Often people disregard the occurrence of death. We want to believe that there won't be a problem, that medical capabilities will allow us to cross over from life to death without difficulty, that for some inexplicable reason our problems can all be solved, but this kind of idle manner negatively avoids the pain and worry that exists from one life to the next gives us only pain and frustration. Impermanence exists and cannot be lengthened any longer. There will come a time when you will speak your last words, you will breathe your last breath, and you will think you last thought, this will all happen be it quickly or prolonged by a day but will nonetheless happen for each person. Therefore, ※the International Society of Tibetology§ would like to present Sogyal Rinpoche's The Tibetan Book of Living and Dying chapter called ※Spiritual Help for the Dying§ as a modern method for every person to find tranquility in their own death and for others. The precious wisdom of Sogyal Rinpoche can help every person when faced with death find healing through spiritual strength.
Sogyal Rinpoche is the author of The Tibetan Book of Living and Dying . Sogyal Rinpoche already has eleven works; each original tour de force is like a jewel made guiding us to understand life and death, and draws from the intellectual sources of Tibetan Buddhist philosophy. Sogyal Rinpoche profoundly explains in an easy-to-understand approach meditation, cause and effect, reincarnation, ways to provide care by the deathbed, as well as a roadmap on the mind. The spirit of Tibetan Buddhism's classic philosophy is elaborated within this modern work.
Providing Care at the Deathbed
In a hospice I know, Emily, a woman in her late sixties, was dying of breast cancer. Her daughter would visit her every day and there seemed to be a happy relationship between the two. But when her daughter had left, Emily would nearly always sit alone and cry. After a while it became clear that the reason for this was that her daughter had refused completely to accept the inevitability of her death, but spent her whole time encouraging her mother to ※think positively,§ hoping that by this her cancer would be cured. Al lthat happened was that Emily had to keep her thoughts, deep fears, panic, and grief to herself, with no one to share them with, no one to help her explore them, no one to help her understand her life, and no one to help her find a healing meaning in her death.
The most essential thing in life is to establish an unafraid, heartfelt communication with others, and it is never more important than with a dying person, as Emily showed me.
Often the dying person feels reserved and insecure, and is not sure of your intentions when you first visit. So don't feel anything extraordinary is supposed to happen, just be natural and relaxed, be yourself. Often dying people don't say what they want or mean, and the people close to them don't know what to say or do. It's hard to find out what they might be trying to say, or even what they might be hiding. Sometimes not even they know. So the first essential thing is to relax any tension in the atmosphere in whatever way comes most easily and naturally.
Once trust and confidence have been established, the atmosphere becomes relaxed and this will allow the dying person to bring up the things he or she really wants to talk about. Encourage the person warmly to feel as free as possible to express thoughts, fears, and emotions about dying and death. This honest and unshrinking baring of emotion is central to any possible transformation 每 of coming to terms with life or dying a good death 每 and you must allow the person complete freedom, giving your full permission to say whatever he or she wants.
When the dying person is finally communicating his or her most private feelings, do not interrupt, deny, or diminish what the person is saying. The terminally ill or dying are in the most vulnerable situation of their lives, and you will need all your skill and resources of sensitivity, and warmth, and loving compassion to enable them to reveal themselves. Learn to listen, and learn to receive in silence: an open, calm silence that makes the other person feel accepted. Be as relaxed as you can, be at ease; sit there with your dying friend or relative as if you had nothing more important or enjoyable to do.
I have found that, as in all grave situations of life, two things are most useful: a common-sense approach and a sense of humor. Humor has a marvelous way of lightening the atmosphere, helping to put the process of dying in its true and universal perspective, and breaking the over-seriousness and intensity of the situation. Use humor, then, as skillfully and as gently as possible.
I have found also, from my own experience, that it is essential not to take anything too personally. When you least expect it ,dying people can make you the target of all their anger and blame. As Elisabeth Kubler-Ross says, anger and blame can ※be displaced in all directions, and projected onto the environment at times almost at random.§ Do not imagine that this rage is really aimed at you; realizing what fear and grief it springs from will stop you from reacting to it in ways that might damage your relationship.
Sometimes you may be tempted to preach to the dying, or to give them your own spiritual formula. Avoid this temptation absolutely, especially when you suspect that it is not what the dying person wants! No one wishes to be ※rescued§ with someone else's beliefs. Remember your task is not to convert anyone to anything, but to help the person in front of you get in touch with his or her own strength, confidence, faith, and spirituality, whatever that might be. Of course, if the person is really open to spiritual matters, and really wants to know what you think about them, don't hold back either.
Don't expect too much from yourself, or expect your help to produce miraculous results in the dying person or ※save§ them. You will only be disappointed. People will die as them have lived, as themselves. For real communication to be established, you must make a determined effort to see the person in terms of his or her own life, character, background, and history, and to accept the person unreservedly. Also don't be distressed if your help seems to be having very little effect and the dying person does not respond. We cannot know the deeper effects of our care.
Showing Unconditional Love A dying person most needs to be shown as unconditional a love as possible, released from all expectations. Don't think you have to be an expert in any way. Be natural, be yourself, be a true friend, and the dying person will be reassured that you are really with them, communicating with them simply as an equal, as one human being to another.
I have said, ※Show the dying person unconditional love,§ but in some situations that is far from easy. We may have a long history of suffering with the person, we may feel guilty about what we have done to the person in the past, or anger and resentment at what the person has done to us.
So let me suggest two very simple ways in which you can release the love within you toward the dying person. I and my students who work with the dying have found both these ways to be powerful. First, look at the dying person in front of you and think of that person as just like you, with the same needs, the same fundamental desire to be happy and avoid suffering, the same loneliness, the same fear of the unknown, the same secret areas of sadness, the same half-acknowledged feelings of helplessness. You will find that if you really do this, your heart will open toward the person and love will be present between you.
The second way, and I have found this even more powerful, is to put yourself directly and unflinchingly in the dying person's place. Imagine that you are on that bed before you, facing your death. Imagine that you are there in pain and alone then really ask yourself: What would you most need? What would you most like? What would you really wish from the friend in front of you?
