Episode 57: Transitioning Through Death & Birth with Nicole Heidbreder, RN

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Nicole Heidbreder:

So within the context of the end of life, that’s also what an end of life doula is trying to do is supporting someone and exploring and talking about what does the end of life mean to that person? Because it’s it’s not, you know, an end of life doula isn’t just there for death. They’re there for this, this ending journey, this ending part of a long journey, hopefully a long journey. So it’s more about a process and talking with them about what are their hopes, dreams, ideals, what are they leaving behind? And then, and then helping them think about choice and options? And how would you want your deathbed to look like who would you want to be there? What would you want the energy of that to be like? And and then trying to support them in and actually sort of, you know, like facilitating that a little bit as much as we you know, as humans can.

Dr. Andrew Wong:

Today’s episode is a special one. We are bringing you a conversation with Liz bear, acupuncturist and co founder of capital integrative health, and Nicole hybrid her a birth and death doula. Here’s Liz bear to tell you more about this episode.

Liz Baer:

Hi, everyone. I’m excited to bring you this conversation with Nicole hybrida. Nicole is a birth and death doula who helps humans take their first breath and hold the hands of those who are breathing their last. Nicole is the owner of graceful fusion which is dedicated to training, equipping and empowering resilient doulas whose love for all stages of life shines from the inside out. This is a beautiful conversation with Nicole about her role as a birth and death doula. We talk about the experiences that led Nicole to become a doula and how she supports her clients using her empowerment, her presence and education. We also talk about what you can do if someone in your life needs support through birth or death. We hope you enjoy the conversation. Welcome, Nicole. I’ve been excited to have this conversation with you for a long time actually, probably since I’ve met you. And then years before when I first heard about the kind of work that you do.

Nicole Heidbreder:

Yeah, thank you. It’s a great privilege to be here. really grateful for it. So thanks.

Liz Baer:

I think you know, there’s your life is so interesting to me, actually, because you’ve been working at these two places that these two massive transition points that all human beings experience, which is the coming into this world and the leaving this world. But maybe you could tell us a little bit about sort of how you got here and how what led you to do this kind of incredible, incredible work.

Nicole Heidbreder:

Yeah. It’s, you know, every every time I’m interviewed by someone, and I’m, I’m always reflecting on how challenging it is for me to share the story. Because the story is, like many heroines and Hero’s Journey is all about these twists and turns and meeting the right person at what turned out to be the right time. But I didn’t know that at the time. Right. So it’s so yeah, I’m always thinking of like how to share this story more so. Well, I can begin with saying that I was I now say one of those sort of lucky people that hadn’t many people in my life close to me die when I was younger. From the time I was eight until 18, I had several friends die in sudden car accidents. Two grandparents die. A friend commit suicide who I was his final phone call. A boy I was sort of dating. I mean, and by dating, I mean hanging out and listening to music with each other. died in a sudden car accident. So there were a lot of deaths in my teenage years. And I didn’t really have anyone to talk to about that I was in a family where there was sort of like, Don’t talk, don’t tell, don’t explore don’t talk about emotions. And also within the context of my hometown, there really wasn’t any talking about those things. And and then I moved to New York City and my early 20s And I was doing five rhythms dance, and at one of the dance classes. I saw this flyer for this weekend kind of retreat workshop on death and dying and I just was like, I need that I want to do that. Like whatever that is. Little did I know that that that that workshop was being taught by someone named Roshi, Joan Halifax, who, you know, I consider to be like a high priestess on this planet. And I just was this like, straight out of the cornfields and 22 year old who didn’t who had no idea Give her context and how much that would actually be woven into my life and the next leg 22 years to come. So I took this training with her that was very helpful for me, and talking about and processing some of those deaths that had taken place. And then my life went about as as normal. And then in my mid 20s, through a series of strange events, I found myself in Sumatra after the Asian tsunami volunteering with a local NGO, and I met a midwife who invited me to a birth. And I went to it, and, and my life was forever changed, I felt. Yeah, I felt like the universe like opened up to me and showed me its secret. And and that was sort of the beginning of like, an existential crisis of my own of like, okay, so that birth was so beautiful. And I, I want to be more births, but I have this other career. And so like, what do I do, like, I’m not sure how to make sense of that. Which, which ends up being important, and my story, because really, being at that birth, instigated me navigating one of one of my kind of second big life transitions. And I did eventually switched to being a birth worker. And that wasn’t an easy jump to make. But I felt so compelled in my heart to do that. And then, which is true for most birth workers, that it’s not really possible to attend births, and to also not attend deaths as a part of it. Because not all mothers make it not all babies make it. And within the first three months of attending births, I was at a birth where a woman had given birth and then started to quickly bleed out. And the doctors were scrambling trying to stop that bleeding. But it eventually sort of became obvious that they weren’t going to be able to stop it. And I, I didn’t really know what to do. At that point in time, I didn’t really have much of an I had very minimal training. So I just sort of scooped one arm underneath her, and then tried to hold her while she finished dying. And that was a very sort of pivotal experience and my own life as a person, as a woman, as a birth worker. As someone who knew that likely I would be at more deaths, but I didn’t understand what that meant in that moment. The thing that I remember most about that moment was, was how beautiful she she was just as a person, she was a very beautiful woman, and the terror in her eyes. Looking over at her baby, and like kind of I mean, I can only assume like, as it was slowly dawning on her that the that they weren’t able to stop the bleeding. And then, and then just sort of how much she like tucked her head towards mine. That was this like, lasting thing that I that I remember, because again, I didn’t really know if I was doing the right thing, but I did something. So yeah, so early on in my birth career, death was this death was a part of that path. And it’s just sort of stayed that way. So then eventually, I went to nursing school. And while I was in nursing school, I was a part of and witnessed several deaths in a hospital that really didn’t sit right with me. Immediately after nursing school, I worked as an ER nurse doing the night shift in DC, which I don’t recommend anybody to do. And Further still, there, I was a part of many deaths that just seem cold and sterile. And I always sort of had this thought in my mind, like, I’m sure that that person never envisioned that they’d be dying like that. That they they’re just always seem to the sort of like disconnect that was there. And so that kind of planted the seed that maybe someday I would work as a hospice nurse. But in my mind, I thought that I was going to work as a labor and delivery nurse and work as a midwife because birth was my thing. And I thought, okay, at the end of my life, I’ll be a Hoss listeners, you know, like when I when I’m close to retirement like I’ll do that then. And then I stopped working as an ER nurse and started working as a labor and delivery nurse. And there were a series of things that happened in my work environment that then I decided to take a pause from working as a nurse as a labor and delivery nurse, and started working as a hospice nurse. And I loved it, I just was instantly like a fish in water. And, and while I was working as a hospice nurse, I was very clear that in these strange ways that a lot of the skills that I had gained over the 10 years of being a birth worker, a birth doula, and a labor and delivery nurse, were so translatable to the end of life. And then that kind of started connecting these dots for me of like, Oh, I’ve sort of been on this journey for a long time, but I didn’t realize that I was. And yeah, well, and then I just sort of had my own inner experience of wanting to be committed to to working in birth and death side by side, and focusing myself and my career and my soul, on the ways in which that I see those two realms as parallel. And, and how can I support them? And how can I? How can I teach and share information with others that can also support those great transitions?

