In this moving meditation on palliative care, Halifax tells a story about a dying Zen teacher who confesses to his students: "Maybe I will die in fear or pain. Remember there is no right way." This sentiment forms the core of a book that provides practical and philosophical guidance to caregivers. Drawing on her 30 years of experience in the "contemplative care of the dying," Halifax honestly enumerates the challenges of being with the dying while exalting it as "a school for unlearning the patterns of resistance... [it] enjoins us to be still, let go, listen, and be open to the unknown." According to Halifax, "bearing witness to dying" can teach innumerable lessons to the livingassuming "we give up our tight control strategies, our ideas of what it means to die well." Halifax is a Zen priest, and while many of her teachings derive from Buddhism, her supremely readable book will attract readers of all faiths who will appreciate her clarity and compassion and the poignancy of these stories of ordinary people facing their final hours with quiet courage. (June)Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Deathby Joan Halifax, Ira Byock
The Buddhist approach to death can be of great benefit to people of all backgrounds—as has been demonstrated time and again in Joan Halifax’s decades of work with the dying and their caregivers. Inspired by traditional Buddhist teachings, her work is a source of wisdom for all those who are charged with a dying person’s care, facing their own death, or wishing to explore and contemplate the transformative power of the dying process. Her teachings affirm that we can open and contact our inner strength, and that we can help others who are suffering to do the same.
“This compelling, brave, and wise book draws from a lifetime of remarkable work with people at the end of life.”—Andrew Weil, MD
“Joan Halifax has a knack for straight talk and sublime insight—a no-holds-barred approach to life’s greatest challenge, dying well. This book beckons to those who dare, and those who care; it’s a profound and practical guidebook to the inevitable final dance.”—Daniel Goleman, author of Emotional Intelligence
“This book is a gift of wisdom and practical guidance for living.”— Ira Byock, MD , author of Dying Well and The Four Things That Matter Most
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"Being with dying” is a phrase that aptly describes the human condition. We may be unique among species in being aware of our mortality. Although the capacity to contemplate death is an essential human trait, most people actively eschew thinking about how their life might end.
While the dominant orientation of
Western culture toward death is avoidance, for over 2,500 years
Buddhists have studied the question of how one can best live in the presence of death. In a sense, a life-threatening injury or disease makes Buddhists of us all, waking us from the illusion of immortality,
suddenly and from that time forth. From the moment of diagnosis, death becomes the bell that won’t stop ringing. Like a dreaded phone call, we can try to avoid it, but the noise is always there. We can distract ourselves with medical information and frenetic activity. We can drink or take drugs to muffle the peal, but at quiet moments we can always hear its ring. Ultimately, usually reluctantly, we find that only by answering the call can we hope to silence the shrill bell within.
Life-threatening illness calls us to a place—metaphorically a desert or mountain peak—where, as we sit, the hard wind of reality strips away all the trappings of life, like so much clothing, makeup, and accessories. We are left naked, only “me” with my in-breath and out-breath in this moment, here and now. Illness reveals that at every moment of every day we are—and have always been—merely a heartbeat away from death. This incontrovertible fact need not be depressing. Instead, as Roshi Joan
Halifax eloquently conveys in this remarkable book, our readiness to die can inform and enliven how we live and how we relate to one another.
Sitting with just our breath, we may find that in losing all that we have associated with life, we discover a new life within us—raw, elemental, and pure. It is not easy. The disruptions of illness can be terrifying. Guidance is welcome from someone like Roshi
Joan, who is familiar with this foreboding terrain. Yet even alone, we have the wisdom of our bodies. Our in-breath provides, literally,
inspiration, while the out-breath, like the sound of “Aahhhhhh,” allows us to settle calmly in this new reality.
