Music and spirituality are two mediums frequently – almost ubiquitously – partnered in cultures around the world with the intention of enhancing engagement with the divine. Spiritual practices are infused with music to intensify the transpersonal components of worship, meditation, and ritual. Correspondingly, musical encounters are infused with spiritually-based beliefs and practices to provide individuals connections with themselves and others in uniquely powerful ways.
For many, this easy, reciprocal flow from music to spirituality may come as no surprise: both are malleable mediums responsive to the people engaging with them and the settings in which they are engaged. For instance, Amazing Grace performed at a funeral in a church with a large congregation might be led with a louder volume, increased pressure, and heightened resonance to match the congregation’s energy as they worship through song. In contrast, Amazing Grace performed bedside in a hospital room with a patient and caregivers might embody quieter, more prayerful qualities intending to comfortingly hold the patient in their depleted physical state and engender intimate musical sharing.
As music and spirituality intertwine, their boundaries become increasingly fluid to the point that distinguishing between one and the other becomes trivial. To be spiritual is to be musical, and to be musical is to be spiritual.
A similar malleability is also present in individuals’ health journeys. Objective characteristics of health – such as symptom acuity/chronicity; treatment dosage and frequency; and curative versus palliative outcomes – are subjectively experienced in response to the individual’s values, morals, and disease trajectory. For instance, one person’s 6 out of 10 pain is their daily baseline and thus easily managed, while another’s 6 out of 10 pain is breakthrough and requires treatment. Similarly, one person may prioritize the improved quality of life offered by palliative care while another may prioritize the potential increased longevity offered by curative treatments.
These dynamic, emergent qualities of music, spirituality, and health are a result of each being culturally situated phenomena. That is, the manner in which music, spirituality, and health are conceptualized and engaged with is directly informed by the distinct cultures in which they manifest. This leads to a fraught but important question: If music, spirituality, and health are each unto themselves complex phenomena derived from cultural factors, how do all three interact when they intersect in a singular encounter?
Board-certified music therapists frequently navigate this encounter in hospice. Hospice is a philosophy of care that prioritizes quality of life with six months or less to live, putting critical health issues at the forefront with limited time to facilitate resolution and closure. At such a juncture, spirituality can be a critical resource for patients and families who are simultaneously managing in the moment and preparing for the future. The type of resource spirituality can become (e.g., comfort in ritual, strength from scripture or peace through prayer/meditation/worship) is determined by the specific faith traditions of the patient – not just an identified denomination but the explicit experiences patients engaged in as part of their spiritual practice.
Music therapists assess those faith traditions for each patient and, coupled with a similar assessment of patients’ music traditions, craft music experiences that help patients become aware of and engage with their spiritually-based resources. These culturally informed clinical music processes interweave music, spirituality, and health in a way that affords patients agency in dictating the circumstances of their death. Yet, contemporary discussions in the music therapy literature have tended to frame spirituality from such a broad and generic stance that it becomes difficult for music therapists to locate spiritually-based resources in patients.
To address this limitation, my co-author (Cathleen Flynn) and I recently authored a paper that explored a specific culturally informed music, spiritual, and health intersection: music therapy for Christian patients and caregivers during imminent death. Using this intersection as a foundation, we developed a theoretical model positioning music therapy as a psychospiritual ministry providing patients and caregivers access to a faith-based resource – the Holy Spirit – that assists with transcendence as end-of-life transitions neared.
Transcendence, a difficult concept to lock down, is a movement beyond the typical, readily accessible experiences that define our day-to-day to experience the self and other in new ways that push beyond our known thresholds. For Christian patients who are imminently dying, that transcendence is vertical, an upward trajectory that moves them closer to an integration with the divine as they move beyond the corporeal. For Christian caregivers, that transcendence is horizontal, an outward trajectory that moves them closer to mortal support structures that assist in their transition to bereavement. The Holy Spirit, an intermediary between the mortal and divine, is the faith-based avenue through which these different but concomitant transcendences occur. From this vantage point, the music therapist assumes a ministerial role, constructing dynamic music experiences that facilitate interactions with the Holy Spirit promoting patient and caregiver transcendence.
Such explicit framing is ethically fraught. First, we do not argue that adopting a Christian lens is the “only” way or the “correct” way for music therapy to be practiced in hospice; rather, we introduce this theoretical model as a broad template for conducting spiritual assessments of patients from diverse traditions and beliefs. Second, this is a person-centered model wherein any implementation of Christian theology into music therapy processes is cued by the patient rather than introduced by the music therapist; this is an essential aspect as it avoids the perception that music therapists might leverage privilege to proselytize to patients. Third, there are numerous avenues for ethical and effective clinical support of Christian patients and families at the end of life, and this model is not meant to be a linear prescription; rather, it is an exploratory avenue that opens a multitude of additional doorways for providing psychospiritual care.
As the baby boomer generation continues to advance in age, it will be increasingly important that healthcare systems are well positioned to provide comprehensive end-of-life care addressing mind, body, and spirit as equal partners in whole-person health. Music and spirituality continue to be important day-to-day aspects for many people, and exploring diverse permutations of music, spirituality, and health intersections can be an important contribution to this pursuit of the good death.