If you do these two practices, I think you would find that what the dying person wants is what you would most want: to be really loved and accepted.
I have often seen also that people who are very sick long to be touched, long to be treated as living people and not diseases. A great deal of consolation can be given to the very ill simply by touching their hands, looking into their eyes, gently massaging them or holding them in your arms, or breathing in the same rhythm gently with them. The body has its own language of love; use it fearlessly, and you will find you bring to the dying comfort and consolation.
Often we forget that the dying are losing their whole world: their house, their job, their relationships, their body, and their mind 每 they're losing everything. All the losses we could possibly experience in life are joined together in one overwhelming loss when we die, so how could anyone dying not be sometimes sad, sometimes panicked, sometimes angry? Elisabeth Kubler-Ross suggests five stages in the process of coming to terms with dying: denial, anger, bargaining, depression, and acceptance. OF course not everyone will go through all these stages, or necessarily in this order; and for some people the road to acceptance may be an extremely long and thorny one; others may not reach acceptance at all. Ours is a culture that does not give people very much true perspective on their thoughts, emotions, and experiences, and many people facing death and its final challenge find themselves feeling cheated by their own ignorance, and terribly frustrated and angry, especially since no one seems to want to comprehend them and their most heart-felt needs. As Cicely Saunders, the great pioneer of the hospice movement in Britain , writes: ※I once asked a man who knew he was dying what he needed above all in those who were caring for him. He said, ＆For someone to look as if they are trying to understand me.' Indeed, it is impossible to understand fully another person, but I never forgot that he did not ask for success but only that someone should care enough to try.§ It is essential that we care enough to try, and that we reassure the person that whatever he or she may be feeling, whatever his or her frustration and anger, it is normal. Dying will bring out many repressed emotions: sadness or numbness or guilt, or even jealousy of those who are still well. Help the person not to repress these emotions when they rise. Be with the person as the waves of pain and grief break; with acceptance, time, and patient understanding, the emotions slowly subside and return the dying person to that ground of serenity, calm, and sanity that is most deeply and truly theirs.
Don't try to be too wise; don't always try to search for something profound to say. You don't have to do or say anything to make things better. Just be there as fully as you can. And if you are feeling a lot of anxiety and fear, and don't know what to do, admit that openly to the dying person and ask his or her help. This honesty will bring you and the dying person closer together, and help in opening up a freer communication. Sometimes the dying know far better than we how they can be helped, and we need to know how to draw on their wisdom and let them give to us what they know. Cicely Saunders has asked us to remind ourselves that, in being with the dying, we are not the only givers. ※Sooner or later all who work with the dying people know they are receiving more than they are giving as they meet endurance, courage and often humor. We need to say so＃§ Acknowledging our recognition of their courage can often inspire the dying person.
I find too that I have been helped by remembering one thing: that the person in front of me dying is always, somewhere, inherently good. Whatever rage or emotion arises, however momentarily shocking or horrifying these may be, focusing on that inner goodness will give you the control and perspective you need to be as helpful as possible. Just as when you quarrel with a good friend, you don't forget the best parts of that person, do the same with the dying person: Don't judge them by whatever emotions arise. This acceptance of yours will release the dying person to be as uninhibited as he or she needs to be. Treat the dying as if they were what they are sometimes capable of being: open, loving, and generous.
On a deeper, spiritual level, I find it extremely helpful always to remember the dying person has the true Buddha nature, whether he or she realizes it or not, and the potential for complete enlightenment. As the dying come closer to death, this possibility is in many ways even greater. So they deserve even more care and respect.
Telling the Truth People often ask me: ※should people be told they are dying?§ And I always reply: ※Yes, as quietly, as kindly, as sensitively, and as skillfully as possible.§ From my years of visiting ill and dying patients, I agree with Elisabeth Kubler-Ross, who has observed that: ※Most, if not all, of the patients know anyway. They sense it by the changed attention, by the new and different approach that people take to them, by the lowering of voices or avoidance of sounds, by the tearful face of a relative or ominous, unsmiling member of the family who cannot hide his true feelings.§
I have often found that people instinctively know they are eddying, but count on others 每 their doctor or loved ones 每 to confirm it. If they don't the dying person may think it is because family members cannot cope with the news. And then the dying person won't bring up the subject either. This lack of honesty will make him or her feel only more isolated and more anxious, I believe it is essential to tell the dying person the truth; he or she at least deserves that much. If the dying are not told the truth, how can they prepare themselves for death? How can they carry the relationships of their lives to a true conclusion? How can they take care of the many practical issues they must resolve? How can they help those who are left when they are gone to survive?
From my point of view as a spiritual practitioner, I believe dying to be a great opportunity for people to come to terms with their whole lives; and I have seen many, many individuals take this opportunity, in the most inspiring way, to change themselves and come closer to their own deepest truth. So by kindly and sensitively telling people at the earliest opportunity that they are dying, we are really giving them the chance to prepare, and to find their own powers of strength, and the meaning of their lives.
Let me tell you a story I was told by Sister Brigid, a Catholic nurse working in an Irish hospice. My. Murphy was in his sixties, and he and his wife were told by their doctor that he did not have long to live. The following day Mrs. Murphy visited her husband at the hospice, and they talked and wept all day long. Sister Brigid watched as the old could talk and frequently broke down into tears, and when this had gone on for three days, she wondered if she should intervene. Yet the next day the Murphys seemed suddenly very relaxed and peaceful, holding hands and showing each other great tenderness.
Sister Brigid stopped Mrs. Murphy in the corridor and asked her what had taken place between them to have made such a great change on their behavior. Mrs. Murphy told her that when they found out her husband was dying, they looked back over their years together, and many memories came back to them. They had been married almost forty years, and naturally they felt enormous sorrow, thinking and talking about all the things they would never be able to do together again. Mr. Murphy had then made out his will, and written final messages to his grown-up children. Al of this was terribly sad, because it was so hard to let go, but they carried on, as Mr. Murphy wanted to end his life well.
Sister Brigid told me that for the next three weeks Mr. Murphy lived, the couple radiated peace and a simple, wonderful feeling of love. Even after her husband died, Mrs. Murphy continued to visit patients at the hospice, where she was an inspiration to everyone.