Indeed, mortality teaches us a lot about life, if we let it. People I have met as patients have often told me that having a serious, life-threatening condition forced them—or gave them the opportunity—to reprioritize the things to which they accord time and energy. Ask a person who is on a heart or liver transplant list, or someone facing cancer chemotherapy for the third or fourth time, “What matters most?” and the answer will always include the names of people they love. After the diagnosis, many people decide to swiftly complete projects or turn over work-related responsibilities to others. Most decide to spend more time with family and friends. It is common for people to place higher emphasis on aesthetic aspects of life, including food (when they can enjoy it),
nature, children, music, art, and other things of beauty.
It would be wrong to give the impression that in acknowledging mortality and the approach of death, people must embrace death or become passive while preparing to “go gently into that good night.” In fact, in my experience, an element of defiance often exists within an emotionally and psychologically robust attitude toward death and life. Perhaps the most defiant act in the face of death is the love of one person for another. The love of two people is a deliberate act of creation and an affirmation of life. In the context of progressive, incurable illness,
love is a declaration to the force majeure that whatever else we can or cannot change, including death itself, we matter to one another!
Time and again, I have witnessed remarkable people respond to what they felt was the utter unfairness and unacceptability of death’s approach by becoming ever-more-fully alive in each moment. This was not denial, but a sophisticated response to an unwanted, difficult situation. One such person, a teenage girl with recurrent leukemia, said of her waning life, “It is what it is.” She knew that she had a limited time to live,
yet she was not about to give death more power than it was due.
Instead, she was determined to embrace life with increased intensity in whatever time she had left.
Being with dying is not a philosophical or metaphysical matter detached from the reality of life;
it is rather a practice of profound and pragmatic significance. This book is a gift of wisdom and practical guidance for living.
Ira Byock, MD
In many spiritual teachings, the great divide between life and death collapses into an integrated energy that cannot be fragmented. In this view, to deny death is to deny life. Old age, sickness, and death do not have to be equated with suffering; we can live and practice in such a way that dying is a natural rite of passage, a completion of our life, and even the ultimate in liberation.
difficult work of offering spiritual care to dying people has arisen in response to the fear-bound American version of “the good death”—a death that is too often life-denying, antiseptic, drugged-up, tube-entangled,
institutionalized. And our glaring absence of meaningful ritual,
manuals, and materials for a conscious death has generated a plethora of literature. Although techniques for compassionate care have been developed specifically for dying people and caregivers, many of these teachings on death can address healthy adventurers as well—acolytes eager not only to explore the full range of life’s possibilities but also to focus pragmatically on the one and only certainty of our lives.
After four decades of sitting with dying people and their caregivers, I believe that studying the process of how to die well benefits even those of us who may have many years of life ahead. Of course, people who are sick or suffering, dying of old age or catastrophic illnesses, may be more receptive to exploring the great matter of dying than those who are young and healthy, or who still believe in their own indestructibility. Yet the sooner we can embrace death, the more time we have to live completely, and to live in reality. Our acceptance of our death influences not only the experience of dying but also the experience of living; life and death lie along the same continuum. One cannot—as so many of us try to do—lead life fully and struggle to keep the inevitable at bay.
In our discomfort, we often joke about death, the only thing as certain as taxes. Woody Allen has famously typified the attitude most of us find amusing and normal: “It’s not that I’m afraid to die, I just don’t want to be there when it happens.”
Funny, yes; but the tragic distortion is that when you avoid death, you also avoid life. And I don’t know about you, but I want to be there through all of it.
When a group of people gathers together for a meditation retreat, important shifts in one’s mind and life may unfold. I often think of one retreat in particular, because what happened one day illustrates with fierce clarity the fragility of these human bodies we inhabit, and the gravity of what Buddhists call “the great matter of life and death.” This particular retreat took place sometime in the seventies at a quiet center on Cortez Island in Canada,
a place then called Cold Mountain Institute. It was the beginning morning of the program, and we had just finished the first period of silent sitting meditation. The bell rang softly to announce the end of the period, and we all stretched our legs and stood up to do walking practice—but one man remained seated.
