Dec 27, 2017
Elizabeth Semenova is the Director of Operations at Integrated MD Care. She shares her insights and personal stories about dealing with loss. The holidays can be an especially difficult time, listen to how Elizabeth handled her own loss and how she and Dr. Bob help others. Transcript Dr. Bob: Welcome to A Life and Death Conversation with Dr. Bob Bob Uslander. I'm here with a guest who I'm excited to introduce everybody to, and somebody who has a wealth of experience and insights. And I'm very pleased to have her as part of my expanding team here at Integrated MD Care. So you're going to get to know quite a bit about my new director of operations for the practice, Elizabeth Semenova.Elizabeth, say hello to our listeners. Elizabeth: Hello. Dr. Bob: So Elizabeth came to us a few months back. And the way that we initially met was through a referral that she had made to us for a gentleman who was struggling with Parkinson's disease and was really at the tail end of his life, and Elizabeth made a recommendation that he contact us. And it was a real blessing for us to be able to meet this gentleman and guide him through the last weeks of his life. After that, we just had a few more encounters. And, Elizabeth, maybe you can share how what it was about what we do that drew you in and kind of encouraged to you to reach out and try to become part of the tribe. Elizabeth : Well, after I referred friends, clients to you, I looked more into what it is that you do and how you do it, and explored information that I received from other sources about your work, and I was inspired by your openness to life and death and your perspective on the importance of accepting and talking about death as a part of life. I was particularly intrigued by your willingness to support patients and families who are looking for resources, education, and services regarding the End of Life Option Act in California. So that's how I came to connect with your practice. Dr. Bob: Cool. Well, we're very happy that you did, and just to kind of summarize, Elizabeth came on, and we didn't have a social worker who was working with us. Elizabeth has a master's in social work and had been working as a social worker within the hospice world for several years. And we were really blessed to have her come and go out. She went out on a handful of patient visits when I was doing initial evaluations for people who were looking at aid and dying. And it was a real blessing to have her expertise and just her presence there to support those patients and families. Then we just had some changes at the office, and it became very clear that Elizabeth had a strong leadership ... had some strong leadership experience and genes. And everybody in the practice really felt comfortable with her guidance, and I offered her the position to help lead the practice, which has been great. So it's just been a short time, but the difference in our efficiency and just getting things done has jumped quite a bit. So we appreciate your very wise counsel and leadership, and it will continue to be a blessing for all of us for a long time to come. Elizabeth: I'm very humbled by your confidence and appreciation. Dr. Bob: Well, there's more to come. So let's talk a little bit ... We've had some conversations, many conversations around our individual kind of perspectives and feelings about death and how to work with people through those challenges. I know that you've had some very personal experience with loss and death in your life, and I'd like to hear a bit about that if you're comfortable sharing. And let's see how we can provide some valuable guidance, comfort, wisdom for some other people who might need that at this point. Elizabeth: Sure. I first encountered grief and loss and bereavement when I was in seminary, and I took a class on the subject. I remember being very inspired by everything that we read and discussed, but feeling a little disconnected from it, not really knowing how to understand it or contextualize it. Dr. Bob: Had you had any personal loss up until that point? Elizabeth: I had lost grandparents, but no unexpected losses, no tragic losses at that point. And several years later, I was living in Colorado with my daughter, who was nine at the time, and we received a phone call from my brother-in-law, who was my daughter's father's brother. So my daughter's father and I were married when she was a baby and had since separated but stayed very, very close as family and friends. And his brother called me to let me know that he had died suddenly in a car accident. That was my first real experience with death and loss. And at the time, as I said, my daughter was nine. So my purpose was to make the process as comfortable and manageable for her as I could, to do what I could to contribute to her healing and resilience in dealing with the loss of her father. Dr. Bob: So you were dealing with it on your own and then having to understand, learn how to navigate that for her as well. Elizabeth: Yes, and I think that I didn't deal much with it on my own at first because I was so focused on caring for her. The initial loss was devastating. I mean, the pain in my body and the tears were endless. And I remember reaching out to friends and just feeling so lost and unable to think or function or grapple with the pain that was physical as well as spiritual and emotional, which really surprised me. I didn't realize that that was something that could happen. But I turned my attention to making sure that she was okay. So it was really a few years before I started to deal with my own experience of the loss. Dr. Bob: Had you had at that point training in ... Had you been through the social work training or had been involved in any way with hospice? Elizabeth: No. At that point, I hadn't had any experience end-of-life care, palliative care, hospice care. I went into my master's program in social work later, so I had been involved in social services but not in any official certified capacity and not with this field at all. I'd worked a lot with homeless populations, mental health recovery, addiction recovery and really didn't have any context for dealing with loss other than what I had touched upon briefly in seminary. Dr. Bob: So now several years later, you're in a very different place. You have a whole different set of experiences and knowledge base. And so it's interesting because you can probably look back at how you managed and how you responded to things and helped your daughter, and see it through a different lens because you would probably ... I'm assuming that that experience helped