By Gila Cohen Davidovsky, LCSW
Early in my career, I was a perinatal social worker. My clients suffered miscarriages, infant mortality, medical complications and mental health crises. I enjoyed working with my clients, watching them grow, helping them access better care, and encouraging positive changes in their lives. During this time, I too became pregnant. This pregnancy ended in a miscarriage. It was a challenging time as so many around me were pregnant and having babies. We tried again, and several months later I was once again pregnant. Reaching the 12-week milestone I started to share my news. A sonographer colleague, offered to give me a sonogram. In her exam room, pressing the wand into my slightly protruding belly, she informed me, I was carrying identical twins as they were sharing the same sac. Unable to focus, I left work early in total disbelief. I knew twins made me high risk and I saw these risks every day at work. I was overwhelmed and scared, intrigued and tentatively excited. In the following weeks I continued to work while trying to conceal the unavoidable. Soon clients asked me questions about my belly, and I shared minimally while redirecting to them. Maternal preoccupation coupled with the intensity of my job was all consuming. I wanted to be fully present for my clients and, at times, I wished I could leave my pregnant belly at home. All my clients were high risk for many different reasons. Financial security, family stability, and white privilege separated me from my impoverished, disenfranchised clients. Despite what at times seemed like insurmountable obstacles, I found my clients’ tenacious grit inspiring; their unrelenting determination taught me resiliency when I needed it most.
At approximately 22 weeks pregnant, I attended a conference on high-risk pregnancies - professional irony on this fateful winter’s day. I wasn’t feeling well, so I went to see my doctor at the hospital. I called my dad while having contractions, and he said what he thought would be comforting, “you will get pregnant again.” “I am pregnant now!” I yelled. My doctor tried everything, yet nothing could stop the contractions. I delivered non-viable twins. Their lungs were not strong enough to take their first breath, and they were too low in weight for medical intervention. The nurse encouraged me to see the twins. They were swaddled with blankets and placed on my bed – my brief time to grieve. I could barely look at them and I was uncertain what to do. The bitter cold New York City winter air felt harsh and brutal as I walked out of the hospital, my arms empty and my belly void of life.
According to halacha, Jewish Law, life begins when the fetus leaves the womb and takes its first breath; it is because of this belief that saving the life of a pregnant mother supersedes that of the fetus (Mishnah Oholot 7:6). A nefel, stillbirth, , according to Jewish mourning practice dictates burial in an unmarked grave, without a tombstone, in a special section of the cemetery (Weiner 2017). Only after a baby has lived for more than 30 days, are the laws of mourning imposed (Hilchot Avelut, Mishneh Torah). There is no required funeral or burial service to attend no obligation to say kaddish, mourner’s prayer, and no structured formal time to grieve. The Orthodox Jewish perspective is that I lost a pregnancy - not a child or children - and the process of grieving is the same whether I had a first trimester miscarriage or delivered a full-term stillbirth (Weiner 2017). This was harsh to live through. It was as if I had suffered, say, an appendectomy, and now I was to go home and continue as normal. It was confusing and incomplete; emptiness loomed larger than life.
As culturally sensitive clinicians, we need to understand the Orthodox Jewish perspectives on prenatal loss. At the time the laws were written, medical intervention was minimal and it was not uncommon for pregnancies to result in stillbirths, additionally, many babies did not survive the first month of life. The reason for the lack of formal ritual is not intended to minimize or dismiss the emotional suffering, but rather to spare the mourners the burden of the stages of mourning (Weiner 2017).
A few days later, with no bereavement days and no maternity leave, I was expected to return to work, and so I did. Filled with feelings of longing, envy, anger, and grief, I realized I couldn’t adequately sit with my clients and be there for them, and I am not certain that those who knew what had happened could sit with me comfortably either. I was wounded and not ready to be a healer. I took a leave of absence and used the time to heal and to find another job as a clinician in an outpatient mental health center. During this time, each month felt like an eternity. Eventually my dad’s words, “You will get pregnant again” echoed true once more. My next pregnancy was riddled with anxiety, but in due time, I delivered a healthy baby. Holding my precious little girl in my arms, life began.
