Facing Death and Finding Hope

Facing Death and Finding Hope - A Guide to the Emotional and Spiritual Care of the Dying
Review of Presentation by Christine Longaker at the NHO National Conference, Dallas, November, 1998 by Paul Barry

Christine Longaker, author of Facing Death and Finding Hope - A Guide to the Emotional and Spiritual Care of the Dying, was among the presenters at the NHO Symposium in Dallas, Texas in November 1998. Ms Longaker, a long time associate of Sogyal Rinpoche, author of The Tibetan Book of Living and Dying, addressed the personal qualities that caregivers can nurture to bring to bedside of the dying, and the pertinence of the approach to living and dying emerging from Tibetan Buddhist thought.

Ms. Longaker opened the session with an exercise. She asked the audience to just sit quietly and use the image of a shaken glass of muddy water to represent the usual state of our mind, and to imagine that by sitting quietly we could allow another aspect of mind, the natural clarity, to emerge. She asked that the audience members allow their minds to slowly settle as they sat. She ended this opening exercise with the suggestion that such an exercise allows a person to be a little more present. She emphasized the importance of the quality of presence that caregivers bring to their care for the dying.

Ms. Longaker then spoke of her entry into a spiritual path. She spoke of the death of her husband 20 years ago of leukemia, and how her experience with his death moved her toward an involvement with issues related to end of life care. She spoke of her involvement in a hospice program and her introduction to Sogyal Rinpoche. She spoke of her continuing involvement with Sogyal Rinpoche, Rigpa (Sogyal Rinpoche's network of training centers), and the Spiritual Care Education and Training Program, with which her role is Senior Educator. She spoke of putting into daily practice, from whatever spiritual tradition a person follows, an experience that supports the ability to more present in moments of caring for the dying.

Ms Longaker noted that such daily practices also provide care for the caregiver, creating an atmosphere of greater peace, and the ability to be more present. Ms. Longaker spoke of personal qualities that contribute to care for the dying. She noted genuineness, confidence, and presence.

In speaking about the quality of presence Ms. Longaker addressed the dual aspect of presence. She spoke of our habitual way of being outwardly active but internally absent. The counter to this was seek internally, and act from, a deep clear awareness. She said that recognizing the dying person as a whole person could enhance this quality of deep presence. She spoke of seeing the dying person as more than their suffering. She used the image of mist on a mirror to describe a patient's suffering. The suffering was not always there. The patient has an essence: intact, whole, infinite, unborn and undying. She described a point of view of death as a transition, that essence continues past this transition. She addressed the possibility that care can support the infinite part of person.

Ms Longaker spoke of genuineness from the point of view of recognizing that there was not a huge difference between the caregiver and dying person. She suggested that caregivers be open to letting the dying give their final lessons about life. She used the image of little boats on a river moving toward a waterfall - the moment of death. She pointed out that no one could be certain when that moment would come for him or her.

In referring to some ideas described in her book she spoke of four tasks of living and dying. She described death as a very active time of life. The four tasks she described as follows: 1. understanding and transforming suffering; 2. making a connection, healing relationships, and letting go; 3. preparing spiritually for death; and, 4. finding meaning in life. She indicated that her main focus in her talk was to address the third task of spiritually preparing for death and assisting patients in this task. She noted that in attending to this task with clients causes us to look at our own death, our fears and how we are applying ourselves to the task of living and dying.

Points that Ms. Longaker made were often accompanied by a story. She said that she used stories rather than overheads. Several points that she made included quotations and references to Sogyal Rinpohe's work. One quotation, she indicated, summed up a great deal related to the spiritual practices around dying. She repeated several times: "At the moment of death, there are two things that count: Whatever we have done in our lives, and what state of mind we are in at that moment."