Liz Baer:

Wow, that’s incredible. Love, love hearing that story. Nicole. Sorry, I hope I didn’t talk to her. It was it was wonderful. No, it was wonderful. There’s so many little pieces that I want to touch on. One that one that I think is sort of useful as a frame up is if you could describe to me what’s what’s the difference between so I hear a hospice nurse and labor and delivery nurse and then I hear birth doula and then death doula. What’s the difference between the two? Yeah,

Nicole Heidbreder:

that’s a great question. Um, so one can say that no matter what kind of doula we’re talking about, whether it’s abortion, doula birth, doula, end of life, doula there, there are now fertility, doulas. That it, it’s a term used to describe a support role that is not focused on medical interventions and medical advice. And so one of the things that for me, has become very clear is how much our medical system and how much our society focuses on and talks about birth and death as physical journeys. So you know, there’s sort of this Adagio of like, well, as long as the mother and baby are alive, and then then you know, like, then it was in then it was a good birth. And same with death, as long as this person that died in the ICU, or that died in the ER or at home had a pain free death, then then that’s sort of this like, benchmark of like, okay, well, at least they had a pain free death, which, for me, very clearly is woefully neglectful, and sort of harmful. And kind of gross, that that we let that be taught in medical school and nursing school, in that vein, because it’s, it’s reductive and it’s it’s actually damaging to the person that’s giving birth and the person that’s dying. And it’s, it’s also damaging to the providers that are in the room with those people to view it and to teach it as a as a reductive experience this like physical thing. So I find that the the kind of emergence, or let’s say, reemergence of the doula role, was from a group of people that were sort of intuitively feeling like yeah, there’s actually more to birth than just the baby and the birthing person being alive at the end. Because it’s also this spiritual and emotional and psychosocial journey, that that that birthing person is on and also that that new human that that soul is on within the portal of birth. And same thing with death. That, that it’s not just that that person is physically letting go of their of their body, but they’re also coming to a reckoning of who they are, what their relationships are. And an end to that end, I can say that as a medical provider, as a nurse. I’m I don’t always have the time and the capacity to sit with someone in those non physical realms and to help them explore that. And so So birth doula has kind of emerged on the scene as someone who can explore with a birthing person. How are you feeling? What are your desires? What are your fears? The other thing that a doula role does is really sort of two things that I teach in my trainings. And again, this is true no matter what kind of doula we’re talking about, but that their role helps to slow things down and helps people think about choice and options, which our medical system is horrific at doing. Our medical system does not slow things down. And it does not remind individuals that they have choice and options that can reflect them as a human being so so a birth doula, help someone prepare for their birth and visioning. What would it what is it good birth look like to you? Like how do you even define a good birth? And then is there as a physical presence to help try to reach for that and try to achieve that? I mean, there’s, there’s so many other things. So we can’t guarantee it, but we try to. So within the context of the end of life, that’s also what an end of life doula is trying to do, is supporting someone in, in, in exploring and talking about what does the end of life mean to that person? Because it’s, it’s not, you know, an end of life doula isn’t just there for death, they’re there for this, this ending journey, this ending part of a long journey, hopefully a long journey. So it’s more about a process and talking with them about what are their hopes, dreams? ideals? What are they leaving behind? And then, and then helping them think about choice and options? And how would you want your deathbed to look like, who would you want to be there? What would you want the energy of that to be like, and and then trying to support them in actually sort of, you know, like, facilitating that a little bit, as much as we, you know, as humans can?

Liz Baer:

It sounds like, it sounds a lot like the doula is like, part coach, part, like, spiritual guide, part, therapist, you know, and really meeting all these needs that are, you know, maybe someone can find with a partner potentially, like if you have, like, a partner when you’re that you’re giving birth with or you’re in a household that’s connected with your dying process, and that they’re even able to be available to talk about these things. Because I think a lot of people, family members may not even be available to talk about the realities of death, right? So the doula comes in and in fills in these, these spots that are not really met by our medical, medical establishment and maybe not even able to be met by the people who are closest to us because exactly as to the situation.

