Death Doula Julia

19/04/2026

It might be past April 16th, but it always a good day to think about Advance Planning.

"Prepare for the worst and Hope for the Best 💕

April 16 is Advance Care Planning (ACP) Day in Canada. It’s more than just paperwork—it’s about peace of mind.
Think of it as your "Plan B".
Here are some things to do today (or as soon as possible)

19/04/2026

Understanding Morphine & Hydromorphone for Dyspnea (Shortness of Breath) in Hospice

What is Dyspnea?

Dyspnea or shortness of breath is the feeling of air hunger, like the body is not getting enough oxygen. It is not just physical. It is processed in the brain and can feel like panic.

How These Medications Work In the Brain?

Morphine and hydromorphone act on opioid (mu) receptors in key areas:

*️⃣Brainstem (medulla) – regulates breathing rhythm.

*️⃣Limbic system – reduces fear and distress.

*️⃣Cerebral cortex – changes perception of breathlessness.

In simple terms, the body may still be working to breathe, the brain no longer feels like it is suffocating.

What does these medications do?

They:

✅Decrease the sensation of air hunger
✅Reduce the brain’s panic response
✅Slow rapid, ineffective breathing
✅Improve breathing comfort
✅Promote relaxation

Evidence-Based Practice

Opioids are considered first-line treatment for refractory dyspnea in hospice and palliative care.

Clinical evidence shows that low-dose opioids reduce breathlessness, improve patient comfort and they do not cause harmful respiratory depression when used appropriately

This is supported by the American Academy of Hospice and Palliative Medicine, the National Comprehensive Cancer Network (NCCN) and the World Health Organization (WHO).

Morphine vs Hydromorphone

Both of these medications work similarly. Hudromorphone however may be used when Morphine is not tolerated, when kidney function is reduced or when smaller , more concentrated doses are needed.

💙 Important to Know

✅ Medications are carefully titrated
✅ Doses are individualized
✅ Patients are closely monitored

What families May Notice

After medication, your loved one may:

*️⃣ Breathe more slowly and comfortably
*️⃣ Appear more relaxed
*️⃣ Have less visible distress

Don’t walk this journey alone.
Follow me for clarity, comfort, and evidence-based education.

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19/04/2026

Active Dying vs. Imminent Dying, What’s the Difference?

Families often ask:
Is this the end or are we close?

These two phases can look similar, but they are different.

ACTIVE DYING(Days to Weeks)
This is when the body is clearly declining.

Common signs:
• Sleeping more, harder to wake
• Eating and drinking very little
• Increased weakness
• More confusion or withdrawal
• Changes in breathing patterns

This is the body slowing down.

IMMINENT DYING (24-72hours)
This is when death is very close.

Common signs:
• Long pauses in breathing (apnea)
• “Death rattle” (noisy breathing from secretions)
• Mottling (purple/blue skin, especially on hands/feet)
• Minimal or no response
• Cool skin, dropping blood pressure

This is the body preparing for the final moment.

Please note these phases varies between patients, for some the phases can be longer while for other’s it is shorter.

Why this matters:
When families understand these stages,
they can shift from fear to presence.

They can:
• Sit closer
• Speak words of love
• Be present for the final moments

As a hospice provider, I always remind families: You are not just witnessing death. You are witnessing a sacred transition.

Don’t walk this journey alone.

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19/02/2026

Great Opportunity for Grief Support in Cumberland County

https://www.facebook.com/share/p/1E4uvMwPgM/

Loss changes us, and sharing that experience can be part of healing. Holding Hearts Bereavement Support Group is back in Amherst on Saturday, February 21sr.
Come as you are - listen, share, or simply be present. You don't have to go through grief alone.
Sign up here: https://docs.google.com/forms/d/e/1FAIpQLSdpkDk_lFgC4tfax3Xp12Nt839qW5PSmvMCBndTSDozfalzdw/viewform?usp=sharing&ouid=111572101742055148765

04/02/2026

I strongly believe in getting Death Education. In North America we spend alot of time preparing for a baby, thinking about it months in advance. But when it comes to death, we push it out of our minds and only deal with it when its too late.

Is death education important? We think so!
That's why the When You Die Project was created: to foster a conversation about the end. Through our films, website, podcasts and social media content, we want to bring more people into the conversation. We encourage educators , as well as workers within the death care industry, or individual communities , to use these materials to spark meaningful dialogue about death, dignity, and care.
To find out more about our educational offerings, contact chelsea@whenyoudie.org

04/02/2026

🕯🤍🕯

This poem is written for the person who chooses Medical Aid in Dying (MAID), and for the people who love them and stand beside them in that choice. It is also written for those who do not support this option; my intention is not to persuade or to change minds, it is simply to ask that we do not walk away from one another, that even in disagreement, even in discomfort, no one is left alone at the end.

