George and Shirley Brickenden, who are 95 and 94, respectively, decided they didn’t want to wait any longer for death to arrive. They’d been married for 73 years and their bodies weren’t faring so well. Shirley had a heart attack in 2016 and nearly died; she now had rheumatoid arthritis and was in constant pain. George was found passed out, unconscious, on his birthday and his heart was also failing.
Under Canadian law, both of them qualify for what’s known as physician-assisted death. They’re older than 18, Canadian citizens, mentally competent, suffering from a “serious and incurable disease, illness or disability,” and in an “‘advanced state of irreversible decline,’ with enduring and intolerable suffering.” Furthermore, there was no coercion involved. They checked off all the boxes.
And both of them decided to end their lives together, in peace, at the same time last week.
Shortly before 7 p.m., Mrs. Brickenden turned to her husband. “Are you ready?”
“Ready when you are,” he replied.
They walked into their bedroom and lay down together, holding hands. The two doctors, one for each patient, inserted intravenous lines into their arms.
Angela rubbed her mom’s feet. [Pamela] rubbed her dad’s. “They smiled, they looked at each other,” Pamela said. Then Mr. Brickenden looked at his children, standing at the end of the bed.
“I love you all,” he said.
This is exactly why the law was passed. Forcing people to live in pain is a form of torture. The Brickendens were able to get their lives in order, say goodbye one last time to their children, and end life hand in hand with the person they love most. If you were to imagine your own perfect death, it would probably look something like that.
And yet there are many religious groups that oppose letting people make that decision because it’s thwarting God’s plan for their lives. They’re so “pro-life,” they would rather see people suffer than die on their own terms. In some cases, like when a dying patient ends up at a Catholic hospital that doesn’t allow the procedure, the result is even more cruelty.
In Canada, however, this is now a legal procedure with sensible hurdles in place to prevent people from abusing it. It was made for situations like these. There may be certain situations where the moral thing to do isn’t always obvious, but this isn’t one of them.
As age and overwhelming infirmities overtook them, on a beautiful spring day, after 73 years of marriage, they toasted each other with family and good champagne, held hands and left this life gently and together, on their own terms. This was their final act of love, hoping their act will pave the way for others who are suffering. They were fully at peace with this decision and had the support of their four devoted children who have always known this was how they wanted it to be when the time came. We are all forever grateful for the compassionate assistance of Dying with Dignity. They have blessed this earth together for 73 years and it’s time for them to bless the stars.
In the United States, death with dignity is only legal in six states and Washington, D.C. That leaves a lot of places where people who are ready to end life are forced to prolong it against their will. That needs to change.
As an internal medicine physician practicing in a busy urban hospital setting, I care for people of all ages who have never considered their own mortality. Far too often, this results in an experience at the end of life that doesn’t embody the goals and values of the life they have lived. They suffer, and so do the people they love. It’s led me to question, why is this?
For the vast majority of human history, we have been thoughtful and intentional about death. Without the benefits of modern medicine, we cared for our family members at home when they became ill. When people died, they were laid out in the parlor of the home, surrounded by family, and ancient death rituals were performed. Death was an expected occurrence that was accepted and planned for. Our cultural understanding, at least in the West, began to deteriorate about a century ago as death became increasingly medicalized.
Despite our culture’s propensity to share just about everything, the idea of death remains a cultural taboo, keeping us from personal reflection, discussion with those we love, and planning ahead.
Why death is left out of the wellness conversation.
There are only two things we really know for sure: We are born, and we will die. As a culture, we invest in nutrition, exercise, and spiritual well-being as a means to live well—but a critical part of living well is dying well. A recognition of our own mortality can allow us to live an even more fulfilled life. We become better people who feel more grateful for our experiences every day.
While historically many people pondered death and the idea of an afterlife through the lens of religion, the growing number of Americans turning away from organized religion and seeking a hybrid spiritual identity invites us to actively explore other cultures’ practices around death, both past and present. Almost every philosophical and spiritual tradition encourages thinking regularly about death to not only reduce our fears but ultimately, to live a more authentic, meaningful, and even joyful life.