As a Tibetan Buddhist practitioner, I am constantly reminded that we never know when death might approach, but for years, I’d avoided dealing with one of the most practical aspects of death—the paperwork. I was not alone: Roughly half of all adults in North America do not have a living will. Then recently, I suffered a near-fatal illness that left me viscerally aware of how unprepared for death I was, and I made a pledge with two of my friends to get ready to leave our bodies behind for both ourselves and the people who survive us.
Bridging the end of December 2017 and the beginning of January 2018, I spent a month in a Vancouver, British Columbia hospital with a bacterial lung infection that had also invaded my pleural cavity—the first time I’d come down with a severe illness. After ten days in an intensive-care unit, I was moved to a recovery ward where I suffered a relapse. I spent my 62nd birthday, Christmas, and New Years with strangers in the hospital.
One night in the ICU, while I was partly delirious and falling in and out of sleep, I had a vision of a deceased friend reaching out to me. From what felt like disengaged consciousness, I looked down at my body on the hospital bed and realized I wasn’t ready to die. I hadn’t studied my lama’s [teacher’s] bardo teachings to navigate the intermediate state between death and rebirth, and did not want to take that journey without a road map. It didn’t matter whether this was a drug-fueled hallucination or an actual near-death experience. The important thing is that I rejected death, not out of fear, but through a recognition of the dreamlike nature of reality. After this experience, I felt that my attachment to this life and the things in it had diminished. I no longer wanted to ignore what came next. I wanted to be prepared.
When I told my friends Liv and Rosie about this vision, we agreed to study the bardo teachings together once I’d had a couple of months of recuperation. By March, however, our plans shifted. Rosie had heard about a man (I’ll call him Ben) who had died on Lasqueti Island, an off-the-grid enclave in Canada’s Southern Gulf Islands that a local cookbook once described as “somewhere between Dogpatch and Shangri-La.” He had left his closest friends without any instructions. They had no idea if he had a family or where they might be.
“And he left an old dog behind!” Rosie said, “Can you imagine?”
“Not the bodhisattva way to die,” I replied, referring to the Buddhist ideal of compassion. I also imagined what mess I might have left, had I not made it.
Promising they would never leave others in such a quandary, Ben’s closest friends created a document called the Good to Go Kit, which detailed information required for end-of-life paperwork. (It is now sold at the Lasqueti Saturday market to raise funds for their medical center.)
“I’ve been wanting to make a will for 20 years,” said Liv, who would soon turn 70, “but research throws me into information overload, which adds to the emotional overwhelm I feel just thinking about it.”
“What if we did this together instead of studying the bardo?” suggested Rosie, who was in her early 50s.
Writing a will, figuring out advanced healthcare directives, and noting our final wishes didn’t have the mystical lure of bardo teachings, but we set that aside for a year while we took on this more practical area of inquiry.
To use our time wisely, we set several parameters in place. We decided to meet one weekend a month to allow time for research and reflection between meetings, and we chose to keep our group small for ease of scheduling and to allow us to delve deeper into each topic.
“I’d like this to be structured,” said Liv, “so it doesn’t devolve into a social event.”
Rosie and I agreed but we knew better than to believe there didn’t need to be some socializing. She offered her place for the first meeting and said she’d cook.
“We’ll get our chit-chat out of the way over dinner,” she said. “Since we can all be a little intimidated by this process, we have to make it fun.”
Later in March at Rosie’s garden suite, we sat down to dinner and Liv passed out copies of “A Contemplation of Food and Nourishment,” which begins with the appropriate words: “All life forms eat and are eaten, give up their lives to nourish others.” The prayer was written by Lama Mark Webber, Liv and Rosie’s teacher in the Drikung Kagyu school. (I also study with Lama Mark, although my main teacher, Khenpo Sonam Tobgyal, is in the Nyingma lineage.) Turning our meetings into sacred practice seemed the obvious container to keep us on topic.
After dinner, Rosie rang a bell, we said a refuge prayer and recited the traditional four immeasurables prayer to generate equanimity, love, compassion, and joy toward all sentient beings.
We traded our prayers for notebooks and reviewed our Good to Go Kit. Rosie smiled at the expected question of pets—including the name of the person who would be caring for the pet, the veterinarian and whether money had been set aside for their expenses. The form also asked whether we had hidden items or buried treasure.
Liv laughed and said, “People still bury strongboxes in their backyards?”
My answer was more prosaic: “Storage lockers.”
Rosie, Liv, and I are all single and childless. We are all self-employed and independent and have chosen Canada as our adopted homeland, meaning we have no family here. So we considered what roles friends might play and focused on those who were closer geographically than sentimentally.
Pulling them in to act on our behalf seemed like such a “big ask” as Rosie said, but it was time to get real about our needs. The three of us shared our feelings about involving friends outside the dharma versus those within.
When I was in the ICU, my friend Diane visited on several occasions and later told me she remained calm until she reached her car, where she cried uncontrollably. In marked contrast, my dharma friend Emma calmly asked what I needed and didn’t make much of a fuss. My Buddhist friends tend to view death as a natural transition from one incarnation to the next, while other friends may see it in more dire terms: as a finality or even failure. For end-of-life situations, asking non-Buddhist friends for limited practical support seemed kinder for all involved.