Jewish mystical tradition assigns a numerological value to each Hebrew letter. The word Chai, means life and is made up of Hebrew letters that together add up to 18. I brought life into the world three times in the 18 years between the losses of the non-viable twins to the time my dad went into home hospice. These 18 years were filled with life, my dad visited frequently and we treasured our time with him. While my dad was in hospice, every few weeks I flew across the country to visit. I was a clinician in private practice, a wife, mother, and daughter, and I had to juggle many hats. Each visit, I helplessly watched my dad in pain as he slowly deteriorated. He was always emotionally and cognitively present. Together we spoke honestly about dying. He shared his fears, I shared my sadness; we cried, we laughed, we embraced. Dad taught me more than any hospice textbook ever could about the need to talk about dying, as the stages of grief ebbed and flowed in the process of living with my father dying. He knew he was dying and on more than one occasion he asked the rabbi to read with him Viddui, which is a prayer of confession said at one’s deathbed. He was brutally honest, no such things as euphemisms. Sometimes, his brutal honesty was painful and hard to hear and in dying this was no different. This openness made me a better clinician. I do not shy away from painful topics that others may find uncomfortable. At times, I was angry that he chose not to fight his disease by trying more medically aggressive interventions. My dad was going to live and die on his terms; he was inflexible and stubborn. We all get to make choices about how we live our life, and if put to the test, how we die. My father always respected my choices. In the end, I accepted his.
At work during these weeks every incoming call from family was filled with the dread of bad news. There were days when I hid my phone so I could remain focused at work. Self-care was critically important during this time. I didn’t take on new clients and I sought out supervision. The flights were exhausting and clients knew that I was taking extended weekends away. For clients who knew what I was going through, it sometimes stirred up their own loss; at times I had to remain extremely focused on my client in an effort to ensure difficult thoughts didn’t intrude in the therapeutic space. Their pain was my distraction and I needed to be certain I was being attentive and therapeutic. For other clients, sharing a brief sentence or two about my struggle gave them permission to open up and process their own story of loss.
When the dreaded phone call came, I called a colleague for coverage, texted all my clients, and embarked on the journey to my childhood home to bury and grieve for my father.
Before the funeral, the body is cleaned and prepared through the ritual of Taharah, purification, by the Chevra Kedusha, the burial society; a person known as a shomer, watcher, is with the body until burial to protect the body and as a way to show respect, burial should occur as soon as possible (Lamm 2000). Jews, wealthy and poor, are buried in white shrouds, a symbol of purity and simplicity -- we are all equal in God's eyes, and not rewarded by what we wear, but who we are (Talmud, Moed Katan 27b, Kettubbot 8b). Cremation is strictly forbidden (Drucker 2013, Lamm 2000). In America, it is required that the body be buried in a closed plain pine casket, the inside is not lined (Lamm 2000).
The next day was a brutal hot summer day. I, along with my brothers and my father’s brother, gave a Hesped, which translates to lament or wail. Similar to a eulogy, it is meant to be honest words of reflection. One should remember the deceased with words, which break the heart, and cause tears (Shulchan Arukh: Yoreh Deah 344:1). At the graveside, children, siblings and spouse of the deceased perform Krei’ah, it is the act of tearing ones clothes (Lamm 2000). I rend my garment by making a small cut and then tearing it. For a parent, this tear is done over the heart (Kitzur Shulchan Arukh 195:3-4). This outer torn garment is then worn during the week of mourning (Lamm 2000). Many less observant Jews will wear and tear a black ribbon pin. I found that tearing my shirt was a profound and symbolic expression of the intensity of my grief.
The oppressive heat of the California sun beat down on us as we buried my father. I dug the shovel into a mound of earth and covered his casket. In the process, all my being was forced to confront death. There was no escaping reality when the sound of the earth landed with a thump on the casket.
