End of Life Mitzvahs

by Rabbi Ron Isaacs

In recent months, I read a very powerful piece in The New York Times that detailed the last day in the life of President George H. W. Bush. It described how in the last week of the president’s life he had stopped eating and was mostly sleeping.

His longtime friend and colleague, James Baker visited him frequently in his last days, and was there when he passed away. Baker described how, at the end, he held Bush’s hand and rubbed his feet.

The former president died in his home, surrounded by several friends, family members, doctors and a minister. As the end neared, his son George W. Bush, also a former president, who was at his own home in Dallas, Texas, was put on speaker phone to say goodbye.

He told his father that he had been a “wonderful dad” and that he loved him. “I love you too,” Bush told his son. And those were his final words.

Bush’s doctor described how everyone present knelt around the president and placed their hands on him and prayed for him. It was a very graceful and gentle death, accompanied by loved ones who gathered in the intimacy of his home in Houston.

For almost four years now, I have been privileged to visit nursing homes, assisted living facilities and private homes to sing and play music for people in hospice under the title of my role as “Chords of Comfort.” I also make visits as a hospice chaplain.

On some days, my patients are alert and able to converse with me. On others, they lie in bed unable to speak and sometimes sleep.

On such occasions, I sit by their bedside and just keep them company. Sometimes a family member or two is present when I visit.

Several years ago when I arrived to visit a certain patient, I was surprised to find members of her family singing and playing guitar while the patient, who could not speak, moved her head rhythmically back and forth.

One of her youngest grandchildren had flown all the way from San Francisco, Calif. to New Jersey just to sing for her great grandmother. It was obvious that the singing and playing brought great comfort and pleasure to her.

When the family asked me to join in with my guitar, it became clear to me that we all were feeling spiritually uplifted by the beautiful music that we created together.

There is a rabbi who directs a Jewish-end-of-life care/hospice volunteer program. As part of his training program, the rabbi asks the volunteers to reflect on a moment when they were in need of someone to be present for them.

One man related the story of his bicycle accident when a stranger sat silently with him on the curb until the ambulance arrived. Another volunteer described how her grandmother sat knitting in the corner of the hospital’s delivery room throughout her three-day-long labor.

What both of these stories have in common is the power of someone simply being present for another person.

Chaplaincy – spiritual care – is all about accompanying another person while being fully present. It is all about trying to ensure that there will be times during the day when a patient is not left alone and has someone by their side.

Even when someone’s life is transitioning, healing of spirit is possible until the very last breath. It is especially at these times when our very presence can raise their spirits, which not only benefits them, but also us.

Being present and ensuring that no one is left alone is an incredible act of kindness and a supreme act of holiness. In the Jewish faith, it is considered a “mitzvah,” a religious obligation. 

I hope that you will consider ways that you can help reduce isolation for those who are alone and provide them with “accompaniment.” Let us continue to find ways to be fully present for members of our own family and for those in the wider community who will benefit from our companionship and just “being there for them.”

Perhaps you may wish to consider committing to one specific act of accompaniment each month that will lift the heart and brighten the spirit of someone else – and probably do the same for us.

Complete Article HERE!

Welcome to the Departure Lounge.

Destination: death

Ricky Gervais with Penelope Wilton in the Netflix series After Life.

By

Images of sandy beaches, sun-kissed swimming pools and azure blue skies gleam from the window and walls of what appears to be a new travel agent opening in a London shopping centre. But browsers may be surprised by the destination, for it is a journey every one of us will one day take: death.

Look more closely at the posters and it becomes clear that the words are all about “passing away” (half of British adults prefer to avoid the word “death”, apparently). The Departure Lounge, in Lewisham, south London, is the brainchild of the Academy of Medical Sciences, whose mission is to promote biomedical and health research. Death, it turns out, is one of the most under-researched areas in healthcare, accounting for less than half of 1% of money spent.