This story shows to me the importance of telling people early that they are going to die, and also the great advantage of facing squarely the pain of loss. The Murphys Knew that they were going to lose many things, but by facing those losses and grieving together, they found what they could not lose, the deep love between them that would remain after Mr. Murphy's death.
Fears About Dying
I am sure one of the things that helped Mrs. Murphy help her husband was that she faced within herself her own fears of dying. You cannot help the dying until you have acknowledged how their fear of dying disturbs you and brings up your most uncomfortable fears. Working with the dying is like facing a polished and fierce mirror of your own reality. You see in it the stark face of your own panic and of your terror of pain. If you don't look at and accept that face of panic and fear in yourself, how ill you be bale to bear it in the person in front of you? When you come to try and help the dying, you will need to examine your every reaction, since your reaction will be reflected in those of the person dying and will contribute a great deal to their help or detriment.
Looking at your fears honestly will also help you in your own journey to maturity. Sometimes I think there could be no more effective way of speeding up our growth as human beings than working with the dying. Caring for the dying is itself a deep contemplation and reflection on your own death. It is a way to face and work wit it. When you work with the dying, you can come to a kind of resolution, a clear understanding of what is the most important focus of life. To learn really to help those who are dying is to begin to become fearless and responsible about our own dying, and to find in ourselves the beginnings of an unbounded compassion that we may never have suspected.
Being aware of your own fears about dying will help you immeasurably to be aware of the fears of they dying person. Just imagine deeply what those might be: fear of increasing uncontrolled pain, fear of suffering, fear of indignity, fear of dependence, fear that the lives we have led have been meaningless, fear of separation from all we love, fear of losing control, fear of losing respect; perhaps our greatest fear of all is fear of fear itself, which grows more and more powerful the more we evade it.
Usually when you feel fear, you feel isolated and alone, and without company. But when somebody keeps company with you and talks of his or her own fears, then you realize fear is universal and the edge, the personal pain, is taken off it. Your fears are brought back to the human and universal context. Then you are able to understand, be more compassionate, and deal with your own fears in a much more positive and inspiring way.
As you grow to confront and accept your own fears, you will become increasingly sensitive to those of the person before you, and you will find you develop the intelligence and insight to help that person to bring his or her fears out into the open, deal with them, and begin skillfully to dispel them. For facing your fears, you will find, will not only make you more compassionate and braver and clearer; it will also make you more skillful, and that skillfulness will open to you all kinds of ways of enabling the dying to understand and face themselves.
One of the fears that we can most easily dispel is the anxiety we all have about unmitigated pain in the process of dying. I would like to think that everyone in the world could know that is now unnecessary. Physical suffering should be kept to a minimum; there is enough suffering in death anyway. A study at St. Christopher's Hospice in London , which I know well and where my students have died, has shown that given the right care, 98 percent of patients can have a peaceful death. The hospice movement has developed a variety of ways of managing pain by using various combinations of drugs, and not simply narcotics. The Buddhist masters speak of the need to die consciously with as lucid, unblurred, and serene a mental mastery as possible. Keeping pain under control without clouding the dying person's consciousness is the first prerequisite for this, and now it can be done: Everyone should be entitled to that simple help at this most demanding moment of passage.
Unfinished Business
Another anxiety of the dying is often that of leaving unfinished business. The masters tell us that we should die peacefully, ※without grasping, yearning, and attachment.§ This cannot fully happen if the unfinished business of a lifetime, as far as possible, is not cleared. Sometimes you will find that people hold onto life and are afraid to let go and die, because they have not come to terms with what they have been and done. And when a person dies harboring guilt or bad feelings toward others, those who survive him suffer even more deeply in their grief.
Sometimes people ask me: ※Isn't it too late to heal the pain of the past? Hasn't there been too much suffering between me and my dying friend or relative for healing to be possible?§ It is my belief, and has been my experience, that it is never too late; even after enormous pain and abuse, people can find a way to forgive each other. The moment of death ahs a grandeur, solemnity, and finality that can make people reexamine all thei rattitudes, and be more open and ready to forgive, when before they could not bear to. Even at the very end of a life, the mistakes of a life can be undone.
There is a method for helping to complete unfinished business that I and my students who work with the dying find very helpful. It was formulated from the Buddhist practice of equalizing and exchanging the self with others, and from the Buddhist practice of equalizing and exchanging the self with others, and from the Gestalt technique, by Christine Longaker, one of my earliest students, who came to the field of death and dying after the death of her husband from leukemia. Usually unfinished business is the result of blocked communication; when we have been wounded, we often become very defensive, always arguing from a position of being in the right and blindly refusing to see the other person's point of view. This is not only unhelpful, it freezes any possibility of real exchange. So when you do this exercise, begin it with the strong motivation that you are bringing up all your negative thoughts and feelings to try and understand them, to work with them and resolve them, and finally now to let go of them.
Then visualize in front of you the person with whom you have the problem. See this person in your mind's eye, exactly as he or she has always looked to you.
Consider now that a real change takes place, so the person is far more open and receptive to listen to what you have to say, more willing than ever before to share honestly, and solve the problem between you. Visualize vividly the person in this new state of openness. This will also help you feel more open toward him or her. Then really fell, deep in you heart, what it is you most need to say to the person. Tell him or her what the problem is, tell the person all your feelings, your difficulties, your hurt, your regret. Tell him or her what you haven't felt safe, or comfortable enough, to say before.
Now take a piece of paper and write what you would say, all of it. Then, when you have finished, immediately begin to write what he or she might say in response to you. Don't stop to think about what the person used to say: Remember that now, as you have visualized, he or she has truly hear you and is more open. So just write, see what comes spontaneously; and allow the person, in your mind, to express completely his or her side of the problem as well.
Search yourself and see if there is anything else you need to say to the person- any other hurt feelings or regrets from the past that you have been holding back or have never aired. Again, each time after you have stated your feelings, write a response by the other person, writing down just whatever comes into you mind. Continue this dialogue until you really feel there is nothing more you are holding back, and nothing more that needs to be said.
