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.”

Read more of this story...

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