To show up, care for, listen, and watch: a doula to the dying

The Rev. Hajime Issan Koyama, a Buddhist chaplain based at the Zicklin Residence of the Metropolitan Jewish Hospice, in Riverdale, [NY] works with people at the end of their lives—many of whom are isolated and have been abandoned by friends and family.

The four stages of interaction for the caregiver at the end of life are said to be: to show up; listen; care for the other; and watch—not unlike the process of Zen meditation. Issan’s job is to listen to his patients and walk with them as they are dying, to the place where they will be going. …to help ease his patients’ fear of their final passage.

Armed with the understanding that comes from years of study of Zen meditation and psychological methods, Issan says he is a “doula”—midwife. He can go everywhere his patients need him to go—to the point of death. At that point of death there is a door. He and the patient pass to the door hand in hand. The patient goes through. But Issan does not. He stays on the other side.

Issan says that on occasion he has found this process to be very frightening. He decided that he needed to create a better relationship with his fears. Further, he wanted to learn why he felt this powerful urge to compassion, to work with those at the end of life. He sought the aid of a psychologist skilled in dream analysis.

After analysis, Issan found that this urge to compassion stemmed from his understanding of his own childhood isolation and abandonment. An orphan, he was born into a wealthy family but cared for by a paid caretaker. As a child he lived in an ivory tower; there was an abundance of wealth but a total lack of love. Issan now uses this hard-won compassion, to help others who are dying in isolation and abandonment. Issan, like many in this business, is what Jung called a “wounded healer.”

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This fear of death...

This fear of death: We really fear it and yet we don't know what death is, or who dies. As long as we haven't investigated down to the 'foundation of death,' we'll have to fear it all the livelong day. But once we have investigated down to the foundation of death, what is there to fear? — because nothing in the world dies. There is simply the change, the exchange of the various elements, and that's all. Change is something we already know. The Dhamma has taught us: 'Inconstancy' — things are always changing. 'Stress' — where is there if not right here? 'Not-self' — this already tells us — what is there of any substance, that's 'us' or 'them'? The Dhamma tells us with every word, every phrase, and yet we prefer to fly in the face of the Dhamma. We want that to be us, we want this to be ours. This wanting is an affair of defilement: That's not us, it's simply defilement from head to toe — or isn't it?

--Venerable Acariya Maha Boowa Ñanasampanno, "The Principle of the Present"

A Pure Land death story

The Buddhist Pure Land tradition, which is quite large and diverse, focuses on the practice of reciting the name of the Buddha as means of calming the mind, encouraging faith, and creating wholesome conditions for daily life. The tradition is replete with stories of the deaths of sincere practitioners, which may be read for their amazing content or as inspiration for practice. Here is one.

Ven. Master Chin Kung has often told the following story to encourage us in our practice. The story was told to him by an older practitioner, Mrs. Gan, in 1984.

“Mrs. Gan had a relative, an elderly lady who had lived in San Francisco. This relative helped her son and daughter-in-law with the housework and took care of their children.

After several years, when the grandchildren had grown older and were attending elementary school, she had more time to herself. With this extra time, she was able to practice nianfo every day without interruption. Nobody knew about this. On the day she passed away, people discovered how much she had achieved in her cultivation. She passed away at night. In the morning, when her son and daughter-in-law went to her room to see why she was not yet up, they found her dead, sitting cross-legged on the bed.

They also found a will on the bed telling them how to arrange her funeral. There were even mourning clothes, which she had personally made for everyone, on the bed. She was a true practitioner, but nobody knew this when she was alive.

This elderly lady had no karmic obstacles. She knew when she would pass away. She performed her daily routine as usual and passed away without suffering from any illness. She passed away with ease and freedom. The elderly lady had achieved in her practice, so she had no obstacles.”

Two Paths Toward Death, One Path of Comfort

[The hospice chaplain] was asked if the daily encounter with other people’s deaths was ever too much. He paused, and said a chaplain’s own distress and sense of vulnerability to death were, in a way, part of the job. “It is my first bond with my patient,” he said.
In the best of worlds, he said, a relationship based on that helps a patient make peace.
“But many times, this never happens,” he said. “We are there to be there. That is the point. It is my job to stay when there is no answer.”