The idea of the Departure Lounge, explains the academy’s president Professor Sir Robert Lechler, is to enable visitors to ask any questions they might have about the dying process, and also to collect ideas and experiences that could inform future research. “The best time to have conversations about death probably isn’t when you’re confronting it, but well before,” he said. Which is why a shopping centre was deemed an appropriate location – the hope is that the Departure Lounge will attract people who might not be regular visitors to science museums.

Death has been a zeitgeist subject for some years now – witness the Death Café phenomenon, the growth of conferences and books on dying and TV series like the recent Ricky Gervais Netflix comedy After Life. But, says Lechler, the conversation is becoming more urgent. Put simply, there’s more of it about. “Between now and 2040 we’ll see an increase of 25% in the number of deaths per year,” he said. And it’s more than numbers: the run-up to dying is different. “We’re living longer, and the context of death is changing. Longer life means we accumulate more long-term conditions, and people tend to be frail for longer,” he said. “The risk is that people are going to die badly, as opposed to dying well.”

Dr Katherine Sleeman, a palliative care consultant at the Cicely Saunders Institute at King’s College London and a member of the advisory group behind the Departure Lounge, says patients often want to talk about death. “People call it the last taboo, but that’s not my experience. Healthcare professionals can be fearful about raising the subject, but I find patients are often relieved when it’s mentioned. They know they’re dying, and they want to talk about it.”

Also much misunderstood, she says, is that palliative care, far from spelling the end, can mean much better outcomes. “Research shows that when provided early, palliative care is associated with fewer hospital admissions, better pain relief and lower financial costs to the NHS,” she said. “I always say that my aim isn’t to help you live longer, it’s to help you live better.”

On hand will be guides including Yvonne Oakes, a former palliative care nurse who now works as a “soul midwife” or end-of-life doula, supporting patients and their families. In her experience, many people have had negative experiences of death with relatives, and assume that when their time comes isolation, pain and discomfort will be inevitable. That, she says, simply isn’t true. “There is definitely such a thing as a good death. It comes mostly, I believe, from accepting death rather than struggling against it.” And The Departure Lounge, she hopes, will enable people to start to think about acceptance of death, “in a non-threatening, and unforced, way.”

Research into dying, says Sleeman, really matters and can make a real difference. “Many people, and that includes doctors and academics, say: what’s the point of research if it’s not going to prolong life? But that isn’t the point. Quality is crucial: research is quite clear that most people would choose quality of life over length of life.”

The Departure Lounge is supported by the Health Foundation and Wellcome Trust; more information at departure-lounge.org

Top tips for a good death

Remember this is your death: it’s OK to think about what you really want and don’t want, and be clear about it.

Don’t be afraid to ask for help, and to accept help if it’s offered and you want it. You don’t have to struggle on alone.

Make amends for past hurts and disappointments. Some people write letters – you don’t have to post them.

Consider making a death plan, which is the life-end equivalent of a birth plan. Where would you like to die? Who do you want with you – and who do you not want there? Would you like music to be playing? Do you want to avoid attempts to resuscitate you?

Be aware that death involves loss, so there is inevitably going to be emotional pain, both for you and for those you love. But that doesn’t mean you can’t look for the joys in life, even as your health deteriorates. Life can have meaning and enjoyment right up to the end.

Yvonne Oakes

Complete Article HERE!

A 16th-Century Manual on How to Die, and What it Teaches Us About Life

Michel de Montaigne urged Western culture to think and talk more about death, but Western culture still hasn’t listened

By Rachel Ashcroft

In his three-volume collection of Essays (1580), the French thinker Michel de Montaigne (1533–1592) famously declared that the best way to prepare for death was to think about it constantly. “Let us have nothing so much in minde as death. At the stumbling of a horse, at the fall of a stone, at the least prick with a pinne, let us presently ruminate and say with our selves, what if it were death it selfe?” Montaigne advised that we must contemplate death at every turn and in doing so, we make ourselves ready for it in the most productive way possible. On a more personal note, I managed to achieve this by spending four years writing a Ph.D. thesis on Montaigne’s work, a task which forced me to contemplate death every single day.

