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How to Die Well

How to Die Well

The late great Tibetan Buddhist teacher Kirti Tsenshab Rinpoche (1926 – 2006), answers questions about death and dying put by Ven. Pende Hawter, founder of the Karuna Hospice Service in Brisbane, Australia, in Dharamsala, India, in May 1990. This piece was excerpted from an article from Mandala Magazine’s Sep-Oct 1997 issue. You can read the entire interview and additional advice from other Buddhist teachers in Mandala’s eBook Meeting Death with Wisdom. 

 

Photo: Wolfgang Saumweber; Kalachakranet.org.

What is the best way that we can help people who are dying or who have just died?

 

When a person is dying and in great trouble there is great benefit in trying to get them to feel a bit better, a bit happier, to turn their mind to good thoughts.

If a person has faith in Buddhism, we can enunciate to them the things they have learned to trust and take refuge in. We can remind them about bodhicitta, about equanimity, about stabilizing the mind in meditative concentration, etc.

For a person who does not have religious faith, we can advise them to think, “May everybody be happy, may all living beings please be happy, may every living being please somehow be freed from their misery.”

Also, for a Buddhist who is about to pass away it can be very beneficial to gently remind them of the qualities of the Buddha, to encourage them to bring to mind the form of the Buddha, to put a picture of the Buddha in their room. These things can have great benefit and can cause the person to take rebirth in a fine place. You can also say prayers in their presence.

 

Is it better for Dharma practitioners to take as little medication as possible at the time of death?

 

There is no blanket answer here. You have to look at the individual person. If a person is in excruciating pain, then to relieve them of pain is obviously a good thing. However, if the person has a tremendous spirit or a tremendous capability, who can bear the pain and keep a clarity of what is happening to them, then to give that person a soporific that takes away that clarity is maybe not the thing to do. So it completely depends on the person.

For a Buddhist with meditational practices it can be very helpful to employ practices such as: bringing to mind that the pain has arisen because of certain causes and conditions, karma; remember various mind training ideas that can really strengthen and build up the mind, like convincing themselves that they are capable of bearing all sorts of difficulties.

A person who has never had the opportunity of doing such practices can be told things such as, no matter what a person believes, they are going to get these pains so there is no point in being tied up in them and worried by them; it is better to try to distance themselves from them and to see that just like everybody else it is happening to them too. Most people can probably get their mind around the idea (at times at least) that being upset won’t make the pain go away, it is not giving any relief.

It can also be tremendously beneficial to repeat thoughts such as, “May this excruciating pain never happen to anybody else,” or “If this pain ever happens to anybody else may they quickly be relieved of it.” Even if a person has never been religious in their life before, these sorts of prayers can help greatly.

 

In the West the usual signs of death are when the breathing and heart have stopped. But, in Buddhist terms, how long is it before the consciousness leaves the body after these things have occurred?

 

There are probably two types of people that can be identified here. The first type is somebody like a young child or someone who has been wasting away for a long period of time, a person who has had a long gradual process leading to death. In this sort of case the subtle mind or consciousness probably won’t remain in the body very long, perhaps only for a day or so.

The second type is somebody who has quite a strong body, who has been in quite good health, and dies rather more quickly. For this type of person the subtle mind or consciousness can stay for as long as three days.

Another sort of death is that of a sudden, violent death. An example would be the case of two people fighting and one of them is killed and dies suddenly. In terms of the length of time the consciousness remains in the body of such a person we could put this type of case in the first category, that is, a person who has undergone a long slide into death, with the subtle consciousness leaving fairly quickly.

 

How can you tell when the consciousness has left the body? What are the signs of the consciousness leaving the body?

 

For the person whose mind may remain in the body for as long as three days, it is said that just before the subtle consciousness leaves the body it becomes enclosed in a smaller and smaller dimension, and that dimension is said to be defined by a red and white sphere. When this sphere comes apart, the subtle consciousness is let free and this is indicated by a small amount of blood coming from the nose and a white fluid from the sexual organ.

Even though you sometimes find people in whom there is no sign of any blood or fluid from the lower part of the body, it usually does occur. Remember, I am not talking about the person who dies suddenly.