This short video from the New York Times website shows how religion and spirituality can be a support at the end of life. It features a Buddhist hospital chaplain and offers insights into spiritual support of the dying. The video accompanies this story.

A perfect day to die

Thus, it is suggested that we practice dying (find a perfect day to die) with a very interesting and enjoyable and sometimes frightening exercise called 'Taking a Day Off.' It is a daylong contemplation of seeing the world without ourselves in it. It speaks to that place within us that asks, How can I not be among you? Some call this practice 'Dead for a Day.' We walk the streets as though we were not there, as though we had died yesterday. We see the world in our absence. We act as though we were already dead and had this last chance to visit the world we have left behind. We grieve for ourselves and go on.

The power of such an exercise is demonstrated in the popularity of such films as It's a Wonderful Life. Something essential is drawn to the surface when we recognize that This day may be the last day of the rest of our life.

Experience each breath as though it were the last. Enter each moment, each conversation, each lovemaking, each meal, each prayer, each meditation as though there may never be another.

Just as yesterday we pretended to be dead, today we pretend we are alive. We walk the streets filled with presence. We watch the gratitude at our rapid recovery. We cut out the middleman of death, not needing to die in order to take our next incarnation, we take birth now, in the middle of the street, in the midst of a life redoubled by new birth.

We enter life so fully that even if we died it would not spoil our day.

--from A Year to Live: How to Live This Year As If It Were Your Last, by Stephen Levine

Latent fear of death

The Pali word anusaya refers to the latent tendencies that we all have, one of which is our fear of death. It lives in our consciousness somewhere and weighs us down, actually having quite a bit of influence on us, as it shows up in smaller, more tangible fears. It darkens our lives. It is a chronic form of anxiety.

Anusaya is constantly fed by things we see and hear: when someone we know dies, or when we see a dead animal in the street, or when we hear that a friend has grown seriously ill or see a friend after some time and notice that he has aged. The way of Buddhist practice is to flush out these fears, to open the doors and windows and let in some fresh air, to stop talking about these matters in a whisper, repressing and denying them. It's exhausting to live that way: it requires a huge amount of energy to hold that kind of fear down. And it doesn't ultimately work.

--from Living in the Light of Death: On the Art of Being Truly Alive, by Larry Rosenberg

No Death, No Fear-Thich Nhat Hanh

Dying with Confidence: Contemplating impermanence

From Anyen Rinpoche's book, Dying With Confidence, come these practices for creating a Dharma Vision for ourselves.

Contemplate Impermanence from the Outer Point of ViewReflect on how your outer environment has changed during the past year. Recall how the seasons changed: how the plants, flowers, and trees transformed over time; how the daylight increased and decreased. Think about it both in your own personal living environment and throughout the globe as well. Think about the natural catastrophes that occurred around the world. Reflect on all the births and deaths of people, animals, and insects. Allow the enormity of these changes to reach you on the deep level until you feel with certainty that not even one thing remained the same.

Contemplate Impermanence from the Inner Point of ViewImagine yourself as a small baby. See the physical changes you have gone through until now. Sometimes looking at photos of yourself from childhood to the present can be a poignant way to examine your own physical impermanence. Look at the transformation that has occurred in you physically. Then think about your physical being from last year until now, from last month until  now, from yesterday until today. See that your body is changing even from moment to moment.

Contemplate Impermanence from the Secret Point of ViewReflect on the wild  nature of your own mind. Remember yourself as a child and how your intelligence developed over time. Look at how your  mind changes moment by moment as it fills with entertaining distractions or follows after different sensory experiences. Contemplate how you are constantly transforming mentally and how the mind is also impermanent.

Contemplate the Impermanence of Things to Which You Are AttachedIf you are attached to material objects in the world around you, reflect on their changing nature. If you are attached to a person, reflect on him or her growing old and dying. Actually envision his or her physical and mental changes. If you are attached to your own life, as we all are, go through your body from the ends of the hair on your head to the tips of your toes and try to find anything that is lasting or permanent in your body. Do a very thorough examination, looking from outside to inside to see if you can find anything that is unchanging. Do this until you are confident that you, too, are actually going to die, and that you cannot hold onto this life forever.

