This three-part series is inspired by training in June 2023 as an end-of-life (EOL) doula with Henry Fersko-Weiss. Henry is a key pioneer of the modern death doula movement, with more than 20 years experience not only serving hundreds of people at their deathbeds, but also training thousands of people in EOL doula work, contributing significantly to revival and definition of the death doula role itself.

While I occasionally refer to EOL doula work as a touchstone, my focus is rather upon a quality Henry emphasised early: presence. Its experience may seem self-evident, understanding of the word taken for granted, but the intuitive importance of in-person presence took a beating from postmodern philosophers, and its destabilisation as a practical, never mind ethical, priority is reflected very clearly in our collective absorption by tech and media. If it nonetheless remains a ubiquitous, prescriptive emphasis in helping professions, for example, how do we reconcile these forces? What precisely do we mean by presence? Why is it important, and how can it be developed? How should presence be understood in relation to mediation, even to its ultimate disappearance in death itself?

Whether owing to my current profession as a classroom teacher, to overall interests in philosophy, psychology, pedagogy, or the various other vocations, contemplative traditions and practices which I’ve also explored, my own fascination with presence is indeed founded upon very simple though sometimes epiphanous personal experience– experience that’s immediate, social and in person. Most purely and often, it’s through eye contact.

Even as an introduction to these posts, therefore, that’s where I’d love to start– with looking you in the eye, and you looking in mine.

Literally.

(And literarily.)

Because first literally, and at least metaphorically, whether at the deathbed or elsewhere– sharing presence means to look each other in the eye.

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Presence in the Room

“Rather than worry about doing something specific,” Henry questioned in class almost immediately, “what is the quality of the presence you bring to the bedside?” Yet doing something specific seems so much more tangible, and practical. What even is “presence”? The many semantic suggestions of the word range from simple and intuitive, to outright metaphysical. ‘Bringing it to the bedside’, however, implies presence to be something carried and shared, and indeed, most would agree upon presence being a person’s affect or demeanor– the way they carry themselves. While ‘quality’ suggests one’s presence can be better or worse– an absolutely crucial dimension to clarify– let’s so far take Henry’s question to suggest that this affect or demeanor is itself a significant influence upon the world. Although reference to a person’s presence might implicate their active, even very forceful effect on the world, it especially emphasizes a way we participate in time and space that’s much more subtle. Certainly, intention may be involved; ideally, all of us bring not just will but carefully weighed responsibility to our presence. Yet one’s causal participation in the world requires no conscious intent at all. This is affect as effect: whether engaged, deliberate, passive or accidental, whether grumpy, joyful or sad, a person’s presence shares inevitable cause and effect. Presence is one’s participation in this power by each our unique and fleeting spread of sentient sparks. A newborn baby, without yet its most basic of bearings, bears raw presence at its most naive, still entirely innocent even of identification with, never mind intentional participation in, this world of cause and effect. Though merely more than a fresh, glowing glob of pure, unadulterated presence, this helpless little being exercises powerful influence nonetheless.

What about quality? Does a high quality of presence suggest having presence? Speaking of it unqualified is surely to assume a quality that’s particular. Can it be called ‘having presence’ even for an inanimate object, a painting in a gallery, for instance, to irrepressibly draw one’s gaze? Never mind the qualities– beauty, skill, engagement, charisma, etc– that might give a human being presence? Certainly for me, no doubt for most, the sentient, in-person presence of another human being– particularly through eye contact– is the most formative frame of reference. As a lover of sports and of music, I’ve long been attracted to the presence of great performers, for example. Someone’s ‘having’ presence suggests possession, and clearly presence can be commodified; marketing itself manufactures a kind of presence. Whether such advantage is taken or not, however, presence often starts as something intimate and even innocent that may attract and accumulate further presence, perhaps to become a powerful presence itself. A World Cup soccer match, for example, may be a mutated exploitation of the elite abilities on the pitch, but the foundational presence of those athletes indeed attracts compounding attention of scouts, agents, advertisers, a stadium full of fans, literally billions more fans riveted to live moments via broadcast, etc. One doesn’t need Baudrillard to see how factors among these concentric layers complicate the qualities of presence– as might an exchange of text messages, for example, or riding the trending wave in real time of some viral meme– and we will return to this point in Part Three. Whether possessed by popes or presidents, however, by coaches, moms or memes, powerful presence is magnetic; any collective or interpersonal presence intentionally and immediately shared with other sentient beings has compounded, synchronistic power; and often, such sharing begins organically, modestly, and intimately.

