Embracing Fear and Grief: A Death Midwife Navigates End-of-Life Planning with Her Mom

By Naila Francis, 02/08/2021

We were together in my car one day when my mom brought up my single status (a recurrent topic of her initiation). Even though she knows I am happily single, something about me having a partner feels reassuring to her. “I just want to know you’ll be taken care of when I’m gone,” she said.

Tears filled both of our eyes as I tried to brush off her allusion to the inevitable and changed the subject.

That was before I became a death midwife and grief coach—before I knew about health care proxies and advance directives, or living wills, and the measure of comfort and ease those documents can bring to families in the throes of grief.

I had some familiarity with end-of-life planning. As a former journalist, I once interviewed a doctor who’d written a book sharing the journey of her ICU patients, with the goal of helping families prepare for end-of-life decisions and the challenges their loved ones could face. And while I remember thinking how sobering a read that was, I filed all the good doctor’s guidance and wisdom into a future preoccupation.

After being certified as a death midwife, however, I wanted to ask everyone I knew: Have you thought about what quality of life would look like to you in your final days? What about who you’d want involved in your care? Who will make decisions about your health and finances if you can’t? Do you know what you want done with your body after you die?”

This, of course, is part of my work now, steering people of all ages through these questions, the paperwork, the hard but necessary conversations about the final phase of their life.

Yet when it comes to my own family, the topic of death and dying still lingers in the shadows, despite the many losses we’ve all suffered — and our real life experience of the mess that ensues when the deceased’s affairs are not in order.

When I try to talk to my mom about her death, she skirts the subject. “You’ll know what to do when the times comes,” she tells me.

Yet I won’t. I know she wants to be cremated because she’s long said so. But I can only guess at what will matter to her in the end — the little things that will still make life meaningful, the decisions that will support her peace of mind, allow her to be treated with dignity and compassion. I can understand her reluctance to delve that deep. Still I can’t think of a better way to feel taken care of than to know all of this. To be able to honor her wishes while also having the freedom to grieve without being thrust into the chaotic planning and guesswork death often creates.

A few weeks ago, my mom was scheduled for a minor procedure. After having lost my dad to esophageal cancer years ago, I’m unsettled by any health issue that pops up for her. Especially now when we are living through a pandemic, and I am haunted by the grim headlines, the staggering death toll. By our collective vulnerability.

I know all will be well and yet I’m filled with dread. I also know it’s time to once again broach the discussion about an advance directive.

Before I do, however, I spend some time imagining our conversation, thinking about how I’d begin. Where I’d keep my focus.

I decide to review The Conversation Project starter guides, created to help families talk about such matters. While I can easily bring compassionate expertise to navigating end-of-life decisions with strangers, when it comes to negotiating the subject with my mom, what I bring is fear — and anticipatory grief.

My mom is the love of my life. There have been times since my dad died when the knowledge of her impermanence sneaks up on me, and I can’t get through a single one of those moments without tears, without wishing we could somehow simultaneously leave this earth.

It is one thing to carry an awareness of death deep in my bones, to so intimately clasp my own fragility. But to acknowledge my mom’s sears me with profound sorrow. I let myself sit with this discomfort, lean into it, breathe through all that aches.

It turns out she already has a living will (she didn’t realize an advance directive was the same thing)!

She shares her will with me, too, gives me the contact information for the lawyers who drafted it, tells me somewhere — she’ll have to find it — she has all her passwords written down. All of it so casual, so plainspoken. Somehow unencumbered except for what is in our hearts.

I give her the advance directive I brought with me. She doesn’t have a health care proxy, and she’ll use this form to amend her own paperwork.

“What’s that?” she asks, pointing to additional papers in my folder.

It’s a longer questionnaire that covers everything from funeral and memorial wishes to body disposition and obituary details. A series that will prompt an even deeper conversation about her values.

“We can save that for another time,” I say.

She nods. “OK.”

I feel relieved, lighter. Grateful for this space that is now being held by love.


Naila Francis, death midwife and grief coach.

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5 Responses

  1. Angie says:

    I love your style of writing. It’s such a gentle, cutting to the core the edge of which glides not only through emotion but also offers an amazing amount of information. Thank you for the time, for the rawness, for the vulnerability and for the willingness to do this essential work.

  2. Barb Lenzi says:

    I’m glad you’re on top of things, Naila. My mom made things really easy for us when she died. We knew where everything was, what her finances were, what she wanted. The funeral was prepaid, the only decision we had to make was which urn to get. Pre-planning really does make a difference.

  3. Well done Naila!
    I am a Massachusetts RN that has worked with geriatric patients and their loved ones for well over a decade. It never ceases to amaze me the aversion Americans have to talking about death…..as though we have the option of getting out of this life ALIVE!
    I work now privately with aging elders and their friends/families to plan for the many difficulties that may arise as they age. Most often I am asked to mediate the “Conversation” even amongst folks that spend every waking day together. It may seem odd to some, but I am actually good at this area of care. My own Mom and Dad died in our family homes with all of us around and I am grateful they were willing and competent to talk about their wishes prior to leaving this earth.

  4. Elle says:

    Naila, this post outlines so beautifully how we as supportive loved ones can utilize openings in conversation to engage our beloved people in good talk about what matters most around end-of-life issues. My mom approached me about prepaying her funeral costs (I’m her financial POA), and documenting her wishes for memorial, luncheon, etc. I will facilitate a conversation with her including my siblings as soon as she is ready to take it to this next step. Inspired by my mom, my husband and I are planning to review and revise our health care decisions documents, and share our choices with our kids.

  5. Paul Nigel Harris says:

    Your writing is spare, beautiful and touching…a true outpouring from a dear, caring soul. Since first experiencing your open smile, I have loved you dearly and want the world filled with people like Naila Francis! We are gifted when our parents give us a clear directive for handling their deaths. Each unanswered question is an added stress at a time when our hearts are aching and dealing with the grief of this unparalleled loss. Parents’ directives come as a giant gift to their offspring…sadly, many are not well organized so the working together with your mother before her demise will be precious time and I imagine can bring about deep conversations that you might not have had before. Among my greatest regrets are the conversations that I did not have with my parents and I so wish that I could now ask so many unanswered questions.

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