To see if you are truly ready to conclude the dialogue, ask yourself deeply if you are now able to let go of the past wholeheartedly, really able, satisfied by the insight and healing that this written dialogue has given you, to forgive this person, or to feel that he or she would forgive you. When you feel you have accomplished this, remember to express any last feelings of love or appreciation you may have been holding back, and say goodbye. Visualize the person turning away and leaving now; and even though you must let go of him or her, remember that you can keep his or her love, and the warm memories of the best aspects of your relationship, always in your heart.
To come to an even clearer reconciliation with the past, find a friend to whom you can read your written dialogue, or read it out loud by yourself at home. Once you have read this dialogue aloud, you will be surprised to notice a change in yourself, as though you have actually communicated with the other person, and actually cleared with them all the problems you have been having. Afterward you will find it far easier to let go, to speak directly with the other person about your difficulties. And when you have really let go, a subtle shift in the chemistry between you and the other person will take place, and the tension in the relationship that has lasted so long will often dissolve. Sometimes, amazingly, you can even become the best of friends. Never forget, as the famous Tibetan master Tsongkhapa once said, ※A friend can turn into an enemy, and so an enemy can turn into a friend.§
Saying Goodbye It is not only the tension that you have to learn to let go of, but the dying person as well. If you are attached and lcing to the dying person, you can bring him or her a lot fo unnecessary heartache and make it very hard for the person to let go and die peacefully.
Sometimes the dying person can linger on many months or weeks longer than doctors expected and experience tremendous physical suffering. Christine Longaker has discovered that for such a person to be able to let go and die peacefully, he or she needs to hear two explicit verbal assurances from loved ones. First, they must give the person permission to die, and second they must reassure the person they will be all right after he or she has gone, and that there is no need to worry about them.
When people ask me how best to give someone permission to die, I tell them to imagine themselves standing by the bedside of the person they love and saying with the deepest and most sincere tenderness: ※I am here with you and I love you. You are dying, and that is completely natural; it happens to everyone. I wish you could stay here with me, but I don't want you to suffer any more. The time we have had together has been enough, and I shall always cherish it. Please now don't hold onto life any longer. Let go. I give you my full and heartfelt permission to die. You are not alone, now or ever. You have all my love.§
A student of mine who works in a hospice told me of an elderly Scottish woman, Maggie, whom she visited after her husband, close to death, had already fallen into a coma. Maggie felt inconsolably sad, for she had never spoken to her husband about her love for him, nor said goodbye, and now she felt it was too late. The hospice worker encouraged her, saying that although he seemed unresponsive, perhaps he could actually still hear her. She had read that many people who appear to be unconscious can in fact perceive what is going on. She urged her to spend some time with her husband, telling him all she wanted to say. Maggie would not have thought of doing this, but she went ahead and spoke to her husband of all the good times they had shared, of how she would miss him, and of how much she loved him. At the end, once she had said her goodbyes, she told him, ※It is hard for me to be without you, but I don't want to see you suffer any more, so it is all right for you to let go.§ Once she had finished, her husband let out a long sigh and peacefully died.
Not only the one who is dying, but his or her whole family has to learn how to let go. Each member of the family may be at a different stage of acceptance, and this will have to be taken into account. One of the great achievements of the hospice movement is to recognize how important it is to help the whole family face their own grief and insecurity about the future. Some families resist letting their loved ones go, thinking that to do so is a betrayal, and a sign that they don't love them enough. Christine Longaker tells these families to imagine that they are in the place of the one who is dying. ※Imagine you are standing on the deck of an ocean liner, about to set sail. You look back on the shore and see all your family and friends waving goodbye. You have no choice about leaving, and the ship is already moving away. How would you want the people you loved to be saying goodbye to you? What would help you most on your journey?
Even a simple exercise like this can help so much in enabling each member of the family in their own way to deal with the sadness of saying goodbye.
Sometimes people ask me, ※What should I say to my child about the death of her relative?§ I say to them to be sensitive but tell the truth. Don't let the child think that death is something strange or terrifying. Let her take part as far as possible in the life of the dying person, and answer honestly any questions the child might pose. A child's directness and innocence can actually bring a sweetness, lightness, even sometimes a humor into the pain of dying. Encourage the child to pray for the dying person, and so feel that he or she is really doing something to help. And after the death has taken place, make sure that you give the child special attention and affection.
Toward a Peaceful Death When I think back to Tibet and the deaths I witnessed there, I am struck by what a calm and harmonious environment many of them occurred in. This kind of environment, alas, is often lacking in the West, but my experience over the last twenty years has shown that it can, with imagination, be created. I feel that wherever possible, people should die at home, because it is at home that the majority of people are likely to feel most comfortable. And the peaceful death that the Buddhist masters advise is easiest to obtain in familiar surroundings. But if someone has to die in hospital, there is a great deal that you the loved ones can do to make that eath as easy and inspiring as possible. Beign in plants, flowers, pictures, photographs of loved ones, drawings by children and grandchildren, a cassette player with musical tapes, or, if possible, home-cooked meals. You might even get permission for children to visit or for loved ones to stay overnight.
If they dying person is a Buddhist or a member of another faith, friends could make a small shrine in his or her room, with inspiring pictures or images. I remember a student of mine, Reiner, who was dying in a private ward in a hospital in Munich . A shrine had been created for him a with pictures of his masters on it. I was very moved by it, and realized how profoundly Reiner was being helped by the atmosphere it created. The Buddhist teachings tell us to make a shrine with offerings when a person is dying. Seeing Reiner's devotion and peace of mind made me understand just how empowering this can be, and how it can help inspire people to make their dying a sacred process.
When a person is very close to death, I suggest that you request that the hospital staff do not disturb him or her so often, and that they stop taking tests. I'm often asked what is my attitude toward death in intensive care units. I have to say that being in an intensive care unit will make a peaceful death very difficult, and hardly allow for spiritual practice at the moment of death. As the person is dying, there is no privacy: They are hooked up to monitors, and attempts to resuscitate them will be made when they stop breathing or their heart fails. There will be no chance of leaving the body undisturbed for a period of time after death, as the masters advise.