 

What effect does it have on the consciousness if the body is touched or moved before the consciousness leaves the body? For example, often in a hospital, after the person’s breathing and heart have stopped, various procedures are done on the body. Does this interfere with the consciousness?

 

Firstly, if the person was an adept with some sort of meditational abilities, they are trying to remain with a gentle sort of concentration at this point. If we shake the person violently at this stage it will disturb that concentration.

That is why there is a tradition in Tibet for the helpers of a dying person, even if that person is not a great yogi or yogini, to avoid disturbing the body for as long as three days. And if the body has to be moved, they would do so very gently and carefully, not violently or suddenly. This tradition has come about in Tibet to avoid disturbing the mind of the dead person.

In addition, if we have to remove the sheets and mattress, etc., from the bed of the person who has just died, we should do so slowly and gently so as not to disturb the person’s mind.

Similarly, if a person dies with their eyes open, there is a tradition to close the eyes, and if there is an unpleasant expression on the face it is common to smooth out the skin to make the face look more pleasant. These things should also be done with gentle and slow movements to avoid disturbing the mind of the person who has just died.

Everybody has their own burial habits, and in Tibet we had ours. The tradition in Tibet was for the body to be taken away for disposal after three days. To facilitate this, the arms and legs would be bent into the flexed position. Because the weather could be cold, if the person’s arms and legs were outstretched when they died it could be rather difficult to get them into that flexed position. So slowly, slowly over the three days you would make sure you could work them up into that position so that you would be okay when it was time for the body to be taken away. I doubt if there is much need for that where you all come from!

 

What is the Buddhist view of suicide?

 

It is a great fault for a Buddhist to kill themselves. Why is this so? Because all living beings are important and to hurt or destroy any living being, oneself included, is wrong. Suicide is usually the result of anger. Just as anger directed towards others can lead to their being killed, which is a great fault, so to hurt or to kill oneself is also wrong. For a non-Buddhist, it is the same. As I mentioned, all living beings are important and to harm somebody or some thing that is important is considered wrong.

So we have to think about how we can help these people who are experiencing this tremendous suffering and hardship. If over a period of time we can introduce them to ideas about how their mind is working, then we can really be of tremendous benefit to them and help them out of the difficulties they find themselves in.

 

What is the best way to prepare for one’s own death?

 

For the person who is already familiar with meditational practices, when they see that their death is approaching, this is the time to turn the mind to practice.

For those who have not thought much about religious things at all in their life, they should try and get hold of that which is the heart of religion. And what is the heart of religion? It is to be kind, to think well of others, to hope that good comes to others in their lives. If a person who has never before thought about those things can somehow do so, then this is the best thing they can do to prepare for death.

The person with some knowledge of religion from before will enjoy listening to stories about the Buddha’s excellent qualities, what they did for others and so forth, and this will bring joy to their mind. For the other sort of person, it can make them feel good and bring joy to their mind to tell them how certain people have helped others, how somebody did something nice for somebody else, etc.

What I am saying, in other words, is that dying is a situation where a person needs to have prepared beforehand because you can’t get it together while you are in the middle of it.

A Pilot’s Story

A Pilot’s Story

“Greater love hath no man than this, that a man lay down his life for his friends.”
– John 15:13

Through our work, our family has the great privilege of getting to know elders in our community, and to hear stories from their lives. We’ve had the opportunity to care for and get to know veterans of World War II, including a soldier who fought at Bastogne with General Patton’s army; a woman who as a teen was part of the Polish resistance in the Warsaw ghettos; the daughter of Irish immigrants who met Helen Keller while serving in the foreign service in Egypt in 1952; an Auschwitz survivor, who survived ten concentration camps; and others.

 

One of our clients and friends, John Eilertson, was a captain and pilot in Marine Medium Helicopter Squadron 365 in Vietnam from 1964-65.

John flew hundreds of missions during his time in Vietnam, transporting wounded soldiers, Marines, and South Vietnamese civilian and military to medical facilities; supporting Marine patrols on the ground; evacuating American and Vietnamese wounded, as well as Vietnamese refugees; resupplying marines in the field; search and rescue missions; and combat operations.