Nicole Heidbreder:

Well, that’s right. And that, and that’s sort of what I’ve seen time and time again, and also acknowledging that your closest loved one may have an intention, and a desire to step into that supportive role. But they’re also going through their own emotional journey that they have done that they don’t have to but but that they’re navigating, and digesting and trying to metabolize. And and I, I sort of tried making this analogy of like, light going on, I don’t know trekking in Nepal. Going on some kind of like wild camping adventure into a really intense forest that you’ve never been in. It’s like, yes, you could do all of the research by yourself, read the books, read and read websites. And then and then plot your own course up Annapurna, and then do that. Or you could also talk to some people that have that have done it before, that have actually done that track that have maybe been Sherpas for other people, doesn’t mean you have to hire them. But like there, you can talk to other people that may have some feedback, some insight, some best practices, some a bit of mentorship to share about that. And the reality is that that is actually how our society used to function was that that kind of sharing of information and mentorship was kind of a part of I like a part of the gig of being a human. So, you know, 100 120 years ago, you and I would have grown up seeing an aunt or cousin or two or a neighbor giving birth. What is it like in those first two, three days postpartum? What is it? What is a two day postpartum? You know, new human being like, and what is that bleeding? Like, what, what is that breastfeeding, like? What are what is just, we would have been exposed to that. And similarly, we would have been exposed to witnessing our parents maybe show up for the neighbor, or an aunt, an uncle, a cousin, someone who lived physically close to our house, we would have just seen, oh, this is how a community shows up. This is how you support someone. This is, this is the kind of normal family fights that kind of take place. And, and this is, these are the many shades of grief that people go through. And we would have had a normalization of all of that, such that when it came our time to give birth, or when it came our time to bury our parents, we actually would have had like a better idea of what to do, we wouldn’t have just sort of be like, kind of fumbling in the dark. But because of the process of the sort of industrial complex of hospitals and, and the way that our medical system has expanded, and our own psyches and obsession with youth and ability, and fear of old age and fear of disability. And so it’s a confluence of many things that then has separated us as average citizens from these experiences of birth and death. So a lot of us just don’t have a lot of experience in that we like we never got the mentorship, we never got the exposure through osmosis of how to step into those spaces. So I also think that the doula role is this kind of ancient role. I mean, let’s be honest, like there’s, there are hieroglyphics in Egypt of like, you know, clearly a person that was likely a type of midwife kneeling in front of someone giving birth, and then that person have their arms around to maidens by their side. So it’s not like we’ve created anything. We just as a society sort of got off course, with our obsession with technology and modernity. And I think that there’s an awareness by many of us, that, that the I don’t even know, I don’t want to say that we need to get back on course, but that we need to chart yet another different course. Do you?

Liz Baer:

I mean, I don’t know how much of the history of of this kind of work. But it seems like not even not even like 100 years ago, maybe even like 75 years ago, we were in such a different place with birth and death, and we are now and you know, they used to eat, I remember my grip, like hearing, even I think probably even my dad talking about growing up and like, the aunt was in the parlor, you know, for everybody to kind of come and visit over a period of time, and we were much more accustomed to just even having it around and understanding that it was it that it really was a part of life and now, like so many things, we really outsourced it. Yes. Likely like you’re saying because of our own well, because of our own discomfort with what what is so truly inevitable.

Nicole Heidbreder:

Yeah, well, it will I think, again, I it’s a you know, it’s it’s the web that has no waiver, it’s that concept of like, it’s it’s so it’s a it’s such a confluence of so many things. So I think it’s, it’s modernity, it’s technology that has then removed us from like, being with blood and taking care you know, of our elders and wiping their feces and giving them the bed baths and now we hire people to do that. Or we place them in a nursing home women which again, I guess is hiring some someone to do that but so there’s a real sort of physical distance. Also modern psychology for a while, you know, people like, like Freud, which you know, gave many beautiful contributions but also let’s be honest with just was like a didn’t do a lot of favors to especially women, and to Why think much of society a brilliant human being. But he, you know, he was sort of the person that was like, okay, when someone dies, like, then don’t talk about them, don’t explore that, like, you just cut that off. And then that kind of became this pervasive way of dealing even with grief. So, anyways, so, yeah, so I think we’ve just distanced ourselves and distance ourselves and distanced ourselves. And, and I think also we as a society, something that, that I really see which I, which I don’t understand where this desire came from, or I don’t, I don’t understand where things shifted, but we also live in the society with how much people just want to defer to someone who they think knows more than them. So, you know, there’s this there’s this thing that I see for, for people in labor, and, and also sometimes people that are getting close to the end of life of this, like, oh, whatever my doctor says, you know, like, then I’ll then I’ll do, and also this sort of like, like thinking that you got saved in, in the hospital, like, like, for a lot of birthing people, especially who have a hospital based birth. The main, I know this as a labor and delivery nurse, that, you know, we cause quite a lot of problems sometimes just by our routine interventions that we’re doing. And then we, and then we save the woman at the end of the day, and then we save the birthing person at the end of the day. And so then they’re walking around with this narrative of like, well, thank God, that, you know, that they did that emergency C section. Thank God that, um, yeah, that they were there to Yeah, to get my baby out and whatever emergency way that they did. While meanwhile, I know that a little bit of how they ended up in that emergency C section, or that emergency situation was because of unnecessary interventions. And that is also massively true at the end of life. That and and we know this through statistics, and through research by like, you know, the amount of money through through Medicare that is spent in the last year of someone’s life on unnecessary interventions that don’t actually prolong life, and that certainly don’t prolong quality of life is astronomical in a sort of an epidemic, an epidemic, I would say, in our within our medical system. But despite the fact that we have evidence that shows that there still is this thing of like, okay, well, if my doctor is saying, yeah, like do do we get another round of chemo, or if my doctor saying, get yet another valve replaced that like, then I’m going to do that? Because there’s this, I again, I don’t know what it is, but I just I see it, that there’s this feeling to want to defer to somebody else that that we think or we hope knows more than us.

