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Lions Roar : November 2017
“Medical training can sometimes involve both vertical vio- lence and horizontal hostility, with various forms of bullying and without an emphasis on self-care. So clinicians are stressed out and facing high-demand situations of great criticality,” Halifax says. “The sense of not being able to meet a patient inti- mately and to provide a connection that allows real care to hap- pen discourages and demoralizes clinicians.” While economic pressures contribute to the dehumaniza- tion of medical care, Halifax says that medical technology, while offering great benefit, also creates a separation between clinician and patient. “It disallows the kind of intimate contact that doc- tors and nurses had in the past with their patients, which was so much more focused on care. Now the emphasis is on cure.” Compassion is the key to balancing the scales of cure and care, Halifax says. “When we work with clinicians at Upaya, we acknowledge the challenges they face—pathological altruism, burnout, moral suffering, empathic distress, and disrespect. We teach them how to work skillfully with these challenges and give them tools to help understand the value of compassion in relat- ing to patients.” That involves discovering and cultivating intimate con- nection—with oneself and with others. A Zen priest who has explored many different religious traditions, Halifax began to practice Buddhism in 1965. “As I worked with dying people, caregivers, and others experiencing catastrophe, I practiced meditation to give my life a strong spine of practice and an open heart from which I could see beyond what I thought I knew,” she writes. “Buddhism has more resources for dying people than any of the other traditions that I’m currently aware of. Each of the Buddhist traditions offers various contemplative technologies that are profoundly helpful in supporting us not only in living, but also in dying.” In Being With Dying, Halifax offers tangible tools for navi- gating the unknown. “I wanted to essentialize some of the key practices that I feel both people who are dying and caregivers can use as they face suffering and face death,” she says. Practices such as meditation and asking specific questions bring out the value of inquiry, Halifax says. “It’s not just somebody telling you what death is like or why it’s important to prepare for dying and death. It’s asking ourselves questions so we understand that wisdom exists within us. We can develop the capacity to discern deeply and to live our questions.” Mediation practices are particularly beneficial when we feel helpless, when we don’t know what to do or say. “Often we feel that silence and stillness aren’t good enough when suffering is present,” Halifax writes. “We feel compelled to ‘do something’—to talk, con- sole, work, clean, move around, ‘help.’ But in the shared embrace of meditation, a caregiver and the person who is dying can be held in an intimate silence beyond consolation or assistance.” Halifax says that when she is sitting with a person who is dying, she asks herself, “What words will benefit this person? Does anything really need to be said? Can I know greater inti- macy with this person through a mutuality beyond words and actions? Can I relax and trust in simply being here, without need- ing my personality to mediate the tender connection we share?” Halifax acknowledges language does play an important role in end-of-life care. “Language can be a distraction and a way that we push away intimacy. But language that is authentic, honest, unprescribed, spontaneous, and about connecting can be very important for both the caregiver and the person who is dying. Language can loosen the knot that has tied a person to the hard edge of fear and bring them home to compassion- ate, heart-opening truths.” Halifax says language and silence are sister gifts we can use to prepare us both for dying and for caregiving. At NYZCCC, Koshin confessed to me that the night before, when he got the call from Michael Stone’s wife, he didn’t know what to do. “I said, ‘What can I do for you?’ Carina said, ‘He loved you so much and just for you to know that he’s dying right now is what you can do for me.’” “I wouldn’t have thought that was what was needed,” Koshin marveled. “I have lots of skills to offer, but what was needed in that moment was just to hold the whole thing in my heart, because we were loving friends. “I was reminded, once again, that you don’t know what is needed. Those are the fundamentals of this work—dropping your ideas and coming back into your direct experience. That’s scary shit for most of us. I know it was, and still is, for me.” As I left NYZCCC after a day of sorrow, stories, learning, and laughing, I realized that I knew only one thing for sure. That I too didn’t know what to do when death met me at the door that morning. And starting with not knowing, when facing death, is perfectly okay. ♦ Robert Chodo Campbell says that sometimes what is needed most is simply to acknowledge that death is in the room. How will you die? continued from page 59 PHOTOBYSEANKERNAN LION’S ROAR | NOVEMBER 2017 78