I remember feeling concern as I turned to look at him: why was he not getting up? He was still sitting in full-lotus position, his legs perfectly folded and his feet resting on his thighs. Then, as I watched in shock, his body tilted over to one side, slumped and sagging, and he fell to the floor. He died on the spot. There were several doctors and nurses participating in the retreat who helped perform CPR and administer oxygen, but it was too late. Later we learned that his aorta had burst while we were
This man was healthy enough—perhaps in his late thirties. He almost certainly had not imagined when he came to this retreat that he would die during it. And yet, that day, sixty people sat down to meditate—and only fifty-nine stood up.
It’s an unnerving story to most of us, who move through our lives feeling and acting as though we are immortal. We glibly reel off truisms about death being a part of life,
a natural phase of the cycle of existence—and yet this is not the place from which most of us really function. Denial of death runs rampant through our culture, leaving us woefully unprepared when it is our time to die, or our time to help others die. We often aren’t available for those who need us, paralyzed as we are by anxiety and resistance—nor are we available for ourselves.
As someone who works with dying people, I used to feel a little apologetic about being Buddhist,
concerned that my practice might seem sectarian and inappropriate. But over the years I’ve seen how much the teachings of the Buddha have helped the living and the dying of every faith, and my reservations have dissolved. It’s crucial that we Westerners discover a vision of death that valorizes life. The encounter between East and West has unwrapped the gifts of love and death, and now we can see that they are two sides of the coin of life. I hope this book, which reflects the forty years of work I’ve done in the field of care of the dying,
reflects back to you some of the extraordinary possibilities that can open for each of us in life as we encounter death.
What’s written here is not theoretical but grounded in my work with dying people and in the many years I have had the privilege of teaching professional and family caregivers. It is also influenced by my friendship with Roshi Bernie Glassman, who articulated the “Three
Tenets,” a basis for peacemaking. The Three Tenets are not-knowing,
bearing witness, and compassionate action. These three reflect the kind of experiences I have had with dying people, those who are grieving,
and caregivers. The tenets have become guidelines for me as I practice being with dying.
The first tenet, not-knowing, invites us to give up fixed ideas about others and ourselves and to open the spontaneous mind of the beginner. The second tenet, bearing witness,
calls us to be present with the suffering and joy in the world, as it is, without judgment or any attachment to outcome. The third tenet,
compassionate action, calls us to turn or return to the world with the commitment to free others and ourselves from suffering. I have used the three tenets in my work with dying since Roshi Bernie shared them with me years ago, and they are used in this book as a way for us to consider how we can be with living and dying.
As you will see,
I have not made much distinction in this book between living and dying.
We normally make a false dichotomy between living and dying, when in reality there is no separation between them, only interpenetration and unity. The meditations and practices offered here can be, with a few minor changes, done for oneself if ill or dying, for one’s dying loved one, for oneself if one is a caregiver, for all beings, or simply because they make our living more vivid and tender.
After each chapter in this book I offer suggestions for meditations you can do on your own, so that you can have some practical experience of what it is like to begin looking at the great matter in this integrated,
concentrated way. These practices are upaya, translated from Sanskrit as “skillful means”—the techniques and technologies we can use to be more skillful and effective in our living and our dying through training our heart and mind. They are gateways to be entered again and again, until you make them your own through your own experience with them.
I sometimes say that our monastery in Santa Fe should have a slogan hanging over the gate: “Show up.” That’s all we have to do when we meditate—just show up. We bring ourselves and all of our thoughts and feelings to the practice of being with whatever is,
whether we are tired, angry, fearful, grieving, or just plain resistant and unwilling. It really doesn’t matter what we’re feeling; we just come to the temple and sit down. So experiment with using whatever arises for you as a component of your meditation practice: “Oh, look who’s here today—resistance. How interesting.” Or maybe: “Today I feel scared. Let’s sit with that.”
Our attitude of openness and inclusiveness is essential as a basis for working with dying, death,
caring, and grieving. The only way to develop openness to situations as they are is by practicing the partners of presence and acceptance. We give our best to experience everything as totally as we can, not withdrawing from the vividness of any experience, no matter how scary it seems initially. This is actually a totally ordinary state. I call it “no-big-deal dharma”—simply everyday life. It is nothing special.