Liz Baer:

And I think yeah, for sure. And I think too is, you know, well, you would know this way better than I would, but I, I wonder I guess is a better way to put it. And for a few people who I’ve seen at the end of their life that there can be there’s can be like a kind of like a peacefulness like, Okay, I kind of got this I’m gonna it’s gonna be okay. And then as it gets closer and closer, there’s like, wait a minute, no, no, no, no, I’m pissed. I don’t want this. So, you know, there’s that pull between what we as human beings, you know, life is amazing. And it’s also let’s face it, it’s hard. And I think as we start to see it slip from our grasp, there can be such a desperation completely to hold on. Even if it’s a lot of times it’s like I think individually done, but then you also have pressure from family to keep going to keep fighting, keep fighting, keep fighting. There was a person who I know who I worked with who she, she just decided to stop. And I saw such a her interventions and I saw such a peacefulness come over her with that decision. Even though it was very difficult for her whole family, you know? So I wonder you know, how does a death doula fit in into these different processes where do is one call one in? And yeah, can they help smooth that over for the family and create alignment between the family and the person who’s dying?

Nicole Heidbreder:

Yeah, we can try. We’re not family therapist. But yes. And, you know, and families or families like, as Tolstoy, you know, explained to us all families are dysfunctional in their own in their own way. So, so I, so, I work as an end of life doula, and I teach people how to be end of life, doulas through an organization name and Nelda. And the way that we kind of envision the end of life doula role, is what we call an a three phase model. So the first the first phase of the model is meeting someone and really just hearing their story and their you’re hearing their story about the disease, the journey of the disease, where and how they’ve gotten to this point in time, then you shift a little bit and you’re hearing their story, their life story, so who are they who have they been, during the various years of their life, who and what were their loves their heartaches, their sorrows, their, their, their major lessons, their their major contributions of of what they leave behind them. And then ideally from that conversation, which isn’t, which is a sort of like an internal exploration that you as the end of life doula are kind of helping someone do. And the hope is that, out of that internal exploration, that then there’s an external manifestation of working on some kind of legacy project. And by a legacy project, it could be as simple as writing some letters to you know, to loved ones, it could be a plaque on a bench and your favorite park, it could be a book of recipes that you leave behind, it could be a quilt, it could be video montages. It could be audio recordings to be played at you know, certain pivotal times for your children that you’re leaving behind. It can I don’t know it could it could be leaving money to some institution, you know, really could be anything and so that’s kind of like the first phase of the end of life doula role and then the second part is helping that person explore what would be a vision of a good death for them. So who would be there? What would it be like the music the lighting the energy the the place in their home or the or the or someplace else where it would take place and and then kind of trying to get that down and then helping to get their caretakers their loved ones family or chosen family kind of all on board on that and and how can we kind of best set ourselves up to approximate this kind of end of life plan. And then and then the end of life doula would kind of be on call and would try to help support that plan. Sitting vigil sitting at the deathbed. And then after the death has taken place, then the end of life doula meets with the loved ones for maybe two or three visits that are really just about reprocessing the death, you know, this sort of like, well, I know that I’ve was there a little bit throughout this journey, but what was it like for you, as the primary caretaker, what has been your emotional journey and that’s really about using narrative therapy and kind of integration so sort of Yeah, so So helping someone process the, the the final month and the death and kind of supporting them a little bit on their grief journey, although I just want to emphasize that end of life doula is in general, are not like licensed grief therapist or you know, trained in that way. So it’s really about this reprocessing and the death experience. So that’s sort of the the three phase model if you will, of what an end of life doula can offer. And then the way that that looks really depends on I would say the end of life doula and and the situation so there are some end of life doula is out there that are like, so creative, and amazing. And they really kind of focus quite a lot more on like a legacy project and sort of like elaborate sort of like visual kind of parties and, you know, rituals and that kind of stuff. Then there are other end of life, doulas I know that are a lot more into narrative therapy and really almost help their clients sort of almost come up with like, an end of life autobiography, in a way so, so there’s different end of life. doulas that kind of bring a different skill set. So the way that it might look is going to is going to be a bit different depending on that on the unique skills of the end of life doula. The other thing that can really make a difference is when you when the end of life doula is hired. So sort of to answer kind of part two of your question, there really is no. There there really isn’t. Is no like average of when the end of life doula comes on the scene. I have been hired a week before someone dies. I’ve also been hired by by several women who have metastatic breast cancer, you know, braca, like, I mean, you know, that are given a very limited prognosis, six months, but they, the person diagnosed with breast cancer, then hires me as an end of life doula, but also says just so you know, like, I’m also doing treatments. And I’m, you know, I’m going to do the full range of surgery, chemo, radiation, and hopes that I can lengthen my life and not die in six months. And I’ve had two clients that have had that, and like, they’re more active at this point than I am like, they’re on vacation. They’re like, they’re walking about Planet Earth as though they don’t have cancer. So with those two women in particular, you know, we did a life review, we talked about a legacy project, they engaged in their legacy project. And then we also created a loose kind of visual plan of what their deathbed would look like, but never enacted it, because they’re still very much alive and thriving. So so that the range of when an end of life doula would come into the picture can look very, very different. Depending on that end of life, doula and then and then the person that’s, that’s dying, and then I also work in DC, as an end of life doula supporting people doing medical aid and dying. So which I don’t? Do you want to?

