Title:Ends and Beginnings

For hospice and labor and delivery nurse Nicole Heidbreder (NHS’13), standing with patients at the two threshholds of life gives meaning to all that’s in between.

It’s hard for Nicole Heidbreder (NHS’13) to casually answer that quintessential DC question, “Well, what do you do?”

The hospice and labor and delivery nurse usually says she works in birth and death in the medical setting, and then waits for the thousand-yard stare, the furrowed eyebrows, the confused “oh.” It doesn’t help the conversation that, as a nurse for seven years, Heidbreder has developed an allergy to small talk and prefers asking the tough questions.

“Hospice and birth are phenomenal to me because you go straight to ‘Tell me how you’re doing?’ I would much rather have those conversations than go out to happy hour,” Heidbreder laughs.

A graduate of the School of Nursing & Health Studies accelerated second degree Bachelor of Science in Nursing program, Heidbreder has brought her unique blend of calm rationality and deep empathy to her hospital work, and to patients in need of end- of-life or palliative care at hospices in the Greater Washington area.

Comfortable working in birth and death, Heidbreder considers the two events to be life’s great equalizers.

“When you’re in that much physical discomfort, it’s really hard to have a fake personality,” Heidbreder says. “You are the essence of you. I love being around people in that space.”

Heidbreder has gravitated towards those spaces for decades. Prior to attending Georgetown, she trained as a birth doula in California, where her mentors encouraged her to embrace the overlap between birth and end-of-life care. Inspired, Heidbreder began to offer her own doula workshops in 2009, and in 2017, applied those principles to what she calls her “death work.” This includes a podcast (“The Magical Deathcast”), a death meditation series, and bi-monthly Death Cafes—salon-style meetings where strangers share coffee and cake, and discuss death.

Providing these services to her community felt natural to Heidbreder, who, as a young girl in Quincy, Illinois, used to wake before the sun to ride around with her dad in his pickup truck to register their neighbors to vote.

“I was raised by a father who instilled in me that it’s one thing to take care of yourself and pay your rent, but if you’re not serving the community you live in, what are you doing?”

To better serve her patients, Heidbreder fuses her experiences with life’s endings and beginnings as a teacher with the International End of Life Doula Association. She works to help reframe how the American health care system approaches life, death, and the in-between.

“Our medical system treats birth and death as medical events. I find that incredibly reductive,” Heidbreder explains. “It misses the beauty and nuance of those life transitions.”

Landing at Georgetown

The opportunity to explore those transitions through a public health and social justice lens attracted Heidbreder to Georgetown. But, already carrying a heavy student loan debt from a prior masters and bachelor’s, she couldn’t afford another degree.

So she tried her luck at the Nurse Corps Scholarship Program offered through the U.S. Health Resources & Services Administration. It covers full tuition plus costs for two students from any state, and Heidbreder was selected as a 2011 recipient.

“It was a gift to my life,” she says simply. “And with great gifts comes great responsibility.”

Heidbreder enrolled in Georgetown’s 18-month program and relished going back to school as an adult. Taking anatomy, physiology, and pathophysiology in her early 30s, when she had a deeper understanding of her body, provided greater perspective and purpose, she remembers.

Moving from New York City to DC and downsizing parts of her life to prioritize her studies was difficult. She’d spent her 20s working in music promotion, where she regularly rubbed elbows with Lou Reed, Patti Smith, and Alicia Keys. But after three or four years her passion had waned. “I realized that being cool is actually about doing meaningful work, not hanging around with famous people,” Heidbreder says.

She was ready for a change and eager to invest more time in a service- oriented profession but took some time finding her way to Georgetown.

“My life has been more about hitchhiking in Africa and shaving my head at 25,” Heidbreder laughs. “When I didn’t have a plan, I’d wing it.”

She discovered her passion for birthwork and, later, nursing while “winging it” in Indonesia. There she met an American midwife who invited Heidbreder to shadow her while she assisted local births in remote villages.

Just 10 months earlier, the 2004 tsunami ravaged the region and limited access to prenatal care. Births were fraught, including the first one Heidbreder attended where a woman delivered a baby who wasn’t breathing. While that baby’s life hung in the balance, the mother gave birth to another child. No one knew she was carrying twins.

The shock reminded Heidbreder how little space there is between birth and death. Her thinking was only reinforced in Uganda when, shadowing another doctor, Heidbreder remained to hold a new mother’s hand as she hemorrhaged shortly after giving birth.

“I didn’t have any medical training, I didn’t know what I was doing, but I just knew I couldn’t leave her. That was the moment I knew I was going to be a birth worker,” Heidbreder says.