How to bring end-of-life discussions into the wellness movement.
No matter your spiritual or religious beliefs, here are six steps to take action toward living more comfortably with death:
1. Take time for personal reflection about what matters most to you.
Make it count, and make it a regular practice. I like using my birthday as an annual reminder to step back and reflect.
2. Recognize which relationships matter most to you.
Think about the one or two people in your life who you would want to speak for you if you were unable to speak for yourself, AND ask them to serve as your health care proxy.
3. Have a conversation about your values and priorities.
I like the card game Go Wish to help with this conversation. Go Wish has 35 cards with simple prompts about what might matter most if you are seriously ill or at the end of your life. The goal: to facilitate a conversation and prioritize what’s important so those who have to make decisions for you will know your wishes.
4. Document your wishes.
Do this in the form of an advanced health care directive or living will, and make sure your health care proxy has a copy.
5. Discuss your wishes with your health care provider.
You don’t need to wait for them to bring it up. You can start the conversation about your end-of-life preferences with your health care provider at your next visit.
6. Revisit your wishes annually.
As new circumstances arise or your health condition changes, review your wishes annually with your loved ones.
End-of-life wellness looks different for everyone. The goal is to identify what is most important to you, regularly check back in with yourself, and create a network of people who support your values. Give one of these steps a try today, and see how it goes. You might be surprised that by making choices about how you want to live and die, you feel inspired to live life to the fullest.
Fifty years ago, a physician was admitted to the hospital with stomach cancer. He wrote down in his own medical chart that he did not want CPR or to be connected to a breathing machine. His wishes were disregarded — he underwent CPR numerous times and was connected to a breathing machine until he died. Back then, not only were people treated in ways they did not want, many patients were also arbitrarily denied potentially lifesaving therapies.
Doctors decided who deserved to live or not: In one New York hospital, doctors put purple stickers on the charts of patients they determined would not receive CPR or other similar measures without the patients’ or their families’ knowledge. Decisions about life and death were subjective and opaque.
End of life care has considerably improved since then. Patient preferences now help direct physicians and nurses about what type of care they would want to receive. But 50 years into the future, we will look back on today and conclude that medicine was sorely lacking when it came to how we handle death.
Many in medicine, as well as patients and caregivers, continue to equate more procedures, more chemotherapy, and more intensive care with better care. Studies in patients with cancer and heart disease, the two greatest killers of mankind, show that patients receiving palliative care, which is an approach that focuses on quality rather than quantity of life, can actually live longer. While the goal of palliative care is to help people with a serious illness live as well as possible — physically, emotionally and spiritually — rather than as long as possible, some people receiving palliative care might also live longer since they avoid the complications associated with procedures, medications, and hospitalization
In addition, while medical advances have moved forward at blinding pace, the ethical discourse surrounding many technologies has not kept up. Take, for example, cardiac devices such as pacemakers and mechanical pumps that can be placed in the heart. Many patients with terminal illnesses who want to deactivate these devices find resistance from the health system, since some continue to equate deactivating them with euthanasia. We need to continue to make sure that even as technological advances blossom, patients remain at the center, and physicians continue to honor their wishes.
And while the palliative care specialty has greatly improved end-of-life care, too often, palliative care has been used as a way to avoid the culture change needed by all medical specialties to better handle death. Despite its many benefits, many patients and physicians are scared of “palliative care” because of its strong association with the end of life. Some have been compelled to change the title of their practices to “supportive care.” To many patients, the very name “palliative” implies that they will be abandoned, making them very reluctant to accept their services. The fact is that palliative care can, and should, be delivered to patients with serious illness alongside conventional care.
But the issues go beyond the name — one recent study showed that palliative care-led meetings with families of patients in intensive care units led to an increase in post-traumatic stress disorder symptoms among family members. Palliative care specialists are often consulted in tense situations when patients are critically ill, and they often have no prior relationship with patients or their families, who might be unprepared to have serious discussions with them. That’s why most of these difficult conversations should be delivered by the doctors and surgeons primarily responsible for treating the patients. One study estimated that by 2030, the ratio between palliative care specialists and eligible patients will be 1 to 26,000. Palliative care specialists cannot be entirely responsible for end-of-life care by themselves.
