Tag Archive for 'hospice'

An Interview with Alissa Hirshfeld-Flores: Birth, Death and Hospice

Author Alissa Hirshfeld-FloresIn “This Whole Wide World is Just a Narrow Bridge” you bring together insights gleaned from your experiences with birth, death, and hospice. I will quote here from your bio, which proves to contain a poetic introduction to the selections we ran earlier at The Fertile Source: “Her book presents her reflections on what she learned from 12 years working at hospice, which corresponded with experiencing the intersection of the death of her mother, birth of her daughter, and own near-death experience post-partum. While the book speaks candidly about death, it is ultimately a celebration of life.” How and when did it occur to you to braid these strands together? Can you talk to us about the process of writing the book?

I started to journal intensively when my mother was beginning to decline in a more serious way, and I knew she was probably nearing her final months or weeks. Writing helped to contain and make sense of all of my grief feelings. At just about this time, I had also given notice that I would be leaving my bereavement manager position at hospice, after working there for a dozen years, to transition back to full-time clinical work (in a group psychotherapy practice). My daughter at that time was 5.

My mother ended up dying about a month after I left hospice. The timing of things allowed me to have a true bereavement period, as I was slowly building up a caseload and so had a few quieter months of working less than full-time, and thus more time to write as well. As I continued to journal, I realized that I wanted to explore and integrate my experience not only of losing my mother, but of all I’d learned through my years at hospice, as well as my transition into motherhood.

Because I’d gone back to work when my daughter was just 3 months old, I didn’t have adequate time to fully contemplate my traumatic birth experience (which almost killed me) and her birth. As I grieved my mother, it seemed the perfect opportunity to deeply reflect upon the experience of being mothered and becoming a mother, as well as the ephemeral and sacred nature of life.

My writing ultimately was very therapeutic on many levels and became a bit of an obsession! It poured out of me. As I began to share some of it with friends and family, they encouraged me to turn it into a book.

Two beautiful and powerful ideas you present that support the image of the bridge in your title have to do with ways we could better stand to support women in transition: post partum doulas and mentors to help fill in some of the void following the loss of one’s mother. Do you see these types of relationships fostered in our current society? Has it changed at all since you wrote the book? Do these concepts find expression in your professional life as a spiritual counselor? Are there specific pathways or structures you envision our society constructing (maybe these already exist?)?

Unfortunately, I don’t see these relationships fostered enough in our society. I wish our health care system would cover care such as that provided by post partum doulas—whom I think provide such a wonderful service—so that they could be available to most women. The period of adjusting to a new baby in the family is such a vulnerable one for families. I do think grief counselors and women peers in support group can fill in as mentors for women bereaved of mothers—if women have an opportunity or inclination to go for grief counseling (but unfortunately many don’t).

I also think it is a shame that many women are socialized not to ask for help for themselves, and therefore don’t look for the opportunities that do exist. I do feel that I get an opportunity to fill in these voids of support for some women, in my work capacity as a counselor or spiritual director. I have to remind so many women that I see that while it is admirable that they want to protect and care for their children, husbands, parent(s), etc., they have to be sure to put on their own oxygen mask before assisting those around them.

And can you talk about your title and how you landed there?

The title evolved over time. The working title was very bland: “Reflections of a Hospice Worker: How I Learned to Embrace Life.” An author relative of mine suggested that I flip the clauses, “How I Learned to Embrace Life: Reflections of a Hospice Worker.” That was better, but still lacked something. And the fact was, I no longer worked at hospice at my final stages of writing.

I have always loved the Hebrew song based on the quote by Chasidic rabbi Nachman of Breslav: “This whole world is a narrow bridge, and the main thing is not to fear (but to have faith).” I was still thinking about a title, when I began to hum that Hebrew chant. I then replaced “Reflections of a Hospice Worker” with “This Whole Wide World is Just a Narrow Bridge,” as in “How I Learned to Embrace Life: This Whole Wide World is Just a Narrow Bridge.”

Finally, a friend who read a more final draft of the book suggested I drop “How I Learned to Embrace Life.” So you can see how many people helped birth the title! I like the final product: it is poetic and captures one of the book’s central themes, that there is a thin line between life and death and that life is tenuous and precious.

You spend some time in your book reflecting on your assumptions about your mother and how they shift not only as you prepare to become a mother, but as she nears death. What do you take forward from these shifts in perception regarding your own mother as you in turn mother your own daughter? Will you share your book with your daughter (if you haven’t already—I’m not sure how old she is)?

I think that when one becomes a mother, one naturally reflects on how one wants to parent the same as how we were mothered and how we want to do it differently. This process is heightened when one loses a mom, when one is sorting through the positive memories as well as the negative ones. I learned from my mother both how to parent and how not to parent. Both lessons ultimately are valuable.

My mother was very warm, loving and ultimately supportive, and she also had her areas of struggle. Since it is so automatic to do what was done to us, we really have to be conscious about the things we want to do differently—so that we don’t pass on any mistreatment that was done to us. My mother, for example, imposed many of her own ambitions onto me, although they weren’t necessarily a fit for me. I hope I don’t do the same to my daughter. I hope I am a better parent because of all the things I learned from my mother.

My daughter has seen the book and has scanned it to find her name (mentioned several times!) When I do readings, she wants me to read the parts about her!

Have you had any reaction from the hospice community regarding your book? (I could see it being used in the classroom, for example). Similarly, within your faith and your religious community? How did you choose the metaphors of faith you used in the book?