educate you about how to support others who might find themselves in similar circumstances going forward. Is that a fair assessment? Elizabeth: I think that's right, although I would say that the experience of a sudden tragic loss that is unexpected is very different from the experience of being with someone on hospice or someone who is more naturally at the end of their life. My father-in-law died several years later on hospice of cancer, and we had the opportunity to be with him, and to say goodbye, and to share love and memory with the family. I would say that that educated me more on how to be a hospice social worker than the experience of losing Natalia's father. Dr. Bob: I get that. Yeah, for me, the loss of my parents, neither of which was completely unexpected--they each had their struggles in different capacities, but it wasn't sudden and traumatic, which adds just a whole multiple layers of complexity to, I imagine to the grieving process. So can you share ... Do you have some thoughts that you'd like to share for people who might be in circumstances like that, who might still be grieving after a traumatic loss, especially with respect to children? Elizabeth: Sure. Dr. Bob: Not to put you on the spot, but I just- Elizabeth: I would say that the first most important thing is to reach out to people, to stay connected because it's an extremely isolating emotional experience. It's rare, and it can feel uncommon and lonely, so in order to stay stabilized, especially on behalf of my daughter, reaching out was really an important part of making things work. In the context of helping my daughter, I had never experienced that kind of loss as a child, so I didn't know what she might need from first-hand experience. So I reached out to friends of mine who had lost parents at a very young age, and I had two friends in particular who were very helpful in sharing with me their experience, what was important to them, what they felt was missing from care that could've been provided for them. The thing that stood out the most to me was they talked a great deal about people shying away from the subject and how that was detrimental to their recovery, to their healing, to their resiliency. So I made efforts to be very open and communicative with my daughter about the circumstances of the loss, the experience of the loss both for her and for other family members, and to share vulnerability of my own sorrow with her. And I think that that openness has been helpful to her. I think that she would say that we've created a safe space for her to be however she is, and to feel however she feels, and to share that, and to not feel alone with it. Dr. Bob: I think that's probably really critical to not feel like there is ... just to feel like it's okay to feel however you feel and not to have any expectation or to feel like, "Oh my goodness, it's been four years or five years, and I should be over it, but it's still painful," but for you to allow that and to help them see that this too shall pass. Things cycle and the feelings will come, and they will go, and to be able to freely express that has got to be critical. Elizabeth: Yeah, and I think another thing that really stood out was that everybody's grief experience is different, so allowing her to know and accept that my experience would be different from hers and that she doesn't have to match my emotional experience with the loss of her father, that she doesn't have to expect anything of herself, that I don't expect anything of her, and that it's okay to be. However, she is with it at the time of the loss and going forward because I don't know what her life will hold in terms of how she integrates this into her world, into her emotional experience. I don't know how it's going to impact her, and I just want her to know that whatever it is that she needs, she has access to the support that I can provide and that others can provide, and that it's always okay to let that experience be a part of who she is, and that it can shape her, but it doesn't have to overwhelm her. Dr. Bob: It's beautiful. Elizabeth: Thank you. Dr. Bob: You said something I wanted to touch on a little bit, in that people tend to shy away from the subject. And I see this all the time after someone dies, I think especially when it's someone younger or it's unexpected, sudden, is that the people around who might be very well-meaning who would want to provide comfort are afraid that because they don't know what to say, they don't want to make things worse. They don't want to say something that will be offensive or painful. So they probably instead don't say anything, don't call. That discomfort creates this distance. Do you have thoughts about how people ... because not so many people ... Like you said, it's rare for somebody to experience a sudden traumatic loss in their own life, but it's not as rare for people to know somebody who they care about who is in this position. So can we try to provide some guidance for people who are wanting the comfort or connect with someone who's had a loss? Elizabeth: Yeah. I would say that there are no words that make sense at that time, and to have the expectation that there's the right thing to say or that something you can do will make it better will solve the problem or somehow fix something is an unrealistic expectation. I think that death is such a part of life that it can't be ignored, and being willing to be simply present with people as they experience loss and grieve that loss at the time of the loss and ongoing because it becomes a part of their life, is the most you can offer. I don't think that there is anything that a person should do to help support someone other than just be there for them and with them. Dr. Bob: Yeah, I mean, I agree. I think that there are ... It's a challenge because you don't want to push yourself on somebody, and I know when people say--they're very well-meaning--"Call me if there's anything I can do if there's anything you need." But in that situation, most people aren't going to call on people other than a select few and say, "Oh, I need someone to be with me," or, "I need meals prepared because I can't function enough to cook for my family." Elizabeth: And I think that's a factor of our society's unwillingness to be comfortable with death. It's not considered acceptable to be in deep sorrow, and to need support, and to reach out to a friend or a loved one. I've heard a lot of people, especially spouses, share that their family members, after a certain number of months or years say, "It's time to move on," and that, to me, doesn't make