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Working as an emergency room nurse, Margaret Coberly came in contact with death on a daily basis. However, it wasn't until her own brother was diagnosed with terminal cancer that she realized she understood very little about the emotional and spiritual aspects of caring for the terminally ill. To fill this gap she turned to the unique wisdom on death and dying found in Tibetan Buddhism. In this book Coberly offers sound, practical advice on meeting the essential needs of the dying, integrating stories from her ...
Working as an emergency room nurse, Margaret Coberly came in contact with death on a daily basis. However, it wasn't until her own brother was diagnosed with terminal cancer that she realized she understood very little about the emotional and spiritual aspects of caring for the terminally ill. To fill this gap she turned to the unique wisdom on death and dying found in Tibetan Buddhism. In this book Coberly offers sound, practical advice on meeting the essential needs of the dying, integrating stories from her long career in nursing with useful insights from the Tibetan Buddhist teachings.
In the West, death is viewed as a tragic and horrible event. Coberly shows us how this view generates fear and denial, which harm the dying by adding unnecessary loneliness, confusion, and mental anguish to the dying process. Tibetan Buddhism focuses on the nature of death and how to face it with honesty, openness, and courage. In this view, death is not a failure, but a natural part of life that, if properly understood and appreciated, can offer the dying and their loved ones an opportunity to gain valuable insight and wisdom. Coberly argues that the Tibetan Buddhist outlook can be a useful antidote to the culture of fear and denial that surrounds death in the West and can help caregivers become more fully present, fearless, honest, and compassionate.
Sacred Passage highlights two very practical teachings on death and dying from the Tibetan Buddhist tradition and presents them in clear, nontechnical language. Readers learn about the "eight stages of dissolution leading to death," a detailed roadmap of the dying process that describes the sequence of physical, psychological, and spiritual changes that occur as we die. Coberly also presents the "death meditation," a contemplative exercise for developing a new relationship to death—and life. The book also includes a lengthy, annotated list of recommended readings for added guidance and inspiration.
"An important book for both caregivers and patients. Coberly compellingly demonstrates how terminally ill people can experience emotional and spiritual healing, even when they cannot be cured."—Journal of Hospice and Palliative Nursing
"A much-needed, wise, and helpful guidebook."—Barbara Dossey, R.N., director of Hospice Nursing Consultants
"This is a rich and wise book that will help many people."—Joan Halifax Roshi, Project on Being with Dying, Upaya Zen Center
Any man's death diminishes me, because I am involved in Mankinde, and therefore never send to know for whom the bell tolls;
tolls for thee.
I was in nursing school a terminally ill child turned his big, wondering eyes toward me and asked, "Am I going to die?" I was stunned. What was I
supposed to say? What
say? I didn't even know what I was allowed to say. Certainly I could not respond from my experience. Embarrassed and confused, I said something like
"Don't be silly! Of course you're not going to die. You'll live to be a hundred," and then immediately changed the subject. Wanting to feel safe,
not threatened, I had retreated behind the mask of the mundane, and my heart closed. I did not feel good about it, but back then I knew no other response.
Like most of my peers, I had reached adulthood without having talked much about death. I was certainly not prepared to face it myself. In fact, I had been deeply conditioned to believe that I was guaranteed a bright future and a long life. Why would I think about death? No one else did.
Nor was death a topic for study or reflection in my nurse's training. This was unfortunate since, as a practicing nurse, I was surrounded by constant grief,
pain, and death—often overwhelmed by it. I had few coping strategies. It was easy to adopt the customary aloofness of many health-care professionals, to distance myself from the anguish of my patients and their families. At times I
heard about or was witness to certain events occurring around a death that seemed extraordinary and mysterious to me, but for the most part I viewed death the only way I knew how, with closed-minded indifference. By focusing on the disease, carrying out nursing functions dictated only by physical signs and symptoms, and relating to nurses and doctors rather than to patients, I was able to protect myself from thinking or feeling too much about death. Or so I
thought. But my aloofness began to generate a new dissatisfaction—a disturbing feeling of being unkind. I felt a gnawing discomfort about my tendency to rush about busily preoccupied instead of giving a few moments of my time to genuinely comfort the bereaved. It was becoming evident that my unwillingness to face the fear of death had made me unavailable to human beings at a time when they most needed my genuine, compassionate presence.
didn't fully realize just how unprepared I was to face death until my brother became terminally ill with a fast-growing lung cancer that was rapidly metastasizing, distributing malignancy throughout his body. For several weeks after his diagnosis I was unable to be of any real support or strength to him or anyone else, because I was so preoccupied with my own terror. I felt crippled just when my strength and comfort were needed the most. Death anxiety relentlessly pressed against my chest, and dread incapacitated me. The pressure soon became so unbearable that it forced me to turn inward and look at my own attitudes about death. To me death was a monstrous intrusion—an unwelcome,
abnormal, and horrifying event. The prospect of death seemed chillingly final and unbelievably sad. I did not want to think about death, and I felt excruciatingly uncomfortable around dying people. But my brother needed me. And if I was to be a genuine presence during his dying trajectory, I would have to gain the knowledge required to overcome my fears. At this critical turning point I was forced to decide between making the effort to improve my understanding by facing death honestly, or doing nothing at all and returning to the comfort of my conditioned responses, denial and avoidance. I thought about how much easier it would be for me to bury myself in work, to pull double shifts in the emergency room and be simply too busy to face death with my brother. But one look into his terrified eyes and I knew I had no choice. Thus began my personal and professional research into thanatology—the study of death and the circumstances that surround a dying trajectory.
