Filipinos are, more often than not, the type to shy away from conflict. Maybe if we don’t talk or think about something, it’ll eventually pass, whether it’s a squabble between friends or a serious political matter. This is especially true when it comes to the afterlife: we have what can be called https://geriatrics.stanford.edu/ethnomed/filipino/delivery.html“fatalistic perceptions” when confronted with serious or life-threatening illnesses. Diyos na ang bahala sa atin, we say, as if imagining our ideal resting place is tantamount to digging a hole in the ground.

Perhaps, that’s where the problem lies. “The God that you and I believe in doesn’t work that way,” Charity Marohombsar tells me over Zoom on a Monday afternoon. We’re about an hour and a half into our conversation, the notebook beside me filled with interview soundbites that I want tattooed on my body. “From the moment we are born, He knows exactly when our lives will end, so it doesn’t make it happen any faster. Why refuse to talk about death then?”

As an end-of-life doula since 2017, Marohombsar challenges her clients to not only destigmatize death, but to celebrate it — to consider it a festivity as grand as a golden anniversary or a gender reveal. Death doulas like her instill this mindset in the dying and their loved ones, doing everything they can to “elevate the dying process” and ease the transition between this life and the next.

Preparing for the afterlife

Death doulas like Marohombsar function outside the scope of the local healthcare system. (The closest alternative we have is palliation, or palliative care — specialized treatment given to patients at all stages — and even then, the purpose isn’t exactly the same.) This gives her free rein to craft a more flexible caregiving plan: one that doesn’t depend solely on doctors’ orders and can be customized to accommodate physical, emotional, and even spiritual needs.

“My engagement always starts with a discovery process, where I find out what they need. What are the key areas in the life of this person that I must guide them through?” she explains. Unwillingness to forgive, for instance, is not information patients readily share, nor is guilt or deeply embedded childhood trauma. Marohombsar is trained to pick up on subtle cues and read between the lines. “If they say they want to pursue [a partnership with me], then that’s when I send an engagement proposal.”

Patients usually book 90-minute Calendly sessions but are free to reach out even after their time is up. “When they hire me as a coach, they can text me at any time. I leave some of my hours open at night because that’s when all negative thoughts sink in, when everyone else is asleep and they’re left alone,” she shares. Some of the services available to her clientele include life reviews (where they look back on everything they’ve accomplished to see if they’re satisfied), forgiveness tours (where they are encouraged to tie loose ends with estranged family and friends), and putting together living wills. These are always the most difficult conversations: deciding on treatment options and post-death arrangements today, instead of outsourcing them to bereaved family members.

Taking second chances

It’s no surprise that most people who consult Marohombsar are closed off and in deep denial when they first enter her space. Families often struggle with or even avoid talking about advance directives and life support decisions: in a study conducted on critically-ill Filipino-American senior citizens, researchers found that only 10% of them completed treatment due to their belief in the inevitability of their disease.

But she has deeply personal reasons for refusing to give up on them. “I definitely would not have had the appetite to talk to people like this if I hadn’t stared death in the eye myself as a stage 4 breast cancer patient in 2016,” she shares. Marohombsar was diagnosed with an aggressive tumor that metastasized to her bones. During her weekly chemotherapy infusions, she would find herself dropping by the rooms of fellow patients with no visiting family members: “I don’t know where I got the courage but I would just come up to them and ask them how they are and try to help them process what was going on in their lives.”

After her successful rounds of treatment miraculously cleared her PET scans, Marohombsar was free to return to work, as a corporate executive in one of the country’s biggest conglomerates. But she soon realized that her heart belonged with the sick and dying. She says that after the Lord was gracious enough to prolong her life, she felt that it was only right to fulfill her end of the bargain. Marohombsar formally left her post and began taking courses and a certification program in the United States. “It honestly felt like cramming med school into a year because I had to learn the top 15 causes of death and how they’re treated,” she shares. Today, she uses this knowledge to help distill doctors’ prognoses into simple and actionable steps for patients.

When I ask her how it feels to be constantly surrounded by people who might not be around the next day, she gives me a sad smile. “I’m such a strong empath. Pag namamatayan ako dati, you couldn’t talk to me for weeks,” she says. But since shifting to a state of compassion, her perspective on death and her practice have both changed for the better. “We tend to see compassion as lesser work. But if I have 20 patients, I cannot be immobilized by one death: I need to protect myself from getting sucked in by the pain so I can continue to hold space for many more people.” With this, Marohombsar adheres to a strict morning routine, waking up as early as 3 a.m. to wait for any “airdrops,” or what she calls instructions from the Lord that are meant to start her right. After doing her exercise regimen, hearing Mass, and listening to a devotional podcast, she’s ready to meet her clients. All Wednesdays and Sundays are also blocked off so she can clear her auric field and release all pent-up emotions.

Changing the system

As a recovering cancer patient who has been in and out of treatment facilities, Marohombsar knows how “disease-centric” these places can feel. “Hospitals are not designed to truly look at the patient. I can count on one hand the number of times I’ve seen a doctor ask how someone feels, what they’re struggling with emotionally,” she shares. “No one ever holds a patient’s hand and walks them through every single step they’re about to take.” However, Marohombsar is quick to note that it’s not the fault of any specific individual but the failing of a global healthcare system that has been passed down generations: one that sees tumors to be shrunk, rather than people to be taken care of.

She also bemoans the fact that patient-doctor relationships are almost always terminated once treatment is completed, when survivors require aftercare to fully integrate themselves back into society. “As a cancer patient, you’re told to come back for scans every six months during the first year post-treatment, then every year if the results are good,” she says. “These people usually experience scan-xiety in those moments and no one advises them on what they could do for their mental health.”

In addition, survivors also grapple with a distinct type of grief associated with either losing the body parts that once housed their tumors or finding it difficult to perform on the same level pre-diagnosis. “There are tools that I give them that can help alleviate these emotions and also manage the stress that comes after,” she shares. “Oftentimes, survivors I speak with want to go back to work and I have to be the one to help them draw boundaries. We have an accountability to take care of ourselves, so our bodies don’t go back to our pre-cancer state.”

“It’s important to have people like me who can take stock of a patient’s emotional wellbeing and give them solutions that aren’t just administering anti-depressants."

But while these flaws persist, Marohombsar still claims that things are better off today than they were six years ago. Within the next month, she’ll be opening a sanctuary – a temporary space as they wait for the completion of their hospice in Tanay. There, cancer patients can manage other aspects of their wellness, like nutrition and psychosocial support. Just recently, a group of internal medicine residents at St. Luke’s Medical Center also reached out and asked her to speak about patient care — a sign that the integration of end-of-life doulas is no longer a pipe dream. “It’s important to have people like me who can take stock of a patient’s emotional wellbeing and give them solutions that aren’t just administering anti-depressants,” she shares.

As for our individual views on death, Marohombsar acknowledges that it’s out of her control, much like dying itself. But while she may feel alone in her advocacy, she continues to convince others to proactively plan their passing. One thing that almost always helps her tip the scale? “I tell [my patients]: if you truly love your loved ones and you don’t want to pass these hard decisions on to them, then you will find time to sit with me and answer these questions,” she says. “After that, my batting average is very high. Almost 100% will suddenly agree.”

While this figure seems strangely high, I think it checks out. If there’s one thing stronger than our fear of the unknown, it’s the love we have for our families.