To emerge on the right side of history, the entire culture of medicine needs to be turned around. End-of-life care is not just palliative care’s business. It is everyone’s business, from emergency room doctors to primary care physicians. Physicians need to abandon outdated ideas that their role as healers is incompatible with helping patients die comfortably and on their own terms. Helping patients die well is as important as helping them live to the fullest.
In the next installment of our occasional series Windows into Health Care, health reporter Kara Lofton spoke with hospice nurse Lori Carter. Carter has been a hospice nurse for 20 years. She said for her and for many of the hospice nurses she knows, the work is a calling. She said some of what she does is straight-up nursing — managing pain, dressing wounds, and addressing symptoms of end-stage disease. But the most subtle part of the job is helping families navigate one of the most intimate and emotional times of their lives.
LOFTON: For you, when you think about hospice and the work that you do and being called to it, what does that mean exactly to you?
CARTER: Just being with the patient and the family in the most emotional time of their life. Helping them give each other that last act of love. I appreciate and I feel honored that I am with that patient and that family during that time.
LOFTON: So some people, and I’ve heard especially in Appalachia, can have preconceived notions about what hospice is and what you actually do exactly. Explain to me what you do. What happens when you go into a home for the first time and how does that relationship form?
CARTER: Well, depending on, you know, what is going on with the patient and how early or late in the disease trajectory that we get them, you introduce yourself and…you listen. The big thing is you listen…You can find out f there is struggle already between what is happening with the patient and how the family is dealing with that. Of course, you know, we treat any symptoms that the patient has. I mean, my job I feel is [to be] the patient advocate and just trying to palliate those symptoms that they have inside [so] that they are comfortable.
I find out, you know, is there any things that they want to do before they die? You know, what are they able to do? And I try to facilitate that in any way that I can. I have a bag of ramps in my car right now, [in] that a patient wanted some ramps. I knew that would be the last time he got to eat ramps, so I went and dug some up.
LOFTON: Some people think of hospice as giving up so, to speak. When you hear that what is your reaction to that?
CARTER: I think it’s very sad. You know, we all are going to die. We all are. And, you know, normally the patients that we get — they have already fought for a very long time. This is the last act of love that you can give and, you know, it’s going to happen whether hospice is there or not. And they are most certainly not giving up. I mean, they’re getting ready to go down a path that they’ve never been down either.
LOFTON: Has this work changed how you think about death?
CARTER: It most certainly has. My family was not the type that, you know, went to funerals all the time…I came into hospice blind, really. And I quickly learned that it is a special experience. You have to believe that quality of life is better than quantity.
And I tell you how I cope with things is I will walk into a home, and I will look…there’s always pictures on the walls of, you know, families. And I will look at those. I always do. And I can see what that patient looked like, and how robust they were, and how happy they were. And then I see the patient now, and that actually helps me know what I need to do and how I need to direct the family into what’s happening. You know where they are in this, this experience that they’re getting ready to have.
LOFTON: One of the things I think is interesting about hearing conversations around hospice, especially from providers in hospice, is that we hear a lot about a nursing shortage and yet, and like nursing turnover in hospitals. But hospice seems to have lower turnover rates. And people who become nurses in hospice tend to stay around despite being around death all the time, essentially. Why do you think that is?
CARTER: I think it is a calling. I think you do realize that it’s a special kind of nursing — you fall so much in love with what you do, and the families, and the patients. And I cannot imagine doing anything else. I don’t think it is for every nurse. I don’t. I think that you have a special belief and you want that special relationship with the patient and the family. I worked in the hospital and some nurses think that’s great, and that’s wonderful for them. But I didn’t feel, for me, that I could give the care — and the personal care, maybe I should say — that I wanted to. I just didn’t feel that I could do that. And with hospice, I can.