He received the Distinguished Flying Cross for a mission he flew on July 12, 1965, helping rescue a reconnaissance Marine patrol that had found itself, while on a scouting mission about 30 miles west of the American Airbase in Da Nang, suddenly surrounded by 50–100 Viet Cong soldiers.

Later, years after the war, John, a Catholic, traveled with his first wife Edie to Assisi, the birthplace of St. Francis, the 13th century saint. There he happened to meet a retired Marine Colonel who had been a good friend of the patrol leader, Frank Reasoner (see tribute below), who died that day in 1965 – the only casualty. For John, in the holy city of Assisi, this fortuitous meeting brought something full circle. “It was unique,” he says. “It was almost like a God-given meeting with somebody who knew him.”

Here is John’s story, as told to Cassidy & Kate:

Edie and I went to Assisi and were staying overnight in a hotel just outside of the city. We were going out for dinner and while I was waiting for Edie downstairs in the lobby, this gentleman came in and we got to talking. It turns out he’s a retired Marine Colonel who had been Regimental Commander of a regiment at Camp Pendleton [the Marine Corps Base about 50 miles south of Newport.]

We got to talking and he found out that I’d been a Marine helicopter pilot in Vietnam in 1965. And it turns out that I got a Distinguished Flying Cross for helping rescue a 30-man patrol that had been surrounded by the North Vietnamese about 30 miles southwest of Da Nang.

Their company commander was shot and killed, and they had a lot of wounded and they put out a call for withdrawal from the field.

It was the middle of the night and I was in my quarters at the airbase and they told me I had to go to the operational tent. We got a real quick briefing and went right out there to try and rescue our guys in the field. It was pitch black. One of those nights that was just absolutely pitch black. No moon or stars or anything.

We cranked up two helicopters. I was flying the second helicopter.

Bill Barber, who was an old war office chief, who had served in World War II and Korea and had a lot of flying experience, he was leading in the first helicopter, and we went roaring out there.

The reconnaissance patrol had lit a mag flare that was really bright. Bill called in on the radio and went roaring in and the North Vietnamese just opened up, firing at us. They had three machine gun positions set up around the patrol. You could see the green tracers from their bullets triangulating and lighting up the darkness. They couldn’t see us because we flew without any lights on, but they could hear us approaching and would fire at sound.

Bill went in and landed, and his crew hauled in as many Marines as they could, about ten, I think. Then he called out over the radio and quickly took off again.

Then I went roaring in on the position that I had seen in the black and the darkness.

There was no light at all. I had to just hover over the position, as best I could, and used a really sparring approach into it.

I lucked out and came out pretty close to where Bill had taken off from.

There were trees on both sides, so you had to be really careful landing. It was pitch black. I went roaring in and landed.

I took on a large number of people. I forget exactly how many now, but apparently I landed pretty close to the large body of them and hauled out the most. There were a lot of wounded. I told my crew chief: Get as many as you can. They came pouring on; and that left three left in the zone: a company commander, one other marine, and a dog. (The Marines had a dog with them on patrol. This was fairly common, John said. “If you had a sniper, you’d send the dog in. We’d take them into the field.”)

Our helicopter was so heavy, the last three couldn’t get on.

There happened to be a reconnaissance helicopter from our squadron that was out that night on a separate mission, and which happened to have on board a battalion commander. He heard our mission over the radio and, as luck would have it, gave them the order to fly in and support us. I told my copilot, as we were hovering above the landing zone: Quickly turn on our lights and turn them off; give them a flash of lights in the zone, so that they could spot us and come in. And that was enough for them to be able to get in and get those last three guys.

I made a roaring exit out of there so as not to hit any trees. And we made it out okay.

It all happened fast. It’s scary but you have to do the best you can. And when I went out, I did a sharp turn to stay clear of the trees. There were some tall trees, bordering fields.

It turns out that that company commander who lost his life, Frank Reasoner, was a senior first lieutenant and was a good friend of this gentleman I was talking to in Assisi. It was unique. It was almost like I was having a God-given meeting with somebody who knew him.

