It's autumn; the leaves are falling. We pick the last of our gardens. Soon it will be winter.
Birth... death... birth... death... birth... the cycle never ends. When the leaves fall and begin to decay to become the compost that is the fertile bed for the next cycle of life, we rejoice in the turn of the wheel. Birth... death... birth... death... birth....
Every single being who is born will die.
But when we think of our own deaths, or the deaths of those we love, it is more difficult to find joy in our hearts. Perhaps because we live in a society that hates and fears old age, illness, helplessness, failure and death, we have no experience of what to do, how to act, how to be when we hear those inevitable words, "You have only a few months to live." Probably we hear them first in relation to someone else, and our hearts skip a beat. What do they mean? Fear, sadness, panic, helplessness, anger, all our emotions rush through us in a storm. Where is the wisdom to guide us now?
We spend most of our life acting as if the future stretches out before us endlessly. When death gets closer and closer, suddenly the future disappears, and we are left with the present moment. Death is inevitable, and we have the power to choose to accept it as another opportunity to learn and grow. Facing death, another's or our own, can be welcomed as a sacred ritual.
Dying usually takes a long time for human beings, sometimes more than 100 years. But the more active part, after it becomes obvious that it is going to be soon, is more often a process that takes days to months. In the past, people died at home as a matter of course. Many children died from common diseases, so death was not as remote as we have made it in the last 50 years or so.
Antibiotics, immunizations and modern hospitals sometimes hold off death, have made dying more distant and more sanitary and feed the hope that someday it may be postponed forever. Again and again, we see examples of someone almost dying, or even being clinically dead, and then being returned to life with the help of modern medicine. So we postpone thinking about death, being in the presence of death and welcoming death.
Does the idea of welcoming death seem bizarre? If you open yourself to the inevitability of death and see it as the next stage of growth, when your time arrives it will become easier and easier to embrace the peaceful sleep.
Everyone dies their own death, and being with someone who is actively dying, while focusing on being present to what they need, moment to moment, and learning to still the endless chatter of one's own ego fears - this is the gift the dying give to the living. Active dying is the term used in hospice to mean the last stage of life, when death is approaching quickly. I worked as a hospice nurse for several years, 2 1/2 of those with people dying of AIDS. It has been an amazing experience, and I recommend spending time with the dying to everyone.
While it is impossible to not have opinions, judgments, attitudes, hopes and fears while being with someone who is dying, the work of focusing on their needs, their life, their wants, while setting your own aside for this time, is a spiritual discipline worth doing. And as you hone your ability to focus in the present moment, ground, center, attend to the needs of the person dying, even when it is yourself, dying becomes a ritual that rivals birth in its sacred presence.
Everyone dies their own death. People do not necessarily become nicer just because they are dying, although some do. Rather, we humans tend to become exaggerated versions of who we were before. So the cranky just may turn crankiness into an art form in the time of active dying. And persons who have spent their lives avoiding looking at themselves, avoiding intimacy, avoiding emotional honesty, are less likely to suddenly become interested in these things, just because they are dying, than is someone who has worked to become conscious all along. Death is one last opportunity to wake up in this life.
Don't expect or demand perfection of yourself when you learn you are dying, or when you are spending time with someone who is. Remember that just being with someone is the greatest gift, and that includes being with yourself. If at first you can only spend 10 minutes in the presence of death, and you cannot be fully conscious for even that 10 minutes, don't judge yourself harshly for this. Take some deep breaths, open your heart and do what you can at that moment. What you do and how you are, in the presence of death, will stick in your memory for the rest of your life. Take the opportunity to remind yourself to be brave, to be strong, to be vulnerable, to be present, to open yourself to love.
It really is true that people go through stages like Kubler-Ross described: denial, anger, bargaining, depression and acceptance, although not necessarily in that order, or in exactly those states. And so do those around them. Even after you have been with several people dying, your own emotional states will catch you by surprise. The dying hold up a mirror to our hearts and give us an opportunity to see ourselves.
From the moment we are born, we have tasks to do, things to learn. First, we must learn to control our bodies, breathe, cry, move, understand sensory data. All our lives we struggle to control more and more, beginning with our own bodies and going on to try to control our environment and the people around us. I do not necessarily mean control as manipulation or coercion, but more as learning how to get our own needs met for safety, food and companionship.
First, we sit up, then crawl, finally walk and go on to run, skate, swim, ski and dance. Our mouths and throats make sounds, and we learn to shape them and to communicate more effectively with those around us. We go to school, we go to work, we raise children of our own. Though it all, we are learning to control.
After 50 or 100 years of this, dying can be very hard, because dying is learning how to let go of control. Little by little, the body fails, and others must do the tasks that once were easy. By the end, even eating and breathing may be difficult or impossible without help. Even going to the bathroom. All that is left are the decisions about when to say "enough," when to say "don't do any more interventions," "let me go, let my body go." After all those years of fighting for control, of learning to be in charge, it can be very hard to finally let go and surrender to the will of the body.
