Interview | International Hospice & Palliative Care
with VERA Hospice Charity Fund's Educational Programs Manager, Elizaveta Bakunina

IAHPC feature_Nancy Gershman

 

A Memory Artist at First Moscow Hospice

Interview with memory artist, Nancy Gershman by Elizaveta Bakunina of the VERA Hospice Charity Fund – currently Russia’s only charity fund that supports hospices, their patients and personnel.

 

  • See the IAHPC newsletter article online here
  • View the full slideshow on the VERA Hospice Charity Fund website here; or
  • Read the entire interview below:

5 April 2015

Q:  What brought you to Moscow, and ultimately to First Moscow Hospice? 

My husband – born in Moscow and today, a professor at Carnegie Mellon University in Pittsburgh – was invited by MIT Skoltech to teach a “learning by doing” course for 2 months. I joined him, but always with the intention of having as full a professional life in Moscow as possible.

Q: How did you hear about First Moscow Hospice?

Searching the Internet for Moscow’s most progressive hospices, I learned about an excursion of palliative care nurses from the U.S. that visited First Moscow Hospice back in 1999. Of all the hospices she visited, the blogger, a palliative care nurse, was most impressed by yours – especially the manpower provided by your volunteers.

Q: Talk a little about your presentation, delivered in Russian, to our palliative care staff on February 11th, 2015.

Twenty-three nurses and senior medical staff sat in the Family Room, and before I even introduced myself, I put examples of prescriptive photomontages (or “Dreamscapes”) into everyone’s hand. Their collective reaction was: “What are we looking at? Is this a real photograph?”  It greatly amused them that there could be between 8-13 different elements in a single Dreamscape. This is very typical, because I am collecting stories associated with well-being and happiness, and then synthesizing the imagery in these stories into a seamless whole.

First Moscow HospiceI knew the staff would be familiar with the term art therapist, so I needed to explain why it was necessary to invent this new profession called “Memory Artist.” Art therapists work with patients, encouraging them to make art that expresses their feelings months before they are in a weakened state. But family members keeping vigil with their loved one in their final days or weeks in hospice “work through” the memory artist. Together we construct a new enhanced memory of the patient, which is designed to uplift the feelings of these family members after the patient dies. If the patient can still communicate, their contributions make the Dreamscaping process in the patient’s room even more special for the families post-loss.

Q:  Were there any questions from the nursing staff or the doctors?

Two nurses raised their hands about their Dreamscapes. One Dreamscape was made for a 50+-year old photographer named Jane. As her mother lay dying, she suddenly got this crazy idea in her head that if God would wait and “take her” mother on Christmas eve, then Santa Claus (your “Father Frost”) could take Mom up to heaven in his sleigh. The interesting thing is that Jane never told this fantasy to anyone until I encouraged her to think about “a story about Mom that made you smile.” And she smiled a second time when I told her, “You see? You healed yourself!” Because it was true. All I had to do at that point was to transform her fantasy into a picture that her emotional brain believed was real.

Jane dreaded organizing her mother’s things because it confirmed that her mother was dead and absent from her life. But when I told her we could “bring the best parts of Mom to life in this picture,  she went right to work, supplying me with key images. In a family album, she found this iconic photo of the family home in wintertime, and a favorite photo of Mom in the kitchen. I also asked her to photograph her mother’s sculptures so that we could pick one to replace the snowman in the photo of their home. Back in my studio, I found an image of Santa Claus whose expression shows he has infinite patience to listen to Mom all the way “home.”

Q: What was the long-term effect of Jane’s Dreamscape?

I met Jane three months later, and she confessed that she had stopped going to grief support group — that everyone there was nice but that they were getting a little too “depressing” for her. She also started renovating her kitchen, her mother’s last dying wish for her daughter.

Q:  What do you think is the number one benefit of the Dreamscaping Process?

Hope. Hope that the things we lose can be restored to us. Before Dreamscaping comes into their life, what can the families and friends of the bereaved-to-be look forward to? A last word.  A squeeze of the hand. But also endless indignities that happen to their loved one at the end. Then death. And then grief.