LOFTON: Does working with people at the end of life change how you live your life now?
CARTER: It does. You know, I have heard so many times from patients: ‘You know, I wish I would have done this or I wish I would have done that.’ I hear of their regrets. I see families and patients try to get over, you know, maybe they had been estranged, child had been estranged from a parent or, you know, a parent left and now they’re, they’re trying to make amends. I think …it’s taught me that I need to ask for forgiveness, not to have regrets, say what I need to say to my loved ones. So that when that time comes, you won’t have those regrets and those losses.
LOFTON: When you hear about things that people wish they had done, are there any themes that stand out to you that lots of people kind of have regrets with at the end of life?
CARTER: Oh, I think a lot of times it’s ‘I should have took that trip.’ ‘I shouldn’t have worked so much.’ ‘I should have spent more time with children or spouses.’ It’s those types of things that, you know, they wish they would have done. Things that may happen in life and you really don’t give it a second thought at the time. It seems to come back at the end of life, no matter how trivial it is — you, you remember, ‘I should have said this’ or ‘I should have done that.’ But hopefully for the most part, I think, you know, they may say those things. But again, it’s usually not big, huge things.
LOFTON: Over the last 20 years that you’ve been working in hospice, how has it changed?
CARTER: Well, when I first started, no one knew what it was. And now it is more mainstream. I think people are more, they understand more, what is happening. It — death — is not shunned like it used to be, you know. People talk about it more. Unfortunately with our drug problem, it has caused some problems for us. I have to count pills every time I go. I have to watch neighbors coming over to visit — we have to find a [secure] place to put the medicine. It used to be able to sit beside the bed, but it can’t do that anymore.
LOFTON: As more young people leave the state, are you seeing [a] smaller family group surrounding a patient at the end of life?
CARTER: I am. And I’m seeing, you know, a lot of times it’s the 90-year-old spouse trying to take care of the 90-year-old husband or wife. Family seems to live out of state a lot of times, and it has definitely caused some problems. Fortunately, we also have a long-term care team. And if the patient needs to be placed, they can still have hospice care. But there’s definitely a lot of family that are not local anymore…they’re looking to hire caregivers, [but] they might not be able to afford caregivers. In that case, we just try to ramp up our visits, and try to pull in anyone that we can possibly pull in to assist that family.
Most of us die with deep regrets about how we spent our lives. It sounds very heavy. But if you’d like to have access to your end-of-life wisdom right now, while there’s still time to do something about it, you can. You don’t need to have faced your own mortality to benefit from my experience, and the end of life experiences of many other people just like you. I feel certain you’ll come away feeling much brighter.
In 1995 I got so sick that doctors at St Thomas’s Hospital in London allowed my partner to bring my dog into the hospital ward. That’s how certain medics were that I would be dead by the morning. Both my then partner, Gavin, and my dog, an Irish Terrier called Sam, slept with me for what everyone thought would be my last night.
I got lucky. 25 years later, I’m still alive, with a new partner and new dogs. What a gift. Despite what you may think, the real gift was being forced to face my own mortality at such a young age, because the experience made it possible for me to understand with life-changing clarity what matters most in life.
Before all this happened, I knew that my partner, family, friends, and dog were more important to me than any achievements or possessions. Of course, I knew this – we all know it, right? Rationally this made sense to me. But I didn’t feel it in my gut. I didn’t live it. Like most of us, I was defined by my job and my home. I thought this was how others defined me too.
In his book A New Earth spiritual teacher Eckhart Tolle writes beautifully about how we are all taught from an early age to identify with “doing” and “having.” “I am this potato print” “I am this doll.” Our parents, who were themselves shown love by our grandparents through “doing” and “having,” take us to the zoo, the movies or the ball game; they buy us toys and treats. What we crave, first as children and later as adults, writes Tolle, is “being” -the intimate closeness we feel in the wordless connection we get from touch and scent and looking into the eyes of someone we love. This is “being.”