As opposed to having, how might being present influence one’s quality of presence? The English difference in verbs steers the sense dramatically– not something possessed, and if so only in holding access to it, since of course ‘to be’ suggests a state of being. ‘To be present’ is like present² since ‘to be’ is the very verb of presence, incestuously copulative of also its adjectival form. Just as much for its intuitive simplicity, an attractive default definition of being present surfaces in the voice of Ram Dass: to “be here now”. Less forceful than even mere possession, these near tautologies themselves suggest some loop, some recursive suspension or holding pattern– yet to ‘be here now’ captures in its imperative verb a command to participate in this held state of being actively; in its adverb, temporality emphatically immediate; in its object, suggestion of immediacy in space. That the dimensions of time and space may each be distinct to presence and its ‘quality’ deserves much more attention, in Part Three; for now, let’s say that in requiring no material action, being present is simply being attentive. Receptive. Undivided. Poised before the sound of the starter’s pistol: “Ready. Set.” To be present is doubly intentional– in being willful, and as phenomenological bracketing, this immediacy its intentional field. Being present means being open– a kind of dilation. Such dilation opens one to greater immediacy, and thereby anticipates. Although anticipation may suggest a distracted or divided lean out of the present and into the future, it better may suggest that the present itself is not stable. The present is a verb tense. It’s in time. It’s moving, no matter the weight of its naming and nouning, which is why being present might also be called a state of flow. Each ‘current’ moment is left as immediately as it’s entered. Read aside Nietzsche or Heidegger, perhaps most practically aside Carl Rodgers, presence is as becoming as it is being– entering the current of immediacy with attention attuned. A delicate vacuum, dilated wide.

Non-human presence, non-personal presence– these become obvious contexts for wrapping one’s head around its many qualities. But one’s own death must be the ultimate context for the experience of presence– the ultimate coming, ‘other’ moment, even its transformation into apparent absence– to open up and lean into, to pass through, into, and away. A human being in a coma, in advanced dementia, in the act of dying itself– to what phenomena might they themselves be present? Outside our own experience, we understand and perhaps infer a lot from those who have returned to any form of lucidity from such states, never mind from Near Death Experience specifically. Quality of presence, having presence, being present– but if ‘brought’, brought to what? Brought to whom? To what is a person present? ‘To bring presence to’ is transitive with indirect object; presence ‘to’, a prepositional relation and orientation– which all suggests that presence goes somewhere. It moves. As already noted, the present itself moves in time, as time, but presence may move towards more than the future; the phenomenological concept of intentionality suggests that consciousness is never without an object: presence may be given to the eye of your lover, for example, or to a message on your phone; to a sound, or to a thought; its field may include interoception– awareness of one’s bodily sensations, gross or subtle– but consciousness is always relational. This inescapable intentionality makes what a person gives presence to entirely crucial.

For example, if consciousness is relational in any case, what quantum feedback loop of presence is possible in interpersonal relationship– in precise reciprocation between sentient beings, present and giving presence to one another? Again, this experience of shared presence is so central, it’s given exclusive attention in Part Two of these posts; other intentional objects to which we give presence complicate its quality enough to also deserve more careful consideration, in Part Three. For now, let’s hypothesize the paradox of presence perhaps uncommonly available to those such as an end-of-life doula, which is giving presence to apparent absence– ie, to death itself. There are many ways we humans muse upon death, from existential philosophy to horror movies. Of course, these are just proxy, mediating intentional objects about death, which itself is the ultimate absence. Affected by any of these as anyone surely is, however, the end-of-life doula gets close to death by being at the literal bedside, and even then, it is not to death itself that the doula gives their presence– but to a dying human. The sentient being headed toward imminent first-hand experience of this apparent absence, as well as the living friends and family around them, are the ones to whom the doula gives full presence. Here, and quite crucially, ‘giving presence’ suggests not only where presence is directed– but also that presence can be gifted. Even and perhaps especially as the dying person’s own presence dwindles, the doula lends them their own.

