Recently, while I was working a hospice shift at an inpatient care center, a tearful, grieving man, rumpled from a long night spent at his dying father’s bedside, emerged from the room and muttered, “Your job sucks.” He paused self-consciously when a few of us—nurse, social worker, and myself, a hospice chaplain and death doula—all looked up with stunned chuckles. Backpedaling, he said, “I mean you’re amazing and all, but who would choose to do this?”
This is a common refrain when you tell people you work with the dying. To be fair, few of us feel amazing these days. We’re more careworn and stressed, standing in the shambles of our health-care system years into a pandemic. Frankly, dying is often gritty and full of suffering. At the same time, death is a powerful teacher for the living. “Death is a shift to the great unknown,” says Kelly Arora, professor and former co-director of the palliative care program at the University of Colorado Medical School. “A good death is when we feel like ‘I did my best—in that relationship, in that lifetime, I gave it my all and I got from it what I needed to move forward to what’s next.’” Life is a mystery. Death is a mystery.
Our job is to explore the full range of the experience. Many of us who work with the dying consider it an intensified form of spiritual practice, requiring concentration, attention, and presence.
Life is a mystery. Death is a mystery. Our job is to explore the full range of the experience.
In the transition from animate to inanimate, when a person’s final breath leaves their body, there is a moment of stillness and wonder. For those left behind, questions quickly crowd in: What is life? Where does one’s essence go? What is the spark that makes us human? Death doulas and others who work with the existential aspects of death and dying teach presence and equanimity—with dying, with our individual mortality, with the dead. We teach the families we work with about turning toward suffering, about engaging with the process of dying in ways that bring greater connection and meaning, but we only teach those things because that is what death teaches all of us. The process of dying can be all-consuming, both for the person who is dying and for people who work with death—either in meditation or literally working with the dying. Death is the ultimate form of present-mindedness where each second is precious, and all emotions are in the now.
My own work in this space emerged decades ago after the sudden death of my 23-year-old sister. I was young, alone in graduate school, and completely adrift in the experience of grief. A few years later, I had my own near-death experience after a severed artery. Like many people who discover mindfulness and also many people who end up working in hospice, my despair ultimately led me to my practice. I began asking all of the existential questions I now commonly hear with my hospice patients.
Turning Toward Our Suffering
While people often revert to “bucket list thinking” when considering mortality (skydiving comes to mind), David Chernikoff, early leader in the US hospice movement, meditation teacher, and author of the recent book on aging, Life, Part Two, encourages us to seek meaning through inner experience. He uses the term “contemplative happiness” to describe a sense of awareness and contentment that doesn’t rely on external circumstances to make us feel happy. “The process of actualizing our potential for this contemplative happiness requires us to be willing to face the suffering in our lives and not turn away from it habitually,” he says. When we turn away from what’s difficult, “we shut down our capacity to come in contact with the deeper wisdom, joy, love, and happiness that we’re talking about.”
We are enculturated to turn away from suffering by distracting ourselves on social media, bingeing shows, shopping, eating, drinking, gossiping—anything that mutes painful feelings. Those aspects of what Chernikoff calls “conventional happiness” are fleeting. Facing suffering offers an alternative, a path toward greater meaning. I like to picture myself turning around and looking at whatever it is that is making me suffer. It’s a cognitive trick that’s a bit like a science experiment. I imagine a magnifying glass that lets me pause and study the fear, pain, or unhappiness.
“Where we can transform is within those moments of murk and intensity,” says Francesca Arnoldy, program director of the End-of-Life Doula certificate program at the University of Vermont’s Larner College of Medicine. “It makes my heart more open to seeking and fully enjoying happiness. You don’t want to miss out on it, the wholehearted welcoming of it.”
“The continual contemplation of mortality is what must be sustained,” she says. “I think it teaches us to find awe in the moments we can’t even make sense of sometimes.”
Being With Dying
People often ask me what the difference is between a “good” death and a “bad” death, and the only thing I can identify is connection. People seem to have less angst when they feel connected both to something they are passionate about and to people in their life.
I once asked a dying man if he had any concerns he wanted to talk about and he said, “Life has been good. I love my family and I love to fish.” So we sat and we talked about fishing (one of my favorite meditative activities too) for the next 25 minutes. He had done something he loved as often as he could, and that made his death a little easier.
If companioning the dying isn’t part of your mindfulness practice, there are many other ways to explore death in a meaningful way. An ancient technique, well represented across nearly every tradition and revealed for a modern audience in The Tibetan Book of Living and Dying, suggests we meditate on death every day. It says, “Our exploration necessarily begins with a direct reflection on what death means and the many facets of the truth of impermanence—the kind of reflection that can enable us to make rich use of this life while we still have time, and ensure that when we die it will be without remorse or self-recrimination at having wasted our lives.”
Roshi Joan Halifax, director of the Project on Being With Dying, trains clinicians in compassionate hospice care and has supported dying individuals for more than four decades. She says, “One of the things the realization of our own mortality brings to us is a sense of what is really important for us. Relationships, doing good in the world, benefiting others—all these are threads that make the cloth of happiness.”
“Relationships, doing good in the world, benefiting others—all these are threads that make the cloth of happiness.”Roshi Joan Halifax
Some approach this contemplation as a form of sitting practice, using the breath to raise awareness of life’s fragility and the unknowable mysteries of death. More physical forms of mindfulness around death and dying can be found in yoga. For example, yoga nidra is a deep relaxation process that roughly translates to “yoga of sleep,” which can involve Savasana, meaning “corpse pose.” The purpose of this practice is to ease stress and enhance feelings of rest, to attune one’s senses to a big-picture purpose for life beyond everyday distractions. Others use grief yoga as a way of processing death and loss by transmuting it into movement.
“The Good Stuff”
For Francesca Arnoldy, it takes the form of daily reflection. “It has taught me to say goodbye to each day before I go to bed and to think about this as one less in my grand tally. How did I live it? What am I carrying? What can I heal? Sometimes this work can be heavy but it’s so meaningful in its heaviness that it’s always worth it.”
These techniques not only offer anecdotal evidence for increased feelings of wellbeing when we use death as a teacher, but also have scientific support. C. Nathan DeWall, a professor at the University of Kentucky, studied people’s responses to thoughts about death and dying. His findings, which he describes as “counterintuitive,” suggest that thinking about death triggers a nonconscious coping response. He writes that death is a psychologically threatening fact, but when people contemplate it, apparently the brain begins to search for happy thoughts. For me, this contemplation leads me to desire more connection and more of the ordinary. It makes me think, Did I connect with my children? and How did I show up for my aging parents?
I smile when I think back to the grieving son who said, “Your job sucks.” In that moment, my colleague, a veteran hospice nurse, went to check on the dying man so his son could take a moment to cry. The social worker offered comfort and insights to the man’s wife about the dying process. I sat on the floor with the dying man’s eight-year-old grandson and silently colored for a bit. What we know is that this death work that we do is “the good stuff.” It’s what makes life matter. It’s hard but so worth it.