They had lived, as a matter of fact, in a house almost across the street from each other at Camp Pendleton. I couldn’t believe it! Here he was waiting for his wife to have dinner. And so we all had dinner together that night. Almost like it was a miracle.

Remembering 1st Lt. Frank Reasoner

1st Lt. Frank Reasoner, one of the patrol’s leaders and a graduate of West Point, was killed during the attack, having thrown himself into the line of fire to save the life of a fellow wounded Marine.

Prior to his death, Reasoner showed tremendous bravery and selflessness, initially single-handedly taking on Viet Cong fire – despite the fact that they were surrounded by three machine gun positions and some 100 Vietnamese fighters – to try and allow his men the space to retreat to a safer position.

He was posthumously awarded the Medal of Honor – the first Marine to receive the Medal of Honor during the war. The Marines also renamed the third reconnaissance base in Da Nang “Camp Reasoner.” “The hand-lettered sign near the gates of Camp Reasoner read: ‘First Lieutenant Reasoner sacrificed his life to save one of his wounded Marines. Greater Love Hath No Man.'” (Wikipedia). The Navy frigate the USS Reasoner was also named in his honor.

He was undoubtedly an example of selflessness; of not hesitating to put the lives of others before one’s own; and was beloved among his men. He was only 27 years old when he died, leaving behind a young wife and a baby boy back home.

“Although I wasn’t yet two years old when he died,” says his son Michael, “I can think of no better legacy for a father to leave his son than the one he left me.” Frank would have been 82 this year.

John and his second wife, Natalie

John and Ninta, one of our caregivers.

The Basilica of St. Francis in the sacred Italian city of Assisi.

A gunner’s view from a HU-34 Sikorsky in Vietnam in 1965. HU-34 was the helicopter John, and all marine pilots, flew during the war. Each mission included an aircraft commander, or pilot – John’s role; co-pilot; crew chief, and gunner.

Client Care Conversations with Cassidy

Client Care Conversations with Cassidy

My mom, Cassidy, is the soul of our family business. Sensitive and interested in every one she meets, she’s easy to talk to and has a knack for drawing out people’s stories: a writer by nature, she sees the story in everyone. I don’t think she’s ever met someone she didn’t find interesting, and she almost always gets to know our clients that she oversees on a very personal level — she can tell you where they grew up, what they studied in school, their favorite books. And it really is her personal interest in people and sensitivity that created the model for the kind of care we try and provide. 

Originally from the Midwest, my mom grew up in a small town in Missouri, and in a multi-generational home with her grandmother Katie. The “Cassidy House,” named for her great grandfather (and who she was also named after) was often a refuge to family members who had fallen on hard times.

I initially sat down with her to interview her about some of the basic questions and struggles we often see with new clients — with the idea that this interview/blog post might be helpful for others considering in-home care for a parent or loved one. But we ended up talking about so much more: the loneliness older adults often experience; what it was like for my mom growing up in a multi-generational home; different generations’ concepts of “respect”; the heartbreak and triumphs in our work caring for older adults; and why it can be so difficult for parents to accept care from a child & vice-versa.

 

What would you say is generally the biggest struggle for our clients when we first start working with them?

Generally, I’d say the hardest part for our clients is the sense that they’re losing their independence. Also, admitting that they need help.

What would you say is one of the biggest struggles for the families of our clients?

It’s hard to generalize… Sometimes the hardest part is having to be the one making decisions. Usually, the parent is the one who’s been making decisions throughout their lives and then when a child steps up to decide that the parent needs care, that can create a conflict.

If someone calls and is thinking of care for their parent, what do you advise?

Usually, it’s pretty obvious if the parent needs help. You don’t get a call until someone’s fallen, or they’ve started wandering. There’s already been a traumatic event where it’s become clear that the parent can no longer live safely on their own.

How does a caregiver provide support to an older adult?

A caregiver is like an extension of yourself. If you’re having trouble walking, the caregiver is like your living cane. Or if you can’t concentrate to follow a recipe, the caregiver is another set of hands and brain to help you. If your reactions have slowed down, it’s someone to drive you. It can be companionship for people.

