Nina de Cocq, EOLD, RMT

06/02/2026

One of the hardest lessons in palliative care and hospice is learning that our role is not always to do, but often to be. Families will come to us in moments of deep fear, uncertainty, and heartbreak, and the instinct to “fix” things is strong, after all, most of us entered this field because we wanted to help, to ease pain, to solve problems. But there are times in this work when there is nothing to fix, and trying to do so can leave families feeling unseen in their grief.

Silence can feel uncomfortable, can’t it? We are trained to explain, to comfort, to try and ease the pain with words. And when a family is hurting, our first instinct is often to fill the space with something, anything, that might help. But the truth is, in palliative care and hospice, silence can be one of the most healing gifts we offer. It’s not emptiness. It’s not absence. It’s a space where care, compassion, and presence quietly live. And sometimes, it is exactly what is needed.

We don’t always have to have the right words. We are not here to fix anyone or solve every problem. What matters most, what families need most, is us being fully, quietly, present. There’s incredible power in sitting still, in taking a pause, in simply breathing together. Silence says, I am here with you. You don’t need to respond, to explain, or to perform. You are safe to just be. That alone is enough. And sometimes, when we remind ourselves of that, we realize that we are enough too.

Silence gives families the room to find their own words, or to find none at all, and that is a gift. It gives permission to rest without the weight of questions or expectations. It gives us, as caregivers, the chance to witness, to honor, to hold space for life’s most fragile moments without rushing in to “fix” what cannot be fixed. And in those moments, we may notice something subtle but profound: just by being there, we are giving something irreplaceable. Our presence is a gift, and it matters.

Being fully present in silence requires courage. It asks us to trust ourselves, our instincts, and our humanity. Sometimes we worry that we are not enough, that our gifts are too small, or that we should be doing more. But the truth is, what we offer is not measured in words or actions, it is measured in our willingness to be there, fully and without apology. It is in the steady hand, the quiet breath, the unhurried willingness to simply remain. That is enough. Always enough.

Families may not remember every word we say. They may not notice the perfect sentence, the clever explanation, or the reassurance we offered. What they remember, what they carry long after, is the sense of being deeply accompanied, of being seen and held. And that, our presence, is one of the most profound gifts we can give. Sometimes, the most compassionate thing we can “say” is nothing at all.

xo
Gabby

This was written for my book, "When Words Have New Meaning," which you can find here:
https://www.amazon.com/When-Words-Have-New-Meaning/dp/B0GDFT9WL3

A poem I wrote, “Presence” can be found here: https://www.thehospiceheart.net/post/presence

05/23/2026

"The reality is that you will grieve forever. You will not "get over" the loss of a loved one; you will learn to live with it. You will heal, and you will rebuild yourself around the loss you have suffered. You will be whole again, but you will never be the same. Nor should you be the same, nor would you want to.

The time we take following a loss is important in grief and grieving as well as in healing. This gift of grief represents a completion of a connection we will never forget. A time of reflection, pain, despair, tragedy, hope, readjustment, reinvolvement, and healing.

The time after a significant loss is full of the feelings that we usually have spent a lifetime trying not to feel. Sadness, anger, and emotional pain sit on our doorstep with a deeper range than we have ever felt. Their intensity is beyond our normal range of human emotions. Our defenses are no match for the power of the loss. We stand alone with no precedent or emotional repertoire for this kind of loss. We have never lost a mother, father, spouse, or child before. To know these feelings and meet them for the first time brings up responses from draining to terrifying and everything in between. We don't know that these foreign, unwelcome feeling are part of the healing process. How can anything that feels so bad ever help to heal us?

With the power of grief comes much of the fruits of our grief and grieving. We may still be in the beginning of our grief, and yet, it winds its way from the feelings of anticipating a loss to the beginnings of reinvolvement. It completes an intense cycle of emotional upheaval. It doesn't mean we forget; it doesn't mean we are not revisited by the pain of loss. It does mean we have experienced life to its fullest, complete with the cycle of birth and death. We have survived loss. We are allowing the power of grief and grieving to help us to heal and to live with the one we lost.

That is the Grace of Grief.
That is the Miracle of Grief.
That is the Gift of Grief." -

Dr. Elisabeth Kubler-Ross and David Kessler (Authors of the book: On Grief and Grieving- Finding the Meaning of Grief Through the Five Stages of Loss)

05/22/2026

I know I talk about this often, but it is because I believe so deeply in the importance of having conversations about death and dying before we are sitting at the bedside.

Talking about death and dying will not make it happen sooner, and silence will not slow it down.

