Anne-Marie Keppel's Death Nesting: The Heart-Centered Practices of a Death Doula grants the reader an understanding into rapidly more commonplace world of caring for the dying and deceased. In a manner of speaking, Keppel’s work brings knowledge of how those suddenly thrust into the act of care-giving as a lay person or those who choose to assist as death midwives or death doulas can successfully navigate this final phase of human life from the outside.  While the terms death midwife or death doula are more common, books regarding the emotional, spiritual, mental, and psychological aspects of how these individuals prepare others for the end of life not as prevalent.  

For this reading, Death Nestingis a good introduction for those whose knowledge comes from the medical standpoint: the loved one dies in the hospital, there is a funeral home involved, and there are funeral rites for the living to express their grief so the living can move on.  What this book presents, however, is a return to the old ways which are now enjoying a renaissance: the idea that dying and more specifically, those who care for the dying as family members or the more formal death midwives and death doulas provide a service that is much needed.   

Keppel’s introduction, written by Dr. Karen Wyatt, a hospice physician, alludes to the matter by reminding readers of the roles family played in matters of death, dying, and grieving prior to the start of the twentieth century. Soon after, she notes: “modern society had relegated the dead to funeral homes, the dying to neglected wards in hospital basements, and the grieving to suffer silently in isolation.” (p. xiii). These are the very issues Keppel addresses for an audience eager to re-learn what was common wisdom passed down through generations. Wyatt notes the terrible price current generations have made with this choice: “Without an awareness of death people struggle to find meaning in their lives and never learn that every moment of this existence is precious, simply because it is fleeting.” (pp. xiii-xiv) 

The return to choosing to care for the dying at home requires new skills; moreover, as Wyatt points out, there is “a lack of knowledge about how to be with the dying during all of the unexpected, challenging, and miraculous moments of this process. (p. xiv).  The highest compliment one can give to any work is from someone who is in the profession of caring for those who are transitioning from life to death, and as Dr. Wyatt acknowledges, this is a wisdom which is badly needed by the living at this time. 

Keppel’s work does that by using the analogy of preparing a nest, as one might do for a birth, with the preparation one makes for the act of dying. Death Nesting: The Heart Centered Practices of a Death Doula advises the reader from the start as to the importance of creating the proper environment, or nest, for the person who is dying both as a physical space and a spiritual space. She references the difference between simply having a plan for death that includes having a will, naming a power of attorney, or designating funeral preferences and adding a bit understanding that this might be difficult for the living to grasp during their time of grief. In a book filled with excellent tips for navigating death and dying with a loved one, two of the best are the first ones listed in book: 

  • First, giving the living a chance to not feel guilty if a request cannot be fulfilled by noting the following: “Thank you for making an effort, even if these requests cannot be fulfilled.”(p. 3).
  • Second, Keppel adds an additional recommendation: “Talk about death and dying so that when you die, your friends, family, community, and coworkers will know that it is totally acceptable to talk about their feelings with each other after you’re gone. By living your life while embracing your death, you are giving others permission to do the same. (p. 3) 

For many readers, just these two tips alone are worth making the choice to read the rest of this book and to share it with the many others who may find themselves in a place of caring for loved ones and friends who are in the active process of dying. The introductory nesting meditation as a mindfulness practice prepares the individual who will be doing the work to have compassion and kindness for themselves as a being who enters, experiences, and then leaves this life. By starting the book with a meditation, Keppel helps the reader to engage the proper mindset to begin the work of death nesting. This meditation also serves the living who have not considered their own death and dying journey by asking them to consider who they are from a stand of loving compassion. 