We Will Not Walk Away

When someone has received a terminal diagnosis,
and they’ve been told they have less time
what this translates most to them, is that
they have been moved to the front of the line

A line no one wants to stand in
a line that can often bring fear
a line that changes everything for them
and lets them know that death is near

So many things are taken from them
most importantly, their autonomy and choice
leaving them dependent on everyone and everything
no longer having a voice

So, if given an opportunity to say goodbye to pain,
to end their suffering, and to feel free again
they need to know we support them
that we will not walk away
they need to know that whatever they choose
we are here to stay

by Gabrielle Elise Jimenez

You can find this poem here:
https://www.thehospiceheart.net/post/we-will-not-walk-away

This was written for my book”Dignity Day,” which is about Medical Aid in Dying.
https://www.amazon.com/dp/B0CCCJBT95?

17/10/2025

🧡🎃🧡

At the end of the harvest, before the dark winter, it is believed that the veil between worlds is thin and the dead can communicate with us.
There are many customs and superstitions at this time of year that pertain to death- whether it is appeasing the aggressive spirits, or honouring our dearly departed.

17/10/2025

Great resource for Children 💗

My Life, My Grief is a children's activity series from Canadian Virtual Hospice . Written by Child Life Specialist Ceilidh Eaton Russell, this workbook aims to support children who have experienced the death of someone close to them.

buff.ly/493fxGx

17/10/2025

Something to check out 💗

How do we have those difficult but necessary conversations? We talk about this in Saying Goodbye: Preparing for Death.
You can stream it now, until October 20th.
https://tinyurl.com/SG-OCT

29/09/2025

The Pioneer of Palliative Care in Canada 🤍🕯🤍

The Canadian Hospice Palliative Care Association (CHPCA) joins the world in mourning the loss of a true pioneer and the "father of palliative care," Dr. Balfour Mount (1939-2025).

Dr. Mount’s legacy is monumental. In 1975, he launched the world’s first Palliative Care Unit in Montreal, a groundbreaking initiative that set the global standard for care. He is credited with coining the term ‘Palliative Care’ to define a novel approach blending hospice, thanatology, and academic medicine, which revolutionized the management of life-limiting illness.

We honour his vision of "whole person care," which emphasizes addressing the physical, psychosocial, existential, and spiritual needs of patients and families. This philosophy continues to shape and inspire every aspect of hospice palliative care across our nation and beyond.

Dr. Mount's commitment to dignity has been recognized by the Order of Canada and continues to guide our community.

We extend our deepest condolences to his wife, family, colleagues, friends, and all those grieving this immense loss.
. . . .

L'Association canadienne de soins palliatifs (ACSP) se joint au monde pour pleurer la perte d'un véritable pionnier et du « père des soins palliatifs », le Dr. Balfour Mount (1939-2025).

L'héritage du Dr. Mount est monumental. En 1975, il a inauguré à Montréal la toute première Unité de soins palliatifs au monde, une initiative novatrice qui a établi la norme mondiale en matière de soins. On lui doit d'avoir inventé le terme « Soins palliatifs » pour définir une approche inédite alliant l'hospice, la thanatologie et la médecine universitaire, et qui a révolutionné la prise en charge des maladies limitant l'espérance de vie.

Nous saluons sa vision des « soins de la personne globale », qui met l'accent sur la satisfaction des besoins physiques, psychosociaux, existentiels et spirituels des patients et de leurs familles. Cette philosophie continue de façonner et d'inspirer chaque aspect des soins palliatifs et de l'hospice à travers notre pays.

L'engagement du Dr. Mount envers la dignité a été salué par l'Ordre du Canada et continue de guider notre communauté.

Nous offrons nos plus sincères condoléances à son épouse, sa famille, ses collègues, ses amis et toutes les personnes touchées par cette perte immense.

06/07/2025

So True 💗🕯💗

As a hospice nurse my first go-to is rarely medication. I think that our words, our touch, and our presence can often comfort someone in ways that medicine can’t possibly touch.

Being present at the bedside of someone who is dying can offer profound comfort, even without words.

Your presence can:
• Ease fear and loneliness: Simply sitting quietly, holding their hand, or maintaining eye contact can help them feel less alone.
• Provide emotional support: Hearing a familiar voice, even if they are unresponsive, can be deeply reassuring.
• Offer dignity: Just being there acknowledges their life and their importance, which helps uphold their dignity in their final moments.
• Facilitate peace: Your calm presence can create a peaceful environment, helping to ease the transition for both of you.

Sometimes, silence and presence speak louder than any words ever could.

Having said that, it is also very important that medication is available if needed to relieve suffering that cannot be calmed and comforted easily. As a hospice nurse one of the things that I focus on is teaching families and caregivers how to provide care by using verbal and tactile stimuli, assessing the room to see what might be causing discomfort, and understanding medication, the benefits, and making sure that those present are not afraid of it.

How we care for another human being when they are dying starts with understanding the value of our presence, being educated on what to expect, what could and might happen, what you can do personally for this person, and that you feel confident that your questions and curiosities have been answered. Education is key.

xo
Gabby
Hospice nurse/end-of-life doula
www.thehospiceheart.net

06/07/2025

🕯🤍🕯

The month of July is National Bereaved Parents Month. Although this has been set aside as a special month of remembrance, our children will always be remembered no matter what month it is.