She returned to the states and applied to Georgetown with a determination to improve women’s health and reproductive rights in her own country. Her emphasis on non-traditional care, however, sparked tension in some conversations.

Differing views on patient experiences and a nurse’s respon- sibility enriched class discussion and debate, recalls Margaret Nolan, assistant professor at NHS. She and Heidbreder shared divergent perspectives on the benefits and risks of home birth, for example. Despite their differences, the two remain close today.

“She’s been an amazing mentor of mine,” Heidbreder says. “When I’m having my own career existential crisis, she has been a rock for me.”

Authentic and on the Bright Side

Nolan nominated Heidbreder for the Sigma Theta Tau Nursing Leadership award and, after graduation, also selected her to serve as a preceptor for nurses at another hospital. While managing her own busy shifts, Heidbreder mentored early-career nurses as they shadowed her and learned on the job.

Victoria Yedlin had just graduated from Georgetown when she was assigned to Heidbreder in a labor and delivery unit. Yedlin found herself and the other nurses struggling to balance the demands of patient care in a complex hospital system.

But, shadowing Heidbreder, Yedlin saw how negativity didn’t have to pervade her long shifts. “Nic never seemed jaded,” Yedlin says. “She stayed extremely positive when it came to her patients. No matter what was going on in her life, she came to work ready to provide the best care possible.”

Heidbreder enjoys helping nurses like Yedlin find the silver lining in the profession’s toughest moments. It’s something that she had to do when she became discouraged early in her career.

In clinical rotations, she observed patients with feeding tubes, unaware of their surroundings, caught between this life and the next. It deeply upset Heidbreder, and she considered quitting nursing school.

Heidbreder stayed in nursing, but made the transition to palliative and hospice care, focusing on how her experience with life’s beginnings could ease its endings. But her new role came with its own brand of heartbreak. While hospice is designed to be a six-month journey, many of Heidbreder’s patients are referred to her care with just weeks to live.

To forge trust quickly with patients, Heidbreder avoids small talk and embraces conversations at their hardest points. Asking about adult diapers is as commonplace as letting a daughter or husband know their loved one is expected to die soon.

Sugar-coating the realities of death and dying is ineffective in these moments, she says. Patients facing devastating medical events can easily sense when a healthcare professional is lying to save their feelings. If they feel patronized, they often shut down and rebuff any caregiving offered.

“If you say to someone ‘You’re going to be okay,’ and they know they won’t be okay, they won’t be vulnerable anymore,” she says. “There’s no room for b.s.”

Other than telling the truth, Heidbreder finds that rarely is there a “right thing” to say to someone in crisis. “People just want to not feel alone, and they want to feel heard, validated, and honored,” she says.

To recognize this need in her patients, she engages in active listening—normalizing emotions, being open to questions, providing guidance—while refusing to become cynical or enamored of misery.

A Grounding Spirituality

Heidebreder’s Georgetown theology and ethics professor Ridgeway Addison notes how well Heidbreder straddles the line between life and death, especially in regard to spirituality and faith. She now guest lectures in his Problem of Suffering course.

“I appreciate how her own Buddhist-based spirituality continues to ground her nursing practice and her work as a caregiver and educator,” Addison says.
Heidbreder understands that gaps exist between theory and practice. It’s why she mines her professional experience to provide students with real-world examples of how to ease the burden of suffering for patients. She also draws upon her doula training to suggest more spiritual or emotional approaches to help people cope.

“Her blend of traditional and non-traditional health care experience makes her a unique voice to balance the more codified voices that traditional textbooks, nursing experts, and even creative theologians bring to the syllabus and weekly discussion in the course,” Addison says.

Approaching mortality from diverse perspectives has helped Heidbreder address what she considers our constant “low-grade anxiety” around death. When we’re anxious, Heidbreder explains, we’ll pursue anything that gives our life meaning. This stress often manifests itself in a relentless busyness and, eventually, burnout and resentment.

Healthcare workers, working long hours in professions that constantly grapple with life and death, can be particularly prone to this anxiety, Heidbreder observes. To temper that feeling in herself and make sense of the 15-hours days, the guilt and the constant pressure, Heidbreder makes a point to step back and examine what good she’s done and has yet to do.

Whether she’s embarking on a new journey teaching online workshops, dancing more, buying a house or starting a family, she refuses to do anything that doesn’t feel true to herself.

“Everything—money, sex, good looks—is a total illusion,” she says. “The only thing that is real is being authentic in each and every moment.”

It’s why when people ask her what she does, Heidbreder forgives the small talk and explains. It’s a chance to be honest with herself, in hopes that others will be honest, too.