What a Death Doula Can Teach Us About Living More Compassionately

As a society, we’re in the midst of a bit of a redefinition of what it means to be “smart.” The dehumanizing effects of relentless algorithmic optimization and data-driven thinking have brought into sharp relief the value of emotional intelligence (commonly referred to as “EQ”) as a key leadership skill and a springboard to not only individual success, but collective success as well. 

With an eye toward this welcome sea change, we’ve partnered with our friends at Lexus on a series of interviews with inspiring individuals who are forging new paths and leading their respective industries with empathy and EQ at the forefront of their work. 

Today’s subject: Alua Arthur, a death doula and pioneer in the field of end-of-life care. A former lawyer, Arthur now runs Going With Grace, a practice that provides support both emotional and logistical to the dying and their families, as well as training for others looking to enter the death doula field. We spoke with Arthur about the challenges of being at the forefront of an arena that deals with our most profound collective experience, the distinction between empathy and compassion (both essential to a well-rounded EQ), self-care and the value of a good glass of wine.

InsideHook: Can you pick a catalytic moment when you decided that you wanted to become a death doula? 

Alua Arthur: I’ll give you the medium-sized version of the story. I’d been practicing law for 10 years and developed serious depression. I went to Cuba and met a woman. Well, actually, I was running through the street trying to return something to somebody before catching a bus, and almost got hit by a car. I slammed my hands on the hood of the car, and then was like, “Get it together, Alua. Get your life together. Don’t die in these streets.”

Eventually, I made it to the bus stop, and the same woman who had been in the car that almost hit me was on the bus I was trying to get on. We sat. We talked. Turns out she had uterine cancer. We talked about life. We talked about death. We talked about disease. We talked about men. We talked about legacy and mission and vision and all those things.

I was like, “Wait a minute. She’s going to die. She’s never voiced her concerns and thoughts about death to anybody before.” When she’d talk about it, her friends and family would tell her not to talk about it, like, “Oh, but you’re going to get better, and you’re not going to die.” To me, it was like an existential gaslighting. It was denying her experience. I found it terrible. I thought that had to be really sad and lonely for her.

Looking around the bus, I was like, “Wait a minute. Everybody here is going to die. But it’s not a conversation we’re having in the public domain.” That bothered me. It made me very sad for her. It made me sad for humankind overall. And so I decided I wanted to work with people that were dying or help people prepare for their dying.

Can you talk about the process of getting started? Were there people who had cut a bit of a path prior to you? How did you find your footing, your first clients, communicate your mission? This seems very daunting, to be at the forefront of a new movement.

Hugely daunting. About six months after I came back from Cuba, my brother-in-law got sick. About four months later, he was terminal. I went to be with him and my sister and my niece in New York, where I walked him through the end of his life. I spent two months being a death doula without knowing it, doing all the supportive work for them while they were walking through the process.

When I came back to L.A., I told everybody that this was the work that I wanted to do — well, my therapist, mainly. She knew somebody who knew somebody who had taken a death-companioning intro session. So I found a death midwifery course at Sacred Crossings. The course was three weekends and I took it over the span of six months. You show up in person, watch movies, talk about grief, and learn some practices to support people at the end of life. It was great. It was also not wholly what I thought I wanted to offer to people.

It was very spiritual in nature. There wasn’t a lot of the practical “How do we work with people who are dealing with fears of death? How do we have the conversation with people? How do we change names on a bank account when somebody’s close to the end of life?” None of that was present.

When I first started out, I was doing what I’d learned in the course, which is the spiritual, loving, supportive, compassionate work. But I found that the needs were actually the practical ones, and the practical ones would almost always lead to the emotional ones. But, I had a lot of [internal] resistance to doing the practical things, because I’d been practicing law for so long. It felt boring, obnoxious. But through what I experienced with my brother-in-law, I saw how monumental [helping out with the practical issues] was. They cause a lot of grief at the end of life.

So I figured, “Let’s start there and see what else it might open up.” Preparing for death, people think that it’s a lot about resolving your relationships or thinking about what you want with the afterlife. But it’s also getting your affairs in order. People hang on for a long time because they haven’t done a will, you know what I mean? There are a lot of things that go into preparing for death that transcend the emotional, spiritual and psychosocial.

So I started out doing some of the practical things. And from there, the world kind of opened up. But the process of finding the first client was tricky. [There was] resistance. So often people are like, “I’ve got everything together. I’ve got it figured out.” And I’ll be ok with it and offer myself if they find something they need help with. Before long, they will say “Well, there is this one thing. We’re stuck with this bank account.” And then we’ll uncover a host of things that haven’t yet been addressed. Naturally, I’m very grateful that I get to come and support them through it.

The concepts of empathy and emotional intelligence must factor so heavily into what you do. Are these traits that you’ve always been cognizant of possessing?

