A Date with Death | April 30; 6 p.m. | Letters Community Bookshop, Durham
One day in 2009, Jane K. Callahan picked up the phone and learned that her mother was dying.
Callahan, then 27, hadn’t spoken to her mother, whom she had a complicated relationship with, in two years. Suddenly, she was thrust into the position of coordinating urgent medical decisions and flipping through her mother’s address book, making goodbye calls on her behalf. She felt wildly unprepared.
“I can tell you the awful writhing of my spirit, the systemic pulling apart of my very core, as I sat alone in my room and watched my mother’s hands and feet turn purple,” Callahan writes in A Death Doula’s Guide to a Meaningful End, her new book out this month from Chicago Review Press.
The experience set Callahan, who now lives in Durham, on the path to becoming a death doula.
Death doulas offer guidance and companionship for people looking for end-of-life support for themself or a loved one. Doulas do not get involved in medical care, and the profession operates outside of the health care system. Because there is no state-mandated licensing process, most go through specialized training. For Callahan, this meant time doing volunteer hospice work before training with the International End of Life Doula Association (INELDA) and earning subsequent professional certification from the University of Vermont’s Larner College of Medicine.
She’s now worked with around 100 clients—the young and old, organized and disorganized, those who believe in an afterlife and those who do not—since 2018. She’s worked to help families find common ground with care decisions and helped patients downsize and plan legacy steps. In one anecdote, she recalls a client who, as he got closer to the end, kept longingly referencing a childhood friend he hadn’t spoken to in decades. Sensing unfinished business, she tracked down the friend and facilitated an emotional reunion call between the two men.
The death doula profession is fringe but growing quickly. The National End‑of‑Life Doula Alliance (NEDA) reports that its membership grew from 260 to 1,545 doulas between 2019 and 2024. Loren Talbot, director of communications and partnerships at INELDA, told the INDY that in North Carolina, the organization has trained 354 doulas and has 79 members.
The death positivity movement has seen growth in recent years, and the popularity of “death cafe” events across the globe also points to broader shifts in end-of-life frameworks. According to the death cafe website, more than 23,000 such events have been held across 97 countries since 2011; in the Triangle, you can find death cafés just about anywhere—at Duke University, in Raleigh, and Hillsborough, to name a few.
On a recent sunny afternoon, I met Callahan, who has bright blue hair and was wearing dangly Day of the Dead earrings, at a coffee shop.
“I want this knowledge to be available to as many people as possible,” she explained. “It’s not the same as having a doula walk with you side by side, but this is a way to give people everything I’ve learned over eight years.”
A Death Doula’s Guide to a Meaningful End grew out of a Substack that Callahan, who previously worked as a journalist, began as a way to share reflections on her work; as its title suggests, it is a practicum on how to have a “good death.” Accessible and absorbing, the book is filled with considerations ranging from the logistical (What is my budget for home care assistance? When do I want to be taken off life support?) to the sensory (When I’m in my last hours, what do I want around me? Pasta on the stove? Marvin Gaye on the stereo?).
A blueprint doesn’t mean all is guaranteed to go as planned—in one chapter, Callahan describes a near-death river rafting experience, nodding to the impossibility of planning at all—but writing out a framework is a practice in meaning-making. (In Bhutanese culture, she writes, people are “expected to think about death five times a day” to encourage happiness.)
Callahan includes her own “good death” plan in the book. It involves plumeria candles, drugs, a park bench inscription, and money set aside for climate change research. She hopes to die at a vacation house so that her husband and son won’t associate sad memories with her home. This consideration, too, is practical.
“[The rental] will go on credit cards that are only in my name,” she writes, “and by then I will have relinquished all my property—creditors can’t take from an estate you don’t have.”
A 2024 survey by the National Funeral Directors Association found that 9 in 10 Americans feel comfortable talking about death. Be that as it may, you’re unlikely to see such apparent comfort externalized in American culture—not when biohacking and an obsession with youth have skewed our relationship to mortality, anyway, and sickness and suffering are often managed privately.
“Care homes are tucked away,” said Callahan, pointing to the decline in multigenerational housing over the past century. “We don’t really see the true population in the everyday world. … It’s just not built for people who are very elderly. They’re not in society as much as they could be.”
It hasn’t always been this way. Historians point to the shocking scale of death during World War I and the Spanish flu epidemic as a turning point when mourning, previously a much more communal event, became siloed. As the 20th century continued and life expectancy improved with medical technology, mass media has reinforced individualism and the idea that longevity is more or less in our control, given the right step count and diet.
Then came the pandemic.
“COVID was a reality that forced us to look at our mortality,” said Callahan. “When we would read and watch the isolated and graphic nature of these deaths, we [couldn’t] help but start thinking about what we would want for ourselves.”
I began A Death Doula’s Guide to a Meaningful End believing I had no immediate touchpoints for the subject, as someone who isn’t currently serving as a caregiver or dealing with an illness. And while I’ve never felt that thinking about death is morbid, it always did, at some lingering Calvinist level, feel indulgent.
This was a perspective that lasted all of 10 pages.
As I read, touchpoints rose to the surface. I thought about a neighbor whose health had begun to rapidly fail in isolation, and my aging parents, and their friends. I thought about existential fears about the future and the goodbyes to grandparents in the past. In particular, I thought about childhood friends who died much too early, and, in shame-filled Southern environments that cannot bear to look suffering and mental health in the face, much too quietly. To be alive is to have touchpoints for death.
Early on, Callahan describes the birth of her son. As with the death of her mother, she went to the hospital feeling unprepared, and again the event went sideways. A day into labor, her son stuck in the birth canal, the doctors decide to “vacuum the baby out,” whisking him away and leaving her to feel like “another nobody coming through the system.” Nobody, she observes, checked in with her or explained what was happening. In the end, her son (now 13) was healthy, but the experience “felt eerily, in so many ways, like my mother’s death,” she writes. “Why was that?”
The medical system, as Callahan depicts it, is broadly unable to handle end-of-life care—not by any one doctor or nurse’s fault but simply because the system is straining at the seams and unable to sustain that level of care. (“Our health care system doesn’t have the mechanism for good end-of-life care,” one doctor tells her. “Either you have family, or you have money, or you die in squalor.”)
These crushing structural realities swirl around the book, but Callahan maintains a forward-looking tone, highlighting resources for affordable care, like those at the Durham Center for Senior Life, where she runs a support group for the terminally ill. And while she encourages readers to break the taboos around talking about death, she doesn’t suggest that anyone needs to muster an upbeat attitude about it.
“I’m not sure how I feel,” she said, in reference to the term death positivity. “I think it gives the impression that we should be excited and happy about our deaths, or at the very least at total peace, and I don’t think that’s achievable for the vast majority of people.”
This is a comforting and refreshing reflection, one that appears throughout the book, as she details moments of her own fear and anxiety about dying, despite professional proximity to it. But in that human friction is honesty, and a path toward appreciating what we have today and being more prepared for what may come tomorrow. Reading A Death Doula’s Guide to a Meaningful End can be one important step forward on that path.
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