Helping the Dying
I think this is how most of us would feel. We have such a culture of fear and denial of death that we feel hopelessly inadequate in the face of it.
'Death is a subject that is evaded, ignored, and denied by our youth-worshipping, progress-oriented society,' says Elizabeth Kubler-Ross in Death: The Final Stage of Growth. Yet death fills television screens and other media. Somehow there is a split in our psyche: death is part of our violent world out there. But we don't accept it in here, by coming to terms with our own mortality, by preparing in life to meet death.
The mysteries around death and dying are unnecessary. There is no reason for us not to learn to care for the dying. In fact, there is every reason we should, because caring for those we love, or for any person during their final days, is the last and greatest gift we can offer them. The vast area relating to death and dying is covered in some excellent books by among others, Elizabeth Kubler-Ross and Robert Buckmann.
Here are some principles we can follow:
We are all going to die. It's not a failure or a disaster. We will be sad to see someone move on and we will miss them, but that's samsara, the way of the world, isn't it?
Modern medicine has made such advances in recent years that many people feel that virtually everything should be curable. Doctors may regard a patient's death as a failure, and this feeling rubs off onto relatives and friends, resulting in an atmosphere of helplessness and failure around the dying person.
So the first thing we need to do is check our attitude towards death in general, our own death and then the dying person. Learn to accept the situation, come to terms with mortality and let go of sentimental or unrealistic notions that lead us to pretend it isn't happening. Becoming realistic about death and relaxing our attitude is very liberating, and will result in us naturally finding the strength we need to deal with it. It will also enormously help the dying person.
Perhaps people feel that accepting and coming to terms with death indicate an insensitive and uncaring attitude. It's as though we should pretend right up to the end, avoid giving the impression that we somehow want the person to die.
We begin with attitude. We check our attitude to death:
At the end of a day sit quietly and watch the setting sun. As day fades to night and the light leaves the sky, observe the ending.
'The day is done; it has ended. The bright promise of dawn blossomed into midday then faded beyond noon. Silently evening crept upon us and now there is an ending. The day has passed.'
Reflect on this. Reflect on the impermanence of it all so that you slowly soften the edges of your mind with reality: nothing lasts. Everything is impermanent. This too will pass.
These reflections may disturb you at first, but slowly they will bring you to accept reality. This is reality; we are impermanent, all of us. Don't make it into something morbid, or turn your world into a place of grey despair. Rather use it to liberate your intelligence so that you feel freer, able to flow with the great tide of change instead of thinking you should resist and hold everything immovably in place. Watch the clouds; great towering masses that are there, then gone. See the leaves on the trees; green and vibrant in summer, red and gold in autumn, then blown by winter's wind and gone, leaving the branches bare.
Wherever you are, whatever you are doing, allow your mind to attune itself to the all-pervading impermanence that surrounds us. Your mind will relax a little, loosen its urgent sense of grasping and, as the Buddha said, sit a little more loosely to life.
If you want to, you can help this process along by listing all the people you knew who have died. As you do this, keep reflecting 'I knew so-and-so, now they have died, gone. Yes, we die. We pass away. It is part of the human condition.'
You will free your own mind from a lot of unnecessary confusion and morbidity that you would otherwise most likely project onto the dying person. You will be freer to be with that person physically and psychologically in a clear way, able to meet their needs; be there for them in their final hour in a real, human way.
OPENNESS AND HONESTY
Now is the time to be honest; with yourself and with the dying person.
Many people become confused when someone close is diagnosed with a terminal condition. A frequent response is, 'Don't tell them.' And so a web of conspiracy is spun, with all the friends and relatives being told, while the dying person is treated to a barrage of well-meaning but transparent lies and pretence, 'A few more tests. We don't really know what's wrong. Don't worry, you will soon be up and about. We will have you well and home in no time ...' and so it goes on.
This is cruel and unnecessary. It springs from our culture of denial, which prompts us to deny reality right up to the end.
Supposedly this is for the benefit of the dying person, but in fact it's rarely so. We are the ones who can't bear to face the suffering; in this case the suffering of the dying person. Most people don't realise that we often can't face other people's suffering, particularly if they are close to us. It hurts us to see them suffer so we don't want to allow them their suffering. How do we do this? By shielding them from the truth. So we settle into an uneasy charade, smiling, putting on a brave face, and avoiding the obvious.
The effect of this is to isolate the dying person; that's why it's cruel. They usually know they are dying, and will definitely detect the pretence. All those who should be there for them, comforting them, helping them face and come to terms with death, abandon them at the crucial moment. They are thrown into limbo and may not be able to define or articulate exactly what it is that is happening. All they may know is that they are increasingly lonely rejected, confused and frightened.
So tell them the truth if you can. You may need help at this point, and perhaps an experienced counsellor could advise you how best to broach and deal with the subject. Nowadays there an many excellent hospices around the world, with people who are trained to help the dying.