We started to familiarize ourselves with the responsibilities of someone granted power of attorney for legal and financial proxy and enduring power of attorney for healthcare. Months later, we agreed our network of “dharma sisters” would be the perfect fit. While we hope to maintain our ability to make decisions for ourselves, should we require long-term care, we felt the baton could be passed between a dozen or so trustworthy women. We have since spoken casually about this with a number of these women and have made plans to organize a get-together and discuss our plans in greater detail, offering reciprocal support for what the Buddhist author Sallie Tisdale calls “the immeasurable wonder and disaster of change.”
We concluded our five hours together by dedicating the merit and reciting prayers of dedication and aspiration. Long-life prayers for our lamas were offered, a bell rung, and heads bowed. Without the need for further conversation, we made our way into the chilly spring evening, silently reflecting on our new endeavor.
The next meeting and those following included menus and discussions that varied widely. Our research grew monthly with documents from government agencies, legal and trust firms, and funeral homes. None of which felt specific to Buddhist practitioners, until Rosie told us about Life in Relation to Death: Second Edition by the late Tibetan teacher Chagdud Tulku Rinpoche. This small book is out of print, but I purchased a Kindle copy. In the introduction, Chagdud Tulku, a respected Vajrayana teacher and skilled physician, reminds us that “[t]here are many methods, extraordinary and ordinary, to prepare for the transformation of death.” A book of Buddhist “pith instruction,” it includes in its second edition appendices that above all I found most valuable. These include suggested forms for “Durable Power of Attorney for Health Care,” “Advance Directive for Health Care (Living Will),” “Miscellaneous Statements for Witnesses, Notary and Physician,” and “Letter of Instructions.” It even includes a wonderful note for adding your ashes to tza-tsas, small sacred images stamped out of clay. We loved that idea, though we couldn’t imagine asking friends to go to that extent to honor our passing.
We decided to use a community-based notary public to draw up our wills, but with further research, Liv realized she could also hire them to act as her executor, rather than use her bank. She found someone experienced and enjoyed the more personable experience. In contrast, Rosie and I’ve decided to pay friends now that we’ve found ways to simplify that process for them.
Memorial Societies are common in North America and help consumers obtain reasonably priced funeral arrangements. Pre-paying services at a recommended funeral home allows us to leave funds with them for executor expenses, should our assets be frozen in probate. End-of-life insurance “add-ons” we like include travel protection—should we die away from home—and a final document service to close accounts and handle time-consuming administrative tasks.
In her book Advice for Future Corpses (and Those Who Love Them): A Practical Perspective on Death and Dying, Sallie Tisdale says, “Your body is the last object for which you can be responsible, and this wish may be the most personal one you ever make.” Traditionally in Tibetan Buddhism, the edict is to leave the body undisturbed for three days after death so your consciousness has time to disengage. Tisdale states that American law generally allows you to leave a body in place for at least 24 hours and that while a hospital might want to give you less time, you might be able to negotiate for more.
We then turned to the thorny topic of organ donation, with Rosie and Liv both deciding against. Knowing someone would soon be taking a scalpel to your cadaver would not enhance the peaceful mind they hope to die with, while my view was just the opposite. Besides gaining merit through donation, that same scalpel image provides great motivation to leave the body quickly.
While reading Tisdale’s chapter titled “Bodies,” I began entertaining thoughts of a green burial, but after months of discussion, I ended up where we all started: with expedient cremations. Rosie wanted her ashes buried and a fragrant rose bush planted on top. Liv and I were more comfortable in the water and decided our ashes would best be left there, but not scattered to ride on the wind. We selected biodegradable urns imprinted with tiny footprints. Made of sand and vegetable gel, they dissolve in water within three days, leaving gentle waves to lap our remnants out to sea.
By getting past the practical and emotional aspects surrounding death, Liv has found herself in a space of awe.
“There’s a wow factor to dying that I can now embrace,” she said.
Rosie no longer worries about who will care for her in later years. Without that insecurity, she’s left with a yearning to be as present for the dying process as possible. And I have found that my understanding of life’s importance as we reach toward enlightenment has been heightened.
Our small sangha still meets monthly and is now studying bardo teachings in our ongoing attempt to create compassionate dying from compassionate living. As we have continued with our arrangements, we’ve reflected on what we gained from our meetings. We feel blessed for the profound level of intimacy and trust we now share. We have a deeper regard for other friendships and feel enveloped by an enhanced sense of community. And we all feel more cared for.
As Chagdud Tulku Rinpoche wrote in Life in Relation to Death: “Putting worldly affairs in order can be an important spiritual process. Writing a will enables us to look at our attachments and transform them into generosity.”
One of the great Jewish spiritual teachers of the 20th century, Rabbi Abraham Joshua Heschel argues that facing death gives life meaning; that life and death are both part of a greater mystery; that by virtue of being created in no less than God’s image, we can imagine an afterlife for humanity — yet at the same time death itself is an antidote to human arrogance; and that in death we pay gratitude for the wonder and gift of our existence.
Death as a Way to Understand the Meaning of Life
Our first question is to what end and upon what right do we think about the strange and totally inaccessible subject of death? The answer is because of the supreme certainty we have about the existence of man: that it cannot endure without a sense of meaning. But existence embraces both life and death, and in a way death is the test of the meaning of life. If death is devoid of meaning, then life is absurd. Life’s ultimate meaning remains obscure unless it is reflected upon in the face of death.