Liz Baer:

Oh, I’d love to talk about that. But I have a question. Yeah. Which is, do you see I know, you’re just referring to these two women with metastatic breast cancer is there. It sounds to me strangely empowering to create this sort of idea. I mean, a lot of times we’re planning our funerals, you know what I mean? Like, this is what I want on my funeral, and I’m gonna get that in my will and blah, blah, blah, or your, you know, what is it like your DNR, you’re sort of like leaving will kind of thing. But this sounds just so empowering. Like, with a terminal illness, that may be gives you like, 20 years, or, you know, 10 years, or 20 years, or whoever, but that you’re in a way, like front loading a lot of this, you’re going into the sort of the deepest reality of your situation, and you’re facing it, and creating a structure and creating a connection with it. I, I just wonder if you have any sense that that is something that’s healing for the person that even allows them to live more with what they’re living with?

Nicole Heidbreder:

Well, I don’t know if it, I don’t know if it yields to them living more. But I, but I know that it’s very, it’s deeply meaningful to them. Because Because part of part of the experience of giving birth, and also of, of knowing that you’re going to die of, of knowing that you have a diagnosis that is life limiting, is being confronted with the reality that you don’t have control over anything, and you don’t have control over your body. That that, which is humbling, as fu ck, it’s very, it’s very humbling. Because we, we live in a society, sort of that predicates on this, like illusion of control, illusion of plans, you know, and, and so when someone gets a gets a diagnosis and a disease, there’s this emotional and spiritual thing that I’ve seen that then life gets very small and smaller and smaller, which is also true when you’re in a caretaking role that just life just gets very small. And I think what happens when people engage in these kind of imagining and envisioning what their deathbed could look like and what could be a legacy project that it gives them. It gives them a small ounce of control over something it gives them a small amount of control over what the vision might be, and it allows them to also engage in something that might reflect them as an individual. Because so much of what happens when you have a disease, you have to start relying on people, you have to start realizing that you can’t do what you used to do your identity, you have to let go of your identity of being strong and independent. There’s just there’s just so much that gets taken away from you. Or that gets taken away from a person when they have a disease, and they are facing the true end of their life. And so what I see this sort of thinking about a visual plan and thinking about a legacy project, is that it it gives them a little something while they’re while so much of their life is about being forced to let go.

Liz Baer:

That makes a lot of sense. Yeah. That makes a lot of sense.

Nicole Heidbreder:

It’s just so hard being a human. That’s true.

Liz Baer:

Do do death, doulas, are they do they attend deaths? Yes, so pretty typical

Nicole Heidbreder:

pretty typical that the end of life doula would loosely be living within an on call life to try to be there so that they can come and support the caretakers and loved ones to be at the bedside for those final hours of life. Although but I but it is, but um, it’s it’s not like birth, doulas in that sense where that sort of like one of the main goals of a birth doula is to be there for the birth. So I would say it’s not like that at the end for being an end of life doula that that isn’t our main goal. But that can be a hope that you can be there. Because death is so much more unpredictable than birth is. So I think many end of life doulas try to but also make it very clear to the loved ones that that may not happen. So then our goal is to set them up very well. So that they kind of know what is the plan for the death? What is the plan for the vigil? So that yeah, that there’s that they can feel independent and confident?

Liz Baer:

Got it. Got it. And wondering about, you know, we’re going to talk about a little bit about medical aid. Would you share with us a little what that looks like and what the options are and legalities and all this kind of stuff?

Nicole Heidbreder:

Yes, I’m very happy to I’m very, very proud to because so within Washington, DC, it is legal, to elect to end one’s life with medical aid and dying, which I’m very proud of, because many years ago, when we were advocating and talking to our DC government about making that legal, I was one of the few nurses that was involved in that movement, and that testified in front of the DC council. So it’s very cool for me, to have been a part of the advocacy to get that policy to become legal, and then to now be able to work with people at the bedside that are actually able to have a compassionate death because of that. So I just, like, I’m very proud of that. And I love being able to do that because I I, after having been an activist for many, many years, it’s very rare to actually ever get policy to really change, let alone to get it to change in your lifetime. And then to actually get to like work in that. So medical aid and dying is a process by which very similar to hospice, to physicians are able to assess and determine that someone has a life limiting disease that left to advance on its own would cause distress, harm, pain and I’m, there’s a word I want to use that isn’t coming to me but but basically, that this person who has a life limiting disease is is in the realm of suffering. And so as a medical providers, it actually should be our responsibility to work with them on any and all options to end their suffering. So of course, in an ideal world, we do that through palliative care. We do that through pain management. But as as you and I both know that there are some forms of of pain that we that that are very, very, very difficult to treat. An example of that being once cancer spreads to someone’s bones to their skeletal structure and and and spreads and And that that bone pain is is is very difficult to treat with pharmaceuticals. It’s difficult to treat with CBD difficult to treat with THC, it’s just it’s a known challenge to treat that kind of pain. So, so in any case, when someone feels, okay, I have this terminal disease, I do feel like right now I’m in the realm of suffering. And the reality is that it is likely going forward that I will only suffer even more, they can seek out a physician to help support them in this to physicians have to agree that this person is in the realm of suffering. And then they will write a prescription for a cocktail of medication that is then dispersed to the patient, and then the patient can choose their own day and time of death to drink that concoction of meditate medication at their home.