But once I ask them for happy stories and zero in on the “je ne sais quoi” of this person, I see a change in the room. Everyone gets excited. The prospect of an artist making a magical photograph just for them literally makes the brain release a nice little dose of opiates.

Q: One week after your presentation, you began work as a memory artist in our hospice.  How did you communicate with families?

Memory artist Nancy Gershman at Moscow Hospice #1I studied Russian years ago so I could understand why my pediatrician mother-in-law was always saying “Infection!” whenever she babysat my sons. But thanks to Evgenia Pletneva, the volunteer coordinator, my Russian improved because once I got permission to practice as a memory artist at the hospice, it was sink or swim.  I’d come twice a week and put on my blue volunteer jacket and ID (Nancy Gershman, Memory Artist) and ask the nurses who I should go and see that day. They started recommending patients to me, and these all turned out to be cancer patients, between 40-60 years old.

I introduced myself as a visiting artist and historian and in all cases, these patients fortunately had enough strength and mental clarity to communicate – and understand my Neanderthal Russian.  To illustrate what I would create for them, I always carried around two Dreamscapes as examples.
The first patient was Irina S, a psychologist passionate about Paris and dancing. She asked for a portrait of herself on the top of the Eiffel Tower with a French actor who could dance. Irina knew her body was changed forever, but this portrait conveyed an important message to her family: this vibrant, beautiful person still lives inside of me ….
Her roommate, Tatiana M, was next. She wanted her family to remember the importance of keeping things neat, orderly and beautiful. In her Dreamscape, she requested a beautiful room with floor to ceiling windows open to the Caribbean, with a bottle of champagne, presents and candles on the bed to represent celebration. Because of the Dreamscape, she was able to patiently explain the meaning of her Dreamscape to her son and husband, without scaring them about a future without her.

The third patient, Irina D, was a painter who wanted me to do a photo session with her and her 10-year old daughter, before she has become too weak to stand. Her Dreamscape was modeled upon her tall canvases, which reveal street scenes as if behind elongated keyholes.

Nancy Gershman with patient, Irina D

Everything that is good about this hospice is in evidence: Irina has permission to keep her cat, paintbrushes and canvases inside her room. And because of this she’s also kept her sanity and good humor.  “A friend brought me this cat I call Missouri,” she’d tell me. “But with my Russian accent on the first syllable, it always comes out, “mizz-ery…”

Q: You also taught a bi-weekly Master Class on how to be a Memory Artist.  What was that like? 

Four hospice volunteers trained with me: Anastasia Loshina, Vera Fund’s volunteer coordinator; Irina Petrova, a linguist (and a hospice driver); Maria Petrova; an artist with extensive background in Photoshop (who makes home visits); and Aliya Hammatova; a student (and hospice volunteer). Irina and Maria were the only two that were able to complete the training, so they had time to actually practice being memory artists before I departed for the States.  Working as a team, they worked with a geriatric patient, who was the mother of Oksana, one of the nurses!  I coached Irina through her first interview with Oksana and her mother and now am supervising Irina and Maria in the creation of the Dreamscape.

Our first lesson covered the scientific literature in neuroscience which explains why creating a photo-realistic picture with symbols, metaphors and sensory imagery is so important — it is the language of the emotional brain. This is what makes the viewer feel that they are (or were once upon a time) — in that Dreamscape.  Next, we reviewed past cases from my NYC hospice to prepare for all possible scenarios (as dealing with fearful and sad family members and patients requires being extremely nimble). Then we practiced what to say when entering the patient’s room, as we needed a Russian variant of what I typically say back in the States. Here is what we came up with:

“Hi, I’m an artist and historian. If you like, I will make a picture of the happiest or most momentous day/event in your life on my computer that will look and feel completely real. Maybe it is a dream or a fantasy of something you always wanted to do, or be. As long as it makes you smile or laugh … “

Although all the trainees had some experience with the digital photo manipulation software called Photoshop, there was plenty to learn:

About interviewing:

·      When asking questions, strike a balance between playfully asking for the truth, but be ready to retreat quickly and respectfully if you touch upon something too sensitive

About composition:

·      If your picture looks like art but is not photo-realistic, you won’t be able to trick the emotional brain of the recipient to believe it is a new memory

·      To show two people engaging with each other in the Dreamscape, their bodies need to be positioned so that their sightlines line up (i.e. are they eye to eye?)

