Death Doula Turns Unconventional Job Into Something Beautiful (Exclusive)

• Registered nurse Kacie Gikonyo left her standard medical career to become a death doula over two years ago. In her practice, she works with terminally ill clients and their families to help them cope with imminent death.
• She guides the dying as they get their legal affairs in order and helps them prepare what she calls a “legacy project,” an individual gift to carry on their memory and comfort their loved ones.
• Gikonyo — who has over 14,500 followers on TikTok — is also the founder of the Death Doula School, where she trains people to become doulas themselves, educating them in matters of death and preparing them to run their own businesses.

Losing a loved one is never easy, but easy isn’t what Kacie Gikonyo sets out to make it. Even in her practice as a death doula, she can’t take away a grieving family’s pain. She can’t bring back what’s gone. However, under the right circumstances, Gikonyo can make it somewhat beautiful.

“You can ask pretty much anyone, ‘What was it like when someone that you love died?’ And almost everybody will tell you something bad, something negative: ‘It was terrible, it was scary, we were so alone, we didn’t have the support we needed,'” the Cleveland-based specialist tells PEOPLE exclusively. “There’s never good memories that come back with stuff like that.”

But if those hard moments are grounded in peace, as Gikonyo, 41, has witnessed, heartbreak doesn’t have to be the only emotional takeaway. With some help, those hardest goodbyes can be colored with hues of love and gratitude.

“Part of what I do as a death doula is try to make it so that when you look back at that with sadness, you can also look back at it and be like, ‘You know what? It was really beautiful. We hired this death doula and she helped us to make a beautiful death plan and she really helped to get the family together and everybody understood what was going on. There was minimal fear, minimal anxiety,'” Gikonyo explains.

For the past two and a half years, her goal has been to shape the way people look back at the deaths of their loved ones and help give them some fond memories to hold on to as well.

Before she became a trained death doula, Gikonyo worked in the nursing field for about 12 years. She encountered end-of-life patients regularly, often getting to know them for months or years before it was time to arrange hospice services. Often, the registered nurse watched them go with little support.

“A lot of times these people didn’t even have family, so sometimes we were all they had,” she reflects. “I just right away identified that I was really good at that. People think that doctors and nurses are good with dealing with death, but not all of them, a lot of people are really scared of death.”

She was the go-to nurse for any near-death patients. Other medical personnel would call her for help, asking her how to handle situations regarding the dying. In matters of death, Gikonyo thrived as a nurse.

Then the pandemic hit, and she was among the millions working on the hospital frontlines of COVID-19. During a period of just four weeks, she watched the virus kill 100 of the 350 patients at the long-term care facility where she worked. And because of lockdown restrictions, even those with support systems died alone. People were dying fast — and without any goodbyes to see them off.

“It was terrible, not only for the people who are dying but for their families. Imagine us having to call somebody and say like, ‘Hey, it looks like your mom’s kind of headed towards death and you can’t come in and say goodbye to her,'” Gikonyo remembers. “I ended up finding myself to be almost hyper-focused on being there for these people and helping them to die better so that they weren’t alone and they weren’t scared.”

The problem was that Gikonyo wasn’t there to support the dying. She was there to a be nurse. Still, she says something inside her nagged, “You have to help them.” She started reevaluating her purpose, and when she was laid off amid the COVID-19 panic, she had the space to think beyond nursing.

“I just kind of started googling and looking into how I could work in the death space, and I ended up finding the death doula role,” she tells PEOPLE. What she read made sense: a death doula works on the opposite end of what a birthing doula does. Instead of bringing someone into life, they help people labor out of life.

“It kind of went off like a bomb or a light bulb in my head like, ‘Wait a minute, that’s it. That’s what I am, that’s who I am,'” Gikonyo says. “It was just I knew this was my path.”

She found out about the death doula title one day, and she enrolled in a weeks-long training program the following day. Shortly after she graduated, she opened her own business.

If you’re picturing a death doula as someone who comes in right at the end, when a person is on the verge of dying and holds their hand to escort them out of life, then you have the wrong idea. Gikonyo says she starts working with people “as soon as possible,” meaning the majority of her clients have recently received terminal diagnoses with a short life expectancy ahead of them. They may not have much time, but they have enough left to build a relationship with the doula.

“A lot of times I spend a lot of months with my clients, not only getting to know them and building a rapport with them, but also their family so that the family knows [they] are not alone,” she notes. “When you’re scared, when you have questions, when you don’t know what to do, you have a person to lean on.”

The first thing she does with the client is start planning the end of their life. Plenty of people have no idea where to start, she says. She comes in to ask the hard questions, and while she’s not a counselor, she’s able to guide clients as they get their affairs and emotions in order.