Ms Longaker made a significant point using details from descriptions of Near Death Experiences (NDE's). She described the sense of expansion, peace and joy that characterize many NDE's. She described death as a great opportunity to recognize a connection to the infinite. She also offered the view that a risk is present that a person in death may "smuggle across" all theirs fears, attachments, troubles, etc., which would make any after death experience a continuation of the suffering present in the current life. She spoke of a choice that individuals make in how they live and the many moments of transition in everyday life in which a person may choose to continue the habits and suffering that they experience in life. She noted the many "little deaths" that we experience on the way to the "big death" at the end of life. She spoke of the moment of first waking in the morning, a time of presence and awareness, before all the thoughts and concerns about life flood back in to awareness. She spoke of the possibility that we habitually regenerate our suffering every day, and that there is a choice to do other than that through a daily spiritual practice.

Ms. Longaker shared a number of stories to elaborate her points. She told a story about what she described as the practice of the continuous prayer of the heart. A woman took on the practice in her dying of saying, "Lord Jesus Christ have mercy on me." Ms. Longaker described how this practice transformed the woman's process of dying. She spoke of the importance of facilitating a dying client's effort to find meaning in their life and death. She spoke of the importance of compassion. She told a story of concentration camp victims in W.W.II dedicating their suffering to the wish for the well being of others whom they loved.

Ms. Longaker referred to Elizabeth Kubler-Ross's work. She spoke of a Reverend Mwalimu Imara and the notion of three commitments for a meaningful life. She described the three commitments as follows: To become aware of and accept ourselves; to invest ourselves in authentic dialogue with others; and, to decide on a positive direction of growth.

Ms. Longaker offered a description of a spiritual practice from the Tibetan Buddhist tradition. She spoke of Phowa: Traditional Phowa and Essential Phowa. She described the process of Essential Phowa. The reader may be interested to know that this practice as described is on pages 124-5 of Ms. Longaker's book. Ms. Longaker's book is available through Main Street Books, Doubleday, New York (on the web at http://www.bdd.com). The Spiritual Care Education and Training Program is at 499 Powell Street, Suite 200, San Francisco, CA, 94102-95103 (also on the web at http://www.atlantech.net/rigpa/spcarenw.htm). There is a link to an interview with Ms. Longaker on the Rigpa site at http://www.microtec.net/~inerson/ondeath/longaker.html.

Death and Eastern Thought

Death and Eastern Thought, Frederick H. Holck editor
Abingdon Press, NY 1974

I came upon this book at the local library and half heartedly picked it up for a quick look as it seem rather dated. I was pleasantly surprised. It is a thorough and well written introduction to the topic especially in regard to Hinduism. It also covers Buddhism (giving a history of Buddha's life and how his teachings developed), Jainism, and the Chinese and Japanese traditions. Each chapter is written by a different expert and the forward is an excellent discussion which compares eastern and western ontological concepts. The next three chapters deal with the Vedic period, later Hindu traditions and the orthodox (Hindu) teachings. Next the heterodox teachings are covered, ie Buddhism and Jainism.
Three modern Hindu thinkers are then presented; Tagore, Gandhi and Radhakrishnan. The book ends with short presentations of Chinese Taoism and Japanese pre-Buddhist traditions.
As you can see, well over half of the book is dedicated to some form of Hinduism and it really is a good introduction to this complex ancient religion. The forward and the chapter on modern Hindu thought are especially noteworthy, they bring one much closer to an understanding of the great Vedic philosophical concepts which have taken centuries to develop and which are still unfolding.

The American Book of the Dead by EJ Gold

I do a lot of work with the critically ill and dying and I use this text as a guidebook to help in critical, high stress, transitional situations. It aligns, of course, with the Tibetan Buddhist Bardo teachings, presenting them in a context that is culturally accessible and, dare I say it, sometimes humorous. Without the normal religious context it offers the dharma teachings to westerners and opens the way of equanimity. It gives an excellent presentation of how to recognize the stages of physical death, make contact with the patient or "voyager," prepare the room for passing, and deliver an effective reading. It provides a way for families and the bereaved to participate in a more conscious passage for their beloved by aligning with his or her own spiritual needs and practices.
In the resonance of the various chambers with different psychological states this text is also a workbook for those in psychological stress. The person in crisis can read from the particular chapter which is analogous to his or her condition.
As you can see, all of this is very practical stuff. I would even say that this is a book which can only be fully understood in terms of being used to help others. Indeed as I look at the range and scope of his work it seems that most of Mr. Gold's writings and teachings are of this nature.