If you can, you should arrange with the doctor to be told when there is no possibility of the person recovering, and then request to have them moved to a private room, if the dying person wishes it, with the monitors disconnected. Make sure that the staff knows and respects the dying person's wishes, especially if he or she does not wish to be resuscitated, and make sure that the staff knows too to leave the body undisturbed after death for as long as possible. In a modern hospital, of course, it is not possible to leave the body alone for the three-day period that was customary in Tibet , but every support of silence and peace should be given to the dead to help them begin their journey after death.
Try and make certain also that while the person is actually in the final stages of dying, all injections and all invasive procedures of any kind are discontinued. These can cause anger, irritation, and pain, and for the mind of the dying person to be as calm as possible in the moments before death is, as I will explain in detail later, absolutely crucial.
Most people die in a state of unconsciousness. One fact we heave learned form the near-death experience is that comatose and dying patients may be much more aware of things around them than we realize. Many of the near-death experiencers reported out-of-the-body experiences, from which they were able to give surprisingly accurate detailed accounts of their surroundings and even, in some cases, of other rooms in the same hospital. This clearly shows the importance of talking positively and frequently to a dying person or to a person in a coma. Conscious, alert, and actively loving care for the dying person must go on until the last moments of his or her life, and as I will show, even beyond.
One of the things I hope for from this book is that doctors all over the world will take extremely seriously the need to allow the dying person to die in silence and serenity. I want to appeal to the goodwill of the medical profession, and hope to inspire it to find ways to make the very difficult transition of death as easy, painless, and peaceful as possible. Peaceful death is really an essential human right, more essential perhaps even than the right to vote or the right to justice; it is a right on which, all religious traditions tell us, a great deal depends for the well-being and spiritual future of the dying person.
There is no greater gift of charity you can give than helping a person to die well.
Spiritual Help for the Dying I first came to the West at the beginning of the 1970s, and what disturbed me deeply, and has continued to disturb me, is the almost complete lack of spiritual help for th eddying that exists in modern culture. In Tibet , as I have shown, everyone had some knowledge of the higher truths of Buddhism and some relationship with a master. No one died without being cared for, in both superficial and profound ways, by the community. I have been told many stories of people dying alone and in great distress and disillusion in the West without any spiritual help, and one of my main motivations in writing this book is to extend the healing wisdom of the world I was brought up in to all men and women. Do we not all have a right, as we are dying, not only to have our bodies treated with respect, but also, and perhaps even more important, our spirits? Shouldn't one of the main rights of any civilized society, extended to everyone in that society, be the right to die surrounded by the best spiritual care? Can we really call ourselves a ※civilization§ until this becomes an accepted norm? What does it really mean to have the technology to send people to the moon, when we do not know how to help our fellow humans die with dignity and hope?
Spiritual care is not a luxury for a few; it is the essential right of every human being, as essential as political liberty, medical assistance, and equality of opportunity. A real democratic ideal would include knowledgeable spiritual care for everyone as one of its most essential truths.
Wherever I go in the West, I am struck by the great mental suffering that arises from the fear of dying, whether or not his fear is acknowledged. How reassuring it would be for people if they knew that when they lay dying they would be cared for with loving insight? As it is, our culture is so heartless in its expediency and its denial of any real spiritual value that people, when faced with terminal illness, fell terrified that they are simply going to be thrown away like useless goods. In Tibet it was a natural response to pray for the dying and to give them spiritual care; in the West the only spiritual attention that the majority pay to the dying is to go to their funeral.
At the moment of their greatest vulnerability, then, people in our world are abandoned and left almost totally without support or insight. This is a tragic and humiliating state of affairs, which must change. All of the modern world's pretensions to power and success will ring hollow until everyone can die in this culture with some measure of true peace, and until at least some effort is made to ensure this is possible.
By the Bedside of the Dying A friend of mind, who had just graduated form a famous medical school, started work at one of the larger London hospitals. On her very first day on the ward, four or five people died. It was a terrible shock for her; nothing in her training had equipped her to deal with it at all. Isn't this astonishing, considering she was being trained to be a doctor? One old man was lying in his bed, staring at the wall. He was alone, with no family or friends to visit him, and he was desperate for someone to talk to. She went over to him. His eyes filled with tears and his voice trembled as he asked her the last question she expected to hear: ※Do you think God will ever forgive me for my sins?§ My friend had no idea at all how to respond; her training had left her completely unprepared for any spiritual questions. She had nothing to say; all she had to hide behind was her professional status as a doctor. There was no chaplain close by, so she just stood there, paralyzed, unable to answer her patient's desperate call for help and for reassurance about the meaning of his life.
She asked me, in her pain and bewilderment: ※What would you have done?§ I said to her I woul dhave sat by his side, held his hand, and let him talk. I have been amazed again and again by how, if you just let people talk, giving them your complete and compassionate attention, they will say things of a surprising spiritual depth, even when they think they don't have any spiritual beliefs. Everyone has their own life wisdom, and when you let a person talk you allow this life wisdom to emerge. I have often been very moved by how you can help people to help themselves by helping them to discover their own truth, a truth whose richness, sweetness, and profundity they may never have suspected. The sources of healing and awareness are deep within each of us, and your task is never under any circumstances to impose your beliefs but to enable them to find these within themselves.
Believe as you sit by the dying person that you are sitting by someone who has the true potential to be a Buddha. Imagine their buddha nature as a shining and stainless mirror, and all their pain and anxiety a thin, gray mist on it that can quickly clear. This will help you to see them as lovable and forgivable, and draw out of you your unconditional love; you will find this attitude will allow the dying person to open remarkably to you.
My master Dudjom Rinpoche used to say that to help a dying person is like holding out a hand to someone who is on the point of falling over, to lift them up. Through the strength and peace and deep compassionate attention of your presence, you will help them awaken their own strength. The quality of you presence at this most vulnerable and extreme moment is all-important. As Cicely Saunders wrote: ※The dying have shed the masks and superficialities of everyday living and they are all the more open and sensitive because of this. They see through all unreality. I remember one man saying, ＆No, no reading. I only want what is in your mind and in your heart.'§
I never go to the bedside of a dying person without practicing beforehand, without steeping myself in the sacred atmosphere of the nature of mind. Then I do not have to struggle to find compassion and authenticity, for they will be there and radiate naturally.