If you have difficulty coming to terms with the situation, you may need to spend a little time reflecting on it and allowing yourself to assimilate and adjust to all the implications. Take the time to do it, but don't forget the dying person. They don't cease to be human simply because they are facing death, and who knows? Maybe the best course would be to share your confusion with them if they are mentally and emotionally strong enough to talk about it. If the person is close to you, they might well be distressed at the thought of leaving you, so would welcome the opportunity to talk about it and create the situation where you can help each other.
Some people cannot bring themselves to face death. If this is the case, you don't force the issue. The best you can do is create a atmosphere of caring and support, so that they feel they are still in contact with the human race.
I remember so clearly my father's death. He was in hospital dying of cancer, and had lingered on for many weeks. I used to go and see him every evening, and day after day he became weaker and more frail. I tried to raise the subject of dying but he became afraid and flatly refused to talk about it, so I dropped it and turned instead to topics he felt comfortable with. He was in the process of selling a limestone mine and was planning to use the proceeds to build the dream-extension to his house: a billiards room. So we talked about that. He had great difficulty speaking because the cancer had attacked his throat and his vocal cords. But he had a mechanical device my brother had made for him and he could whisper some words. We discussed the place and the size of the room. There was the issue of lighting and the placing of windows. I contacted an agent in town who gave me information on suitable tables and sizes. Every day I would come with some new piece of information, so he would have something to look forward to and occupy his mind. And thus the days and weeks passed.
Finally one evening I went in quite late and the hospital was quiet. I entered his room and he was dozing, propped up on pillows. Something had changed. His breathing seemed precarious and I knew he was losing his grip on life. I found the ward sister and shared my thought with her. She was one of those forthright English matrons not given to mincing matters. "Yes Mr Nairn,' she said, your father is going to die tonight.' I returned to his room. He was awake, and the night nurse was talking to him, plumping up his pillows and fussing around doing reassuring little jobs. I stayed a few minutes. We didn't talk about billiard tables that night and soon I said I would leave. I said goodbye, knowing in my mind that it was final. He glanced up at the nurse who had said something to him, and waved casually to me, as you would to someone you know you are going to see again in a few hours. I left. He died four hours later.
I have often reflected on that ending and strangely enough always felt OK about it. I think the reason is that I understood that his death was his deal. I had to respect the way he wanted it. Maybe it was the only way he could do it, pretending right to the end. It certainly wasn't my way of doing things, but that wasn't the point. I had done what I could to help him on his terms and that was what it was all about.
This is perhaps what Elizabeth Kubler-Ross refers to as allowing someone to 'die in character'.
So although we can identify the best way of doing things, it may not always be possible. We should bear this in mind and not try to force matters.
Akong Rinpoche was once talking about compassion. He said, 'Accept others as they are. Help beings according to the way they want to be helped.' So often we want to help others on our terms.
COMMUNICATION: LISTENING, TALKING, TOUCHING
Human psychology is a peculiar business. Mostly it's about energy, energy flow. If we have problems or difficulties we sometimes seize up and go all quiet, tense, withdrawn. Psychologically this is dangerous because it stops the normal healthy flow of energy, like building a dam across a river. As the dam within us fills, tension and stress increase, causing great suffering. We know about this and instinctively know that it is necessary to let it out. The commonest way of doing this is talking.
People who are approaching death usually need to talk, be spoken to, and be heard in a real and sensitive way. They also respond to touch, the holding of a hand, wiping of a brow. This helps them remain in touch with their life, begin to come to terms with what lies ahead of them, and accept the process as something normal that happens to all of us. Otherwise there could be a growing sense of foreboding, as though some disaster is about to befall them.
When listening, try not to focus on the words only. Try to hear why the person is voicing the words, to understand the feeling behind the words.
Reading selected passages from favourite books - selected by someone who knows the person's inner life and who is sensitive to where they are at - could contribute to a profound understanding and acceptance of the process.
Often people have unresolved issues in themselves and with others. Help them deal with these. Now may be a good time to help the person deal with issues such as grasping and resentment. Do the resentment exercise with them if they are open to it. (See Chapter 9) If you have unresolved issues with the person, this could be the time to resolve them with sensitivity and compassion. The interesting thing is that doing this will help you as well as the dying person. So a death can be a gift to you as well, helping you to face yourself in a more real way.
Sometimes it is touch that is the communication. Recently an elderly friend of mine was dying. He and his wife never touched although they really cared for one another. Yet somehow his wife couldn't resist stroking him as he was lying in his hospital bed. Your hand is too cold!' he protested. And she intuitively, like a little animal, bent down and stroked his forehead with her warm cheek.