any sense. If someone needs support around grief and loss, it could be at any time. It could be immediately after the death. It could be months later. It could be years later, to be available to offer a cup of tea, to just show up with a small gift, to send flowers to let them know you're thinking about them. I think small gestures that aren't intrusive but are thoughtful can make a really big difference. And those small gestures will let someone know more than just saying, "Call me if you need anything. I'm really here with you. I'm thinking about you." And it opens a door that people might not realize is even there." Dr. Bob: At the time of this recording we're coming up towards the holidays, and I'm wondering if you have thoughts about ... We're talking about children. We were focusing a bit on children, and there are a lot of children who are facing their first Christmas, their first Hanukkah, their first New Year's without somebody. It could be a grandparent. It could be a parent. It could be a sibling. You have anything you'd like to share about how to support the families, especially children through that, those holiday times after a loss? Elizabeth: I'm getting a little emotional as I'm remembering our first holidays without Natalia's father. Something that we've done that she has expressed to me has been really helpful is finding different ways of memorializing him and making him a part of new traditions. So we still have a stocking for him on the fire place. We have made crafts, little ornaments for the Christmas tree that she and I made together in remembrance of him. We make sure to spend holiday time with his family who is still very much our family and to really include him in the things that we do either through memories, or through creating small things that we can carry with us, or through creating new traditions that he can be a part of. And since his passing, we have found new family members and welcomed other people into our world, and I think that it would be really interesting to get their perspective on this, but they have been very open to him being a part of our traditions and our family, and I think that it can be maybe hard to balance the loss of a loved one with the integration of new loved ones. And it's a different kind of blended family. But, again, I think that open communication is the thing that has really made a difference for us, being willing to openly share our love for someone who is gone and at the same time share love for people who are here and know that they're not mutually exclusive, and know that we can all be a family together, and offering that knowledge and experience to my daughter, who has to learn to live with both the loss of her past and the future that awaits her. Dr. Bob: And partly the future that in some ways was created through that loss. Elizabeth: Yes. Dr. Bob: So we talk about silver linings. And after the death of someone who's young and vital, who we expected to be part of our life for decades to come, it's hard to think about silver linings in those circumstances, but sometimes we don't know ultimately what the purpose of our life is. We don't know what the meaning, the reason for our sometimes premature departure. But I know that there are many instances where a death has resulted in new relationships developing and new understandings developing, which wouldn't have happened otherwise. And we don't get to decide whether ... You don't get to weigh the consequences of one versus the other, but we have to appreciate that there are these positive outcomes. And, like you said, you have to reconcile that because I would imagine especially children, they would never want to think that it's okay that this happened, that death occurred because this happened. That would be very I think hard for someone to reconcile. But we have to somehow be okay with all of that, right? We have to learn to be okay with all of it. Elizabeth: Yeah. I at one point in my life received a label of the queen of the silver lining because of my [infallible 00:24:53] optimism. I think that that is not mutually exclusive with the experience of sorrow and teaching my daughter that we can be both happy with the life that we've built since the loss and also deeply wounded by the loss are not mutually exclusive, are something that we can reconcile and that we can live with simultaneously. It's difficult, and it takes a long time I think to bring those things together, to integrate them, but I think that like anything in life, there's a gray area that balances the life and the death, the light and the dark. And being able to live with that unknown, the in-between, I think that's a goal that I've encountered since losing someone that I loved. Dr. Bob: And I'm sure that that understanding has been extremely valuable for others that you've been able to counsel and engage with in your capacity as a social worker, as a friend. I do, the other thing that you mentioned that I completely, wholeheartedly agree with is the value of communication. It think the families, the people who have the most difficulty in struggle and have the most negative impact throughout their lives are those who can't communicate, who don't know how to communicate when they're in this, reeling through these circumstances that they didn't bring on, that they have no control over. Communication is so critical. Elizabeth: Absolutely, and I think that noticing that has been a huge part of what has inspired me to become an advocate for education in this field and for working to create those conversations and allow people to be a little bit more comfortable with acknowledging and experiencing the difficulty and the discomfort that surrounds conversations about life and death. Dr. Bob: Wow, a little light morning conversation topic, but this is really valuable. This is wonderful, and I think that there's so much more than we could tap into and touch on. And I'm going to ask if you're willing to come back and have an additional conversation or two with me? Elizabeth: I would be honored. Dr. Bob: Yeah, I think we have a lot more to discuss. We've been together and with some patients and families, and there will be many other opportunities for us to have these Life and Death Conversations, which I hope others will find some to be interesting and valuable. So thank you for sitting with me and having this conversation today. It was really informative, and really I'm sure valuable for many of our listeners. Elizabeth: Thank you for the invitation. Dr. Bob: Alright. Signing off now. We'll be back and chatting with you again soon.