What these conversations do is help the people we love know what matters most to us if a time comes when we can no longer speak for ourselves.

About a week ago, I received a call from a woman I had never met. She had been given my name by someone I had supported before. Her mother had a sudden change in condition and was in the hospital, no longer responsive. She was about to board a flight to come see her mother who she hadn’t seen in a few years.

I could hear the helplessness in her voice. She felt lost and kept asking, “What can I do for her? How can I support her? What does she need?”

I asked what she knew about her mother. She told me her mother had a strong faith, so I said, “Then the first thing you can do is pray with her.”

So when she arrived at the hospital, she sat beside her mother and prayed.

Later, when we met in person, we went together to her mother’s apartment and looked for the things that might feel familiar and comforting. We found her pajamas, a quilt from her bed, a few photos, her hairbrush, a small mirror, Chapstick, and her Bible.

We brought those things back to the hospital. Together, we changed her mother into her pajamas, laid the quilt over her, and placed her personal belongings beside her bed.

Her daughter read prayers to her for three days.

And then her mother woke up.

One of the first things she said was, “You prayed for me.”

That moment meant everything.

It told her daughter that her mother had heard her. That she knew she was there. That even in the silence, something between them had connected.

Her mother pulled the quilt up close to her, almost as if she were being held by it. And her daughter knew she had brought her something that mattered.

Her mother lived three more days, but in those three days, they connected in a way they may not have otherwise. There had been distance between them, but at the bedside, something softened.

Her daughter called me this morning to tell me her mother had died.

The voice I heard was not the same voice I heard during that first call. There was grief, of course, but there was also peace.

Peace because she knew her mother had heard her.
Peace because she knew her mother knew she was there.
Peace because she had done what she believed would bring her mother comfort.

This is why the conversation matters.

Not just the big conversations about medical decisions, but the tender ones too.

What brings you comfort?
What prayers, songs, or words would matter to you?
What blanket would feel like home?
What small things would you want near you?
What would help the people who love you know how to show up?

Because if the time comes when we no longer have a voice, the people we love can become our voice.

And sometimes, knowing what brings someone peace is one of the most beautiful ways we can honor them.

xo
Gabby
www.thehospiceheart.net

05/18/2026

One of the questions I am asked more than almost any other is this: “Why do we stop food and water at the end of life?”

It is a question filled with tenderness, and often, with fear. Families struggle. Clinicians and caregivers struggle. Anyone who has ever cared for someone who is dying knows how deep the instinct is to nurture, to comfort, to give. We equate food and water with love, with survival, with doing right by someone we care about.

And so, when we are asked to stop, or when a patient begins refusing food and water, it can feel like we are participating in something harmful… or abandoning something essential. Some worry they are contributing to suffering or hastening death. Others feel a conflict with their faith, their values, or the core human urge to sustain life. All of these feelings are valid. All of them deserve to be seen.

But there is another truth, one rooted in the wisdom of the body itself. At the end of life, the body does not want food and water. As the systems begin to shut down, appetite and thirst naturally fade. The digestive system slows. The cues in the brain that tell us “I’m hungry” or “I’m thirsty,” grow quiet. The body needs less energy, less input. It begins turning inward, conserving what little is left for the final work of letting go.

When we try to give food or fluids during this time, no matter how well-intentioned, we create discomfort. The body can no longer process what we are offering. Liquids can pool in the hands, feet, and limbs. Food can sit in the mouth or throat without the strength to swallow. These are not signs of neglect. They are signs of a body transitioning, doing exactly what it is designed to do at the end of life.

This is why stopping food and water is not an act of harm. It is an act of honoring the body’s own wisdom.
It is allowing the natural process to unfold without introducing distress.
It is trusting that they are not dying because we are withholding anything, they are dying because the illness has reached its end. And when we stop giving food and fluid at this stage, we are not causing death, we are helping create the conditions for it to be more peaceful, gentler, and filled with far more grace.

The body will actually let go with a little more peace and grace when food and water is not given at the end of life. The body responds well to this. It prefers this. And when we honor the body in this way we can remove or avoid physical suffering which is inevitable when we push or force food and water.

There are ways to offer care, comfort, and presence:

• Offer, don’t force. If someone shows interest, small sips or favorite tastes like ice cream, Jell-O, or a spoonful of something familiar can be soothing. But refusal is communication, and it must be respected.

• Provide mouth care. Moist lips, a clean mouth, and gentle swabs can bring comfort without asking the body to process what it cannot.

• Watch for cues. Holding food in the cheeks, coughing, spitting out food, or drooling are signs the body is not tolerating intake.