I am pleased to have received excellent feedback from both my colleagues in the hospice community and from my faith community–rabbis, spiritual directors, and religious educators. It was important to me to include the issue of how faith can help one through times of loss and crisis. I observe all the time how faith—no matter what “brand”—sustains my clients.

It is important that people have a way to make meaning during times of difficulty: this might be a religious, spiritual, or existential meaning. And for me personally, working close to death as well as experiencing the miracle of birth while brushing near death, all heightened my appreciation of the mystery of both life and death, intensified my sense of awe and strengthened in me a spiritual sensibility.

Any desire to share us with your work as a consultant for grief-related films (sounds fascinating)? Any specific scene you found powerful to work with or help shape?

I got to be a consultant for Pixar for the movie “Up.” It was a wonderful experience! I was very impressed by how much research went into making the grief experience of the old man in the movie so realistic. During a long afternoon interview with the makers of that film, they asked me detailed questions about how such a character would experience his grief and what might help him to resolve it. We talked both about the use of a memory book as well as how mentoring a child could help one navigate through grief and feel a renewed sense of meaning in life.

Who helped nurture your writer self? Any mentors you’d like to share with us?

I have loved writing since I was my daughter’s age, 9, and I hope she’ll get as much satisfaction from it as I have! I remember various English teachers encouraging me, particularly the editor of my high school literary magazine, for which I was an editor. More recently, two of my supervisors at Hospice in particular supported and encouraged my writing.

Can you tell us a little bit about the novel you are currently working on or any other writing projects?

I am working on a novel about a young woman, who’s just been suspended from her ivy league college, who crosses paths at a New Age intentional community with a 50-something year-old woman who’s just been diagnosed with breast cancer. So it’s about two women, each facing times of crisis and transition, discovering what gives their lives meaning. Similar themes to this book, but with more room for creativity, and character development, and humor. Now, if I could only find the time to work on it . . . .

Any advice for writing mothers?

I would say to cherish and guard those private moments for writing! As moms, we need to replenish ourselves in order to be present and loving towards our children. The creative process, however we tap into it, can certainly help with that.

Alissa Hirshfeld-Flores is a licensed marriage and family therapy, certified spiritual director, and former bereavement department manager.  She currently practices in Santa Rosa and specializes in grief and loss, life transitions, and counseling on spiritual issues.  Her book (This Whole Wide World is Just a Narrow Bridge, Infinity Publishing, 2011, available at Amazon) presents her reflections on what she learned from 12 years working at hospice, which corresponded with experiencing the intersection of the death of her mother, birth of her daughter, and own near-death experience post-partum.  While the book speaks candidly about death, it is ultimately a celebration of life.  Alissa has been a Hollywood consultant for grief-related films.  In her personal time, she enjoys laughing with her husband–a stand-up comedian–and keeping their daughter entertained.  She is currently working on a novel. Alissa also appears on Writer-Speak with host Mikala Kennan (a half-hour indepth interview).

Excerpts from This Whole Wide World is Just a Narrow Bridge by Alissa Hirshfeld-Flores

A Longer Transition

When I awoke, in a clean quiet room in ICU several hours later, nurses and doctors were coming into the room, asking me questions, making sure I was “out of the woods.”  The doctors told me that they stitched up my uterus “like a pot-roast.”  I asked Danny what had happened.  He smiled tiredly and didn’t tell me immediately.  When he did, I didn’t believe him.  Apparently, when I was delivering the afterbirth, because of the way the placenta was attached, it ripped away a part of the wall of the uterus (placenta ecrita).  I bled profusely.  I lost 80% of my blood supply and received 8 liters of transfusions.  Danny told me how terrified he was.  “They asked if you had advanced directives.”  Despite being quite familiar with such things from my hospice work, I hadn’t realized I would need these things before giving birth.  The line between birth and death is indeed quite thin.  “You were hooked up with all sorts of tubes to a respirator.  I was coaching you to breathe,”  Danny explained.

In my woozy state, it felt like the Akeda story in reverse, the story in Genesis in which Abraham receives a command to sacrifice his son Isaac, but is then spared from committing the awful deed at the last minute by an intervening angel.  I had vowed to do whatever God wanted of me in exchange for a child.  But at the last minute, the angels took pity and spared my life.

The nurse brought Sophie in.  She was the most beautiful thing I’d ever seen. I was devastated that she’d had to spend her first hours apart from me, deprived of a proper early attachment period.  She lay in a little glass-walled basinet near my hospital bed.  I loved watching her.  I also, frankly, loved when the nurses took her to the nursery to let me rest.  What would happen when it was time to go home?  Who would take care of her?  Where in the world was her mother?  . . .  Oh, yeah.

I’ve since thought about how wonderful it would be if there were a system similar to and as widespread as hospice, a care team who would come to the home to help care for the newborn as well as giving support to the parents.  True, there are postpartum doulas, whose job it is to support new parents and help with the baby, but they are not widely used (most people have probably not heard of such people —I hadn’t).  And they are not currently reimbursable by insurance.  Surely, this vulnerable postpartum period is similar to the vulnerability prior to a death: a time when all of the emotional resources of the family are challenged.  Research by Drs. John and Julie Gottman suggests that 2/3 of marriages suffer due to the stress that accompanies a new birth.  Divorce rates skyrocket in the first year after a child is born.  What a wonderful beginning it would be for new families to receive homecare after a birth.  How much it might help to prevent postpartum depression, child abuse and domestic violence, as well as lowering divorce rates. Continue reading ‘Excerpts from This Whole Wide World is Just a Narrow Bridge by Alissa Hirshfeld-Flores’

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