Arguably every Ph.D. dissertation carries with it a certain amount of doom and gloom at some point or other, especially during the last few months of writing up. But studying time in Montaigne’s work meant being constantly steeped in his musings and recollections on how ancient philosophers viewed suicide, or the history of funeral practices in Western Europe. By the time I had finished, I was sure Montaigne was wrong, and that in fact I should never think about death again. The stress and anxiety surrounding my submission date meant that the words of a 16th century nobleman concerning the nature of death were low on my list of priorities. And yet on reflection, thanks to Montaigne and his open and honest approach to mortality, thinking about death has actually taught me a lot about how to live.

Thanks to Montaigne and his open and honest approach to mortality, thinking about death has actually taught me a lot about how to live.

Despite what many of us may think in today’s society, talking about death on a regular basis doesn’t have to be scary or morbid. In fact, it can actually make us feel a much deeper connection to the natural world that simultaneously puts the little things into perspective. After all, mortality is a key feature of pretty much everything that exists in Nature, human beings included. The sun, stars, plants and animals — nothing lasts forever, and Montaigne constantly argues in his writing that this is most evident in the mutable physical processes that occur around us: “The world runnes all on wheeles. All things therein moove without intermission.” Winter storms and snows give way to summer sun, flowers wilt and perish. Even the Sun will disappear one day. As humans we fit perfectly into this cycle; we regularly define our lives in terms of birth, aging and death. Montaigne describes his own aging body using seasonal imagery: “I have seene the leaves, the blossomes, and the fruit; and now see the drooping and withering of it [his body].” However, in the natural world, death always gives way to new life. Leaves fall from trees and die before the arrival of new shoots that burst forth in the spring. When human beings die, their bodies decompose and mingle with the Earth, or sail along the breeze as specks of dust, ready to become part of something else.

Thinking about death in this way really helped me to understand that our lives are only one small piece of a much bigger picture — and the bigger picture doesn’t care about how many Twitter followers a person has, or how much money they earn, or where they buy their clothes. It’s easier to put trivial things to one side when we think about how our death actually confirms a meaningful, physical connection to the world around us — we are natural beings who arguably exist for a certain length of time before returning back to the Earth in some form or another. If you’re a fan of The Sopranos, this attitude is perhaps best summed up by the old Ojibwe saying that Tony finds in his hospital room — “Sometimes I go about in pity for myself, and all the while a great wind carries me across the sky.” The end of our life doesn’t mean the end of Nature’s great cycle. As Montaigne remarks, we can find comfort in the fact that our death is merely one part of a much greater plan: “your death is but a peece of the worlds order, and but a parcell of the worlds life.” His tone is so self-assured in the expression of these ideas that his writing becomes living proof of our ability to master any fear we might have about death. Instead we can allow ourselves to return to Nature.

And yet, talking and writing about death constantly is an approach towards our own mortality that often seems completely alien to modern Western cultures. (Eastern cultures are way ahead and can be looked to as an example.) Nowadays it’s relatively rare to engage in an open conversation with friends or family about how we want to be buried, or what happens to the soul after we die. Often these discussions are relegated to funerals or college philosophy tutorials, or they simply don’t happen at all. But Montaigne states time and again that such avoidance is unhealthy and impractical; instead he declares “let us have nothing so much in minde as death” and regularly draws on ancient philosophy to back up his ideas on confronting death head-on. For example, he uses the Stoic philosophy of the Roman emperor Marcus Aurelius (26 AD — 180 AD) to argue that we should relish spending our leisure time in contemplating the meaning of death. Like Montaigne, I believe it is possible to gain a huge degree of contentment from life through attempting to understand death. As well as feeling closer to Nature, death encourages a greater awareness and enjoyment of the present moment. In a strange way, acknowledging that death is certain actually allows us to adopt a more practical attitude towards the time that we do have on Earth. In her book Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, Barbara Ehrenreich encourages us to appreciate life “as a brief opportunity to observe and interact with the living, ever-surprising world around us.” Personally, I’ve found myself feeling extremely grateful during times that I have experienced intense happiness, as well as reaching an understanding during periods of sadness that — like everything else — this too shall pass.