• Honor their choices. If they have an Advance Care Directive, their decision about artificial hydration or nutrition must guide us.

• Above all, prioritize comfort. Hospice and end-of-life teams are here to help families and caregivers understand these changes, to hold space for the grief they bring, and to create care plans centered entirely on comfort and dignity.

Stopping food and water at the end of life is one of the hardest things we ask of families and care teams. It challenges our instincts. It touches our fears. It asks us to redefine what care looks like.

But the truth is simple and profound:
Their body prefers it this way.
We are not hurting them. We are easing their way.
We are meeting them with compassion, not deprivation.

This work is tender. It asks so much of our hearts. But when we allow the body to guide us, when we stop forcing what it can no longer use, we give our patients what they deserve: a death held with gentleness, respect, and deep humanity.

And that is the essence of the care we all strive to provide for the people in our care, and for the people we love.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/a-gentle-truth-about-food-water-and-the-end-of-life

05/07/2026

For the past eight years, I have been caring for an older gentleman who was left completely alone after his wife died. Over time, our relationship grew into something much deeper. We speak twice a day, I visit often, and now I am walking alongside him as his life begins to slow down.

He is 96 years old, on hospice, and still fighting for more life.

Recently, I gave him a copy of my new book, “When Words Have New Meaning.”He told me some of the chapters were hard to read, which I understood because some speak about death and grief. But he said the chapters about life were the ones he loved most.

Now, every time I visit, he talks to me about one of them.

The other day, I walked in and found him holding my book in his hands. He looked up at me and asked, “Am I a lighthouse for you?”

I smiled and said, “Yes.”

Then I asked him, “Am I a lighthouse for you?”

He smiled back and said, “You’ve always been my lighthouse.”

The chapter I am sharing today is called Lighthouses.

Look around you and recognize the people who have guided you through storms, loved you through darkness, or simply helped you find your way. Tell them what they mean to you.

And remember… while someone else may be your lighthouse, you may quietly be theirs as well.

LIGHTHOUSES 🌟

There are people in our lives who become lighthouses, steady, unmovable, shining for us even when we are convinced we should be able to walk the shoreline alone. They show up despite whatever storms they are weathering themselves. They see us clearly, past all the ways we try to appear strong, and they accept us without a second thought. For many of us, these are the people we reach for only when we have run out of ways to pretend we don’t need anyone. Something in us knows their light is safe.

When I was sick for a few months last year, it taught me a truth that my pride kept hidden for most of my life. I wore my independence like it was proof of my worth, believing that needing help meant I wasn’t enough. But illness strips away illusions. It leaves you soft, tired, and honest in a way nothing else can. And in that honesty, I learned that asking for help isn’t weakness at all, it is human. It eases the weight we have carried far too long, and it gives others the chance to use the gifts they have been quietly holding, waiting for us to open the door.

What surprised me most is how many lighthouses I actually have. Some were people I barely knew. Some were friends I love but never let in close enough to see the real tenderness between us. And once I allowed myself to lean in, once I stopped guarding every edge, I found that the light around me was far brighter than anything I could have generated on my own.

Here is what I hope others take from my story: asking for help does not diminish us; it connects us. It softens the walls we have mistaken for protection and lets compassion move freely between us. And when we finally allow ourselves to see our lighthouses, to truly look at the people who stand steady for us, we discover something powerful… even on our hardest, most fractured days, we are not alone.

xo
Gabby

You can find the full chapter of “Lighthouses,” in my book:
“When Words Have New Meaning”
You can find this book here: https://www.amazon.com/When-Words-Have-New-Meaning/dp/B0GDFT9WL3

05/07/2026

Yes. Exactly

Someone recently referred to me as a Death Es**rt, and I will admit, I nearly spit out my coffee laughing. The title caught me off guard, and like most people, my mind wandered somewhere very different than bedside vigils and grief support. But the truth is, that’s exactly what I am. I es**rt people through one of the most profound, tender, and yes, sometimes awkward parts of life: death.

As a hospice nurse, I usually meet people at the time of diagnosis and walk alongside them all the way to the end. As an end-of-life doula, however, I can enter the journey at any stage, whether there is a diagnosis or not. Sometimes it is simply someone curious about their own mortality, or wanting to explore what death might mean long before it ever draws near. Sometimes it is a family member preparing for what lies ahead, or someone just needing a space to ask all the “taboo” questions without hushed tones. Think of it as death prep school, with fewer textbooks and a lot more humanity and compassion.

My intention is to gently light the path before you, easing fear, softening uncertainty, and offering a different lens through which to see this part of life. One that feels less frightening, and perhaps even more peaceful, in the midst of a tender and difficult time.

