WORKING WITH THOSE WHO ARE DYING
Some people say that waiting for dying to begin is far worse than dying itself. Nursing homes are filled with people who anxiously await death's visit. This can last for years. Fear pervades day after day during this time. The fear becomes accentuated when empty chairs are inevitably noticed in the dining room. Every few weeks, another person disappears, evoking terror in one's heart.
When is it going to be my chair? What is going to happen? Will it hurt? Where am I going? Will I know who I am? Will I ever return?
In the mid-1990’s, my father Sampson D. Cooper, aged ninety-two, made his final passage. He had been living in a nursing home and for many years had been confined to a wheelchair. He felt trapped in a body that simply would not function in the way that he wanted. His intellectual capacity diminished dramatically near the end of his life, and he increasingly became disheartened when words and entire sentences disappeared into a black hole that slowly consumed his mind.
For a couple of years, I received weekly telephone messages that Dad had been found on the ground near his wheelchair. He would slip while transferring from his bed or the toilet. Sometimes, I think, he would just lie down on the floor to sleep because the extra few feet to get to the bed demanded too much effort. As an independent person, he would not tolerate being strapped into the chair. Fortunately, he was never hurt in these incidents except for occasional bruises.
One evening, however, we got the message that Dad had been found unconsciousness. We went straight to the nursing home. When we arrived, his eyes were open but he was unable to speak. It did not look good.
We stayed with him until late that evening and I returned early the next morning. As he was not able to eat or drink, the doctor knew that he could not last for more than a day or two. So I sat with him, speaking, singing, being quiet. Shoshana arrived around noon. We spent the afternoon swabbing his lips and mouth with water, trying to help soothe any discomfort. Most of the time we meditated.
My mother had died nine years earlier on the holiday called Tu b'Shevat, the festival of trees, while we were living in Jerusalem. On the long flight between Israel and California, where she had lived and would be buried, I remember looking across an expanse of clouds, feeling Mom's presence everywhere. Her spirit permeated everything. It was a wonderful feeling. I remember wondering if death was really so expansive.
Late in the afternoon with Dad I noticed a change in his breathing. Throughout the day, he had pushed our hands away, not wanting to be touched. Dad was quite independent. We respected his needs and left him alone. But now something had changed. He reached out and wanted to hold my hand. His eyes were wide open, but he was still unable to speak.
As I moved in close enough to whisper to him, he began to emanate a light of life-force that bathed the room. I felt myself carried into a completely different realm, fully conscious, and I sensed more strongly than ever the presence of my mother. My head was two inches from my Dad's. I knew that he could feel her as well. He was quite still, looking straight ahead, holding my hand tightly.
I found myself saying, "It's o.k., it's o.k."
Dad was not religious. He had been angry with just about everything for the last fifteen or twenty years. Mom had given up along the way. But she had asked me to promise to see him through his final years. This was not easy to do. He could be quite nasty. Still, when we returned from Israel, he moved from California to Colorado so that we could spend extended time together.
Now, however, there was not the slightest hint of the anger I knew so well. The last half hour of his life was calm, connected, and extraordinarily powerful. His breath got fainter, I continued to whisper and Mom's presence got stronger. At one point I sensed a deep gratitude from her, and from a part of him, for seeing him through the last years of his life, and especially for what was happening right now.
Then I felt the presence of my mom indicating that she would take over, for he was about to go somewhere that was beyond my limits.
He never closed his eyes until the final shudder when his breath stopped. In that last moment, I began to say the kaddish. Wherever he was, he heard me. A tear formed up in the corner of one of his eyes. I was stunned. And then he was gone.
All the years of our estranged relationship were wiped away in that final half hour. Words did not need to be spoken. The life-force that spread through that room, and beyond, was all that needed to be communicated. Indeed, it is here with me now as I write these words.
Working with dying people means dealing with fear: our own, that of those around us, and that of the person dying. Although most fear of death is diverse and extensive, it essentially falls into three main categories: fear of personal failure in this life, fear of pain in the dying process, and fear of the unknown after death.
When we make peace with our own concerns about death, we are more able to work with others. Many practices in Judaism help us develop skills for this kind of work. Following are exercises that open our awareness and slowly help to alleviate our fears.
We are all familiar with the feeling that we have not done things well; we feel that we have botched jobs or relationships, and we sense that we have left tracks behind that we wish would disappear. We hope that time will heal these wounds, but when we are approaching death, old pains often loom quite large in our universe of regrets. If only we could do it over again; if only we had more time to fix things.
People in the process of dying worry about promises unkept, responsibilities avoided, and life goals unfulfilled. They worry as well about liabilities that are being left behind for others. They are distressed about abandoning people who relied upon them, who they nurtured, loved, or sustained. And they are troubled about people who may have served and loved them but were never properly acknowledged.