By way of contrast, the death-defying attitude of Silicon Valley in recent years provides an interesting case study in 21st-century conversations about mortality. Rather than acknowledging death, a growing number of tech giants are now actively trying to eradicate it. Social commentators argue that modern society is sometimes guilty of believing in its own immutability, as though certain scientific and technological advances give human beings an absolute right to live on forever. Indeed, the cycle of Nature that I described at the beginning of this essay is currently being overturned in order to make way for advances in 3D organ printing, nanobots that can replicate immune systems and even blood injections that supposedly extend our lives. Peter Thiel, one of the co-founders of PayPal, has admitted that he is ‘against’ the idea of death and aims to fight it rather than accept it. The National Academy of Medicine is currently running a “Grand Challenge in Healthy Longevity” which will award $25,000,000 to anyone who can make a major scientific breakthrough in delaying the aging process. Many of the project’s investors want aging to be stopped completely. Meanwhile, Google’s highly secretive Immortality Project was launched in 2014 and aims to treat aging as a disease that can be cured.

There is a distinct air of confidence surrounding these endeavors; for many tech giants it is not a matter of if immortality can be achieved, it is simply a matter of when. Speaking to Tad Friend of The New Yorker, Arram Sabeti of the food tech start-up ZeroCrater once stated, “The proposition that we can live forever is obvious. It doesn’t violate the laws of physics, so we will achieve it.” The “we” in this context is questionable, since many of these projects are being supported by tech giants and celebrities who will undoubtedly be the only people able to afford an immortality cure if it ever becomes available in the future. These advances are being energetically pursued by people who head up large corporations with arguably little thought or respect for death itself, only the right to continue existing. This isn’t accepting death or preparing for it, this is trying to abolish it in the unhealthiest way possible — surrounded by secrecy, with little thought for the long-term effects on society. Such measures do nothing to cure fear of death, they only try to stop it at all costs, which is really just a form of denial.

What would the author of the Essais have made of these developments? Montaigne was famously suspicious of doctors during a time when modern medicine simply didn’t exist. He often complained that doctors were desecrating the natural duration of the human body and interfering with what he considered to be Nature’s work. Even in an age before painkillers or anesthesia, Montaigne (who famously suffered from excruciating kidney stones) was proud of his ability to withstand illnesses and diseases ‘naturally’: “We are subject to grow aged, to become weake and to fall sicke in spight of all medicine.” Therefore it’s very hard to describe the horror Montaigne would have felt upon being confronted with the idea of death-defying technological advancements such as nanobots and 3D organ printing. Not only are these inventions a human attempt to subvert death by artificial means, they also pose other problems too. For millennia, one of the most positive aspects of death originally proposed by Stoic philosophy (and later adopted by thinkers such as Montaigne) was the idea that death comes for everyone. In other words, it doesn’t care about social class — the rich human being dies just like the poor human being and thus reminds us that deep down we are all equals. Will that be true in the future as well or not? Cryogenic preservation is becoming more and more popular, but it currently costs as much as $200,000 to freeze the entire body. We have to imagine that a drug or injection to cure mortality will be ten times as costly. This means that immortality will most likely be for the few, not the many.

So what can we as human beings do to respond to death in a practical and healthy manner? Alongside the popular take-up of meditation and mindfulness (which psychologists have already noted can greatly improve our attitude towards death), a younger generation of advocates — most notably Caitlin Doughty — are heading up an increasingly popular “death-positive” movement. This trend encourages an enquiring approach towards death and funerary practices that draws on the type of calm, reasoned manner that Montaigne would have been proud of. Doughty’s website, The Order of the Good Death, states that the death-positive movement believes that “the culture of silence surrounding death should be broken through discussion, gathering art, innovation and scholarship.” This mission resounds with the philosophy of Seneca the Younger (4 BC — 65 AD), a thinker Montaigne turned to repeatedly when he wanted to understand fear of death. Seneca believed that approaching death through contemplation, mindfulness and discussion was one of the key virtues of wisdom; pursuing such an open and honest attitude towards death would eventually allow an individual to patiently wait for death, as one of nature’s operations. Therefore talking about death, studying philosophy, meditating, and even creating or appreciating art around this theme are all excellent ways to prepare for life’s end.