A primary strength of this book is the author’s acknowledgement of her perspective through her background as well as a basic understanding of the difference between an ancient death doula versus a modern death doula; furthermore, she notes the difference between those who are unpaid versus those who charge a fee before referring the reader to note that there can be legal issues. (p. 7).  Keppel also demonstrates care for the reader as an author by acknowledging “the kind of dying considered in this book is quite privileged. There are so many on our planet who will never have this kind of thoughtful, loving care.” (p. 8) She lists subcategories found in the book including herbal support and mindfulness practices including explanations and cautions.  Throughout the book, Keppel brings up points to consider  in a manner that does not presume that the reader has any knowledge or experience.  For this reason, the book is an excellent primer for the beginner in death doula work, for the family member who did not expect to deal with this situation, and for any caregiver who has not considered the spiritual or emotional realities of creating a fulfilling environment for the person approaching death.  In short, Keppel considers the whole person, which is important in addressing this topic. 

The strength of this book lies in its simplicity: a forward from a hospice physician, a an introduction, considerations, eight chapters, a culminating meditation that closes the work as a ninth chapter, an appendix and a detailed list of resource creates a container to guide the beginner as well as a primer that reminds those who are more advanced in doula work.  It is both practical and personal, as each reader is encouraged through the meditation and the information given to designate their own path before they are at a stage of death and dying. In short, Keppel’s work facilitates in creating the topic and discussion of death and dying a more common occurrence, and a return to the old ways before the prevailing use of funeral homes and a separation of the dying from the living. Throughout the work, there is a clear focus on alternatives as dying and the dying process may not follow what is planned or intended.  

The first chapter, “Beyond Advance Directives” introduces readers to basic terms that may be commonly known, such as living will, ethical will, and medical power of attorney with considerations that might not occur, such as having the person who is the medical power of attorney be clear headed, in the same time zone, and able pick up the phone at any hour. (p. 20). These are practical tips that begin to orient the reader to the reality of caring for a loved one who is dying either as a doula or as a family member.  In addition, Keppel includes considerations if the reader is looking at these items for themselves, and the importance of note-taking about their own feelings regarding the overall situation.  The chapter includes the effects the COVID pandemic had, especially for those who suddenly reconsidered earlier decisions such as refusing life-saving measures. There is an excellent recommended meditation to utilize whether the reader is preparing their own advance directives or going through the process with someone who is dying.  Keppel stresses compassion throughout as “in truth, we do not get to choose our manner of death. Gently holding an understanding of death and dying around the world can help us to be grateful for the options of care and comfort that we have available to us.” (p. 24) 

For many, the second chapter, “Preparing the Nest” is useful regardless of one’s current situation. With the rise of modern technological advances in communication, such as social media sites, email usage, and personal websites, there is a need to prepare for who will control these areas when the dying individual is unable to do so on their own. One key point in preparing the nest is to note how death and the dying process can and should involve more rather than fewer people. As Keppel notes, “In an ideal world, the entire village would come together to care for the one who is dying, but this isn’t always possible. Try to make do with what you have. “(p. 31) The chapter includes options alternate locations outside the home as well as ritual ceremonies, herbal support, and mindfulness practices. The role of a caregiver’s inner circle and the creation for the dying individual of the inner nest are key points that allow the reader a deeper view inside the process, or if the individual is going through the act of dying, a clearer understanding of what to expect internally. 

The third chapter, “Dying Is a Sensory Experience” examines sound, smell, taste, sight, and touch. This chapter helps both with what is commonly known and what perhaps might not be expected. Reminders such as how hearing is one of the integral parts of the dying process (p. 46), the role of scents to comfort the dying (p. 49), the comfort of taste and what happens when the loved one no longer wishes to ingest food or to drink (p. 54), the role that the level of light as well as what is in the loved one’s visual field plays (p. 58), and the comfort that gentle touch brings (p. 59). As an additional highlight, the chapter includes a great sub-section on using Healing CBD or Calendula Oil (p. 55).