The fact of dying must be a major factor in our understanding of living. Yet only few of us have come face to face with death as a problem or a challenge. There is a slowness, a delay, a neglect on our part to think about it. For the subject is not exciting, but rather strange and shocking.
What characterizes modern man’s attitude toward death is escapism, disregard of its harsh reality, even a tendency to obliterate grief. He is entering, however, a new age of search for meaning of existence, and all cardinal issues will have to be faced.
Life as a Way to Understand the Meaning of Death
Death is grim, harsh, cruel, a source of infinite grief. Our first reaction is consternation. We are stunned and distraught. Slowly, our sense of dismay is followed by a sense of mystery. Suddenly, a whole life has veiled itself in secrecy. Our speech stops, our understanding fails. In the presence of death there is only silence, and a sense of awe.
Is death nothing but an obliteration, an absolute negation? The view of death is affected by our understanding of life. If life is sensed as a surprise, as a gift, defying explanation, then death ceases to be a radical, absolute negation of what life stands for. For both life and death are aspects of a greater mystery, the mystery of being, the mystery of creation. Over and above the preciousness of particular existence stands the marvel of its being related to the infinite mystery of being or creation.
Death, then, is not simply man’s coming to an end. It is also entering a beginning.
Our Greatness: The Question of an Afterlife and the “Image of God”
There is, furthermore, the mystery of my personal existence. The problem of how and whether I am going to be after I die is profoundly related to the problem of who and how I was before I was born. The mystery of an afterlife is related to the mystery of preexistence. A soul does not grow out of nothing. Does it, then, perish and dissolve in nothing?
Human life is on its way from a great distance; it has gone through ages of experience, of growing, suffering, insight, action. We are what we are by what we come from. There is a vast continuum preceding individual existence, and it is a legitimate surmise to assume that there is a continuum following individual existence. Human living is always being under way, and death is not the final destination.
In the language of the Bible to die, to be buried, is said to be “gathered to his people” (Genesis 25:8). They “were gathered to their fathers” (Judges 2:10). “When your days are fulfilled to go to be with your fathers” (I Chronicles 17:11).
Do souls become dust? Does spirit turn to ashes? How can souls, capable of creating immortal words, immortal works of thought and art, be completely dissolved, vanish forever?
Others may counter: The belief that man may have a share in eternal life is not only beyond proof; it is even presumptuous. Who could seriously maintain that members of the human species, a class of mammals, will attain eternity? What image of humanity is presupposed by the belief in immortality? Indeed, man’s hope for eternal life presupposes that there is something about man that is worthy of eternity, that has some affinity to what is divine, that is made in the likeness of the divine…
[T]he likeness of God means the likeness of Him who is unlike man. The likeness of God means the likeness of Him compared with whom all else is like nothing.
Indeed, the words “image and likeness of God” [in the biblical creation story] conceal more than they reveal. They signify something which we can neither comprehend nor verify. For what is our image? What is our likeness? Is there anything about man that may be compared with God? Our eyes do not see it; our minds cannot grasp it. Taken literally, these words are absurd, if not blasphemous. And still they hold the most important truth about the meaning of man.
Obscure as the meaning of these terms is, they undoubtedly denote something unearthly, something that belongs to the sphere of God. Demut [likeness]and tzelem [image]are of a higher sort of being than the things created in the six days. This, it seems, is what the verse intends to convey: Man partakes of an unearthly divine sort of being.
Our Smallness: Death Teaches Humility
Death is the radical refutation of man’s power and a stark reminder of the necessity to relate to a meaning which lies beyond the dimension of human time. Humanity without death would be arrogance without end. Nobility has its root in humanity, and humanity derived much of its power from the thought of death.
Death refutes the deification and distorts the arrogance of man.
He is God; what he does is right, for all his ways are just; God of faithfulness and without wrong, just and right is he.
Just art thou, O Lord, in causing death and life; thou in whose hand all living beings and kept, far be it from thee to blot out our remembrance; let thy eyes be open to us in mercy; for thine, O Lord, is mercy and forgiveness.
We know, O Lord, that thy judgment is just; thou art right when thou speakest, and justified when thou givest sentence; one must not find fault with thy manner of judging. Thou art righteous, O Lord, and thy judgment is right.
True and righteous judge, blessed art thou, all whose judgments are righteous and true.
The Lord gave and the Lord has taken away; blessed be the name of the Lord.
— Daily Prayer Book, from the Burial Service
Death as Gratitude for Existence
If life is a pilgrimage, death is an arrival, a celebration. The last word should be neither craving nor bitterness, but peace, gratitude.
We have been given so much. Why is the outcome of our lives, the sum of our achievements, so little?
Our embarrassment is like an abyss. Whatever we give away is so much less than what we receive. Perhaps this is the meaning of dying: to give one’s whole self away.
Death is not seen as mere ruin and disaster. It is felt to be a loss of further possibilities to experience and to enhance the glory and goodness of God here and now. It is not a liquidation but a summation, the end of a prelude to a symphony of which we only have a vague inkling of hope. The prelude is infinitely rich in possibilities of either enhancing or frustrating God’s patient, ongoing efforts to redeem the world.