Talking about death, studying philosophy, meditating, and even creating or appreciating art around this theme are all excellent ways to prepare for life’s end.

We can also make sure to engage in practical preparations surrounding our funeral arrangements, wills and life insurance. Rather than becoming a depressing chore, instead we can appreciate that it brings peace of mind to family and friends, as well as ourselves. If we’re lucky enough to be dying in a bed somewhere, surrounded by loved ones, at least we can rest assured that these same people have been taken care of. In the Essays Montaigne praises the practical act of constructing your own grave — many of his friends prepared elaborate tombs, sometimes with their own death masks attached. Montaigne says that looking on a replica of your own dead face is an excellent way to prepare for the inevitable reality of the future and also shows you have taken the time to leave the world in an organized way. Incidentally, this is just one example which demonstrates that in the past, Europeans were far more attentive to the idea of preparing for death in a practical manner. Admittedly this may have something to do with the fact that death was far more visible in everyday life thanks to mass graves and public executions, not to mention the high rates of mortality, particularly amongst infants. Thankfully all of these things are in the past, but death still lingers in society, it’s just slightly more hidden away than it used to be. Whilst we can’t all afford a good death mask, it would be comforting to see a resurgence in openly discussing or enacting any kind of practical preparation for death, an attitude which has clearly been written out of European society in the last few hundred years.

In the Essays, death is natural. It forces us to realize our humble place in the great cycle of mutability that constitutes the workings of Nature. In the meantime, talking, writing and thinking about death can radically improve our quality of life by helping us to gain a greater enjoyment out of our time as one of the living, as well as helping those people we will eventually leave behind. I don’t want to start investing in cryogenics or constructing my own coffin just yet, but talking about death from time to time? That’s something we can all start doing right now.

Complete Article HERE!

‘End Game’ Film Shows the Struggle in End-of-Life Decisions

The Oscar-nominated documentary also spotlights palliative and hospice care

By Deborah Quilter

In a pivotal scene of the documentary End Game, we listen in as a team of palliative care professionals discusses Mitra, a 45-year-old woman who is dying of cancer. Should they approach her about hospice? The hospital chaplain urges the group not to bring it up. She had spoken to Mitra’s mother, who told the chaplain that to Mitra, hospice means death. Dr. Steven Pantilat, a palliative care specialist, agrees with her assessment, noting: “Healthy people want to talk about how they want to die. Sick people want to live.”

This exchange in End Game (available on Netflix) captures human nature, and the delicate dilemma doctors and patients face at the end of life, under the best circumstances. Filmed in the serene hospital rooms and corridors of the University of California San Francisco Medical Center and the recently-closed Zen Hospice Project, situated in a tastefully-appointed Victorian house, we see firsthand the inner workings of hospice and palliative care.

We also see clearly how important it is to talk about these matters before we might need them.

Considering Palliative and Hospice Care

Though palliative and hospice care can greatly ease suffering, they are not easy to talk about or decide on for many patients. Some of the people in the 40-minute documentary are not ready to check out and seem to feel that accepting hospice care would mean accepting death. Their family members don’t want to let them go either.

Mitra’s husband hopes each new treatment will bring a miraculous recovery. Her mother knows her daughter will never walk again, much less recover from cancer and thinks her daughter is suffering. In one scene early in the movie, which is doubtless replicated in many hospital rooms every day, Pantilat asks Mitra’s husband and mother if they want to continue treating the cancer.

“If she were clear in her thinking and seeing herself in her bed the way she is right now, what decision would she make?” Pantilat asks. The question hovers in the air.