Liz Baer:

And they’re usually attended, I imagine, by someone

Nicole Heidbreder:

well, so that’s a great question and sort of just speaks to how sort of ridiculous our medical system is an America. So within the I believe there are now eight states in America, where medical aid and dying is legal. And, and most of those actually, in all of the states, and the laws that are written, There is nothing written that that would cover or that encourages there to be a nurse or physician at the bedside. So in most of the states, these these people and their loved ones are left to do it alone. They’re left to like mix the drug by themselves, and then take it by themselves and then sit and watch sometimes these side effects and to assess, like to read a piece of paper and be like, Well, is this normal? Should we should we do something, which I think is just is like, just so wrong? I that is like, so so, so wrong. So so there is a movement then of many end of life, doulas that are wanting to support people in those moments. So who will come on the day when someone chooses to drink the concoction, and sit with them sit by the bedside, and, and and support the loved ones that are there and also to support the person that has drank the concoction? Because there, it isn’t always smooth. And you know, there can be little side effects that come up. And there are comfort measures, there are ways of handling those in the moment. And also, why do we have this expectation that people should give birth or like or die by themselves? Or you know, like, well, you know that families should just deal with it by themselves in the house by themselves? Why do we believe that kids should be raised that way like well, you know, that couples should just do it by themselves in a house by themselves like, all of these things. It’s like the older I get, I just realize how insane they are that we have this this way of separating our humaneness from each other’s humaneness. So so there are many end of life, doulas that will go and sit by the bedside. I just as a side note to this, I do predict that in the next probably 510 years, that there will be more hospices that will get on board, and will try to support more people and sending a nurse or sending someone from the hospice staff to be at the bedside when people are drinking the medication. But as of right now, that is not the case.

Liz Baer:

Are you allowed to do it in nursing homes? I guess it’s probably nursing. If it’s like legal in your area. Exactly. It’s allowed to be done.

Nicole Heidbreder:

It’s a state designation.

Liz Baer:

Wow, it’s so fascinating. It’s like this subject. I feel like we could go on and on and on. And there’s really one, one last thing that I’d love to learn about from you. So I what I’m hearing is the is we can’t do it alone. We all need help. Like we need connection. We need the collective to show up for each other throughout life and especially at these big transition moments. I’m also hearing too that you know that it’d be really nice if some part of that was built into our medical system to be able to you know, in addition to hospice, but built into to support people at this point, especially if they do medical aid and dying. And then it brings me to something that I know that you’re involved in which is the death Cafe, which is like almost like a grass roots community organization that helps people who are in the realm of dying. Could you tell us a little bit about that?

Nicole Heidbreder:

Yes, I love hosting those. So thank you for asking. So death cafes are free, open public gatherings, where, where any, and all individuals are welcome to sit with each other and have intimate conversations about the many ways that death touches all of our lives. So at at any one of my death cafes, there could be someone in their 70s, who just shows up and is like, you know, I just realized that the next phase of my life is leaving this planet is leaving this realm. And I would just want to be around other people that are talking about that. There could also be someone who’s in their 40s and 50s, and diagnosed with cancer. So they’re, of course thinking about their own mortality. They I’ve that could be someone in their 30s, who’s pregnant, who now for the first time is thinking about oh, shit, I have to actually live like, like, now I’m thinking of my own mortality, because now I’m responsible for my offspring, or not. And then I have had some another person from high school who just lost a classmate and doesn’t really have other classmates to talk about death, and to talk about grief at all. So it’s really beautiful to have all of those people all of those generations in a gathering, talking about death. And so in any depth cafe, the conversation is never predetermined. It’s always it always sort of emerges from the collective consciousness of who’s of who’s there. So we’ll go around the room, people will introduce themselves and express what was their interest in coming to the death cafe. And then from those introductions, there’s usually some overlap, and then we’ll start there as a way of initiating the conversation, and then it kind of meanders. And we may talk about, what does a good death look like? What does a bad death look like? What do we think happens after we die after we physically die? Um What Why is our society so much death illiterate, so So the conversations are really kind of anything and everything about death, and they’re just magical. They’re really, they’re really magical to have people from so many different backgrounds sitting. And there’s something there’s something I think, inherently vulnerable about talking about one’s own mortality, that then just lends itself to these really beautiful, vulnerable conversations with strangers that I don’t think there’s a lot of opportunity to have and many other realms in our life. So I used to offer those in person before the pandemic. And now I offer those virtually, through zoom, they’re free and open to the public. So anyone listening to this, you can go to my website, you don’t have to sign up for a mailing list, although I hope you signed up for a mailing list, but you can just access the Zoom link even on my website. So I really as for me, I feel that that’s part of my community activism and community engagement. And just being someone that’s trying to, to instigate more conversations about our mortality and about who we are and, and how mortality plays a role in all of our lives.

Liz Baer:

Thanks. Will you do you mind taking a moment and letting us know how people can get in touch with with you and even also find resources about death and dying or doula? EEEN?