When I was first told by Doctors who really knew what they were talking about that it was unlikely I would live more than a year, everything I’d done, all my achievements, and everything I’d accumulated, all my possessions, meant nothing to me. Nothing. None of the other noise – the gossip, the grudges; the rivalry or competition- meant anything to me either.
Suddenly, all that mattered to me was this: Who I love. And who loves me.
This is why I was not at all surprised to learn of the hundreds of profound end of life experiences, witnessed by an extraordinary palliative care worker, Bronnie Ware. The dying people she listened to had experienced exactly what I had experienced.
When questioned about any regrets they had or anything they would do differently, common themes surfaced again and again. Here are the most common five regrets which Bronnie noted:
1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
This was the most common regret of all. When people realize that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honored even a half of their dreams and had to die knowing that it was due to choices they had made, or not made.
2. I wish I hadn’t worked so hard.
They felt they’d missed out on some of their children’s youth and their partner’s companionship. A lot of men (and some women) talked about this regret. All of the men Bronnie met deeply regretted spending so much of their lives on the treadmill of a work existence.
3. I wish I’d had the courage to express my feelings.
Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a compromised existence and never became who they felt they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.
4. I wish I had stayed in touch with my friends.
Often they would not truly realize the full benefits of old friends until their dying weeks and it was not always possible to track them down. It all comes down to love and relationships in the end, Bronnie concludes. That is all that remains in the final weeks, love and relationships.
5. I wish I had let myself be happier.
This is a surprisingly common one. Many did not realize until the end that happiness is a choice. They had stayed stuck in old patterns and habits. Fear of change had them pretending to others, and to themselves, that they were content. When deep within, they longed to laugh properly and have more silliness in their life.
The tragedy is that most of us only come to this profound awareness on our deathbed, when it’s too late for us to do anything about it. All we are left with is our regrets.
I can’t tell you how lucky I feel to have been given a diagnosis, mistakenly believed to be terminal, when I was so young. The expected human life span of 83.4 years is 1000 months. Yes, 83.4 x 12 = 1000. Assuming you will live to 100, you can do your own math to figure out how long you have left. However, if you don’t want to die with a lot of regrets:
Live a life that’s true to who you feel you are, not driven by what others expect
Don’t spend so much time ‘at work’
Express your feelings
Keep in touch with your friends
Laugh and be silly
When you too access your end of life wisdom, you will feel that your life is not about your possessions or your achievements. It’s about who you loved and who loved you. So why not get a jump on it and embrace this wisdom and those you love – right now.
From joining coffin clubs to downloading apps like WeCroak, here’s how a growing number of people are living their best life by embracing death.
by Stephanie Booth
Taking a dirt nap. Biting the big one. Gone — forever.
Given the gloom and painful finality with which we speak about death, it’s no wonder that 56.4 percent of Americans are “afraid” or “very afraid” of the people they love dying, according to a Chapman University study.
The cultural mindset is that it’s something terrible to be avoided — even though it happens to all of us.
But in recent years, people from all walks of life have begun to publicly push back against that oxymoronic idea.
It’s called the death positive movement, and the goal isn’t to make death obsolete. This way of thinking simply argues that “cultural censorship” of death isn’t doing us any favors. In fact, it’s cutting into the valuable time we have while we’re still alive.
What does that look like, exactly?
This rebranding of death includes end-of-life doulas, death cafes (casual get-togethers where people chat about dying), funeral homes that let you dress your loved one’s body for their cremation or be present for it.
There’s even the WeCroak app, which delivers five death-relevant quotes to your phone each day. (“Don’t forget,” a screen reminder will gently nudge, “you’re going to die.”)
Yet despite its name, the death positive movement isn’t a yellow smiley face–substitute for grief.
Instead, “it’s a way of moving toward neutral acceptance of death and embracing values which make us more conscious of our day-to-day living,” explained Robert Neimeyer, PhD, director of the Portland Institute for Loss and Transition, which offers training and certification in grief therapy.
Death as a positive mindset
Although it’s hard to imagine, what with our 24-hour news cycle that feeds on fatalities, death hasn’t always been such a terrifying prospect.