When Mitra’s sister flies in from Switzerland, initially there is jubilation over the reunion and we rejoice vicariously with the family. In the next scene, however, we see the sister collapsing in her mother’s arms in the hallway, weeping. Later, we see Mitra’s mother literally staggering down the hallway under the weight of her sorrow. We witness Mitra’s husband’s heart breaking, and their 8-year-old son playfully massaging his mother’s bald head.

There is joy, sorrow, love. The camera captures it all, but there is no narration. We witness the family’s struggles as they go through them in real time. This is part of the film’s power: It is easy to identify with the subjects. Viewers might feel they are losing their own family member.

The Filmmakers’ Vision: Bring Death Out of the Closet

The 40-minute film, directed by Rob Epstein and Jeffrey Friedman, was nominated for an Oscar in the category of Documentary Shorts.

The filmmakers, who won an Oscar in 1985 forThe Times of Harvey Milk, wanted to raise awareness about how palliative and hospice care can give us the right care at the right time. As Friedman explained, birth and death are universal life passages, and of those, death is the one we have the option of facing consciously.

“Most of us avoid thinking about it until it’s too late. By doing that, we set ourselves up to lose control of our life story when we’re at our most vulnerable,” Friedman says. “Couple that with medical technology so advanced that we can keep nearly everyone ‘alive’ using machines — but without taking the time to talk about what the quality of that life will be. The result is that far too many people are getting care they don’t understand and don’t want.”

End Game is about choices we make about how we want to live, when we know our time remaining will be brief,” Epstein adds. “One of our goals in End Game was to inspire conversations — not only about facing death, but about how we want to live, right up to the end.”

End-of-Life Care Explained

According to Pantilat, author of Life after the Diagnosis: Expert Advice on Living Well with Serious Illness for Patients and Caregivers, “Palliative care focuses on improving the quality of life for people with serious illness (whatever the prognosis). It alleviates symptoms like pain, shortness of breath, fatigue and nausea. It’s also about having patients communicate preferences and values, so the care team can attend to their psychological, spiritual and emotional support when they are sick.”

In the United States, hospice is a service to provide palliative care to people, largely at home. For hospice, the eligibility criteria include a prognosis of no more than six months of life and patients and loved ones who have agreed the focus will be comfort care.  Hospitalization, generally, will be avoided.

“Most of the time, hospice is not a place, but a service, although there are facilities focused only on hospice care (as Zen Hospice Project was). All hospice is palliative care, but not all palliative care is hospice,” Pantilat explains.

Many people have the misconception that once you choose palliative care, you’re not getting any other treatment for your illness. “That’s not true at all,” Pantilat says. You could have palliative care alongside chemotherapy, bone marrow transplant and many other serious illnesses. In fact, palliative care might help you live longer.

“There’s never been a study that showed that people who receive palliative care live less long. And there are studies that show that people who receive [palliative care] for the illness live longer. It’s an unmitigated good.” Pantilat says.

Help for the Family, Too

There’s another important feature of palliative care: It also attends to a dying person’s loved ones. The palliative care team will talk to family members and offer them comfort, options and counsel.

Pantilat notes: “When people ask, ‘When should my family come?’ I always say come now. If they get better and live for another six months or year or two, no harm, no foul. It’s one more visit. But if you try to time it when they’re really sick and on death’s door, they might be too sick to have a meaningful interaction or you might miss the opportunity. Things can happen suddenly.

“We try to have these conversations in advance and understand what’s really important,” Pantilat continues. “If visiting with your sister or seeing your daughter get married is the most important thing to you, now’s the time to do it. Maybe you shouldn’t wait 10 months for a wedding, because you may not make it. Instead, could your daughter move the wedding up to next month?”

And speaking of not waiting, the doctor has a message: “If you or a loved one has a serious illness, you should have palliative care. Don’t take no for an answer. Because it will help you live better and may even help you live longer.”

Complete Article HERE!