As long as people focus on the empty part of the cup, the list of concerns grows longer and longer. Many times dying people have their heads and hearts so filled with a sense of personal failure and missed opportunities that they are immersed in a sea of remorse that keeps them, and everyone else, from attending some important issues: forgiveness, open-heartedness, acknowledgement and the expression of unconditional love.
It has been pointed out by health professionals who work with dying patients that the most important quality we need to have when attending someone in the dying process is the ability to be present, to be able to listen, support and be non-invasive. These qualities are of utmost importance. In doing so, however, we sometimes do not have an opportunity to "get real" with a dying person. I was not able to do so with my father; he was somewhere else that last day. And my mother left suddenly, so I never had the chance. Nonetheless, I have been in many situations in which people are able to let go of old patterns and make new connections that bring about a healing for everyone involved.
Whether or not this will occur depends upon a wide set of variables. It should not be a goal. Many people simply are not prepared to be more vulnerable or to take risks in the highly stressed environment that often accompanies the dying process. If however there seems to be willingness on everyone's part to explore deeper questions, here are some practices for working with others in the dying process.
FEAR OF FAILURE
1. Offering Confession and Asking Forgiveness:
In Judaism, this practice is often associated with the high holy days: Rosh Hashana and Yom Kippur. At that time, we communicate with the Divine, confessing things we regret having done, said, or even thought.
At any time in the year, however, we can take on the spiritual practice of confessing our regrets to another person, particularly someone who is in the process of dying. Obviously, this is not easy to do, and must be accomplished with considerable skill and sensitivity. People are reticent to openly reveal things about which they feel guilty. Many would prefer to take these secrets to the grave, and they should be entitled to do so.
The success of this practice is not measured by the amount or intensity of information divulged, rather, success is measured by the degree to which a safe haven is provided in which a person can choose to discuss his or her regrets. Clearly, it must also be safe to not discuss sensitive issues--pressure must never be brought to this situation.
This practice is done with only two people. We begin by sitting quietly, remembering as many events as we can in which we may have done, said, or thought some things we now regret. Sometimes, simply sitting quietly like this is sufficient, for in mystical terms, the souls are communicating on different planes of reality that do not require verbal expression. It goes beyond a glance or gesture. Indeed, even if a person is in a coma, the soul can connect in unknown ways.
Most of the time, however, in this process it is quite useful to speak aloud what is in our hearts. The purpose of this exercise is to be willing to admit mistakes and to ask for forgiveness. When we are able to do so, the process can be profoundly moving. It often opens a potential for new understanding between people and is highly recommended for healing old wounds. Either or both people can speak.
2. ANNULMENT OF VOWS:
This is another spiritual exercise that is normally done during the high holy days but can be addressed at any time during the year. As noted, people in the dying process often feel that they have unfinished business. Releasing them from these concerns can be a true source of liberation.
First, at an appropriate time, we ask a person, "Do you feel that you have made promises or commitments that are still unresolved?" If they say yes, we attempt to find a way to release these commitments that is satisfactory for the person. If it is a promise they made to you, you can say something like: "I whole-heartedly release you from this promise and any other commitments you may have made."
If it is a commitment to someone else, try to find a way to free the person. You might bring in others who are involved. You might use reason. You might take on some things yourself, though you should never assume an obligation of another because of a sense of guilt. You might invite angels to help, use prayers, call on God.
The very fact that these issues are being discussed is the beginning of the process of liberating a person usually leads to much more peace of mind and clarity. In one's final days or hours a great deal can be accomplished along these lines to help her or him through the transition process.
3. TASHLICH: (Sending Away…)
Annulment of vows is one of a number of purification practices. Another is tashlich (sending away), which is done annually the on afternoon of the first day of Rosh Hashana. Usually it is performed by saying prayers at a body of water into which we cast breadcrumbs. The following is a variation on this.
If people in the dying process can write for themselves, have them do so. If they need help in the writing and are willing to let you help, you may write for them. On scraps of paper, write responses to the following:
a. Things I have done in my life that I regret.
b. Anything I may have said to harm someone.
c. Events I would replay, if I could.
d. Things I wished I had said to someone.
e. Promises I made that were never kept.
f. Hopes and dreams that never worked out.
Anything can be added to this list. Each scrap of paper should be crumpled up and burned over a small fire, slowly, contemplatively, until all are gone. In a hospital, or anywhere that fire is not permitted or not practical, each scrap of paper can be cut into tiny pieces and destroyed in some way.
4. FAMILY HISTORY:
If the dying person is a parent, grandparent, or elder relative, an excellent practice is to record as much family history as he or she is willing to offer. Who did what when? What are some of the rarely told family secrets? This should be done with as much detail as you can gather. Exploring the past in great depth is a wonderful form of healing.9
It allows people to reflect on the meaning their lives, the impact they have had, the continuity they have engendered. Although these reflections can raise old wounds, for the most part they are usually provocative and soul satisfying. This process is highly recommended.