Well, at least early death was more commonplace.
Back in 1880, the average American was only expected to live to see their 39th birthday. But “as medicine has advanced, so has death become more remote,” explained Ralph White.
White is the co-founder of the the New York Open Center, an inspired learning center that launched the Art of Dying Institute. This is an initiative with a mission to reshape the understanding of death.
Studies show that 80 percent of Americans would prefer to take their last breath at home, yet only 20 percent do. Sixty percent die in hospitals, while 20 percent live their last days in nursing homes.
“Doctors are trained to experience the death of their patients as failure, so everything is done to prolong life,” White said. “Many people use up their life savings in the last six months of their lives on ultimately futile medical interventions.”
When the institute was founded four years ago, attendees often had a professional motivation. They were hospice nurses, for instance, or cancer doctors, social workers, or chaplains. Today, participants are often just curious individuals.
“We consider this a reflection of American culture’s growing openness to addressing death and dying more candidly,” White said.
“The common thread is that they’re all willing to engage with the profound questions around dying: How do we best prepare? How can we make the experience less frightening to ourselves and others? What might we expect if consciousness continues after death? What are the most effective and compassionate ways of working with the dying and their families?”
“The death of another can often crack us open and reveal aspects of ourselves that we don’t always want to see, acknowledge, or feel,” added Tisha Ford, manager of institutes and long-term trainings for the NY Open Center.
“The more we deny death’s existence, the easier it is to keep those parts of ourselves neatly tucked away.”
Death as a community builder
In 2010, Katie Williams, a former palliative care nurse, was attending a meeting for lifelong learners in her hometown of Rotorua, New Zealand, when the leader asked if anyone had new ideas for clubs. Williams did. She suggested she could build her own coffin.
“It was a shot from somewhere and totally not a considered idea,” said Williams, now 80. “There was no forward planning and little skill background.”
Williams called up friends between the ages of 70 and 90 with carpentry or design skills she thought could be useful. With the help of a local funeral director, they began building and decorating coffins in William’s garage.
“Most found the idea appealing and the creativity exciting,” said Williams. “It was an incredible social time, and many found the friendships they made very valuable.”
Nine years later, although they’ve since moved to a larger facility, Williams and her Coffin Club members still meet every Wednesday afternoon.
Children and grandchildren often come too.
“We think it’s important that the young family members come [to] help them to normalize the fact that people die,” explained Williams. “There’s been so much ‘head in the sand’ thinking involved with death and dying.”
Younger adults have shown up to make coffins for terminally ill parents or grandparents. So have families or close friends experiencing a death.
“There’s lots of crying, laughing, love and sadness, but it has been very therapeutic as all ages are involved,” said Williams.
There are now multiple Coffin Clubs across New Zealand, as well as other parts of the world, including the United States. But it’s less about the final product and more about the company, Williams pointed out.
“It gives [people] the opportunity to voice concerns, get advice, tell stories and mingle in a free, open way,” said Williams. “To many who come, it’s an outing each week that they cherish.”
Death as a life changer
Janie Rakow, an end-of-life doula, hasn’t just changed her life because of death. She helps others do the same.
A corporate accountant for 20 years, Rakow still vividly remembers being mid-workout at a gym when planes struck the World Trade Towers on September 11, 2001.
“I remember saying to myself, ‘Life can change in one second,’” said the Paramus, New Jersey, resident. “That day, I wanted to change my life.”
Rakow quit her job and started volunteering at a local hospice, offering emotional and spiritual support to patients and their families. The experience profoundly changed her.
“People say, ‘Oh my gosh, it must be so depressing,’ but it’s just the opposite,” Rakow said.
During a person’s last days of life, end-of-life doulas fill a gap that hospice workers simply don’t have the time for. Besides assisting with physical needs, doulas help clients explore meaning in their life and create a lasting legacy. That can mean compiling favorite recipes into a book for family members, writing letters to an unborn grandchild, or helping to clear the air with a loved one.
Sometimes, it’s simply sitting down and asking, “So, what was your life like?”