With this kind of open and spacious awareness, we are complete, and this moment is complete. There is nothing special to realize, no transcendent reality to achieve, nothing outside of what is unfolding in any given moment.
Contemplative practice is a completely natural activity. We can live in this straightforward way with things just as they are. Although it certainly helps to have become trained in this process through sitting meditation, we need not reserve a particular time or place, or produce a special state of mind, in order to do it. Nor do we have to force the experience on ourselves. When self-conscious effort or unusual mental experiences arise, simply observe, accept, and let them go. Notice, relax, and let go—three key aspects of mindfulness. The mind of not-knowing is simple,
straightforward, open, and fresh. This kind of mind is like clouds in the sky, water flowing, a light wind; nothing obstructs it.
Whether you are thinking, writing, walking, or sitting in silence, be willing to use all of the ingredients of your life as they present themselves to you. I promise you that, as the poet Rilke wrote, “No feeling is final.”
However unbearable any discomfort seems, ultimately everything we experience is temporary. And please make the wonderful effort to show up for your life, every moment, this moment—because it is perfect, just as it is.
Meet the Author
Joan Halifax, PhD, is a Zen priest and anthropologist who has served on the faculty of Columbia University and the University of Miami School of Medicine. For the past thirty years she has worked with dying people and has lectured on the subject of death and dying at Harvard Divinity School, Harvard Medical School, Georgetown Medical School, and many other academic institutions. In 1990, she founded Upaya Zen Center, a Buddhist study and social action center in Santa Fe, New Mexico. In 1994, she founded the Project on Being with Dying, which has trained hundreds of healthcare professionals in the contemplative care of dying people.
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BEING WITH DYING is specifically aimed at professional caregivers, but non-professional caregivers, such as family members and friends who provide caregiving for a dying person, will find excellent support to guide them along their spiritual path. With unflinching honesty and deep compassion for the dying person, Halifax explores all the aspects of dying and death that, in being with a dying person, a caregiver may experience. She deals with the spiritual, physical, mental and emotional processes that dying activates and how this affects both the dying person and those around him. There was some bias against family members and friends acting as caregivers to the dying. All her empathy lies with the dying person, which is as it should be, but Halifax is, at times, quite unsympathetic to the emotional pain, suffering and struggle from the family caregivers’ side. Her negative view of caretaker archetypes reveals a subtle disdain for the role of family caregivers. Unfortunately, this slightly detracts from the inherent wisdom of her advice and Buddhist philosophy. Not all of us have the temperament or self-mastery to become a detached caregiver. All non-professional caregivers do is try to give their loved ones the best that they can out of love. Yes, with hindsight, the mistakes they make may have made dying more difficult for the departing soul, but the resulting guilt also makes the loss harder to bear even when the non-professional caregiver knows the loved one’s soul is finally at peace. Halifax’s compassion was all for the dying and there was very little left over for the family members living for years in that strange limbo between deep love, anticipatory grief and impending loss. Despite this, the wise reflections, the meditations and the practical advice presented in BEING WITH DYING helped me through the very trying time of my beloved Father’s active dying. Coincidentally, I started reading this book the night he had his third and final stroke, and I finished it 11 days later, the day after his funeral. I regret that I only found this book three years after my role as caregiver to my Father began, because I can see the mistakes I made, despite having help from a professional caregiver for the last 18 months. But I do gain some small comfort from the fact that, in the 6 days it took my beloved Father to actively die, I feel this book truly helped me ease his path slightly (by just sitting quietly with him and following his lead.) I also found the breathing meditations helped me calm my mind and relax my body during this intensely emotional time. Ultimately, BEING WITH DYING was a worthwhile and comforting read for me. I highly recommend BEING WITH DYING, no matter what stage of the caregiver’s role you are currently in.