·      Every time you think you finished a Dreamscape, roll your chair backwards and look at the Dreamscape as if you are the person receiving it. Does it have the intended therapeutic affect (example, to increase their sense of self-esteem)? Or is there an element in the piece that is creating just the opposite effect?

Q: What are the things at First Moscow Hospice that impressed you the most?

Really, the little things impressed me. Like the way the hospice uses red bed sheets to make a patient’s red or purplish tumors less frightening to visitors. The mandatory blue shoe covers we wore inside hospice.  The petting zoo for adult patients and kids visiting family and the in-house florist. The number of volunteers under 30 who were so tender to their patients.  The murals donated by a local artist; the ornamental “butterfly” gate at the entrance. And the Maslenitsa “lady” created out of blinis in the cafeteria.
Q: I understand you also made a home visit with VERA Fund’s child psychologist, Inna Kovleva. What was that like?

Inna took me to visit her only verbal patient, Vadim T, in the Stalinist apartment where he lives with his parents and three brothers. With his degenerative condition still undiagnosed, Vadim spends his days lying on a daybed, with Inna engaging him with her play therapy props. On this day I interviewed Vadim’s mother, and discovered that Vadim has a weakness for fairytales and dry salami. That fact made me remember that a decade earlier when I was in Tyrol, Austria, a restaurant displayed a lebkuchenhaus they had made out of landjäger!  I couldn’t locate the photo, so I assembled this house from scratch – in Photoshop – and placed Vadim at the front door.

Vadim T's Dreamscape by memory artist, Nancy GershmanWhat made this case truly special for me was that Inna and I delivered Vadim’s Dreamscape on his birthday, and that the printout of the Dreamscape was light enough for Vadim to hold in his hand. And speaking of synchronicity — the parents treated us to an Austrian torte with raspberries! Inna continues to send me dispatches from her sessions with Vadim, especially when he fantasizes out loud a story to go with his Dreamscape …

Q: At PSYForte (continuing education for mental health professionals) and at Co-Operate (a hotline for cancer patients and their families), you gave Master Classes in “Constructing a New Memory” to psychologists. After this experience, what do you think is your niche/place in the Russian healthcare system?

Memory Artist Training by memory artist, Nancy

Leo Tolstoy knew better than anyone how attached Russians are to suffering. In fact, you could say that the Russian culture is all about the “cup half full” – only it’s half full of unhappiness. Conversely, Americans take their pursuit of happiness to ridiculous extremes, so none of this was a great surprise.

What did surprise me is the number of mental health professionals holding onto this mindset for dear life.  So I would always pose this question to participants: If you had a choice between a memory that produces either a dose of serotonin or cortisol, which would you choose?

So, Dreamscaping was either a breath of fresh air or an alien exercise. But in each class, we discovered again and again how even just talking through a visualization of a new memory could free one of regrets and deep sadness.

Q: What things did you find challenging, or expected to be challenging and were not? Did you feel yourself at any time, uncomfortable or weird?  

At First Moscow Hospice, the biggest challenge was speaking the language. But I found that both patients and staff who understand the effort it takes to be audible and articulate (when you are sick) were extremely patient with me. Talking with my hands helped, too. Otherwise, I felt very much at home. The place feels like it was conceived with love …

Q: What are your plans for the future? Will you come back some day and do it again? 

My immediate plans are to take the curriculum I developed at your hospice and make it into a handbook on how to become a memory artist.  If I can procure a grant, I will most certainly be back again, and will be thrilled to reunite with my trainees.

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