Calling myself an es**rt may sound a little… risqué, but really, it fits. I walk alongside people, so they don’t feel alone. I hand them tools and “assignments” (don’t worry, no grading involved), like writing down what’s most important to them, shaping the story they will leave behind, or even planning the legacy they want others to carry. It’s not about doom and gloom, it’s about helping people see that even in the end, they have a voice, and that their life mattered.

So yes, I am The Death Es**rt. I help people prepare, I witness their stories, and I make sure their wishes are honored. And if the title makes you giggle before it makes you think, good. Death doesn’t always have to be heavy. Sometimes an opportunity to laugh is exactly what carries us through.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/the-death-es**rt

05/06/2026

Some stories stay with you forever. This one will stay with me for the rest of my life.

A few months ago, I met Thomas and Cecelia a couple married for 63 years, together for 65. They had lived a beautiful, full life, side by side, and, as fate would have it, they were also diagnosed with terminal illnesses within weeks of each other.

At first, Thomas cared for Cecelia. She was more symptomatic, and he did everything he could to ease her pain. Then, when her treatments showed small signs of improvement, the roles reversed, and Cecelia became his caregiver as his own illness progressed. Their love moved fluidly like that, each giving what they could to the other, always with tenderness and devotion.

They hired Tongan caregivers who provided extraordinary care, gentle, compassionate, and constant. Together, we made sure Thomas and Cecelia had everything they needed.

Because they were both terminal and given six months or less to live, they each chose to participate in Medical Aid in Dying (MAID). Both qualified, both received their medications, and both decided to keep them tucked away on a shelf, not in fear or haste, but in peace, knowing the option was there when the time came.

As the weeks passed, they grew weaker. Neither wanted to die before the other, and that quiet, unspoken ache was one of the hardest things to witness. Finally, they decided to take the medication together, and they asked me to be there.

Prior to this decision I helped them with their end-of-life planning, which included creating a musical playlist, video messages for their two grandchildren, and finding a new home for their cats.

The morning I arrived, their caregivers greeted me with tears in their eyes. Though they chose not to stay for the ingestion, they had lovingly bathed Thomas and Cecelia, helped them dress in the clothes they had chosen, and even made a meal for me. Their presence filled the house, even after they left.

Before handing them the medications, I sat with Thomas and Cecelia and listened as they shared about their life together, about the joy, the laughter, the challenges, the countless memories that made up six decades of love. They said they had been blessed beyond measure and were ready to leave this world together, just as they had lived it. I witnessed them saying a long, tender goodbye to each other. There was not a dry eye in the house.

Before we began, they handed me a card and asked that I not open it until they were gone. They told me they were ready and Thomas said to me, “Gabby, we are MAID for each other… get it, MAID for each other???” This was a private joke they shared between themselves but felt compelled to share it with me as well. We all giggled.

They took their medications at the same time, though Cecelia laughed softly and told Thomas he was “going too fast.” He slowed down and matched her pace, just as he had done all their lives. They held hands and drifted into sleep together. Thomas took his last breath fifteen minutes later. Cecelia followed two minutes after him. Their hands still tightly clasped together.

I quietly sat with them, tears in my eyes, my heart full of gratitude. I did not rush this moment, it is too sacred for that. To be invited into their life and into their death was an honor beyond words. What I witnessed that day redefined for me what love can look like, steadfast, gentle, and wholly united.

When I finally opened their card, I read these words:
“Dear Gabby,
Thank you for everything. As you shared with us, this option gives us our voice back.
The truth is, we have always had our voice, we just didn’t have anyone who was listening. And you did. Thank you. We will be forever grateful to you. Our wish for you is that you find a love like ours, because you deserve that.”

And I cried.

After calling hospice, I waited until the funeral home arrived. I followed their gurneys out to the car, sprinkling flower petals over them and on the walkway to the car, my final act of love and respect.

This experience changed me. It reminded me of the power of love, choice, and dignity, and how, when we honor both life and death, we bear witness to the most sacred part of being human.

Thomas and Cecelia taught me that love doesn’t end when life does. Sometimes, it carries both hearts across the threshold together.

PS My mom and dad died thirty years ago, and coincidentally, their names were Thomas and Cecelia. Both struggled with a terminal illness, both would have qualified for this option. I would have wished this kind of ending for them.

xo
Gabby

I have never quieted my voice relative to my support of MAID, Medical Aid in Dying. And while I respect those who do not support this, I feel compelled to remind everyone that this is a choice that is made after someone has received a diagnosis and is dying. This option offers them autonomy, a voice, and a choice to end their suffering. I have been present for 300+ people who have chosen this option, never have I done this with two people at the same time. This was a first, and will probably be the one and only, but it has touched my heart deeply and I will never forget this experience.