Death is the end of what we can do in being partners to redemption. The life that follows must be earned while we are here. It does not come out of nothing; it is an ingathering, the harvest of eternal moments achieved while on earth.
Unless we cultivate sensitivity to the glory while here, unless we learn how to experience a foretaste of heaven while on earth, what can there be in store for us in life to come? The seed of life eternal is planted within us here and now. But a seed is wasted when placed on stone, into souls that die while the body is still alive.
The greatest problem is not how to continue but how to exalt our existence. The cry for a life beyond the grave is presumptuous, if there is no cry for eternal life prior to our descending to the grave. Eternity is not perpetual future but perpetual presence. He has planted in us the seed of eternal life. The world to come is not only a hereafter but also a herenow.
Our greatest problem is not how to continue but how to return. “How can I repay unto the Lord all his bountiful dealings with m?” (Psalms 116:12). When life is an answer, death is a homecoming. “Precious in the sight of the Lord is the death of his saints” (Psalms 116:14). For our greatest problem is but a resonance of God’s concern: How can I repay unto man all his bountiful dealings with me? “For the mercy of God endureth forever.”
This is the meaning of existence: to reconcile liberty with service, the passing with the lasting, to weave the threads of temporality into the fabric of eternity.
The deepest wisdom man can attain is to know that his destiny is to aid, to serve. We have to conquer in order to succumb; we have to acquire in order to give away; we have to triumph in order to be overwhelmed. Man has to understand in order to believe, to know in order to accept. The aspiration is to obtain; the perfection is to dispense. This is the meaning of death: the ultimate self-dedication to the divine. Death so understood will not be distorted by the craving for immortality, for this act of giving away is reciprocity on man’s part for God’s gift of life. For the pious man it is a privilege to die.
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.’”
Even for an unwavering nonbeliever like myself, a couple of days last week were very close to a religious experience as we watched my wife’s mother, Ruth Aylward Pommer, 87, pass from this life into what she so fervently believed would be glory in the next.
Observing the initially distressful but finally serene end of a purposeful life robustly lived was both moving and humbling, a replaying of nature’s endless symphony of life and death far beyond any human capacity to halt or reverse it. Reality in perpetually unstoppable motion.
I come from a small family, but Ruth’s extended clan is relatively vast, so it was a beautiful and compelling thing to see the legions of daughters and sons, grand-kids and great-grandkids and great-greats, other relatives and friends filter into the room to hold vigil, voice rosary prayers, tell stories, and say their final good-byes.
It was particularly magnificent to see Ruth’s children closely arrayed around her bed, eyes red with anguished concern, stroking her hair, dabbing her brow, whispering soft encouragements into her ears, carefully watching her for signs of pain or distress so they could immediately do what was required to ease it. This is love expressed in its deepest, most primal, most authentic form.
Although I have spent long hours reading and writing about the unsubstantiality of supernatural ideas, as Ruth slipped quietly away I still realized once again what I already knew — that spiritual yearning is as universally human as rage against injustice. And it is powerful. So powerful.
When the kindly young priest from Ruth’s small farming community delivered the words of last rites in respectful, gentle tones, and anointed her forehead and palms with holy oil, it felt ancient, almost primordial. It felt natural to embrace any ritual, any hope that would make this not a sad end but a beginning of something profoundly better.
For many people, few things in life are as terrifying as its end, and the attendant possibility of immortal nothingness, or, worse, endless suffering. This is why most Christians, including, as Ruth was, Catholics, focus their lives on not displeasing God and improving their chances of being heartily welcomed by St. Peter in Paradise one blessed day.
I get it, especially after this past week, after seeing fervent faith up close in ways I rarely do, at a time of great angst and sadness over the passing of a woman much loved and honored in her lifetime. Even I mourn the end of her life in a personal way. Aside from the courtesy, respect and kindness she always showed me, the big-city alien grafted onto a small farming town by way of a happenstance meeting with her daughter in a far-away land, she also gave me another treasured gift: acceptance. From the beginning, she went out of her way to make me feel part of the large family she headed.
So, there I was at the end of her life, a most secular fellow in the midst of a most religious tribe, and I must say, it was terribly moving.
The funeral service in a breathtakingly lovely community church was fittingly transcendent, with its respectfully hushed tones, the great-grandchildren singing “Amazing Grace” in the choir loft, the candles and incense, readings from Ecclesiastes (“To every thing there is a season …”), the well-said sermon that honored and treasured Ruth’s long life. People came from far and wide to attend, some driving for days to reach the church.
And there was comfort food in church halls after the wake and funeral service and then the burial gathering the following day an hour away, where she was to be laid to rest with her husband. Food is part of the ritual of human passing, where pleasure and pain, good memories and sad immediacies, converge for sustenance of those who have been left behind.
As I went through this process, though from a further emotional remove certainly than Ruth’s immediate family, I still appreciated the essential value of such loving rituals and heavenly yearnings in helping survivors move on and face their next existential challenge. I tried to not focus on the reality that these painful passages also can bring out the worst in us.
So, although nonbelievers can often be antagonistic toward faith, I am reminded that it is pointlessly unkind and destructive to ever denigrate something so visceral and nurturing to people’s lives, whatever one’s philosophical differences.
I was thinking last week, as I waited patiently with others for the inevitable, that at such times theology and religious doctrine seem irrelevant, even as they precisely structure the final proceedings of a life lived out. What matters is love, remembrance and, as necessary, forgiveness.