I’ve always identified empathy. With my work practicing law, I worked in social justice. I did domestic violence and restraining orders and sexual assault. I worked in government benefits, helping people that had lost their Medi-Cal and their welfare, their food stamp benefits. So I’ve always been interested in social justice and trying to right the wrongs and ills of society. And they’ve all been fueled by empathy.

But I’ll say that in death work, it’s become primarily important that my focus is on compassion rather than empathy. Can I draw the minor distinction as I see it for you?

Of course.

So in the work itself, empathy often says, “I know what you’re feeling” or “I can feel what it is that you’re feeling” or “I can identify what you’re feeling. I can put myself in your shoes.” But when it comes to people who are dying, that’s actually really dangerous, because I can’t draw on any experience I’ve had while living that could mirror the experience of dying. You cannot be in those shoes.

When a friend is in a breakup, I can be like, “Oh, my God. Yeah. I know what that feels like.” I actually don’t, but I can [say that], because I’ve done it before. Or I can pull from other losses or friend breakups or difficulties with parents, relational challenges. But with dying, we can’t.

If we try to do that, we minimize the experience that the other is having. It’s profound. It’s huge. I have no idea what it is like to be actually dying. I do death meditations out the wazoo, sit with people all day long, and never will I know what it feels like until I’m actually there. Also, it makes us collapse the space between me and the other when I feel like I know what it is they’re feeling. It doesn’t allow me to step back and say, “Well, what are your needs?” because I’m stepping in to do what I think they need. 

This is part of the problem I had when I first started my practice. I thought I knew what people needed. They reminded me I didn’t. I was like, “What do you mean? This is what I know that you need. You need somebody to close your chakras.” And, they were like, “Chakra what?” It takes some separating, and creating clear edges between myself and the other. And I think that’s where a big part of the emotional intelligence comes in.

Just as visionary leaders understand the importance of emotional intelligence in forging new paths, Lexus understands its importance in the world of automotive design. As they’re fond of saying, “When you design around pure technology, the result is a leading-edge automobile. When you also design around humanity, the result is a Lexus.”

This focus on emotional understanding and human-centered craftsmanship is abundantly evident in the brand’s new flagship LS, a new standard in luxury autos that seeks to create a deeper connection between driver and car to deliver a truly empathetic driving experience. 

Regarding the nuts and bolts of your process, I’m presuming that there are elements of what you do that are somewhat codified but then adapted to account for the unique circumstances of each client. I’m interested to hear what that process looks like.

Well, it begins with a very short recitation of why they’re reaching out to me. Either it’s a family member or the person themself, but it’s, “What are you seeking, what is your end goal?” And then I work backwards from there. It almost always looks like a long conversation to begin with, and then me showing up to their house. Then a one-on-one where I’m also looking at what they haven’t yet told me in the first conversation and then creating a plan of action from there.

Going With Grace, the company I run, our mission is “What must I do to be at peace with myself so that I may live presently and die gracefully?” Every individual’s answer is different because for some people it’s experiential — for some people, it’s “Sit with my granddaughter one last time.” For some people, it’s their affairs. For some people, it’s relational. There are so many different categories, and so the process, while it’s a lot of talking, leads us down very different roads.

Do you feel people are relatively forthcoming? Or does it take some time to drill down what they actually want, versus what they might say out of the gate?

It takes a little bit of time, but not as much as you would think. We have to establish a decent amount of trust right off the bat. Dying is the most intimate and vulnerable act any of us will ever do, and I find that as people get closer, they get a lot more intimate and vulnerable. When I’m coming into the home of somebody who no longer resembles the person that they’ve been because they’re near the end of their life, they’ve learned to put down a lot of those masks that we wear. But sometimes we’re still holding on to some of them, and it takes patience, of course, just to break through and get to the root of why they’re reaching out to me.

What would you say is the hardest part of your work?

Running a business. By far. This business shit is for the birds. If I could do this for free, I absolutely would. If I was not so full of this mission that I could manage to do something else with my time, I would, and I would just offer this as a heart offering. But the way this body and this vision are set up, this is all I got. And I still got to pay my bills. I still have student loans from law school, and I like nice wine.

Given the emotional weight of your work, what are some ways that you make sure to take care of yourself at the end of the day, aside from the wine? Actually, I guess the wine can be part of it.

The wine helps a lot. But so does a gallon of water. There are some very basic practices that I try to do every single day, which is meditate, exercise, drink a gallon of water, stretch and take my supplements. If I’m doing those things, then I’m pretty solid.

But really that’s self-care lite, because then there’s the deeper work, which is looking at my shadow and where I overstep my own boundaries and the wounds that I’m acting out. We make self-care into lavender eye masks and foot baths. But realistically, for me, it’s about caring for the universal and individual lived experience, making sure that the whole of the self is being taken care of — not just soaking or watching Netflix.