"Griefwalker"

Griefwalker is a National Film Board of Canada feature documentary film, directed by Tim Wilson and produced in 2008.  It is a lyrical, poetic portrait of Stephen Jenkinson’s work with dying people.  Filmed over a twelve year period, Griefwalker shows Jenkinson in teaching sessions with doctors and nurses, in counselling sessions with dying people and their families, and in meditative and often frank exchanges with the film’s director while paddling a birch bark canoe about the origins and consequences of his ideas for how we live and die.  A few of the themes appearing in the film: Where does our culture’s death phobia come from?  Is there such a thing as good dying?  How is it that grief could be a skill instead of an affliction?  Who are the dead to us?  How can seeing your life’s end be the beginning of your deep love of being alive?

The film in its entirety may be watched for free on the National Film Board of Canada web site.

On losing someone you love

On Losing Someone You Love
by John Aske

I once asked Phiroz Mehta what the central problem of our lives was. He pinched his arm and said: ‘We think we are this body, but we’re not.’

When I lost my mother after looking after her for five years, not only had I lost the last member of my family, but I also lost the main motivation for getting up in the mornings.

First comes the self-pity. But since no amount of that helps you or the way you feel — it just makes you feel worse! — you have every reason to put it aside and no reason whatsoever to let it nibble at you; that’s just as pointless as concerning yourself with the weather!

Much more of a problem for me was seeing something interesting or going to the theatre or a concert, and not having anyone to discuss it with. If I went on holiday — I went to Mexico in the spring of 2011 — I could tell someone all about it, someone who was genuinely interested. But suddenly there was no one to tell, and no one to be interested in what I was, or did, or anything. Unsurprisingly, I lost interest in myself.

Men never really stop being little boys. When we are small, we want to tell mummy what we’ve been doing, and bask in the interest. Then, when we are older, we tell girlfriends or wives, or whoever we’re very close to. It’s a very human search for approval and acceptance.

The time that my mother was in hospital in a coma, I found to be very distressing. There was the ghost of a presence. And it was almost a relief when she died. It is at those times, when everything is thrown into question, that we need support and wise advice.

In my bedroom, I have pinned up on the wall the following conversation between Ajahn Chah (the abbot of a famous Thai monastery, Wat Pah Pong) and an old lady who had gone to the monastery but could only stay for a short time as she had to return to take care of her great grandchildren. She asked if he could please give her a brief dhamma talk.

‘Listen,’ he said, ‘there’s no one here, just this. No owner, no one to be old, to be young, to be good or bad, weak or strong. Just this, that’s all; various elements of nature playing themselves out, all empty. No one born and no one to die. Those who speak of death are speaking the language of ignorant children. In the language of the heart, of dhamma, there’s no such thing.’

We see life and death as broken pieces, because we do not understand the timeless, unbroken reality from which they seem to emerge. As Phiroz said, ‘We think we are this, but we are not.’

This did a great deal to raise my spirits. But then I remembered what the Buddha himself said, and I pinned that up with the other piece:

‘There is this unborn, unmade, unconditioned, and if there were not, there would be no liberation from the born, the made, the conditioned.’

That liberation is what Ajahn Chah called ‘the language of the heart’, and the place he called ‘our real home’.

When Ramana Maharshi was dying, his grieving followers asked, ‘What will we do when you have gone?’ to which he replied, ‘Where would I go?’

Whatever happens to us, whatever we do, our lives and deaths are a function of the unborn, unmade, from which we have never been separated for a moment, and which is the refuge that can never be taken away from us. We just need to live with it until we see it for what it is, for what we are.

vinnanam anidassanam anantam sabbato pabham
‘Infinite, trackless consciousness shining everywhere.’

(From Buddhism Now) 

A teaching story from the Jataka tales

An inspiring story from the Jatakas, the stories of the Buddha, tells about a family in India. There were an old father and mother, with a grown-up son who had a wife and child. They were very loving to each other, caring and close so that the family was the symbol of love for the whole village. 