If someone you love has died in a hospital, you may have seen modern death at its worst: overly medicalized, impersonal, and filled with unnecessary suffering. The experience can be a bitter lesson in Buddha’s most basic teaching: the more we try to avoid suffering (including death), the worse we often make it.
Even though roughly half of Americans die in hospitals and other institutions, most of us yearn to die at home, and perhaps to experience our leavetaking as a sacred rite of passage rather than a technological flail. You don’t have to be a saint, or be wealthy, or have a Rolodex of influential names to die well. But you do need to prepare. It helps to be a member of at least one “tribe,” to have someone who cares deeply about you, and to have doctors who tell you necessary truths so that you can decide when to stop aggressive treatment and opt for hospice care. Then those who care for you can arrange the basics: privacy, cleanliness, and quiet, the removal of beeping technologies, and adequate pain control. They can listen and express their love, and provide the hands-on bedside care hospice doesn’t cover.
From then on, a more realistic hope for our caregivers, and for ourselves when we are dying, may not be an idealized “good death” by a well-behaved patient, but a “good enough death,” where we keep the dying as comfortable and pain-free as possible, and leave room for the beautiful and the transcendent—which may or may not occur.
Hospice professionals often warn against high expectations. Things will probably not go as planned, and there comes a point when radical acceptance is far more important than goal-oriented activity. They don’t like the idea, inherent in some notions of the “good death,” of expecting the dying to put on a final ritual performance for the living, one marked by beautiful last words, final reconciliations, philosophical acceptance of the coming of death, lack of fear, and a peaceful letting go.
“I don’t tell families at the outset that their experience can be life-affirming, and leave them with positive feelings and memories,” said hospice nurse Jerry Soucy. “I say instead that we’re going to do all we can to make the best of a difficult situation, because that’s what we confront. The positive feelings sometimes happen in the moment, but are more likely to be of comfort in the days and months after a death.” This is what it took, and how it looked, for the family of John Masterson.
John was an artist and sign painter, the ninth of ten children born to a devout Catholic couple in Davenport, Iowa. His mother died when he was 8, and he and two of his sisters spent nearly a year in an orphanage. He moved to Seattle in his twenties, earned a black belt in karate, started a sign-painting business, and converted to Nichiren Shoshu, the branch of Buddhism whose primary practice is chanting. He never left his house without intoning three times in Japanese Nam Myoho Renge Kyo (“I Honor the Impeccable Teachings of the Lotus Sutra”).
He was 57 and living alone, without health insurance, when he developed multiple myeloma, an incurable blood cancer. He didn’t have much money: he was the kind of person who would spend hours teaching a fellow artist how to apply gold leaf, while falling behind on his paid work. But thanks to his large extended family, his karate practice, and his fierce dedication to his religion, he was part of several tribes. He was devoted to his three children—each the result of a serious relationship with a different woman—and they loved him equally fiercely. His youngest sister, Anne, a nurse who had followed him to Seattle, said he had “an uncanny ability to piss people off but make them love him loyally forever.”
When he first started feeling exhausted and looking gaunt, John tried to cure himself with herbs and chanting. By the time Anne got him to a doctor, he had a tumor the size of a half grapefruit protruding from his breastbone. Myeloma is sometimes called a “smoldering” cancer, because it can lie dormant for years. By the time John’s was diagnosed, his was in flames.
Huge plasma cells were piling up in his bone marrow, while other rogue blood cells dissolved bone and dumped calcium into his bloodstream, damaging his kidneys and brain function. He grew too weak and confused to work or drive. Bills piled up and his house fell into foreclosure. Anne, who worked the evening shift at a local hospital, moved him into her house and drove him to various government offices to apply for food stamps, Social Security Disability, and Medicaid. She would frequently get up early to stand in line outside social services offices with his paperwork in a portable plastic file box.
Medicaid paid for the drug thalidomide, which cleared the calcium from John’s bloodstream and helped his brain and kidneys recover. A blood cancer specialist at the University of Washington Medical Center told him that a bone marrow transplant might buy him time, perhaps even years. But myeloma eventually returns; the transplant doesn’t cure it. The treatment would temporarily destroy his immune system, could kill him, and would require weeks of recovery in sterile isolation. John decided against it, and was equally adamant that he’d never go on dialysis.
After six months on thalidomide, John recovered enough to move into a government-subsidized studio apartment near Pike Place Market. He loved being on his own again and wandered the market making videos of street musicians, which he’d post on Facebook. But Anne now had to drive across town to shop, cook, and clean for him.
The health plateau lasted more than a year. But by the fall of 2010, John could no longer bear one of thalidomide’s most difficult side effects, agonizing neuropathic foot pain. When he stopped taking the drug, he knew that calcium would once again build up in his bloodstream, and that he was turning toward his death.
An older sister and brother flew out from Iowa to help Anne care for him. One sibling would spend the night, and another, or John’s oldest daughter, Keely, a law student, would spend the day.