“It’s kind of a two-step thing: first you get it all done on paper, you work with an attorney, you get this, you get that. Now you’ve got all of these documents done,” Gikonyo says. “But step number two is you have to tell all of your family members all of that stuff. You can’t be the only one who knows whether you want CPR or not. You have to say to all of these people, ‘Here’s what I picture the end of life looking like for me, and here’s what I want.'”

It’s imperative that these plans be taken care of early in the process, “before things start getting scary towards the end,” the death expert notes. “We don’t want to be having to deal with that then.”

Thinking ahead benefits the client primarily, of course, but Gikonyo has also seen how it can smooth things over for all parties involved.

“This helps so much prevent any drama, fighting, arguments amidst the family at the end when the person can no longer speak for themselves because you already heard it from their mouth six months ago when they made all of this planning they told you,” she says.

As they prepare the formalities, Gikonyo starts working on readying the client and their family for the harder aspects of death they’ll soon need to grapple with. As difficult as these conversations are, she says it’s part of what she loves most about the process. Yes, she’s tasked with telling people about the aforementioned “scary” things they’re going to see and hear, but Gikonyo is grateful to provide tools for them to handle it all.

“If I’ve educated you about that and I’ve prepared you about it before it happens, then instead of you being terrified when you see something like that, you’re going to say, ‘Well, wait a minute, Kacie told me this could happen and here’s what she said we should do,'” she tells PEOPLE. “So, instead of just being paralyzed in fear and what do we do, you’re able to identify what’s happening and I’ve given you the steps of what should we do in this situation.”

Indeed, family is a crucial part of Gikonyo’s process. She facilitates the part they play in their loved one’s death because she knows how difficult it can be to bridge the gap between the dying and those who will miss them. From her years of experience both as a doula and a nurse, she’s aware of how hard it is for communication to flow when it starts to get grim, both on the sides of the patient and their family members.

“If your mom is dying, she’s not going to want to tell you her thoughts about dying or that she feels like she’s going to die because that’s going to make you sad and you’re going to cry and she never wants to see that from you,” she observes.

Gikonyo has seen people take their questions, thoughts and feelings and “just jam them down.” She steps in to be “the pillar of support” in such critical moments.

“I am that person who’s here for all of us. You can tell me the scary things you’re thinking of, you can tell me the crazy questions that you have,” she says. “There’s nothing you can say that’s going to shock me and make me not want to be here for you.”

It may come as a surprise that most of Gikonyo’s clients are younger, and therefore they’re leaving behind a whole family to mourn them. While the client may have been able to walk their loved ones through the difficulties of disease, that task becomes harder and harder when mortality takes form.

But once Gikonyo gets to know everyone involved, her very presence answers that common question of, “Who’s going to make sure that my family’s okay after I die?”

She adds, “It brings a little bit of comfort to the dying individual to know they have somebody really strong who’s going to help them through this and make sure that they’re okay.”

Beyond the “scary parts” that the family will likely witness, Gikonyo has figured out a way to care for a client’s support system in their grief, after the death has occurred. After they plan the end of life, Gikonyo and her client get started on what she calls a “legacy project.”

“They say each person dies two deaths, once when you physically die and once again when you’re spoken of for the last time,” she says. “A legacy project is something that the dying individual is creating, something tangible that they’re going to leave behind for their loved ones.”

The actual product varies from person to person, but the goal is consistent. The client can leave behind something that will live on after them. They don’t have to fear fading from memory.

In one instance, Gikonyo worked with a poetry professor. She loved writing poems, but in her rocky last year of life, cancer claimed her ability to work on her craft. Then suddenly, in her last month of life, verses started flowing in her mind, but the client was too weak to put them to paper.

“So she would tell me her poems and I would document them, and they ended up all being about her children — she had an adult son, an adult daughter,” Gikonyo recalls to PEOPLE. “I was like, ‘Why don’t we create books like a book for him and a book for her that are full of all of these beautiful poems that you’ve created?’ That was an idea of a legacy project that we did.”

The death doula had the poems bound in hardcovers, and after the professor died, Gikonyo delivered the books to the author’s kids with a special letter from their mom.

“A lot of times the families know [about the legacy project]. This particular family did not know. The mom had not told them that she was hearing her poems again. I think she kind of wanted it to be a surprise,” Gikonyo says, though she notes that in most cases the families get involved in the projects.

She’s helped people create scholarship programs in their names, make lasting art and even create new life. Gikonyo says she once worked with an avid gardener who tended to her plants alongside her husband. As she neared the end, she maintained the importance of her garden living on after her death. She worried it would die too, but Gikonyo reassured her that didn’t need to be the case.