One day, very suddenly, the son died and all the people in the village were shocked. They thought, ‘Now we must console this family because they must be completely devastated; they were so close and loving.’ so they all went to the family. When they arrived they found that nobody was mourning but the family was living naturally as though nothing was wrong. They asked the father, ‘What happened? We thought you loved your son very much? Hasn't he died?’ The father answered, ‘Yes, he died.’ The villagers asked, ‘Then why aren't you mourning? Why aren't you sad? You are here as if nothing happened. What is this?’ 

The father replied, ‘Well, I knew from the beginning that everything changes, nothing lasts all the time. So when I had this son, I loved him very much and I knew that there would be a time when we would have to part. because we did not know when this would happen, while we were together we tried to give our most, the best to each other. because of that we became the symbol of love. Now, what we knew would happen some day has happened. so, I am happy because I didn't do anything to upset him during his lifetime. I did everything possible for him and he did everything that was possibly good. Before I didn't have a son and I was not unhappy. Then I had a son and I was very happy. Now I have returned to the previous state when I had no son.’ The villagers asked each family member and each responded in the same manner.

--as told by Rob Nairn in Living, Dreaming, Dying: Wisdom of Tibetan Psychology

Neither yours nor mine

Preparing for [experience at death] begins with simply being who we are and where we are in this very moment. If we want to be successful in terms of experiencing our death and journey after death, then we have to master the experience of nowness. Whatever we are going through, that is who we are in that moment. When we speak about nowness, we are not talking about anything external, so we should not look for it outside. We should look directly at the space of our immediate experience, which is always right in front of us--the space that is neither yours nor mine, neither theirs nor ours.

--Dzogchen Ponlop Rinpoche, Mind Beyond Death

A teaching story from Ajahn Brahm

One of my favourite anecdotes on death is the story of Asoka's brother.[1] Asoka was the Indian Emperor who became a Buddhist. Asoka had a brother, named V´tasoka, who seemed completely unspiritual, and was into sensory pleasures. Being the brother of the Emperor afforded him many opportunities to indulge in them. In order to lead his brother into understanding the Dhamma, Asoka set a trap for him.

As I re-tell the story, with some literary licence, the Emperor was in his bath while his robes and insignia were laid outside. Asoka had arranged for some of his close advisers to be walking with his brother and, as if by accident, to come through the bath house. Pointing out the Emperors robes just lying on the bench, the advisers said to Asoka's brother, 'Why not try these on for size? Who knows? One day when your brother dies, you will probably be Emperor. Try them on. Go on, it will be alright'. At first the brother would not do it. He knew that it was illegal to do so. But in the end his pride got the better of him. Who wouldn't like to dress up in the Emperor's clothes? It was all pre-planned, and so as soon as he was dressed in the Emperor's clothes, the Emperor Asoka came out of the bathhouse and caught him! 

The Emperor asked: 'What are you doing? Are you usurping the throne? Are you a traitor?' Because this was a crime, the Emperor said, 'Even though you are my brother, I have to administer the law impartially. The penalty for this is death.' 

Despite his own brother's desperate pleas for mercy, the Emperor insisted on maintaining the law and having his unfortunate brother killed. However, he added, 'Seeing you are my brother, and you would like to be Emperor so much, for the next seven days you can enjoy all the pleasures of an Emperor. But you will have none of the responsibilities. You can enjoy my harem. You can have whatever you want to eat. And whatever entertainment I enjoy, you can enjoy as well. The pleasures of the Emperor are yours for seven days. But after seven days, you will be executed'. Then the Emperor left. 

After seven days, the Emperor Asoka summoned his brother to the place of execution. The Emperor asked him, 'Did you enjoy the harem, all those beautiful girls? Did you enjoy the best food from my kitchens? Did you enjoy my musicians and other entertainers?' The brother looked down at the ground, his shoulders drooping and said, 'Could I enjoy all that? I couldn't even enjoy one night's sleep. How can you enjoy anything when you know that you are soon to be executed?' 

The Emperor smiled and said, 'Now you may understand!'

--Ajahn Brahm, "I Know, but I Don't Know"

A basic tenet of the Buddha's teachings is that the mind and body work together, but that the body lies under the control of the mind. The mind is what orders the body to do this or that activity, but when the body wears down, the mind is of necessity put to some hardship as well. It doesn't lie under the control of the nervous system, although the brain can be regarded as a central office. When the body dies, disintegrating in line with the nature of its various elements, the mind — if the necessary conditions of unawareness, craving, attachment, and kamma are still present — will have to reappear in this or that plane of existence and to continue experiencing suffering and stress.