Mumford and Sons’ Tackle Death and Dying in ‘Beloved’ Video

“Everyone knows loss in one way or another. This song is about that,” Marcus Mumford says of Delta track

A young boy watches over his dying mother and fantasizes about better times with her in the video for Mumford and Sons’ new Delta single “Beloved.” The son and mother, who’s still wearing a hospital gown, run around, go shoplifting and ride horses on a beach. “Before you leave, you must know you are beloved,” Marcus Mumford sings against a serene backdrop of synths and guitars, “and before you leave, remember I was with you.” It all builds to an emotional finale.

“Everyone knows loss in one way or another,” Marcus Mumford said in a statement. “This song is about that. I’d never sat with anyone as they died before, and it had an effect on me. As it does everyone I know who has experienced it. But there’s wildness and beauty in it as well, and a deep honoring, that became the beginnings of this song that we worked up called ‘Beloved.’ I feel determined for people to take whatever they want from it, and not to be emotionally prescriptive.”

Thich Nhat Hanh’s final mindfulness lesson:

How to die peacefully

Thich Nhat Hanh, 92, reads a book in January 2019 at the Tu Hieu temple. “For him to return to Vietnam is to point out that we are a stream,” says his senior disciple Brother Phap Dung.

“Letting go is also the practice of letting in, letting your teacher be alive in you,” says a senior disciple of the celebrity Buddhist monk and author.

By Eliza Barclay

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.

He’s considered the father of “engaged Buddhism,” a movement linking mindfulness practice with social action. He’s also built a network of monasteries and retreat centers in six countries around the world, including the United States.

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.

Brother Phap Dung, a senior disciple of Thich Nhat Hanh, leading a meditation on a trip to Uganda in early 2019.

Eliza Barclay

Tell me about your teacher’s decision to go to Vietnam and how you interpret the meaning of it.

Phap Dung

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.

Eliza Barclay

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.

Phap Dung

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.

Eliza Barclay

And as one of his senior monks, do you feel like you are passing the candle too?

Phap Dung

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.

Eliza Barclay

So he is 92 and his health is fragile, but he is not bedridden. What is he up to in Vietnam?

Phap Dung

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.

Eliza Barclay

But you are also in this process of letting him go, right?

Phap Dung

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.

Eliza Barclay

What have you learned about dying from your teacher?

Phap Dung

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?

Thich Nhat Hanh leading a walking meditation at the Plum Village practice center in France in 2014.

Eliza Barclay

What are some of the most important teachings from Buddhism about dying?

Phap Dung

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.’”

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Here’s What Mortality Can Teach Us about Living in the Moment

“Maybe we need the promise of death to guard against taking life for granted.”

By

I drove back to my home the next day, pensive. In my kitchen that evening, I picked at a burrito I’d grabbed from a food truck down the street. I drove home starving, but lost my appetite after a few bites. Outside my window, Sunset Boulevard was a river of light, a constant stream of headlights and bike lamps, colorful blinking restaurant signs and fluorescent streetlights. In a shadowed parking lot, dark figures moved quickly toward cars.

Something weighed on me, though I couldn’t articulate it precisely. I wandered around my place, sitting on my couch and moving to a chair, picking up a book and setting it down to watch TV instead. I turned the TV off and considered going to bed early. Maybe a good night’s sleep would fix my restless mind.

And then a question surfaced. What if I suffered a sudden stroke, as Auntie had? Her situation had at first reminded me of my parents’ mortality, but what of my own? Perhaps this crossed my mind because Auntie and I shared a common heritage, and she had suffered a sudden catastrophic event, which could happen to anyone regardless of their age. Maybe the fact that I had faced another transition point, my last week at my first attending job, contributed subconsciously to my mind’s sudden insistence that I consider the meaning of endings. Whatever the reason, I began once again to consider my own answers to the questions I had asked my parents. I knew that I was mortal, that at some point my body would shut down.But though my rational mind knew this, sometimes it felt like mortality didn’t apply to me. I was a doctor. I was there to tend to other people’s mortality. I thought back to all the years I’d clung to the idea of delayed gratification, the times when I’d put my life on hold until I’d completed an educational milestone. If I persisted in my studies, I’d told myself countless times, I’d someday have all the time in the world to enjoy life. I panicked now as I considered what my life would mean if it ended tomorrow in an accident.

