Continuity of Care in a Siloed System: The Quiet Strength of Doula Support

When we speak about the role of an End of Life Doula, we often describe how we support the dying and their people before, during, and after death. We name the many ways a Doula can companion someone on this sacred journey:

• Offering holistic end-of-life planning - Advance Care Plans, Representation Agreements, and other key documents.

• Facilitating conversations that invite reflection on beliefs, values, and wishes.

• Providing referrals and raising awareness of therapeutic supports within our community.

• Offering emotional, practical, and spiritual support to those living with a life-limiting illness - and their companions.

• Advocating for the dying to help realize their end-of-life goals.

• Supporting the strengthening and completion of relationships.

• Assisting with legacy projects.

• Sitting vigil at the bedside.

• Offering respite to family and friends.

All of these roles matter deeply. But one often-overlooked gift that Doulas offer is continuity of care in a siloed system - a thread of steady presence woven through the many changes that occur near the end of life.

Recently, I had the privilege of supporting a young man dying of a brain tumour. He sought every treatment available to him - radiation, surgeries, chemotherapy - and in doing so, became surrounded by a remarkable and vast team of healthcare providers.

He received care at home, where a different nurse or care aide would arrive each day. He traveled multiple times a week to the Cancer Agency. There, a radiation specialist, oncologist, and a team of compassionate professionals supported him alongside his local oncologist, family doctor, and therapist.

Eventually, when it became clear that the treatments were no longer helping, he was referred to hospice for comfort-focused care. The hospice was extraordinary - filled with caring professionals: social workers, counsellors, spiritual care providers, a music therapist, even a pet therapist. Volunteers came in daily. He hired a private physiotherapist and palliative massage therapist as well. Nurses and care aides rotated through, and the palliative physicians worked in one-week shifts, returning every five weeks.

So many hands. So many hearts.

This is what we hope for: a full, well-resourced community surrounding someone at the end of life. But even in this privileged scenario, with such deep and broad support, there were cracks.

Each new caregiver required an emotional investment. Each shift brought someone new who needed to learn the story, build trust, and understand the family’s values and goals. The system, though abundant in services, was still fragmented - siloed.

And through it all, I was there. From the moment I was invited in, three months before his death, until the moment he took his last breath - and beyond, as grief enveloped his friends and family - I remained a constant. I was available in person, by phone, by text. I held space. I did what I could to create a container for his family, a place they could lean out into, should they need it. I witnessed. I normalized. I offered steadiness.

In a sea of changing faces and shifting schedules, this is the role of the Doula: a calm, neutral presence. One who walks alongside. One who listens deeply. One who remembers the whole story when others may only hold a piece.

Continuity of care doesn’t always come from the system. Sometimes, it comes from a single person showing up with their whole heart - again and again.

We are born into the arms of many, and we deserve to be held by many as we leave. In a system where care often shifts and fragments, Doulas help weave the throughline - a gentle presence who remembers, bears witness, and stays. Not to fix, but to companion. To remind the dying and their people that they are not alone, even in the most uncertain moments