--Ajaan Thate, "Steps Along the Path"

"The Tibetan Book of the Dead: A Way of Life"

Death is real, it comes without warning and it cannot be escaped. An ancient source of strength and guidance, The Tibetan Book of the Dead remains an essential teaching originating in the spiritual cultures of the Himalayas. Narrated by Leonard Cohen, this enlightening two-part series [1994; 90 min] explores the sacred text and boldly visualizes the afterlife according to its profound wisdom.

 Part 1: A Way of Life reveals the history of The Tibetan Book of the Dead and examines its traditional use in northern India, as well as its acceptance in Western hospices. Shot over a four-month period, the film contains footage of the rites and liturgies for a deceased Ladakhi elder and includes an interview with the Dalai Lama, who shares his views on the book's meaning and importance.

Part 2: The Great Liberation follows an old lama and his novice monk as they guide a Himalayan villager into the afterlife using readings from The Tibetan Book of the Dead. The soul's 49-day journey towards rebirth is envisioned through actual photography of rarely seen Buddhist rituals, interwoven with groundbreaking animation by internationally acclaimed filmmaker Ishu Patel.

 

Two sides

As there is spring, so there is winter.
Likewise, as there is birth, so there is death.
As there is head of a coin, so there is tail of of it.
Birth and death are the two sides of life.

--Ven. Xin-Xing

Die a good death by becoming more peaceful

The whole emphasis is on trying to encourage the dying person, be it oneself or another, to become more peaceful. How can you die a good death? By becoming more peaceful. The Buddhist way is to try and maintain an atmosphere of peace in the room where someone is dying. It's not very good to have people shouting and screaming, waving and crying and tugging and pulling. What does that do to the poor person who has this very important thing to do, to die? They make it very difficult to die peacefully. Give those present time to become quiet. It is good if friends and relatives are present, people who can show by their presence that they care, that they love, that they are willing to let go, to reassure, to offer support - that's enough.

--Ajahn Jagaro, "Death and Dying"

Dwell on what they have accomplished

Always when you are with a dying person, dwell on what they have accomplished and done well. Help them to feel as constructive and as happy as possible about their lives. Concentrate on their virtues and not their failings. People who are dying are frequently extremely vulnerable to guilt, regret, and depression; allow them to express these freely, listen to the person and acknowledge what he or she says.

--Sogyal Rinpoche, The Tibetan Book of Living and Dying

A calm mind before death

All Buddhist traditions support the importance of maintaining a calm mind at the time of death. The moment of death is a critical moment that is thought to have a strong impact on the next rebirth. In order to have a calm mind at the moment of death, the dying person needs to cultivate calmness during life and be supported to enter into that calm state and maintain it, as much as possible, leading up to the moment of death.

Different individuals may need different kinds of support for this work. Pure Land practitioners (primarily in the Vietnamese, Chinese, Korean, and Japanese traditions) may benefit from chanting the name of Amitabha Buddha or having others chant in their presence. Small chanting boxes are available that play the chant continuously. Practitioners in the Theravada tradition (primarily in South Asian countries such as Sri Lanka, Burma/Myanmar, Laos, Cambodia, and Thailand) also benefit from chanting, usually offered by monks. Western practitioners most often rely on meditation to attain a calm mental state. When dying, these individuals can be guided through the stages of meditation by a fellow practitioner or by a monastic.

We cannot over-emphasize that any effort to support the dying person in the way in which he wishes is wonderful. We may feel we cannot do what is needed correctly. We may feel we do not have the appropriate training or understanding. This is not a problem. Our compassionate presence to the dying person and our wish to support him are the most important things we can offer.

Death and dying

Arising and passing away...

This is the Buddhist understanding of the nature of all phenomena. We are born; therefore, we die.

How can we understand this reality? How can we prepare for our own deaths? How can we care for others who are dying?

This is a journey into the heart-mind. Please let this site be your companion on the journey.