Remember, you can do nothing to inspire the person in front of you if you do not inspire yourself first. So when you don't know what to do, when you feel hardly able to do anything to help, then pray and meditate, invoke the Buddha or any other figure whose sacred power you believe in. When I'm faced with someone going through terrible suffering, I call down with fervor the help of all the buddhas and enlightened beings, with my heart completely open to the person dying in front of me, and compassion for their pain filling my being. I invoke as intensely as possible the presence of my masters, the buddhas, of those enlightened beings with whom I have a particular connection. Summoning all my powers of devotion and faith, I see them in glory above the dying person, gazing down at them with love, and pouring down light and blessing on them, purifying them of all their past karma and present agony. And as I do this, I keep praying that the person in front of me should be spared further suffering, and find peace and liberation.
I do this with the deepest concentration and earnestness, and then I try to rest in the nature of my mind and allow its peace and radiance to permeate the atmosphere of the room. Many, many times I have been awed by the sense of sacred presence that then established itself very naturally, and which in turn inspires the dying person.
I'm now going to say something that may surprise you. Death can be very inspiring . In my experiences with dying people, I have found that I have surprised myself by the way in which my prayer and invocation transformed the atmosphere, and I myself have had my faith deepened by seeing how effective this invocation and prayer and this presence of the buddhas are. I have found that being by the bedside of a dying person has made my own practice far more powerful.
Sometimes I see that the dying person also feels this atmosphere of deep inspiration, and is grateful to have provided the opportunity for our reaching, together, a moment of real and transformative rapture.
Giving Hope and Finding Forgiveness I would like to single out two points in giving spiritual help to the dying: giving hope, and finding forgiveness.
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. At the same time, where appropriate, be sure to remind the person of his or her buddha nature, and encourage the person to try to rest in the nature of mind through the practice of meditation. Especially remind the person that pain and suffering are not all that he or she is. Find the most skillful and sensitive way possible to inspire the person and give him or her hope. So rather than dwelling on his or her mistakes, the person can die in a more peaceful frame of mind.
To the man who cried out: ※Do you think God will ever forgive me for my sins?§ I would say: ※Forgiveness already exists in the nature of God; it is already there. God has already forgiven you, for God is forgiveness itself. ＆To err is human, and to forgive is divine.' But can you truly forgive yourself? That's the read question.
※Your feeling of being unforgiven and unforgivable is what makes you suffer so. But it only exists in your heart or mind. Haven't you read how in some of the near-death experiences a great golden presence of light arrives that is all forgiving? And it is very often said that it is finally we who judge ourselves.
※In order to clear your guilt, ask for purification from the depths of your heart. If you really ask for purification, and go through it, forgiveness will be there. God will forgive you, just as the father in Christ's beautiful parable forgives the prodigal son. To help yourself to forgive yourself, remember the good things you have done, forgive everyone else in your life, and ask forgiveness from anyone you may have harmed.
Not everyone believes in a formal religion, but I think nearly everyone believes in forgiveness. You can be of immeasurable help to the dying by enabling them to see the approach of death as the time for reconciliation and reckoning.
Encourage them to make up with friends or relatives, and to clear their heart, so as not to keep even a trace of hatred or the slightest grudge. If they cannot meet the person from whom them feel estranged, suggest they phone them or leave a taped message or letter and ask for forgiveness. IF they suspect that the person they want to pardon them cannot do so, it is not wise to encourage them to confront the person directly; a negative response would only add to their already great distress. And sometimes people need time to forgive. Let them leave a message of some kind asking for forgiveness, and they will at least die knowing that they have done their best. They will have cleared the difficulty or anger from their heart. Time and time again, I have seen people whose hearts have been hardened by self-hatred and guilt find, through a simple act of asking for pardon, unsuspected strength and peace.
All religions stress the power of forgiveness, and this power is never more necessary, nor more deeply felt, than when someone is dying. Through forgiving and being forgiven, we purify ourselves of the darkness of what we have done, and prepare ourselves most completely for the journey through death.
Finding a Spiritual Practice If your dying friend or relative is familiar with some kind of meditation practice, encourage him or her to rest in meditation as much as possible, and meditate with the person as death approaches. If they dying person is at all open to the idea of spiritual practice, help the person find a suitable, simple practice, do it with him or her as often as possible, and keep reminding the person gently of it as death nears.
Be resourceful and inventive in how you help at this crucial moment, for a great deal depends on it: The whole atmosphere of dying can be transformed if people find a practice they can do wholeheartedly before and as they die. There are so many aspects of spiritual practice; use your acumen and sensitivity to find the one they might be most connected with: it could be forgiveness, purification, dedication, or feeling the presence of light or love. And as you help them begin, pray for the success of their practice with all your heart and mind; pray for them to be given every energy and faith to follow the path they choose. I have known people even at the latest stages of dying make the most startling spiritual progress by using one prayer or one mantra or one simple visualization with which they really made a connection in their heart.
Stephen Levine tells the story of a woman he was counseling who was dying of cancer. She felt lost because, although she had a natural devotion to Jesus Christ, she had left the church. Together they explored what she might do to strength that faith and devotion. She came to the realization that what would help her renew her connection with Christ, and find some trust and confidence while dying, would be to repeat continuously the prayer, ※Lord Jesus Christ, have mercy on me.§ Saying this prayer opened her heart, and she began to feel Christ's presence with her at all times.
The Essential Phowa Practice The most valuable and powerful of all practices I have found in caring for the dying, one which I have seen in astonishing number of people take to with enthusiasm, is a practice from the Tibetan tradition called phowa (pronounced ※po-wa§), which means the transference of consciousness.
Phowa for dying people has been performed by friends, relatives, or masters, quite simply and naturally, all over the modern world〞in Australia , America , and Europe . Thousands of people have been given the chance to die serenely because of its power. IT gives me joy to make the heart of phowa practice now available to anyone who wishes to use it.
I want to emphasize that this is a practice that anyone at all can do. IT is simple, but it is also the most essential practice we can do to prepare for our own death, and it is the main practice I teach my students for helping their dying friends and relatives, and their loved ones who have already died.