To practice presence, Henry recommends pausing outside the person’s room to gather oneself. Meditation or prayer helps in this preparation: mindfulness of the breath, for example; statements of affirmation. Such presence better allows the doula to hold space in what may be the emotional or medical tumult of the bedside. Dying can be messy, as Henry says– yet he emphasises that that never mean the doula is there to fix or solve. Presence to the dying, to a person who is losing control of their own presence quite ultimately, suggests something more delicate: a bearing witness, without any busy scramble for control or solutions– without pursuit even of the perfect death, however defined. Of course, such letting go can be profoundly challenging for any person hoping to help, not least of all those attracted to professions of care. One wants to take control; one wants to make it better. This adds critical context to our understanding of presence itself, however, since so much in life is beyond control, and mortality is the ultimate context, the existential standard, of ‘beyond control’. Perhaps one’s only dependable power in life, ever, is to bear witness– to relinquish material control and be merely present, as captured in Sylvia Boorstein’s clever inversion of the old admonition: “Don’t just do something, sit there”. Paradoxically, despite what critics of ‘being in the moment’ might assume, this letting go is not passive: the great vipassana meditation teacher SN Goenka says of such equanimous awareness, “This doesn’t mean you sit there, like a vegetable, so that someone can just come and cut you.” As emphasised by Goenka, such presence requires active awareness, and equanimity. Equanimity is the difference between being unattached and being detached: not ignoring, not denying, but neither caught up nor clutching on. Equanimity frees one to act with presence that is both open and objective– fully responsive, but unencumbered by distraction or attachment, and therefore without blind reaction.

Henry insists that the doula be entirely supportive of the dying person and their own beliefs– no personal agenda or prejudice should impose in any way upon the dying person’s own values, intentions, and journey, the realisation and support of these being precisely the doula’s role. Successful fostering of these requires a likewise almost paradoxical but similarly suspended presence as active listener: resisting the urge to interrupt, or to prepare one’s response even as the person has not finished speaking, and instead, to allow silences to occur, however long. This openness is indeed a kind of holding pattern— a holding of space. It dilates a delicate vacuum of presence, into which the client is always the first invited. Henry went so far as to describe active listening as perhaps allowing “more than one might hear with their ears”. Metaphorical or otherwise, listening in this way illuminates its physics– a sensitivity to vibration, tactile beyond gross sound.

So it’s true, on one hand: with a focus on presence, one isn’t so ‘worried about doing something specific’. On the other, to be present is plenty specific enough. Neither passive nor reactive, but receptive and responsive, presence dilates– making sense in the rawest sense, a potentially recursive entry into a yet finer quality. Equanimous presence, despite great intention, may itself have little more causal influence than the gravitational pull of a delicate vacuum– dilated wide open. Yet this space allows for whatever active response may be deemed necessary or available– response that itself is present and equanimous. If the presence one gives is not only outwardly but socially active, its perhaps subtlest intentional object may be the eyes of another. In a return of that eye contact, presence not only is given; reciprocated eye contact compounds it, and presence thereby is shared.

Having been present for the deaths of so many over his career, Henry was measured but remarkably frank in sharing tangible experience he has had, more than once, of a dying person’s presence, when their time has come, actually seeming to exit their body. I admire so deeply how practical, how grounded this man seems, that to hear him say anything so intimate to his experience was a gift too personal to presume any further upon here. Wondering or not whether his experience amounts to evidence of presence being metaphysical, I respect him far too much to suggest such a “presence in the room” to be mere cliché of ghost stories, either. Instead of conflation, conjuration, conjecture, let’s return to how Henry began most literally, with “the quality of the presence brought to the bedside”. Collectively, synchronistically– what is the “presence in the room”? However reciprocated or compounded– however shared– the doula’s own key service, and perhaps the only available but ethical control to be taken, is lending to the dying person their highest quality of presence.