Christmas came and went. His sister Irene returned to Iowa and was replaced by another Iowa sister, Dottie, a devout Catholic. In early January, John developed a urinary tract infection and became severely constipated and unable to pee. Anne took him to the University of Washington Medical Center for what turned out to be the last time. His kidneys were failing and his bones so eaten away by disease that when he sneezed, he broke several ribs. Before he left the hospital, John met with a hematologist, a blood specialist, who asked Anne to step briefly out of the room.
Anne does not know exactly what was said. But most UW doctors are well trained in difficult conversations, thanks to a morally responsible institutional culture on end-of-life issues. Doctors at UW do not simply present patients with retail options, like items on a menu, and expect them to blindly pick. Its doctors believe they have an obligation to use their clinical experience to act in their patients’ best interests, and they are not afraid of making frank recommendations against futile and painful end-of-life treatments. When the meeting was over, the doctor told Anne that her brother “wanted to let nature take its course.” He would enroll in hospice. Anne drove him home.
John knew he was dying. He told Anne that he wanted to “feel everything” about the process, even the pain. He took what she called “this Buddhist perspective that if he suffered he would wipe out his bad karma. I said, ‘Nah, that’s just bullshit. You’ve done nothing wrong. The idea that we’re sinners or have to suffer is ludicrous.’” She looked her brother in the eye. She knew she was going to be dispensing his medications when he no longer could, and she wasn’t going to let him suffer. She told him, ‘You’re not going to have a choice.’”
Anne said she “set an intention”: not to resist her brother’s dying, but to give him the most gentle death possible and to just let things unfold. On January 15, her birthday, she and John and a gaggle of other family members walked down to Pike Place Market to get a coffee and celebrate. John was barely able to walk: Anne kept close to him so that she could grab him if he fell. It was the last time he left the house.
The next morning, a Sunday, while Anne was sitting with John at his worktable, he looked out the window and asked her, “Do you think I’ll die today?” Anne said, “Well, Sundays are good days to die, but no, I don’t think it’s today.” It was the last fully coherent conversation she had with him.
He spent most of his last nine days in bed, as his kidneys failed and he grew increasingly confused. He didn’t seem afraid, but he was sometimes grumpy. He had increasing difficulty finding words and craved celery, which he called “the green thing.” He would ask Anne to take him to the bathroom, and then forget what he was supposed to do there. His daughter Keely took a leave of absence from law school, and Anne did the same from her job at the hospital. Fellow artists, fellow chanters, former students to whom he’d taught karate, nephews, nieces, and sign-painting clients visited, and Anne would prop him up on pillows to greet them.
Anne managed things, but with a light hand. She didn’t vet visitors, and they came at all hours. If she needed to change his sheets or turn him, she would ask whoever was there to help her, and show them how. That way, she knew that other people were capable of caring for him when she wasn’t there. “The ones that have the hardest time [with death] wring their hands and think they don’t know what to do,” she said. “But we do know what to do. Just think: If it were my body, what would I want? One of the worst things, when we’re grieving, is the sense that I didn’t do enough,” she said. “But if you get in and help, you won’t have that sense of helplessness.”
Each day John ate and spoke less and slept more, until he lost consciousness and stopped speaking entirely. To keep him from developing bedsores, Anne would turn him from one side to the other every two hours, change his diaper if necessary, and clean him, with the help of whoever was in the room. He’d groan when she moved him, so about a half an hour beforehand, she’d crush morphine and Ativan pills, mix them with water as the hospice nurse had showed her, and drip them into John’s mouth.
One morning her distraught brother Steve accused her of “killing” John by giving him too much morphine—a common fear among relatives, who sometimes can’t bear to up the dose as pain gets worse. At that moment, the hospice nurse arrived by chance, and calmly and gently explained to Steve, “Your brother is dying, and this is what dying looks like.”
The death was communal. People flowed in and out, night and day, talking of what they loved about John and things that annoyed them, bringing food, flowers, candles, and photographs until John’s worktable looked like a crowded altar. Buddhists lit incense and chanted. Someone set up a phone tree, someone else made arrangements with a funeral home, and one of the Buddhists planned the memorial service.
Most of the organizing, however, fell to Anne. It may take a village to die well, but it also takes one strong person willing to take ownership—the human equivalent of the central pole holding up a circus tent. In the final two weeks, she was in almost superhuman motion. She leaned in, she said, “into an element of the universe that knows more than I know. I was making it up as I went along. People contributed and it became very rich.
“That’s not to say there weren’t times when it was phenomenally stressful. I was dealing with all the logistics, and with my own mixed emotions about my brother. I was flooded with memories of our very complicated relationship, and at the same time I knew my intention was that he be laid to rest in the most gentle way possible.”
Hospice was a quiet support in the background. Over the two years of his illness, John’s care had perfectly integrated the medical and the practical, shifting seamlessly from prolonging his life and improving his functioning— as thalidomide and the doctors at UW had done—to relieving his suffering and attending his dying, as the hospice nurses and those who loved him had done.
There were no demons under the bed or angels above the headboard. Nor were there beeping monitors and high-tech machines. His dying was labor-intensive, as are most home deaths, and it was not without conflict.
A few days before he died, two siblings beseeched Anne to call a priest to give John last rites in the Catholic church. “It was a point of love for my siblings. They were concerned that John was going to burn in hell,” Anne said. “But John hated priests.” In tears, Anne called the Seattle church that handled such requests, and the priest, after a brief conversation, asked her to put her sister Dottie on the phone. Yes, Dottie acknowledged, John was a Buddhist. No, he hadn’t requested the sacraments. Yes, his children were adamantly opposed. No, the priest told her, under the circumstances he couldn’t come. It wasn’t John’s wish.