“We’ve all touched other people’s lives,” said Rakow. “Just by talking to someone, we can uncover the little threads that run through and connect.”
Doulas can also help create a “vigil plan” — a blueprint of what the dying person would like their death to look like, whether at home or in hospice. It can include what music to play, readings to be shared aloud, even what a dying space may look like.
End-of-life doulas explain signs of the dying process to family and friends, and afterward the doulas stick around to help them process the range of emotions they’re feeling.
If you’re thinking it’s not so far removed from what a birth doula does, you’d be correct.
“It’s a big misconception that death is so scary,” said Rakow. “99 percent of the deaths I’ve witnessed are calm and peaceful. It can be a beautiful experience. People need to be open to that.”
Thich Nhat Hanh has done more than perhaps any Buddhist alive today to articulate and disseminate the core Buddhist teachings of mindfulness, kindness, and compassion to a broad global audience. The Vietnamese monk, who has written more than 100 books, is second only to the Dalai Lama in fame and influence.
Nhat Hanh made his name doing human rights and reconciliation work during the Vietnam War, which led Martin Luther King Jr. to nominate him for a Nobel Prize.
In 2014, Nhat Hanh, who is now 92 years old, had a stroke at Plum Village, the monastery and retreat center in southwest France he founded in 1982 that was also his home base. Though he was unable to speak after the stroke, he continued to lead the community, using his left arm and facial expressions to communicate.
In October 2018, Nhat Hanh stunned his disciples by informing them that he would like to return home to Vietnam to pass his final days at the Tu Hieu root temple in Hue, where he became a monk in 1942 at age 16.
As Time’s Liam Fitzpatrick wrote, Nhat Hanh was exiled from Vietnam for his antiwar activism from 1966 until he was finally invited back in 2005. But his return to his homeland is less about political reconciliation than something much deeper. And it contains lessons for all of us about how to die peacefully and how to let go of the people we love.
When I heard that Nhat Hanh had returned to Vietnam, I wanted to learn more about the decision. So I called up Brother Phap Dung, a senior disciple and monk who is helping to run Plum Village in Nhat Hanh’s absence. (I spoke to Phap Dung in 2016 right after Donald Trump won the presidential election, about how we can use mindfulness in times of conflict.)
Our conversation has been edited for length and clarity.
Tell me about your teacher’s decision to go to Vietnam and how you interpret the meaning of it.
He’s definitely coming back to his roots.
He has come back to the place where he grew up as a monk. The message is to remember we don’t come from nowhere. We have roots. We have ancestors. We are part of a lineage or stream.
It’s a beautiful message, to see ourselves as a stream, as a lineage, and it is the deepest teaching in Buddhism: non-self. We are empty of a separate self, and yet at the same time, we are full of our ancestors.
He has emphasized this Vietnamese tradition of ancestral worship as a practice in our community. Worship here means to remember. For him to return to Vietnam is to point out that we are a stream that runs way back to the time of the Buddha in India, beyond even Vietnam and China.
So he is reconnecting to the stream that came before him. And that suggests the larger community he has built is connected to that stream too. The stream will continue flowing after him.
It’s like the circle that he often draws with the calligraphy brush. He’s returned to Vietnam after 50 years of being in the West. When he first left to call for peace during the Vietnam War was the start of the circle; slowly, he traveled to other countries to do the teaching, making the rounds. And then slowly he returned to Asia, to Indonesia, Hong Kong, China. Eventually, Vietnam opened up to allow him to return three other times. This return now is kind of like a closing of the circle.
It’s also like the light of the candle being transferred, to the next candle, to many other candles, for us to continue to live and practice and to continue his work. For me, it feels like that, like the light is lit in each one of us.
And as one of his senior monks, do you feel like you are passing the candle too?
Before I met Thay in 1992, I was not aware, I was running busy and doing my architectural, ambitious things in the US. But he taught me to really enjoy living in the present moment, that it is something that we can train in.
Now as I practice, I am keeping the candlelight illuminated, and I can also share the practice with others. Now I’m teaching and caring for the monks, nuns, and lay friends who come to our community just as our teacher did.