After my brother died, I practiced for several years as a hospice nurse and acquired much experience working with the terminally ill. At the same time, I began to work on a doctoral degree, studying psychology from both Western and Eastern perspectives. I began to relate certain behaviors I observed among my dying patients to what is described in psychology as the "transpersonal experience." For example, in working with dozens of dying people I
observed that many of them would become deeply absorbed in a connection with some other source of power, of strength and understanding, that was beyond my comprehension as a professional caregiver. The meaning that I or any other caregiver might choose to assign to these observations was of little consequence to the dying person, who found great comfort in the experience.
remember first hearing the word "transpersonal" and being baffled by it. I had no real idea what it meant. Through further investigation, I learned that definitions of such terms as
transpersonal psychology, transpersonal studies,
are still in the formative stages, but that, in general, the transpersonal approach embraces all of human experience and represents "action which takes place
a person, but which originates in a center of activity existing beyond the level of personhood," including the mysterious events that defy modern scientific explanation and transcend ordinary time and space concerns—for example, deathbed visions and near-death experiences, which have been reported by thousands of people. Even though scientific researchers have identified several patterns and themes in such reports, there is much about these events that remains beyond the reach of quantifiable measurement.
Western medical paradigm, based on the scientific model of measurable
"facts" and reproducible results, has enabled medicine to achieve astonishing feats over the last century However, because of its single-minded focus on curing disease to the exclusion of all else, Western medicine has developed an unnecessarily limited view of health, illness, and dying. In particular, the Western medical paradigm has traditionally supported a theory that the mind and body have no connection, that the body is like a machine that when functioning improperly can be fixed by employing a strictly mechanical approach. Unfortunately, when a disease cannot be cured—when the machine cannot be fixed—the sick person is often deemed a medical failure, and, as a representative of defeat, he or she is often isolated, ignored, and avoided.
Over the past forty years, however, data from the emerging field of psychoneuroimmunology, which studies the connections between the mind and body down to the cellular level, has increasingly indicated that the mind does influence the condition of the body in extraordinary ways. For example,
meditation has been shown to lower blood pressure,
and visualization has been shown to produce measurable changes in the immune system. Knowledge about the mind's ability to affect the body has led to new views of illness and health—views in which patients are not seen as machines that are either broken or fixed. A broader definition of health and healing opens up the possibility that the dying, even with their unfixable and incurable diseases, have the potential for healing and the achievement of inner peace.
primary step along the path toward healing in this deeper sense is to identify and reduce the stressful stimuli that prevent relaxation. A simple concentration technique for promoting relaxation has been developed by Western stress researchers,
and in Eastern cultures spiritual practices such as meditation and visualization have for centuries been known to reduce stress and promote inner balance and healing. It can be of great benefit to patients and their families if care providers have some knowledge about specific transpersonal techniques that can be used to assist in a healing process, particularly in the face of death.
visualization, prayer, and self-reflection using such techniques as the life review
are practices that care providers can employ to assist a dying patient who wants to work toward growth and healing. Along with these approaches, I've found certain concepts and teachings from the Tibetan Buddhist tradition to be invaluable in my work with the dying.
came to learn about Tibetan Buddhism purely by chance. One day, after my brother had been diagnosed with lung cancer, I went to the Bodhi Tree Bookstore in Los Angeles hoping to find solace in a book like
Course in Miracles.
While browsing the shelves, I picked up a bright orange book that attracted me. It was
Advice from a Spiritual Friend
Geshe Rabten and Geshe Dhargyey, and I wondered what "Geshe" meant
(later I learned that it is an honored title given to those who complete an advanced academic degree in the Tibetan Buddhist monastic system). When I
turned the book over to see the pictures of the authors, I was hooked from that moment. Their faces were full of so much peace and kindness—and there was no pretense. I started reading to find out how people get that way, how people actually achieve that kind of natural, relaxed happiness.
That was in 1987. About four years later when I was living in Hawaii, a friend encouraged me to attend a ceremony that was to be given by Tai Situ Rinpoche, a revered Tibetan teacher who was visiting Honolulu from India. I had been instructed that during the ceremony when I was standing before Rinpoche, I
should lower my head and not look directly at him. But when I got right up next to him and bowed, I just couldn't stop myself. I looked up and met his eyes straight on, and all I can say is that it seemed like he zapped me somehow. It was very strange, but I suddenly felt deeply happy. Inspired by that experience, I continued to read about Tibetan Buddhism and dedicated myself to becoming a better person. In my reading I was pleased to discover many rich and detailed teachings on death—ideas that have given me great comfort and inspiration in my work with the dying.