Nicole Heidbreder:

Yes, yes. The main way to get in touch with me and to really find anything and everything out is through my website, which is graceful fusion.com Again, graceful fusion.com and from that you can find information about the the end of life doula trainings that I do the birth doula trainings that I do, the death cafes that I that I host and also if you’re looking for someone, if you’re looking for an end of life, doula to support you with medical aid and dying, you can find ways of hiring me through that. And additionally, in the past, like four or five years, I have been doing more trainings on being a grief facilitator. And so it’s not yet really apparent on my website, I still have to update it. But I I do personally sort of see my work as a as an end of life doula kind of going forward, maybe doing a little bit less of working with people. As a traditional end of life doula, but more getting into working as a grief facilitator and kind of helping people with some of the anticipatory grief that comes with having a life limiting disease and then also with their loved ones after they’ve lost someone. So one more thing that I would love to share is that I’m currently working on creating a course. And the working title of it is called the end of life, step families, but I’m probably going to change it to being the end of life for dysfunctional families. But the the course is going to be about some skills and best practices for helping people that come from dysfunctional families navigate that, so that they don’t walk away with more harm and more trauma. And then also after the death has taken place, kind of how to process that because I, well, I also come from a very dysfunctional family. And I know how the epicness and the intensity of energy of losing a loved one permanently to death can really instigate a lot of those old wounds and old dynamics and old projections and an old hurts that that are inherent in family dynamics. And I, I’m, I’m just I’m so excited about creating this, and I can’t wait to sort of like share it. And I, I really see that as a lot of what my work is going to be doing going forward.

Liz Baer:

Thanks for sharing about your course it sounds really interesting. And I think it’s going to be really needed for a lot of people. And I’m wondering, has that come out of your own experience? I know you were you attended your father’s birth, you kind of doula hit do lead him throughout the whole process, and that, that your own family has, like we were saying, Tolstoy says, you know, your only family had its own dysfunction.

Nicole Heidbreder:

Yeah. Yeah. Thanks for asking that. Yes, I was with my my father at his death, and which was a beautiful experience for me and a gift to be with him. Yeah, my father was diagnosed with metastatic cancer. Sort of right away. So we have no cancer in our family bloodline, and no notion that he had cancer. So when he was diagnosed, and it was already metastatic, it was already in his spine. It was pretty devastating for me, for him for all of us. Because there was sort of an obvious awareness that the prognosis would be Yeah, it would be short. But but I didn’t realize how short it would be. So he ended up dying, within three months of being diagnosed. And that was just such a journey. It was a really challenging journey, that, that taught me a lot. So one of the things that I learned in that is just how much how much are my own family’s old dynamics, and kind of roles that had been a part of, of my childhood, you know, like, you have the golden child, you have the black sheep, you have the, the funny one who doesn’t, who doesn’t have to be responsible, I think I had such an awareness of I hated those roles, and I hated the one that I got pigeonholed into, and how much of my 20s and 30s was a process of me what I thought was emancipating myself from from those roles, but of how much once there was this intense diagnosis, and the reality that we were gonna lose our patriarch that those roles and those dynamics, those, those old wounds, those old gripes against each other. Just came to the surface. It also was so apparent how my brothers and my mother and I have different coping mechanisms, and also have different ways of processing grief. And so I think that that’s inherent in any family. I mean, that I think that’s just being a human you. I mean, you and I have a lot in common but I’m sure that we grieve and also handle things just differently. But what happened with my father’s diagnosis, and then his death was how much my family and I clashed over what What to do, and how much we were not able to really communicate in a way that fostered connection. But rather, we were right back into kind of drama and blame and avoidance, triangulation manipulation. And, and just and like how painful that was I really I, I was almost like befuddled by it like, Oh no, how is how is this happening? I also was aware that even for myself, there were so many times when I was sort of laughing at myself, because even I was doing things with with my father that I knew, I knew not to do. But yet I, in the beginning of his diagnosis, I struggled to accept it, I really I really felt like no, like, this is not the right time. This is not when I want to lose him. This is not on. This is not on my timeline. This is the wrong script, someone hadn’t had someone to hand me a different script. And I can see that there are ways in which that that that I was like tripping over my own feet. So the other thing that happened around that time was that one of my best friends, her father was also diagnosed with cancer. And it just was like a tale of two cities watching are watching our families go through that. One, because in my family, we have major addictions, and I’m the only one that’s ever done therapy, and that’s ever even read a book about, you know, relationships or attachment style or anything. So I’m in a, I’m in a unit with people that are rather avoidant, and not really dealing with themselves. So so that was sort of one experience. So not only do we have like different family dynamics, but also just different resources, and seeing the way that that affected the end of life journey was like astronomical to me. So when my friends family, you know, they had like group phone calls where they talked to each other, they had aunts and uncles that were helping that we’re doing research on finding second what’s the opinion yes, second opinions and able to afford to fly to Boston to speak to a different specialist and hiring home health aides to come in and do caretaking and and all the while they themselves coordinating their rotation of care so that it wasn’t being a burden on any one person. And then compare and contrast in my family, where there was blame and disagreement, and struggle trying to figure out how to get things paid, figuring out what could be paid by Medicare, my father was a military personnel. So we did have military health insurance to cover some things, but not all things. And just trying to navigate our healthcare system was a nightmare. And most of that fell on my shoulders. And my father and my parents live in Southern Illinois. So there was quite a lot of strain on me flying back and forth between DC teaching workshops, working then flying back to Illinois, dealing with health insurance, taking care of my parents, trying to be the translator for medical advice and information, to get them to understand sort of, like what’s going on. And I think I did as best of a job as I could. And I also could have, you know, I think that I also can see ways that I could have done better. And it just it was such a just going through that with my best friend and kind of watching her family and then experiencing my own family really revealed to me how the propensity for more harm that can happen when there’s a death that takes place in in a in a family unit. And it isn’t also that that had been my only exposure to acts as a hospice nurse. I saw that daily, like I would drive to one house where people are talking to each other and making a plan and it’s like all hands on deck. And then I would drive to another house to see my next patient. And you know, when where maybe they’re just alone and there’s like one caretaker who was drowning, and they’re not understanding the advice of what’s been good Have into them. So I had witnessed that, but of course, I hadn’t personally experienced it. And then when I personally experienced it, I realized like, wow, this is a it’s really hard. And, and something that was very clear to me was that it took me months, if if not over a year to have even a semblance of peace over my father’s death, not because he died, but because of the level of family dysfunction. That was a part of it. It wasn’t just that I lost my father was that I lost my family, I lost my sense of family, and, and felt more, more sort of deeply alone than I could like, Fathom feeling. And I don’t think I’m unique in that, and I don’t think I’m alone in that. And I think that there are a lot of people that experienced that. And sadly, what I know to be true is that there are so many books out there that are written about the end of life, you know, Frank gosta, saysky, and BJ Miller, and just, you know, and all these, like famous people, and all those books, I have read them, you know, all of them talk about, use this as an opportunity to have these conversations with your loved ones that you just hadn’t had yet. And you know, what, that actually is wildly inappropriate for many families. For many families, where there is addiction and mental health issues, you actually need to talk and have boundaries, boundaries around your heart boundaries around what you’re doing.