As is the custom of observant Jews, along with my mother, brothers and my father’s brother, I observed shiva. Shiva, is the 7 days of mourning following the burial. During Shiva, we remained together in my parent’s home. Extended family and friends delivered meals daily so that we could focus on the task of mourning. I sat on the customary low stool, I did not listen to music and mirrors in the house are covered. During shiva, personal pleasures are denied and we do not bathe, shop, cook or engage in work activities (Drucker 2013, Lamm 2000).
In a house of Shiva, visitors come to provide comfort and traditional formal greetings are avoided. It is customary to not speak until the mourner does. Comforting mourners is an act of loving kindness towards the living, and the dead (Kitzur Shulchan Arukh 193:11).When leaving instead of saying goodbye one customarily says ‘May God Comfort you among other mourners of Zion and Jerusalem’ (Drucker 2013, Lamm 2000). Several times a day kaddish, the mourners’ prayer, said with a required quorum of 10 men. Modern orthodox women often choose to say Kaddish (Smart and Ashkenas, 2013).
When the week was over, I got up from the low stool, walked outside and around the block for the first time in a week, and then flew back to return to my life - fatherless. For the following year, I said kaddish. As an observant Jewish woman I did not feel obliged to say kaddish as men are, but my dad raised me to believe women are no less than men and to make my own choices not bound by social or religious protocols. I found the process healing, religiously, spiritually, and psychologically. Within the first year, I returned for the unveiling. This is a formal dedication of the tombstone. On the anniversary of my father’s death, and during several Jewish holidays, as is the Jewish custom, I light a candle in his memory, and say kaddish and yiskor, a prayer of remembrance. Jewish law expects the mourner to go through the stages of mourning (Moad Katan 23a, Talmud), for me, after the loss of my father, the Jewish laws of death and mourning provided comfort and structure in going through the mourning process and contending with the unbearable loss.
When I returned to work the week after my father’s funeral, one session stands out. As I opened the door, my client walked in my office, sat down in my usual chair, and said, “Today is your turn, sit - tell me how you are.” I was speechless, transference and counter-transference powerfully at play. I sat down, out of place on the edge of the couch, paused and I said, “I appreciate your genuine kindness in wanting to be there for me - I am okay.” She responded, “If I said ‘okay,’ you would make me expand.” We both smiled and I nodded in agreement. We sat in silence for a few moments. I felt like she was making sure I was fully present and I could be there for her, and I articulated this. I shared that I had experienced a week of mourning and I was ready to return. She then replied, “I am glad you are okay, we are going to have to stop for today,” stood up as if to leave, and then asked if she could have her regular seat back. We returned to our previously - established seats, and resumed our work together.
My client’s sincere gesture reminded me of the universality of grief, and the desire to comfort. For me, the beauty and ritual of the grieving process in Judaism makes sense. In pregnancy loss, there was a void with no prescribed grief process either for me or for others trying to comfort me. After I lost the pregnancy I did what was expected - I moved forward, and in time, created life. Even in death, my dad has a strong presence; there is no comparison in these two losses. Pictures taken at priceless moments mark the passage of time and of a loved life lived, and lost -- I will always miss my dad.
As a therapist working with clients who may be in the process of grief, it is important that the clinician familiarize themselves with the rituals and customs of mourning in working with observant Jewish clients. Issues of mortality, the afterlife, existential questions as well as questions about end of life care, living wills and dying need to be understood in a culturally sensitive framework that allows the client to feel respected and understood. Understanding religion and spirituality, and being comfortable talking about these issues in therapy is essential to the observant Jewish client.
Drucker, R. (2012). The mourner’s companion, second edition. Highland Park, New Jersey: Ramat Gan Publications.
Lamm, M. (2000). The Jewish way in death and mourning, revised and expanded. New York: Jonathan David Publishers.
Smart, M., and Ashkenas, B. (2013) Kaddish Women’s Voices. New York: Urim Publications.
Weiner, J. (2017). Jewish guidance on the loss of a baby or fetus. Hakirah, The Flatbush Journal of Jewish Law and Thought, (23), 93-111.