What had I learned about death in doing this work? I’d seen that no amount of considering or preparing for it made it easy. Talking about it to prepare frightened loved ones, saying or writing good-byes (if one was lucky and lucid enough to do so), and trying to make peace with a higher power might soothe us and help us. We feared it and sought to control every aspect of it, even considering physician-assisted suicide to give us a sense of agency over an unconquerable aspect of human existence. But if death was not only a medical fact but also a spiritual and sacred passage, then it would always have a certain mystery that was perhaps worth accepting rather than attempting to control. Because we can’t control it. We can’t always anticipate or prepare for it. What we define as a “good death” may not be in the cards for us. But maybe we can use the inevitability of death to live differently. Maybe we need the promise of death to guard against taking life for granted.

I thought back to the many times I feared death as an outcome for my patients, convinced that it was my job to forestall it, to control and manipulate nature. Giving death this much power distorted my view on life—my own, and that of my loved ones and patients. Fighting and fearing death obscured finding meaning in living moments.

What if I regarded my own death with reverence instead of fear? I wondered. Or, even more radically, what if I had some sort of gratitude for the transience of my life? Would it change what I worried and cared about? Wasn’t it necessary to think about this when I was in the midst of building a life? Or rather, living my life? And the more I thought about mortality and what it had come to mean to others and what I thought it meant to me, I realized that life was simultaneously so vast and so small.

It was daybreak after a good sleep and exhaustion as the stars emerged. It was the first crisp bite of an apple, the taste of butter on toast. It was the way a tree’s shadow moved along the wall of a room as the afternoon passed. It was the smell of a baby’s skin, the feeling of a heart fluttering with anticipation or nerves. It was the steady rhythm of a lover’s breathing during sleep. It was both solitude in a wide green field and the crowding together of bodies in a church. It was equally common and singular, a shared tumult and a shared peace. It was the many things I’d ignored or half appreciated as I chased the bigger things. It was infinity in a seashell.

I thought and thought that night, making mint tea and taking a few sips, watching the steam rise from the cup and then disappear. It felt strangely calming to focus on the cooling of heat, to appreciate the fact of temporary warmth. Maybe this, too, was the lesson of mortality: appreciating what we have now, in the midst of life, knowing that it is all a temporary gift.

I didn’t want the sum total of my life to be only a collection of my worldly achievements, boxes of degrees, and lists of patients I’d treated. I thought of what I had pushed off or considered unimportant, the things I promised myself I’d do when I “had the time.” I’d call the friend I had been meaning to call for the past year since I moved to LA. I’d take my mother to the beach in Santa Barbara. I’d take a pottery class. I’d write regularly to my uncles in Mumbai. I’d learn to cook Thai food. I’d adopt a puppy. I’d deal with my fear of bugs and go camping. These all seemed like such cheesy wishes as I thought about them. But these were the things I didn’t want to leave my life without doing. Which meant they weren’t small things.

That night was the beginning of a conversation I continue to have with myself, especially in the moments when the wrong parts of my life feel big and cast shadows over the smaller things. Those are the times I return to my copy of the Gita, having stumbled across a passage that perfectly captured how the fact of death has taught me to live differently:

No matter how strongly you ascribe to the universal delusion that you can avoid pain and only have pleasure in this life (which is utterly impossible), sooner or later you must confront the fact of your inevitable aging and eventual death Therefore, because death stirs people to seek answers to important spiritual questions it becomes the greatest servant of humanity, rather than its most feared enemy.

And there it was—the life lesson, and the death lesson. Vast and small, interlinked. Infinity in a seashell.

Adapted from THAT GOOD NIGHT by Sunita Puri, published by Viking, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2019 by Sunita Puri.

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