Many older people are living alone, extremely isolated. For instance, one client I saw yesterday, who’s doing great, she said she loves being in her house, but she gets pretty lonely. She loves having her caregiver there for the few hours she comes. She’s a helper, but she’s also become a friend. This client’s house looks like a different place now because the caregiver is doing such a good job making everything sparkling. When you’re on your own, a friendly face, can make a world.

Why do you think so many people seem to get lonely as the age?

Often it’s just numbers. The older you get, the more people that you’ve known and loved have died. If you had a partner, the odds are that they died. And the way our society is, kids move away. It’s not the way it was when people stayed where they grew up and families were more interdependent. Yet, maybe that’s changing again. More kids seem to be moving in with their parents now for economic reasons.

Do you think people actually feel lonelier as they age?

I don’t know if older people actually feel lonelier, because you can be lonely at different periods throughout your life. But the normal ways people alleviate loneliness, older people can’t always do easily: go out, visit a friend, etc. You’re generally more confined by age.

Also, when your senses starting to diminish, the world can narrow. It doesn’t have to, but it can. Most people don’t admit that, I don’t think. But one of our clients actually said that to me. She’s been divorced a long time and now has Alzheimers. I think with all of the dementia diseases, not only is your brain doing things to you, but all the fear that surrounds that diagnosis makes you afraid to go out even at the beginning stages, when you’re relatively okay, because you’re afraid all the time. And you could be forgetting things or you think things are happening to you. Or if you’ve become incontinent, you’re embarrassed you might have an accident. We have one client who was having spontaneous nose-bleeds and was terrified to go out in case that might happen.

What was it like growing up with your grandmother? Did she always live with you?

Not long after I was born my parents moved from Jeff City to Sedalia with me and my older brother Ward. We moved into my mother’s family home because her father had died in 1950 (I was born in 1952); and it was the norm then that the daughter would look after the mother and/or father.

The story goes that my grandmother, Katie, was devastated when Jack McGrath (my grandfather) died in 1950. She wanted to die, too. She took to her bed and became reclusive. And then I always remember hearing that she had a lobotomy because she felt nauseous all the time! She died when I was 7 years old.

She had the two front rooms in the house. And she had a helper, Bess, who was a caregiver essentially, who stayed with her and helped my mother look after her.

There were always a lot of people in the house, an uncle who never got married. It was always a multigenerational house and I had a wonderful childhood.

I loved my grandmother. I loved Bess. My uncle E.G. would come stay and visit. I loved Roseanne (my grandmother’s cousin who lived with us). With all those people you have more relationships and get more attention. I don’t have any bad memories of my childhood.

How did you and Katie spend time together?

I would go sit in her room and read. Or they would read to me when I was little. I remember reading in her lap.
I also used to go cut the flowers from other people’s gardens to take to Katie – I didn’t realize that flowers didn’t belong to everybody. But when I cut a rose from our doctor’s garden down the alley, his wife (who later shot Dr. Beck) told my grandmother. It was a small town. My cousins Kate and Carol – their grandmother lived up the block. And her sister-in-law Stella half a block the other way. It was a small community. For Ward and me, it really was a wonderful childhood.

Why did so many family members live with you?

It was just part of the cultural tradition that you looked after your people. It was just what was done. And the ones that didn’t have the means always had support. Everyone was looked after.

I remember hearing about my mother’s uncle, Joe. I think he didn’t have a job and lived in the big house with us on the third floor. Katie’s father made a lot of money, relative to that time and place, so it was understood that the ones that needed help, would go to Katie. And I think Roseanne, Katie’s cousin, was also on her own — partly because she was an alcoholic — but had also because she’d been unlucky in love. She must have been married at one point, but when I was young, I remember she had a boyfriend who said he was just going to the cleaners and never came back! I remember the drug store would deliver a brown paper bag with whiskey for her. But then too, if you’re Irish, it was just accepted there were going to be some alcoholics in the family…

Do you think people respected their elders more then than perhaps we do now?

I think that older people were more respected before. I always looked up to older people. I think because I was brought up that way. Maybe my generation hasn’t done such a good job bringing kids up. You have to teach manners. It’s not something that’s innate. We were going to build a house for my parents at our old home on Bellis St. And then my dad died…
Older people may be diminished but the sense of self however slight or slipping on the outside, is as solid inside as when they were young.