SAVOUR THE PAST
Rejoicing is a healing and enriching emotion that we often neglect in life. As death approaches we sometimes allow problematic issues to overshadow us and our relationships. We can reverse this tendency in a beneficial way by reminiscing, by revisiting happy and positive periods with old friends. Talk about old times, acknowledge past happiness, joy, richness. Reawaken the sunny days and balance or banish any present tendency to doom and gloom. This is not to deny and suppress past unhappiness, but to bring balance and happiness into the present. The happy mind is more relaxed, more at peace. The heart can know some gladness in the face of death.
Interestingly, this will echo a spontaneous process that is triggered when we die: the mind re-runs the entire lifetime like a fast-wind movie. So there is value in the principle of re-visiting the past to bring balance to the present. There are many touching stories of old friends doing this, and in the process freeing each other of apparently minor but significant issues from the past. Not infrequently this results in the dying person finally being able to relax, let go and die with their minds at peace.
Many people lie in a coma for long periods. Not all regain consciousness before they die. The question is: can we communicate with them? The answer is yes. There is a great deal of evidence proving that the person is 'there', often hanging onto life for strange and unnecessary reasons. Talk to them. Tell them what you think they need to know, make your peace, help them make their peace.
If there is no chance of recovery and the person is still not dying, it may be that they are hanging on out of concern for someone who is still alive. If this is the case and you are the person, you need to talk. Tell them that you are OK, that they don't have to feel responsible for you. Allow them to go on and face their new future. Tell them you love them and will miss them, but that their passing is not the end of the world. You will survive and they must go on their way.
There are many accounts of this being done, of the dying person giving a sigh of relief and dying peacefully. This was illustrated in an old Tibetan story of Gampopa's wife.
Gampopa was a famous Tibetan meditator in the 11th century. Before becoming a monk he was a physician; such a good one that his fame spread throughout Tibet. He was, in fact, often known as The Physician. He was also extremely handsome.
When he was relatively young his wife became ill and took to her bed. Gampopa employed all his healing skills to no avail. Her condition deteriorated until it was obvious that she could not recover. She lay, week after week, on her deathbed, in great pain.
Gampopa puzzled over this. 'I have done all within my power to help her, but her condition is hopeless. She should have died months ago yet she lingers on in pain and great suffering. What can be the cause of this?' He decided to speak to her about it.
'Dear wife, you know I have done everything possible to heal your sickness, but have failed. Your malady is incurable. You should have died months ago, yet you cling to life and prolong your pain and suffering. This is causing great anguish to both of us. What can be the cause?'
'Dear husband, the cause is simple. I love you so much that I cannot bear the thought of some other woman becoming your wife. I will not die and allow that to happen.'
The astounded Gampopa thought about this for a while. 'My dear wife, this cannot go on. I will make a promise to you. Upon your death I will become a monk and be celibate to the end of my days. No woman will ever take your place.'
His wife gave a great sigh of happiness and died peacefully.
DON'T PLAY GAMES
We often say things like 'everything is going to be alright'. This is usually not true in life and certainly will be a lie in death if it is suggesting that the dying person is heading into some wonderful state. We don't know what state their minds are in. We can do our best to create a peaceful environment for them and help them resolve issues, but it is not for us to tell them that wonderful experiences with rainbows and angels lie ahead. Honesty and practicality will help the dying person. If they have some knowledge of the bardo teachings, or if they are meditators, you can remind them to focus and recognise. Discuss what is to come so that they can be clear in their minds. But don't spin fanciful stories that are of short-term comfort only.
NEGATIVE AND PAINFUL EMOTIONS
Sometimes we can help people to deal with negative and painful emotions that well up as death approaches.
The classic process of dying involves some of the following stages: denial, anger, bargaining, depression and acceptance. Many other reactions are mixed into this: fear, anxiety, hope and guilt.
This example is from a little book entitled Tuesdays with Morrie, by a young man named Mitch who began visiting an older man who was dying. It illustrates how one might deal with a negative emotion. The meetings were clearly a rich experience for both of them. The author comments on self-pity.
I asked Morrie if he felt sorry for himself.
'Sometimes in the mornings,' he said. 'That's when I mourn. I feel around my body, I move my fingers and my hands - whatever I can still move - and I mourn what I have lost. I mourn the slow, insidious way in which I am dying. But then I stop mourning.'
' Just like that?'
'I give myself a good cry if I need it. But then I concentrate on all the good things still in my life ... Mitch, I don't allow myself any more self-pity than that. A little each morning, a few tears, and that's all.'
A dying person is experiencing the death of the body, not the mind. So we can help them right to the end, to strengthen and liberate their minds.
Years ago when I was studying various methods and theories of psychotherapy, I asked Akong Rinpoche what he thought was thel best method of therapy.
'Compassion,' he said without a moment's pause.
I think it's the same here. It's good and useful to know theories and techniques that can hone our skills in helping the dying, but it's worth nothing if we lack compassion and the desire to help. If you have the desire to help and care for others, you will instinctively do what is needed. Even if you feel inadequate, your caring and loving will communicate itself to the dying person as a great comfort and a blessing.