Final Gifts - Maggie Callanan and Patricia Kelley

Final Gifts - Maggie Callanan and Patricia Kelley
Bantam Books 1997 240pp
ISBN 0-553-37876-7

As I read this book it gradually dawned upon me that the authors, two hospice nurses, were revealing hard won secrets from over 40 years of clinical experience and compassionate work with the dying. Their insights alone make this unassuming little book worth its weight in gold. It is truly indispensable. How can I express this strongly enough? I wish that I had read it years ago. I hope that everyone who is around me when I die has read it. It should be a primer in every medical field of study (MD, Nursing, Health Sciences) and could change the way that working with the dying is envisioned for many years to come.
Final Gifts posits and (in my opinion proves), that we need to pay attention to the words, gestures, comments, utterances and indications of those who are close to death. Any and all of these forms of communication serve to inform caregivers as to what the dying person is experiencing or what he or she needs for a peaceful death. The language is often symbolic and may even appear nonsensical, but if listened to and gently examined it usually holds the clue to some element that is important in the persons passing.
This is a rather revolutionary concept. It hints that we have some knowledge and control of the time and circumstances of our passing and will strive to let others know about it. The authors call this Nearing Death Awareness. We know when our death is near and have things to say about it! The communication is often in another language and requires a compassionate listener. Professionals should be tuned in to NDA and more importantly they should help family and friends to become aware of it as well.
The book has an organized and interesting structure, presenting concepts and principles and then backing them up as well as illustrating them with well written case studies. It starts by presenting the challenge of finding some meaning or opportunities for growth at the time of death.According to the authors' experience, growth is possible at the time of passage when the wishes of the dying are held paramount and attended to.
It introduces Nearing Death Awareness, (a patient's attempt to describe what he or she is experiencing and/or what he needs for a peaceful death) and describes the similarities and differences to Near Death Experience (NDE). It is important not to get the two concepts confused...I found no significant similarities.
The authors go on in the next chapters to show the similarities between the birth and death processes, tell a bit about the history of hospice, share how NDA was developed, and give a variety of useful practical information about symptoms and circumstances surrounding the time of death. I found this last section to be particularly helpful because due to their experience the authors are able to present the things that are truly useful - in a well organized format- disregarding those that are too clinically complicated for the layperson.
One important caveat that the nurses warn us about is to know what our own beliefs are and to be careful not to project them onto the passage of those who are dying. This comes up several times in the book. It becomes clearer as the authors examine Kubler-Ross's five stages. The simple process of being a good listener is very important in dealing with denial and anger. A good listener, a compassionate guide, is free of preconceptions and ideology, and will not strive to lead the dying anywhere but will accompany him, providing encouragement and support on his or her own unique path to awareness.
The book goes on to present 5 chapters describing death experiences from the authors' work. This is the "What I am experiencing" part of NDA.
The final section of 6 more chapters deals with What I Need for a Peaceful Death. I found the presentation of a short case study illustrating an underlying principle to be most effective. The chapter headings organize the material nicely. It covers, among other things; urgency, reconciliation, being held back, symbolic dreams, choosing a time, choosing location, right conditions, verbal permission and particular dates.
The authors end with a list of specific reminders for keeping NDA in mind when working with the dying. Quickly paraphrasing some of these:

* Pay attention to everything a dying person says. A pen and notebook might come in handy to write everything no matter how seemingly insignificant which at a later time might make sense.
* Important meanings in any message are possible
* Watch for key signs and gestures
* Respond to things that you don't understand with gentle inquiries
* Pose questions in open ended encouraging terms
* Accept and validate what the dying say.
* Don't argue or challenge.
* The dying may employ images and terms from work or hobbies to convey valuable information. (p225)

This listing doesn't do justice to the final section. It is well presented and thorough, an excellent summary. In fact, looking back I have hardly done justice to the entire book through this review. I can only urge you to go out and pick it up or visit your local library. If on your way to buy this book you go through Amazon.com you will see that this book has 92 reviews...with all but a few rating 5 stars. You won't find anyone including the present reviewer who can't speak highly enough about it.