I think what you’re saying is very meaningful. Like there are parts of self-care that aren’t pamper-y. There are parts of self-care that are innately scary and difficult, but no less important.

Very important. More important, I’d say. For example, if you deal with an anxiety that has you running over and over again in your head the things you said to that one person that one time, how are you ever going to enjoy a bath? We got to deal with those things. That’s some self-care. Let’s get to our root challenges. I’m not going to call them issues, because I don’t think that they lead to our brokenness. But the things that maybe make it challenging for us in life and create more suffering. For me, that’s the epitome of my self-care. But then, I also got to drink my water. Hydrate.

Can you talk about any specific moments in your work that you have found particularly gratifying and/or meaningful?

There’s one that I’ve been thinking about lately — there was this one woman, her daughter was dying. She was in her mid fifties or sixties, and her daughter was in her thirties or so. I left them alone for the evening. Daughter was actively dying. But the mother felt comfortable that she would be okay for the evening. 

I sleep with my ringer on when a client is actively dying. The mom calls me in the middle of the night to ask if it was okay if she got into bed with her daughter. And mind you, this is a child that she carried in her womb, had given birth to and nurtured as a child, had taken care of for her entire life. To me, it highlighted the fear that exists in the dying process, and also the tenderness that’s available when we’re willing to open ourselves up to it.

Just the fact that she even thought she had to ask permission…

Yes, to hold her child while she was dying. I felt so honored to be able to give her that permission, even though it exists inherently, but to be like, “Absolutely, yes. You should do that. Yes, you can do that.” It’s such a … the system is so broken.

In one of your previous interviews, I saw you had used the phrase, “What we don’t say chokes us as we die.” I find that to be very powerful. Can you talk about the role of communication in end-of-life care?

First, I think when I said that I was probably talking about leaving things unsaid. We have this vision that comes mostly from the movies, of let’s say a dad laying on his deathbed. He’s estranged from his son, and his son busts in at the 11th hour, and he’s like, “Dad, I always loved you.” Dad’s like, “Son, I forgive you.” And then the dad dies. That’s not how it happens. People often are just stuck with these things that they haven’t yet said. Some of my work is making sure that all of those things are said so that they don’t get choked by them. But, more importantly, making sure that we are speaking as authentically and vulnerably and effectively as possible, and consistently also checking in to make sure that we’re being understood.

That sort of leads to my next question, which is regarding things that you’ve learned through your practice that you think are applicable to other professions of just life in general …

Everything. There’s no element of being with dying that is not also about being with living. Every little last bit of it. Communication, relational hygiene, purpose, being pretty clear about what we’re doing and why we’re doing it, intention, our values. Everything. Everything. Talking to somebody about what kind of death they want to experience is going to tell me a whole lot about what that type of life they’re currently living. Life and death are just opposite sides of the same coin.

What do you mean by that?

I play this fun game on Instagram where I find a quote about life, and I slash out the word “life” and write “death” and see if the quote still rings true. Most of the time, it’s like, “Whoa!” It totally blows your mind because it’s that much more powerful. Try it sometime.

In terms of training other people in this work, what’s the most important thing that you try to communicate right out of the gate to somebody who’s wanting to learn about end-of-life care?

The most important trait, the trait that makes the most effective death doulas, is people who have built a strong personal relationship with death and dying themselves. That does not mean that you don’t have any fears or thoughts or concerns around dying. It just means that you’ve dug into them, because that’s the thing that’s going to make us able to show up to meet somebody else for their needs and not what we think they need.

We go through 12 modules online, on all the elements of death care. And through every single one, I ask them to relate it back to themselves — I ask that they spend some time not only learning the skills and the information and the practices, but also learning how it relates to themselves.

Do you feel that the experience of teaching people these practices has influenced the way you approach your own work?

Majorly, because first of all, I’m learning from them all the time. In the very first calls with the students, I’m like, “Just so we’re clear, we are all equally teacher and student here.” I just happen to gather some information based on what I’ve done before and put it to them for their consideration. Then they think about it, optimize it in their ways and spit it back to me. I learn so much from the students. One student once went down the loop about who the body belongs to, and I was like, “Whoa! That hasn’t crossed my mind yet. Who does the body belong to?”

I feel like teaching a skill, even one that you know really well, puts a whole new lens on it that can be really helpful in growing it personally.

Absolutely. Another thing it does is it invites curiosity, because it’s like, “Oh, how do I do this thing?”, rather than just doing it by rote. I really appreciate that. I’d say approaching the work with curiosity is one of the things that I strive for. I don’t ever want to get to the point where I’m like, “I know how to do this,” because, first of all, a client’s going to knock me on my ass when I have that thought, because they’re going to remind me I don’t know shit. But as long as I can approach it with constant curiosity, then I’m still in the space of learning about it. I’m also growing nonstop, and it stays interesting. Not that death will ever get boring for me, I don’t think. We’ll see.