Why did you and Dad consider building a house for your parents?

I think that’s just what you do. They looked after us the best they could. They didn’t ask if we would look after them. We offered it. It’s just what you do.

What are some of the saddest things you see doing this work?

What I think of as sad — and sometimes I’ve been proven wrong — but sometimes people being put into a nursing home is really sad. Not everyone suffers as a result of being moved into an institution, but often it can feel like people are being discarded. Of course, not all cases are like that. We have one client who is actually doing much better now that she’s in assisted living. She’s closer to her son who lives nearby (she lived in LA before) and she is actually re-learning to speak a bit. And that’s fantastic.

Memory care units can also be incredibly sad. And I realize families often feel they have no other option. But you can tell people often feel their kids are just trying to get rid of them… But on the other hand, what do you do? Most people would say people with advanced Alzheimers don’t have a sense of self, but I don’t believe that. But many doctors would say that.

I think the saddest thing for me is when people are just written off. Older people may be diminished but the sense of self however slight or slipping on the outside, is as solid inside as when they were young.

Whats the nicest thing about doing this kind of work?

I think it’s really nice when you can help somebody. That’s what life’s about. To give something to someone, to give some care. I believe that’s the most meaningful thing in life and just a general truth in living. And it’s satisfying – take clients like Lorraine and Bob [two clients who have since passed away]. They didn’t have any children and as independent as Lorraine was — she did everything possible that she could for Bob — but at some point she realized she needed help to help him better. And to have been able to satisfy someone who was so self-sufficient and self-giving for her partner, that was very special.

Or with Barbara [a client with advanced Alzheimers and old friend]. I know that she’s still there inside. Fortunately, her family has supported her presence as well, even though she can’t talk much any more. But to know that you’re making sure she gets the best possible care you can provide. That’s a moral obligation. And Barbara said she wanted that – she had longterm care insurance and made good plans for herself. She looked after her parents as well in her own home. I’m sure she still recognizes me. Of course, I can’t know for sure because she can’t really communicate conventionally anymore. But I can feel she knows me. You can tell.

Do you think it’s hard for parents to be cared for by a child?

I think it just depends on the person. Sometimes you don’t want your kids to see your weaknesses or what we consider “diminished.”

I also think that people don’t want to really see their parents, to see their frailties, especially when they have held them highly. And then there are people whose parents were awful, but I hope it’s truer, that more people like or admire their parents and I think it’s hard to see them failing.

Why do you think that is so hard for kids?

Generally, it’s hard to see people that have become so feeble. And also our society, particularly, is geared towards only seeing beauty in young and perfect bodies. I don’t know for sure about other societies, but I watch a lot of European movies. They show actresses that may have makeup on, but you also see the lines in their faces. Here there’s so much emphasis on youth and perfection. We tend to erase the lifelines. If you think of the photos of W.H. Auden, a face like that is actually really interesting.

 


Coral Tree In-home Care provide caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 250 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.
“Affirmation,” a Poem by Donald Hall

“Affirmation,” a Poem by Donald Hall

To grow old is to lose everything.
Aging, everybody knows it.
Even when we are young,
we glimpse it sometimes, and nod our heads
when a grandfather dies.
Then we row for years on the midsummer
pond, ignorant and content. But a marriage,
that began without harm, scatters
into debris on the shore,
and a friend from school drops
cold on a rocky strand.
If a new love carries us
past middle age, our wife will die
at her strongest and most beautiful.
New women come and go. All go.
The pretty lover who announces
that she is temporary
is temporary. The bold woman,
middle-aged against our old age,
sinks under an anxiety she cannot withstand.
Another friend of decades estranges himself
in words that pollute thirty years.
Let us stifle under mud at the pond’s edge
and affirm that it is fitting
and delicious to lose everything.

 


Coral Tree In-home Care provide caregivers, old-fashioned kindness, and neighborly support to older adults who want to live at own home safely, comfortably, and as independently as possible. Since 2010 we’ve helped more than 250 families in Newport Beach, Laguna Beach, Newport Coast, and neighboring Southern California communities live safer, happier lives.