My only request is that we do not walk away, and regardless of our personal feelings about this, we show up simply so they do not go through this alone. Thomas and Cecelia had two adult grandchildren, their own children died a few years earlier. Their grandchildren supported them but chose not to be there. Thomas and Cecelia gave me permission to share their story.

My poem: “We will not walk away": https://www.thehospiceheart.net/post/we-will-not-walk-away

My book “Dignity Day”: https://www.amazon.com/Dignity-Day-end-life-medications/dp/B0CCCJBT95

05/06/2026

Someone asked me if I still feel anything when someone dies, or if I have become numb to death after all the years I’ve spent in end-of-life care, and all the goodbyes and deaths I have witnessed. The question caught me off guard, not because it was offensive, but because it reminded me of how misunderstood this work can be.

The truth is that I feel everything. I always have. What time and experience has changed is not the depth of my feeling, but my relationship to it. I’ve sat at the bedside of so many people as they take their last breaths and I have held hands, whispered final words, witnessed love, fear, surrender, and grace. These moments don’t numb you; they shape you and they soften you. And eventually, they bring you to a quiet place of peace with death itself.

I don’t sit in discomfort. I don’t rush to fix what can’t be fixed. I show up with presence, with reverence, and with a deep understanding that this, too, is part of life. When you’ve been in the room enough times, you stop trying to resist what’s happening, and you learn to honor it.

Making peace with death doesn’t mean I am detached or unfeeling, it means I have found a steadiness within myself, a kind of sacred pause that allows me to be fully present. I am not overwhelmed. I am not trying to make sense of it or avoid the weight of it. I am just there, grounded, bearing witness without judgment, without needing to rescue or retreat. It’s not about being numb, it’s about knowing exactly where I am and why it matters so much.

I have made peace with death; not just as a part of my work, but as a part of life. I accept its presence, both personally and professionally, and I am prepared for it in ways that don’t make me less emotional, only less afraid. My experience has gently shaped me, teaching me how to sit with those who are dying and those who are grieving, to hold space in the sacred stillness of a final breath. And while I’ve grown familiar with death, I hope I never grow numb to its significance. Each goodbye remains holy. Each moment, a quiet reminder of how deeply we are connected.

Even after all this time, I still believe that death deserves our presence, not our fear.

xo
Gabby

You can find this blog here:
https://www.thehospiceheart.net/post/death-deserves-our-presence-not-our-fear

04/24/2026

When I am dying, I don’t want the last sounds I hear to be machines beeping and alarms going off telling me what I already know, which is that my body is shutting down and I am dying.

I don’t want machines keeping me alive.
I don’t want machines feeding me.
I don’t want to feel the suffocation of the blood pressure cuff as it squeezes my arm every hour on the hour.
I don’t want IV’s stuck in my arms, or tubes down my throat.
I don’t want other people making decisions for me.

I don’t want to be in a room that isn’t mine, with a view of medical charts and notes stating when I had my last bowel movement, when my medications are due, or how many times I have been turned and repositioned, which by the way is obnoxious when you are dying and I definitely do not want that.

I don’t want fluorescent lights on above my head, forcing me to keep my eyes closed so they don’t burn from the glare.

I don’t want people walking into my room as though it is theirs and not mine.

I don’t want strangers telling me what to do or how to feel or treating me like I don’t have feelings.

I don't want people to talk over or about me as if I can't hear. I can hear and I will hear you!

I don’t want my family to wait day after day in a stark hospital room knowing there is nothing else anyone can do but wait.
This is not how I want to die.
This is not how I want the people who love me to see me die.

I have written down everything that is important to me so that none of the above ever occurs.
I have listed where I want to be, who I want there, what music I want to hear, how I want to be cared for, what I want to wear, how I want my symptoms managed, and to what extent I want people to go to keep me alive.

When I am dying, I want my wishes honored, my voice heard, and my death peaceful.
I want this for you too!

Please write down your wishes and share them with the people you love.
Have the conversation.
Talk to your family and friends.
I promise you… it won’t happen sooner because you talked about it.

xo
Gabby
www.thehospiceheart.net

My book “The Conversation” is a great way to get the conversation started.
https://a.co/d/5kDTiSn

My class “Your End-of-Life Wishes”
can be found here:
https://www.thehospiceheart.net/your-end-of-life-wishes

You can find this blog here:
https://www.thehospiceheart.net/post/when-i-am-dying