So he is 92 and his health is fragile, but he is not bedridden. What is he up to in Vietnam?
The first thing he did when he got there was to go to the stupa [shrine], light a candle, and touch the earth. Paying respect like that — it’s like plugging in. You can get so much energy when you can remember your teacher.
He’s not sitting around waiting. He is doing his best to enjoy the rest of his life. He is eating regularly. He even can now drink tea and invite his students to enjoy a cup with him. And his actions are very deliberate.
Once, the attendants took him out to visit before the lunar new year to enjoy the flower market. On their way back, he directed the entourage to change course and to go to a few particular temples. At first, everyone was confused, until they found out that these temples had an affiliation to our community. He remembered the exact location of these temples and the direction to get there. The attendants realized that he wanted to visit the temple of a monk who had lived a long time in Plum Village, France; and another one where he studied as a young monk. It’s very clear that although he’s physically limited, and in a wheelchair, he is still living his life, doing what his body and health allows.
Anytime he’s healthy enough, he shows up for sangha gatherings and community gatherings. Even though he doesn’t have to do anything. For him, there is no such thing as retirement.
But you are also in this process of letting him go, right?
Of course, letting go is one of our main practices. It goes along with recognizing the impermanent nature of things, of the world, and of our loved ones.
This transition period is his last and deepest teaching to our community. He is showing us how to make the transition gracefully, even after the stroke and being limited physically. He still enjoys his day every chance he gets.
My practice is not to wait for the moment when he takes his last breath. Each day I practice to let him go, by letting him be with me, within me, and with each of my conscious breaths. He is alive in my breath, in my awareness.
Breathing in, I breathe with my teacher within me; breathing out, I see him smiling with me. When we make a step with gentleness, we let him walk with us, and we allow him to continue within our steps. Letting go is also the practice of letting in, letting your teacher be alive in you, and to see that he is more than just a physical body now in Vietnam.
What have you learned about dying from your teacher?
There is dying in the sense of letting this body go, letting go of feelings, emotions, these things we call our identity, and practicing to let those go.
The trouble is, we don’t let ourselves die day by day. Instead, we carry ideas about each other and ourselves. Sometimes it’s good, but sometimes it’s detrimental to our growth. We brand ourselves and imprison ourselves to an idea.
Letting go is a practice not only when you reach 90. It’s one of the highest practices. This can move you toward equanimity, a state of freedom, a form of peace. Waking up each day as a rebirth, now that is a practice.
In the historical dimension, we practice to accept that we will get to a point where the body will be limited and we will be sick. There is birth, old age, sickness, and death. How will we deal with it?
What are some of the most important teachings from Buddhism about dying?
We are aware that one day we are all going to deteriorate and die — our neurons, our arms, our flesh and bones. But if our practice and our awareness is strong enough, we can see beyond the dying body and pay attention also to the spiritual body. We continue through the spirit of our speech, our thinking, and our actions. These three aspects of body, speech, and mind continues.
In Buddhism, we call this the nature of no birth and no death. It is the other dimension of the ultimate. It’s not something idealized, or clean. The body has to do what it does, and the mind as well.
But in the ultimate dimension, there is continuation. We can cultivate this awareness of this nature of no birth and no death, this way of living in the ultimate dimension; then slowly our fear of death will lessen.
This awareness also helps us be more mindful in our daily life, to cherish every moment and everyone in our life.
One of the most powerful teachings that he shared with us before he got sick was about not building a stupa [shrine for his remains] for him and putting his ashes in an urn for us to pray to. He strongly commanded us not to do this. I will paraphrase his message:
“Please do not build a stupa for me. Please do not put my ashes in a vase, lock me inside, and limit who I am. I know this will be difficult for some of you. If you must build a stupa though, please make sure that you put a sign on it that says, ‘I am not in here.’ In addition, you can also put another sign that says, ‘I am not out there either,’ and a third sign that says, ‘If I am anywhere, it is in your mindful breathing and in your peaceful steps.’”