Practice One First make sure you are comfortable, and assume the meditative posture. IF you are doing this practice as you are coming close to death, just sit as comfortably as you are able, or practice lying down.
Then bring your mind home, release, and relax completely.
1. In the sky in front of you, invoke the embodiment of whatever truth you believe in, in the form of radiant light. Chose whichever divine being or saint you feel close to. If you are a Buddhist, invoke a Buddha with whom you feel an intimate connection. If you are a practicing Christian, feel with all your heart the vivid, immediate presence of God, the Holy Spirit, Jesus, or the Virgin Mary. If you don't feel linked with any particular spiritual figure, simply imagine a form of pure golden light in the sky before you. The important point is that you consider the being you are visualizing or whose presence you feel is the embodiment of the truth, wisdom, and compassion of all the buddhas, saints, masters, and enlightened beings. Don't worry if you cannot visualize them very clearly, just fill your heart with their presence and trust that they are there. 2. Then focus your mind, heart, and soul on the presence you have invoked, and pray:
Through your blessing, grace, and guidance, through the power of the light that streams from you:
May all my negative karma, destructive emotions, obscurations, and blockages be purified and removed,
May I know myself forgiven for all the harm I may have thought and done,
May I accomplish this profound practice of phowa, and die a good and peaceful death,
And through the triumph of my death, may I be able to benefit all other beings, living or dead.
3. Now imagine that the presence of light you have invoked is so moved by your sincere and heartfelt prayer that he or she responds with a loving smile and sends out love and compassion in a stream of rays of light from his other heart. As these touch and penetrate you, they cleanse and purify all your negative karma, destructive emotions, and obscurations, which are the causes of suffering. You see and feel that you are totally immersed in light. 4. You are now completely purified and completely healed by the light streaming from the presence. Consider that your very body, itself created by karma, now dissolves completely into light.
5. The body of light you are now soars up into the sky and merges, inseparably, with the blissful presence of light.
6. Remain in that state of oneness with the presence for as long as possible.
Practice Two 1. To do this practice even more simply, begin as before by resting quietly, and then invoke the presence of the embodiment of truth.
2. Imagine your consciousness as a sphere of light at your heart, which flashes out from you like a shooting star, and flies into the heart of the presence in front of you.
3. It dissolves and merges with the presence.
Through this practice you are investing your mind in the wisdom mind of the Buddha or enlightened being, which is the same as surrendering your soul into th enature of God. Dilgo Khyentse Rinpoche says this is like casting a pebble into a lake; think of it plummeting down into the water, deeper and deeper. Imagine that through the blessing your mind is transformed into the wisdom mind of this enlightened presence.
Practice Three The most essential way to do the practice is this: Simply merge your mind with the wisdom mind of the pure presence. Consider: ※My mind and the mind of the Buddha are one.§
Choose whichever one of these versions of the phowa feels most comfortable, or has most appeal for you at any particular moment. Sometimes the most powerful practices can be the most simple. But whichever one you choose, remember that it is essential to take the time now to become familiar with this practice. How else will you have the confidence to do it for yourself or to others at the moment of death? My master Jamyang Khyentse wrote, ※If you meditate and practice in this manner always, at the moment of death it will come easier.§
In fact you should be so familiar with the practice of phowa that it becomes a natural reflex, our second nature. If you have seen the film Ghandi , you know that when he was shot, his immediate response was to call out: ※Ram＃ Ram!§ which is, in the Hindu tradition, the sacred name of God. Remember that we never know how we will die, or if we will be given the time to recall any kind of practice at all. What time will we have, for example, if we smash our car into a truck at 100 mph on the freeway? There won't be a second then to think about how to do phowa, or to check the instructions in this book. Either we are familiar with the phowa or we are not. There is a simple way to gauge this: just look at your reactions when you are in a critical situation or in a moment of crisis, such as an earthquake, or a nightmare. Do you respond with the practice or don't you? And if you do, how stable and confident is your practice?
I remember a student of mine in America who went out riding one day. The horse threw her; her foot got stuck in the stirrup, and she was dragged along the ground. Her mind went blank. She tried desperately to recall some practice, but nothing at all would come. She grew terrified. What was good about that terror was that it made her realize that her practice had to becomes her second nature. This was the lesson she had to learn; it is the lesson, in fact, we all have to learn. Practice phowa as intensely as you can, until you can be sure you will react with it to any unforeseen event. This will make certain that whenever death comes, you will be as ready as you can be.
Using the Essential Phowa Practice to Help the Dying How can we use this practice to help someone who is dying?
The principle and the sequence of the practice are exactly the same; the only difference is that you visualize the Buddha or spiritual presence above the head of the dying person:
Imagine that the rays of light pour down onto the dying person, purifying his or her whole being, and then he or she dissolves into light and merges into the spiritual presence.
Do this practice throughout your loved one's illness, and especially (and most important) when the person is breathing the last breath, or as soon as possible after breathing stops and before the body is touched or disturbed in any way. If the dying person knows you are going to do this practice for them, and knows what it is, it can be a great source of inspiration and comfort.
Sit quietly with the dying person, and offer a candle or light in front of a picture or statue of Buddha or Christ or the Virgin Mary. Then do the practice for them. You can be doing the practice quietly, and the person need not even know about it; on the other hand, if he or she is open to it, as sometimes dying people are, share the practice and explain how to do it.
People often ask me: ※If my dying relative or friend is a practicing Christian and I am a Buddhist, is there any conflict?§ How could there be? I tell them: You are invoking the truth, and Christ and Buddha are both compassionate manifestations of truth, appearing in different ways to help beings.
I strongly suggest to doctors and nurses that they can also do phowa for their dying patients. Imagine how marvelously it could change the atmosphere in a hospital if those who were ministering to the dying were also doing this practice. I remember the death of Samten In my childhood, when my master and the monks were all practicing for him. How powerful and uplifting it was! My deepest prayer is for everyone to die with the same grace and peace that he did.