“She almost cared about her garden with a love like a family member,” she shares. “Part of what we did was really get the family around and create this legacy of ‘Here’s how grandma takes care of this garden, and now she’s passing it on to you and you guys have to take care of it for her.'”

According to Gikonyo, death doulas mostly start their own practices, though some hire other doulas to work for them. They’re not hired by hospitals or hospice care facilities, so it’s a craft led individually.

In her own training, Gikonyo only learned how to prepare someone for the end of life; she wasn’t guided in how to be successful in her line of work — how to open up the business, meet clients and make money.

Luckily, she had the savvy to figure it out herself; Gikonyo has bundled her services and charges ahead for each series of meetings. Her standard 12-visit package is $2,000, though she says she can tailor what she offers based on clients’ varying needs.

“I try to avoid being any exchange of money after someone has died, that’s why I kind of have people pay me upfront. That was just a learning experience for me,” she admits. “At the very beginning, I had charged an hourly rate, which is fine until someone dies and they owe you money and now you have to call their family. That’s very uncomfortable.”

When a client finishes their 12 visits, Gikonyo works with them to reassess and see if they will need to purchase another dozen. In some cases, a terminal illness may be far enough progressed to determine that a client might not make it for the full package. “I’ll offer a half package where it’s only six visits or whatever, just to kind of do what’s best for the family,” she says.

Having established herself so confidently in the industry, Gikonyo has opened a program herself. She’s the founder of her own Death Doula School, which opened in March 2024. She graduated 35 death doulas throughout the year, through both live and learn-at-your-own-pace classes.

Her teachings focus on necessary skills in death and death education without ignoring the crucial business and marketing training side.

“That part right there is where so many death doulas struggle,” she shares. “They get the training and they have the calling and they have the passion, but unless you really know how to move forward, the world doesn’t know about death doulas enough yet to be seeking us out.”

She bolsters her education credentials as a member of the National Doula Certification Board. Currently, she says, there aren’t any standards of care for death doulas or training programs.

“That means that people can really teach whatever they want, which is not great because they’re often not preparing death doulas and teaching them all the things they need to know,” she tells PEOPLE. “I’m on the National Doula Certification Board to work to create scope of practice, curriculum standards and then hopefully start accrediting some death doulas programs so that there can be actually accredited programs out there.”

For the time being, Gikonyo isn’t taking on more clients as she builds the Death Doula School. Her next course is set to start in April, and she’s recently opened enrollment. But even before the classroom doors opened, Gikonyo had over 200 on her waitlist.

“Part of my personal goal and mission here is to change the narrative about death and dying,” says Gikonyo. “While I am marketing myself as a death doula and I am also trying to train death doulas, one of my biggest passions is to educate the world — from healthcare providers, doctors and nurses to civilians — about death and dying.”

It’s no wonder that Gikonyo has also tapped the wide-open world of social media to spread her message. She has thousands of followers on TikTok, where she’s garnered millions of views posting videos about her work.

It’s puzzling to her that discussions of death are often deemed taboo. “Every single human being on this entire planet is going to experience death someday, not only the death of themselves but the death of a loved one,” she says. “If you don’t understand what that looks like and you don’t have any education surrounding that, then it makes it a really terrible, wild, chaotic, scary experience.”

She had little knowledge of social media when she first started out on TikTok, but she was compelled by curiosity. She wanted to know if there were other people who wanted to learn and talk about the end of life.

“I posted a video kind of saying, ‘I’m a death doula, I want to educate about death and dying.’ And right away I had all of these people who were interested,” she says. “The more I posted, the more the people ate it up so I just kept doing it … I’ve gotten a lot of attention but I’ve also educated and helped so many people in the process.”

She doesn’t get clients directly from social media, but it has brought her media attention, thus bringing in interested families or people with terminal diagnoses. With such a widespread reach thanks to her online platform, she’s even acquired some virtual clients outside of Ohio. One man even contacted her to request she come to help him in Washington, even though he’s not quite ready for her services.

“He’s elderly so he’s just kind of got elderly stuff going on, but he’s not necessarily there yet,” she says of the prospective client. “He has set money aside for me so that when he gets nearer to things, he’s completely paying for my travel, my stay and a large chunk of money for me to fly to Washington to be there with him.”

His preemptive interest, Gikonyo says, comes from the fact that he doesn’t expect to have anyone there at the end of his life. She says his siblings and parents have all died, and he’s not married.

Gikonyo explains, “He was just like, ‘One of my biggest fears is doing this alone … and watching you took away all of my fear. I have this money, and I would love nothing more than to know that you’ll be able to be there for me.'”