Ten days after the family’s last walk through Pike Place Market, the hospice nurse examined John early one morning and said, “He won’t be here tomorrow.” She was seeing incontrovertible physical signs: John’s lips and fingertips were blue and mottled. He hadn’t opened his eyes in days. His breathing was labored and irregular, but still oddly rhythmic, and he looked peaceful. The hospice nurse left. Anne, helped by John’s daughter Keely and his sister Dottie, washed and turned John and gave him his meds. Then they sat by his side. Anne had her hand on his lap.
“It was January in Seattle,” Anne said. “The sun was coming through the window and we could hear the market below beginning to wake up. We were just the three of us, talking and sharing our stories about him and the things we loved and didn’t love, the things that had pissed us off but now we laughed about. I can’t ever, in words, express the sweetness of that moment.
“He just had this one-room apartment with a little half-wall before the kitchen. I walked over to put water on to make coffee, and Keely said, ‘His breathing’s changed.’”Anne stopped, ran over, sat on the bed, and lifted her brother to a sitting position. He was light. She held him close, and during his last three breaths she chanted Nam Myoho Renge Kyo, as her brother had always done, three times, whenever he left his house. “I was really almost mouth-to-mouth chanting, and he died in my arms,” she said. “We just held him, and then my sister Dottie said her prayers over him.”
Anne sat next to her brother and said, “John, I did well.”
“I know he would not have been able to orchestrate it any better than how it unfolded,” she said.
“It was a profound experience for me. I realized what a good death could be.”
Under current law, people who have made every life decision based on their personal values and faith suddenly become, due to a terminal illness, a victim of someone else’s theology.
By Harlan Limpert
My Uncle Don died in his mid-60s after a two-year struggle with cancer. He was one of my favorites, an adult with whom I could discuss topics I couldn’t even mention to my parents. As a kid I’d often ride my bike to his home in Richfield with assurance of getting some cookies, Rice Krispies bars or a similarly unhealthful snack.
So when in college I learned he had lung cancer, I was heartbroken. Like so many cancer patients, he “fought the good fight” — chemo, surgery, radiation. Despite all the treatments, the disease was winning.
One day, after returning from one of countless doctor appointments, he walked into his bedroom, pulled out a gun and shot himself. My aunt, hearing the shot from the kitchen, lived another 20 years with that horrendous memory.
My uncle accepted some comfort care but would not succumb to the cancer robbing him of his humanity. He wanted to die as he had lived, on his own terms. But at that time, medical aid in dying (MAID) wasn’t legal. I have no doubt that, after realizing the futility of further treatment, Uncle Don would have taken advantage of MAID, which enables a mentally competent adult suffering from a terminal illness to request from their physician medication that will end life peacefully. Medical aid in dying has been legal in Oregon for 20 years since that state’s’ passage of its Death with Dignity law and is now legal in seven more states, including California.
Many of us know of someone suffering from a terminal illness. Most often they are willing to fight like hell for as long as possible but in the end pray for a gentle, painless death.
For decades, Gallup Polls have shown that a majority of Americans support medical aid in dying as an end-of-life option. Twenty state legislatures, including Minnesota’s, have introduced bills similar to Oregon’s Death with Dignity law. But, despite widespread support, lawmakers are reluctant to act. Why? Despite the overwhelming support of people of faith, some religious leaders are fighting it, insisting that Americans die by what they call a “natural death.” Suffering, they argue, is redemptive (“to change for the better”). Even the loved ones surrounding the dying person, it is believed, are changed — redeemed — by the experience.
Other people of faith — me included — see nothing redemptive about needless suffering. In fact, needless suffering is cruel and pointless. The proper religious response to suffering is to alleviate it, to show compassion to the one who is suffering. And there is nothing “natural” about being connected to numerous tubes injecting futile drugs into a dying person’s veins when that person would prefer her suffering to end. There is nothing natural about a respirator providing oxygen to a person whose clear intention was to have a good death, one surrounded by loved ones and absent of unnecessary suffering.
National Religious Freedom Day was Jan. 16. For at least 25 years, U.S. presidents have issued annual proclamations acknowledging and celebrating the many faiths that exist within our country. They have reminded us of our cherished legacy of religious liberty. They recall how Thomas Jefferson penned the Virginia Statute of Religious Freedom in 1786, which inspired the words of the First Amendment to the Constitution guaranteeing the free exercise of religion.
But when it comes to end-of-life care, an individual’s personal religious freedom is limited by current law. People who have made every life decision for decades based on their personal values and faith suddenly become, due to a terminal illness, a victim of someone else’s theology. The arena of life that is most personal and profound often has people with different religious values determine our options. At end of life, one’s personal values and spiritual beliefs ought to take priority over everything else.
Passing legislation to allow medical aid in dying in Minnesota will enable end-of-life options to be decided by an individual’s values and spiritual beliefs and no one else. Those who choose medical aid in dying can do so. Those who do not would not be affected.
As National Religious Freedom Day is celebrated, let us remember to honor religious freedom and show compassion to those wishing to end their suffering.