I have formulated this essential phowa specially form the traditional Tibetan practice for dying, and it incorporates all the most important principles. So it is not only a practice for dying, but it can also be used both to purify and to heal; it is important for the living, and for the sick as well. If a person is going to be healed, it will assist that healing; if a person is dying, it will help them and heal their spirit in death; and if the person has died, it will continue to purify them.
If you are not sure whether a person who is seriously ill is going to live or die, then whenever you visit them you can do this phowa practice for them. And when you go home, do it again. The more you do it, the more your dying friend will be purified. You never know if you will see your friend again, or if you will be present when he or she actually dies. So seal each visit with this practice, just as a preparation, and go on doing the practice in whatever spare moments you have.
Dedicating our Death
From the Tibetan Book of the Dead:
O son/daughter of an enlightened family, what is called ※death§ has now arrived, so adopt this attitude: ※I have arrived at the time of death, so now, by means of this death, I will adopt only th eattitude of the enlightened state of mind, loving kindness and compassion, and attain perfect enlightenment for the sake of all sentient beings who are as limitless as space＃§
Recently one of my students came to me and said: ※My friend is only twenty-five. He's in pain and dying of leukemia. He is already frighteningly bitter; I'm terrified that he'll drown in bitterness. He keeps asking me: ＆What can I do with all this useless, horrible suffering?'§ My heart went out to her and her friend, Perhaps nothing is as painful as believing that there is no use to the pain you are going through. I told my student there was a way her friend could transform his death even now, and even in the great pain he was enduring: to dedicate, with all his heart, the suffering of his dying, and his death itself, to the benefit and ultimate happiness of others.
I told her to tell him: ※I know how much pain you're in. Imagine now all the others in the world who are in a pain like yours, or even greater. Fill your heart with compassion for them. Andy pray to whomever you believe in and ask that your suffering should help alleviate theirs. Again and again dedicate your pain to the alleviation of their pain. And you will quickly discover in yourself a new source of strength, a compassion you'll hardly be able to now to imagine, and a certainty, beyond any shadow of a doubt, that your suffering is not only not being wasted, but has now a marvelous meaning.§
What I was describing to my student was in fact the practice of Tonglen, which I have already shared with you, but which takes on a very special significance when someone is terminally ill or dying.
If you have an illness like cancer or AIDS, try as intensely as you can to imagine every other person in the world who has the same disease as you.
Say to yourself with deep compassion: ※may I take on the suffering of everyone who has this terrible illness. May they be free from this affliction and from all their suffering.§
Then imagine that their illness and tumors leave their body in the form of smoke, and dissolve into your illness and tumors. When you breathe in, you breathe in all their suffering, and when you breathe out, you breath out total healing and well being. Each time you do this practice; believe, with complete conviction, that they are now healed.
As you approach death, think continually to yourself: ※May I take on the suffering, the fear, and loneliness of all others all over the world who are dying or will die. May they be all freed from pain and confusion; may they all find comfort and peace of mind. May whatever suffering I am enduring now and will endure in the future help them toward a good rebirth and ultimate enlightenment.§
I knew an artist in New York who was dying from AIDS. He was a sardonic character and hated institutional religion, although secretly some of us suspected he had more spiritual curiosity than he admitted. Friends persuaded him to see a Tibetan master, who immediately understood that the greatest source of his frustration and suffering was that he felt his pain was of no use to himself or to anyone else. So he taught him one thing, and one thing only: the Tonglen practice. Despite some initial skepticism, he did practice it; and al lhis friends saw he went through an extraordinary change. He told many of them that, through Tonglen, the pain that before had been pointless and horrific was now infused with an almost glorious purpose. Everyone who knew him experienced firsthand how this new sense of meaning transformed his dying. he died in peace, reconciled to himself and his suffering.
If the practice of taking on the suffering of others can transform someone who has little experience of practice before, then imagine what power it has in the hands of a great master. When Gyalwang Karmapa died in Chicago in 1981, one of his Tibetan disciples wrote:
By the time that I saw him, His holiness had already many operations, some parts of his body removed, things put inside him, his blood transfused, and so on. Every day the doctors discovered the symptoms of some new disease, only to find them gone the next day and replaced by another illness, as if all the diseased in the world were finding room in his flesh. For two months he had taken no solid food, and finally his doctors gave up hope, It was impossible for him to live, and the doctors thought the life-supporting systems should be disconnected.
But the Karmapa said, ※No, I'm going t olive. Leave them in place.§ And he did live, astonishing the doctors, and remaining seemingly at ease in his situation 每 humorous, playful, smiling as if he were rejoicing at everything his body suffered. Then I though with the clearest possible conviction, that the Karmapa had submitted himself to all this cutting, to the manifestation of all those diseases in his body, to the lack of food, in a quite intentional and voluntary way: He was deliberately suffering all of these diseases to help minimize the coming pains of war, disease, and famine and in this way he was deliberately working to avert the terrible suffering of this dark age. For those of us present, his death was an unforgettable inspiration. It profoundly revealed the efficacy of the Dharma, and the fact that enlightenment for the sake of others can actually be achieved.
I know and I firmly believe that there is no need for anyone on earth to die in resentment and bitterness. No suffering, however dreadful, is or can be meaningless if it is dedicated to the alleviation of the suffering of others. We have before us the noble and exalting examples of the supreme masters of compassion, who, it is said, live and die in the practice of Tonglen, taking on the pain of all sentient beings while they breathe in, and pouring out healing to the whole world when they breathe out, all their lives long, and right up until their very last breath. So boundless and powerful is their compassion, the teachings say, that at the moment of their death, it carries them immediately to rebirth in a Buddha realm.
How transformed the world and our experience of it would be if each of us, while we live and as we die, could say this prayer, along with Shantideva and all the masters of compassion:
May I be a protector to those without protection, A leader for those who journey,
And a boat, a bridge. a passage
For those desiring the further shore.
May the pain of every living creature Be completely cleared away.
May I be the doctor and the medicine And may I be the nurse
For all sick beings in the world
Until everyone is healed.
Just like space
And the great elements such as earth,
May I always support the life
Of all the boundless creatures.
And until they pass away from pain
May I also be the source of life
For all the realms of varied beings
That reach unto the ends of space. |