According to Tibetan Buddhism, dying is not something to be feared, avoided, or denied,
but rather something to be contemplated and appreciated as a special kind of opportunity. In this view, death can be an important teacher, allowing us to realize that impermanence underscores everything. All matter is subject to change; death is just the most profound reminder of that fact. My first conscious glimpses of the inescapable truth of death and the changing nature of all things were quite frightening because I was conditioned to deny these realities, not confront them. But slowly my acceptance of impermanence grew,
and finally I was able to embrace the fact that everything changes. Although my hopes for achieving security in the external world were dashed, I gained an awareness of what Tibetan Buddhists call ceaseless transformation, a view of living and dying that I will present in this book in the hopes that it will be as helpful to other care providers as it has been to me.
One of the book explores the problem of death denial in Western health care.
Here I'll share some striking stories that demonstrate how fear and denial harm the dying, their families, and health-care providers; and I'll explain why denial, fear, and avoidance of death have become so difficult to overcome.
What's needed is a new understanding of death and a broader definition of healing, one that acknowledges the emotional and spiritual dimensions of health—dimensions that remain fertile even when people have a terminal disease. Part Two examines some of the central Tibetan Buddhist concepts and practices surrounding death. Although Tibetan Buddhism is not the only effective or important approach to confronting death honestly and openly, for me as a care provider, it has been a particularly valuable source of strength.
The Tibetan tradition is replete with explicit, practical methodologies, and I
found certain insights and applications that enabled me to start developing an attitude of receptivity toward the inevitability of change and death—a far cry from my earlier distancing strategy.
Part Three I provide practical applications of the Tibetan teachings. These recommendations will be of use to anyone who must care for the dying, whether in a hospital, a hospice setting, or at home—or for anyone who has wondered what to say and how to behave around the dying.
My purpose in writing this book is to share with others the many lessons that I
have learned both as a care provider to the dying and as a student of the
Tibetan Buddhist teachings on death and dying. Feeling comfortable and present when facing a dying person requires more than knowledge learned in books; what is also needed is an inner humility and trust that comes from the actual experience of encountering death. The ability to provide healing care for the dying when cure is no longer a possibility involves cultivating skills that can be learned by most anyone who is willing to accept the task. Care providers and loved ones who further arm themselves with knowledge about alternative perspectives that broaden and strengthen their view of healing can greatly enrich their work with the dying. By becoming more receptive to the unusual events such as transpersonal experiences that often occur when a person is dying, care providers and loved ones alike are afforded an opportunity to find new meaning in the dying trajectory.
It has been an honor to be present during the final phase of life, and ultimate death, of many patients, friends, and relatives during my thirty-year career as a nurse. Every experience taught me more about the dying process, and about my own responses to it. The inner treasures of wisdom hidden in a dying trajectory are like jewels lying just beneath the surface. Facing death squarely not only eases a patient's passage out of this world; it can precipitate the emergence of some of these treasures, such as the deep recognition of the invariability of impermanence, or a clear awareness of the integrations that weave together everything in life and death. Care providers and patients alike have the ability to bring forth these and other treasures of the mind, when a resonant and healing spirit suffuses the dying trajectory
ONE: DEATH IN WESTERN HEALTH CARE
Problem of Death Denial
Prevailing Medical Paradigm
School and Death Denial
Denial in the Community
Broader View of Healing
Kübler-Ross and the Plight of the Dying
Care and Healing
Healing and the Power of the Mind
Reflecting on Death
Awakening to Impermanence and Facing Death
Death's Scythe 50
TWO: RESOURCES FROM THE TIBETAN BUDDHIST TRADITION
Origination: The Truth of Impermanence
Form and Shadow Remain Linked
Mind: The Worlds We Find Ourselves In
Mind: The Light Within
The Realms of Cyclic Existence
Tibetan Book of the Dead: An Instruction Manual
Eight Stages of Dissolution
1: Earth Dissolves into Water (Mirage)
2: Water Dissolves into Fire (Smoke) 84
3: Fire Dissolves into Wind (Fireflies)
4: Wind Dissolves into Space (Flame)
5: Ordinary Mind States Dissolve (White Flash)
6–8: Subtle Mind States Dissolve (Red Flash, Black Flash, Clear Light)
Tibetan Art of Death: Two Lamas
Table of the Eight Stages of Dissolution
THREE: PRACTICAL APPLICATIONS FOR CARE PROVIDERS
Buddhist Practice and the Dying Trajectory
Tibetan Buddhist Death Meditation
Hearing the Diagnosis: Death Is Certain 106
Do I Say? Time of Death Is Uncertain
At Death Only the Condition of the Mind Has Value
Developing a Transpersonal Stance in Care of the Dying
Presence, Not Pretense
Peace in Relationships: Forgiveness 119
Peace at the End: Sacred Passage
Posted January 18, 2004