The heart of the book occurs in the chapters four through six: “What the Physical Body Does during the Dying Process”, “Mind, Spirit, and Emotion in the Dying Process”, and  “Discomforts during Caregiving”. These three chapters contain the crux of the work that most readers might consider when looking at what someone would need to know when caring for the dying person. In “What the Physical Body Does during the Dying Process” Keppel reviews the literal workings of the human body during the act of dying. Meditative practices, including handwashing as a meditative practice, suggestions for bedding, items to pack for hospital stays for the dying individual and the caregiver or doula round out a short, but necessary chapter. “Mind, Spirit, and Emotion in the Dying Process” explores the reality and tips surrounding the the mental, spiritual and emotional act of dying. The tips for mental soothing (pp.83-86), the use of psychedelics (pp. 86-88), and even the act of listening (pp. 89-90) is helpful and insightful for the reader’s personal journey as well as the reader’s journey as caregiver or doula. Connecting with one’s ancestors, developing a timeline, and engagement with one’s spiritual or religious community helps during this time. Highlights in this chapter include the section on Reiki and the use of shrines at home and in alternate locations. The sixth chapter, “Discomforts during Caregiving” is the best chapter overall in this book for the caregiver as it brings up what often is not discussed in the open. Keppel brings a realization that it may be uncomfortable as a caregiver to express difficult feelings, by bringing tips to help the caregiver navigate with the dying individual “with the intention of healing” even as the person dying may not be able to reciprocate in the same manner.  This chapter gives an honest look at the downsides of caregiving ranging from what to do when the loved one chooses to decline further treatment when you disagree personally, and meditated techniques to help when there you know that there is nothing to do, such as a novena (p. 108) or Tonglen Meditation (p.109-111).  Keppel addresses particularly sensitive areas, such as language barriers when the dying person reverts to a native language that none around understands (p.111) or those who choose medically assisted dying, (pp.113-115) or what to consider when unexpectedly coming upon someone who is in the process of dying. (pp. 116-117). 

The last two chapters regarding “Talking with Children about Death and Dying” and  “After the Last Breath” are a necessary completion as so often children are left out of the process, and for many what to do post death with the body with home funerals and remains a mystery to many. The strongest highlight for this second covers herbs for remembrance and ceremony (pp.140-143), the good funeral with the understanding of “how we mourn a body matters” (p. 138), and ways of actively grieving as noted in the “Moving Grief” section (pp. 144-152).  The order of this chapter acknowledges the role that the caregiver’s return to the state of the living through the manner of grieving plays in life. 

Death Nesting concludes with a closing Meditation for Dissolving the Elements traversing from Earth to Water to Fire to Air with the addition of Space. Ritualists may find this similar to the rites of a new moon that are commonly performed in a counterclockwise direction to reflect the inward nature of the overall rite.  

While the overall work is strong, the last two parts would benefit from additions. First, the appendix chapter, “The Ancient and Modern Death Doula” seems slightly out of place. Given the book’s title, this would have been better placed at the start for those who were not familiar with the term overall. The positives about having it placed as the appendix gives the reader the option to decide whether to read it first or to enjoy the work and its message before seeing the chapter that gives a full definition. One small helpful addition to the chapter would have been regarding the term death midwife often used interchangeably with the term death doula in the contemporary world of death care. 
The second area that is not quite as strong as it could be is the resources section. It works as a beginner’s list more than an overall comprehensive list due to the rapidly expanding field of death care where additional resources appear faster than publication permits.  

Overall,  Death Nesting: The Heart-Centered Practices of a Death Doula presents as both a journey and reference book for those interested in the field of death care, in the role and practice of the death doula or home caregiver, and for those who wish to start their own pre-death care journey.  The meditations and suggestions are excellent, and the Keppel clearly coms from a place of knowledge, and most importantly, compassion. Keppel clearly indicates that this guide for all its suggestions is a starting point.  The book addresses the practical, the emotional, the spiritual, and the ethical for death workers and interested parties in the field. Finally, the book opens the door by adding gentle practices that assist in living a good life (e.g., being conscious and aware) which Buddhists note will lead to a good death. 

Death Nesting: The Heart-Centered Practices of a Death Doula provides an excellent addition to a growing cannon of works revolving around the field of Death Care. Anne-Marie Keppel presents the subject in a practical yet engaging manner that draws the reader into awareness. This is a book that encourages active learning and participation on the part of caregivers and death doulas who seek to assist in the honorable act of being present and holding space for the dying.

~review by Clio Arjana

Author: Anne-Marie Keppel
Moon Books, 2023