boundaries around communication, reaching out for professional help, knowing what that professional help could look like. Because even at my death cafe, I know like there are people that will come and they’ll talk about Yeah, well, like my brother changed the will the last minute and, you know, my stepmom, like the third wife, or the third husband, like stole this money and did this thing, like those stories are actually more common than I think any of us realize. And it’s very damaging to be writing books about the end of life of like that we’re all going to have this like, connected kumbaya moment, because that actually, that actually isn’t the case for many families. And, and to not acknowledge that only makes those dysfunctional families feel even more alone and more outcast, instead of us normalizing it.

Liz Baer:

So what I hear is, it really speaks to, again, these places where we need more community so that if you’re, if you’re not able to process in a way that is helpful in your own family, that there’s resources out there, not just books that, again, are talking about, like the Kumbaya, but that are able to really meet you where you are with folks who are going through the same type of experience. Yes, maybe that’s an another project for you

Nicole Heidbreder:

do? Well, I envisioned that to be part of the end of life for dysfunctional families as a part of this course that they can take. And then maybe there would even be sort of like monthly gatherings that are just these drop in calls where people can talk and process and share. Almost sort of like a specialized death cafe for people that are that are coming from these dysfunctional families. So yeah, and I think and my, and a main desire I have is also just simply to normalize that, because I know that for me, I’m coming from a family where of having a father that was such a, such a deep alcoholic and workaholic and addictions really rampant in my family, that I, as a younger woman, I didn’t really know how to talk about that with anyone. And and it’s been a process for me to sort of be like, Yeah, I do come from a family like that. And I’m, and I’m sure I have my own issues. And I’m also an okay person, and I’m not damaged because I come from a dysfunctional family. Yeah. So. So I want to gift that sort of normalization to other people as well.

Liz Baer:

Yeah. That’s wonderful. Thank you for that. One last thing to touch on. Is, can you describe to me what a good death looks like? Hmm.

Nicole Heidbreder:

That’s a great question. I want to say in some ways, no, I can’t describe it because I think it’s so mutable and shifting and changing and personally in like, special to the person that is dying. But to that end, I would say some elements of it is that the Death reflects the human being that the death reflects the individual

that someone gets to live leave this life feeling connected to others feeling cared for and feeling loved, which is so difficult to really feel.

I do think some people want to die in a room by themselves. I think there are some people who don’t want their spouse or their children or their parents by their side, they want to cross that threshold unwatched, so I don’t think it has to be with loved one sitting beside them. But I, but I also believe you can be in a room alone and not feel lonely. So So I would say that the dying person doesn’t feel lonely or alone. They may physically be so but that that isn’t like their emotional experience of it that it can be in a room in a building and a house and an apartment that someone feels comfortable in. I think that that really makes a difference. I’ve supported so many people dying at home and, and many of them, even if even if they have like a hospital bed that was delivered to their home, you know, that has like the machine that helps it incline and decline and all that, you know, many of them just want to die like in the recliner, that that like that they love that’s worn, that their body fits comfortably in which I find very poignant and very beautiful. So this sense of physical comfort. And and that there can be that there can be music. And

that there can be things spoken to them that are meaningful to them. And for some people that that’s having loved one sit in prayer and meditation, by their love by their bedside. And for others, maybe that’s having Mary Oliver poetry read to them. For others, maybe that’s having excerpts of the Koran or the King James Bible read to them. But that there are meaningful words or meaningful silence that they’re surrounded by, I think is also important. Yeah, again, as I said, I, for me, it is somewhat of a hard question to answer because I think it’s so unique and so personal. You know, and I would even say, like, for me, if I were to, if I were to be dying soon. As you know, an important thing to me would be to have Hermes and Apollo, my cats by my side. They’re such gifts to my life. And I just, I feel their love and our connection. And I think for a lot of people, the animal kingdom, our pets are our powerful allies to help us transition over. So I would also include that.

Liz Baer:

Me too. Me too. Well, thanks so much, Nicole, for being here. It’s such a pleasure to talk to you. And thanks for all the work that you’re doing for very vulnerable people. Very important parts of their life journey.

Nicole Heidbreder:

Thank you. Thank you. Thank you for all the work that you’re doing. So, yeah, I’m appreciative of the way you are living your life. Thank you. Thanks.

Dr. Andrew Wong:

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