly in the hospice philosophy of care and love working with hospice teams whenever I can.
Also, I think that as hospice and palliative care becomes more mainstream, I find myself seeking out the next emerging, slightly alternative and counter-cultural way to provide end-of-life care. It’s just kind of who I am.
Deanna: "What are your favorite parts of your work as a physician end of life doula?"
Dr. Jackie: I love being bedside as someone transitions into the next world…whatever that may be. This is a sacred time and I often feel like I am in the presence of a divine power during this time. I get to glimpse the great mystery of life and death as I witness someone experiencing Nearing Death Awareness.
The palliative care work I do leading up to these final moments is very important also. I love when I am invited to walk beside people from diagnosis of terminal illness all the way through to their dying time.
Deanna: "Can you speak to the EOL Doula role and how it integrates with Hospice Team Care?"
Dr. Jackie: The Doula Role to me is as follows: A caring and loving individual committed to supporting, in a non-medical way, those people facing the end of their lives. A doula provides non-medical, holistic care to people before, during and immediately after death. Doulas come alongside people they serve to provide care in a gentle, humble and quiet way. Doulas also support the other professionals on the care team.
I have recently developed a pneumonic to remind myself of where I believe as doulas and family caregivers we should focus their efforts.
L E A D E R
L Listening: Active listening to allow patient to problem solve out loud. Gentle words such as “tell me more” will help guide the person through the process.
E Empowering : teach and model self-advocacy…give people the gift of control wherever possible.
A Assisting: This is our work. We can assist in so many ways…from writing letters for someone to helping them keep symptom logs to providing respite for other caregivers. Assisting reminds that we don’t take over completely but remain available to assist when needed.
D Diffusing/Demonstrating: Our role is to be the calm presence in the room, diffusing tensions and decreasing drama wherever possible. We teach by demonstrating collaborative (non-reactive, non-defensive) communication.
E Encouraging: We want to focus on affirming our patient’s and families in their efforts to help themselves. We want to be constantly looking for ways to uplift them…not to tell them what they are doing wrong. Encouraging in this context does not mean heavy-handed persuasion.
R Respecting/Referring: learning be okay with “I don’t know, let’s ask so and so...” Respecting the expertise of professionals involved with the patient and being open to referring patients to those professionals for additional guidance.
Deanna: "What would you say is the most important thing for families to consider when they are choosing to come on to hospice service or not (if their family member qualifies)?"
Dr. Jackie: In a nut shell…”don’t wait, the sooner the better”. If you think you might need hospice, you probably do. You can call a hospice directly and have them come out and assess you for eligibility. Then they can go back to your doctor for approval to start services if you quality. Don’t wait until your doctor prescribes hospice as doctors are people too and sometimes are in denial themselves that the end may be near. People often wait too long and the biggest regret I hear from people about hospice is that they should have had it earlier.
Deanna: "Any parting thoughts for us?"
Dr. Jackie: I’m glad you asked! I am so excited about a project I am working on which I think will be very helpful for EOL Doulas and Family Caregivers who don’t have a medical background. I am about to launch a live, 6 session webinar series called the “Informed Caregiver Course”. In my life’s work as an EOL Doula and Physician my mission is to relieve suffering and that includes the suffering of caregivers and EOL Doulas. I have been at the bedside in the middle of the night and know how lonely it can be when some unexpected event happens. I want caregivers and EOL Doula’s to have some basic but critical information about common end of life conditions so they can be prepared. This course is designed to be accessible to all. Using simple, understandable language I will demystify the medical lingo so that it is less intimidating. I want to prepare caregivers so they can be the calm, self-assured presence in the room.
The Informed Caregiver Course will kick off June 10th and will consist of a series of 6 live webinars with time for Q&A. The first 2 sessions are about pain. The following sessions will address common respiratory symptoms, psychological symptoms, gastrointestinal symptoms and skin issues that can develop at end-of-life. I will be using examples from real people whom I have served in my Doula role.
I will be offering the live launch at a discounted price to those who agree to provide me with feedback by answering a quick 3 question survey after each module. Recordings of each session will be available the following day so you don’t have to worry if you can’t make it to one of the live sessions. I will also be sending out a detailed outline of each session and a study guide so you can review what you have learned.
You can sign up to receive more information on this by visiting www.informedcaregiver.com
Bio: Jackie Yaeger, MD
Dr. Yaeger earned her medical degree at the University of Iowa. After many years as a family physician in Iowa and Wisconsin, in she obtained additional board certification in Hospice and Palliative Care in 2008. She was employed as the hospice medical director and a staff palliative care physician for Gundersen Health System until 2017. At that time, she started her current community based palliative care and death doula practice in La Crosse.
Seeking to deepen her understanding of the spiritual aspects of dying, Dr Yaeger trained as a Sacred Passage Guide/Death Doula at The Conscious Dying Institute in Boulder Colorado and has completed Advanced EOL Doula Mentorship with Quality of Life Care. She is also a graduate of The Metta Institute’s Program “Mindfulness for End-of-Life Practitioners” taught by Frank Ostaseski, founder of the Zen Hospice Project in San Francisco. She is also a graduate of the 3-year program “Spiritual Deepening for Global Transformation”, through The Christine Center in Willard, WI.
Dr. Yaeger is passionate about raising awareness and stimulating discussions about death and dying. She offered a keynote address for the 2018 International Death, Grief and Bereavement Conference at the University of Wisconsin, La Crosse. She has facilitated several “Death Café” events in La Crosse and provides education as a guest speaker at UW La Crosse and Viterbo University. She has done training events for staff of assisted living centers and other agencies working with elders, end of life and caregiving concerns as well as for the public. In October, 2018 she facilitated a full-day retreat at the Franciscan Spirituality Center entitled “Being with Dying”
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