Learning how to die is just as hard as learning how to live, and most people have to do it in a few months instead of the years they took to learn how to be in charge. That is why many religions have specific rituals to help the dying, and the living who care for them, to learn how to dance this new dance, the one that you have just one chance to get right with each person, even yourself. Remember to be gentle with yourself and others, and remind yourself again and again to be present in the moment and open your heart. The exact details of what you need to do will become more apparent as you are able to still the chatter of your thoughts. Death is very quiet, and as it approaches it gives us a wonderful time to practice quieting our minds and just being with each other. You may not be able to do the personal care for your friend who is dying, either because someone else is or because you cannot bring yourself to do it. Not everyone can, so don't judge yourself for this, but do make certain that those needs are taken care of by someone. What the dying want most is to know the living love them.
As death approaches, all those decisions that have been put off into the future present themselves and demand attention. Do you want to die holding grudges? Who gets your stuff? What about those old love letters that you have never shown to anyone; do you want to destroy them before you go, or leave them as one more testimonial to the complexity of your life? Do you want to carry your secrets beyond the grave, or finally in your death will you let those you love really know you?
Who do you want to make decisions about your care when you are no longer able to? Do you want extraordinary means used to keep you alive to the last possible breath? Do you want to die in a hospital, or at home? Can you ask those who love you to take care of your body as it falls apart, and can they really do it?
Don't put up with suffering pain, or allowing those dying to suffer it, unless that is the dying person's choice. Too few in health care really understand pain control, but hospices are getting a lot better at it. Medications exist to allow the dying person to carefully manage their level of pain and consciousness, so demand access to that choice. Pain and consciousness must be balanced out, and most dying people want to be as conscious as possible, while not suffering unbearable pain. Insist that the person dying have control of that balance. People who can press a button to give themselves more pain medication actually use less of it than those who have to beg for each pill or shot on someone else's schedule.
Several people have asked me to help them die more quickly, because they could not stand the pain they were experiencing. Every time I heard that request, I promised that I would help them get the pain control they needed, and that then we could discuss their request again. Every single time this happened, when the dying person could control his or her pain level, that person was content to wait for death and never mentioned hastening it to me again. And some people choose to suffer pain. Demand the right to that choice for yourself, and for those you love.
Some things to ask yourself when contemplating your own death: Can you forgive everyone who has wronged you? This might be your last chance. Can you ask those you have wronged for forgiveness? Can you swallow your pride and admit that you may have been wrong, or that it no longer matters who was right? From my experience in watching others die, only how fully you have loved and cared for others appears to count at the end.
In being present during the time many, many people were dying, I never heard a single one say, "Damn, I'm annoyed that I didn't make that last promotion, or that last million dollars, or beat that competitor." Never. What people do say are things like, "I wish I had spent more time with my kids, my parents, my friends." "I regret that I spent so much time focused on success, and on things, rather than on people, and on life."
This information is one of the gifts the dying give to the living - don't wait. Heal old quarrels now, decide who gets your stuff, cherish your relationships, including the relationship with yourself, and don't put off those things you really yearn to do. Death sneaks up on us. We seldom expect it. When we hear those words or come to the realization that our time is almost up, it will be less of a shock if we acknowledge that it will happen someday and begin getting ready now.
Not everyone dies a pleasant death, even with all that can be done to control pain and ease the transition. And some deaths look particularly awful. If watching someone die with badly impaired lungs isn't enough to get you to quit smoking, you may decide to try it yourself. Some people do become saintlike as they die. Being with them becomes almost an ecstatic experience. The air seems to develop that sparkly quality that occurs during particularly intense rituals. As friends and family gather round, and all the family stories are told over and over while everyone waits, the deathwatch becomes a cathedral, and those gathered there become the priests and priestesses of the ceremony. That time, the waiting for death, is incredible. There is nothing to do but wait, and remember, and learn about oneself and loving presence.
Few people want to die alone, but most get very tired as death approaches and cannot deal with much of anything. Most people want to die with their friends around them, just waiting and being with them while it happens. Do your best to respect the wishes of the dying, whether they want company or solitude, conversation or silence. Most people are not hungry as death approaches, so while it is fine to offer food or water occasionally, don't press them. The system is shutting down and may not need or want them.
A close friend who died of AIDS told me just before he died, "I'm sorry to say this, I'm sorry it took this to do it, but these last five years since I have known I was HIV+, and have known I would probably die soon, have been the best years of my life. I finally started spending time with my family, and doing community work, and taking care of my health. It's been more wonderful than I ever imagined. So while I am sorry that it's just about over, I'm really glad I had this time to live like this. I've always had to hit a wall to learn anything worthwhile, and that's what this has been for me. Just think, if this hadn't happened to me, I could have died without really understanding living. Other than knowing it will soon be over, I have no regrets."
This is the gift the dying give the living.
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