Awake at the Bedside: Contemplative Teachings on Palliative and End-of-Life Care

Awake at the Bedside: Contemplative Teachings on Palliative and End-of-Life Care

Somerville, Mass.: Wisdom, 2016. 347 pp., paper, $19.95.

Empty handed I entered
The world,
Barefoot I leave it.
My coming, my going—
Two simple happenings
That got entangled.
                               —Kozan Ichikyo

Recently a study was conducted at Massachusetts General Hospital on newly diagnosed lung cancer patients. The control group was given excellent medical care. The intervention group got medical care as well as palliative care, which is intended to provide relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

It turned out that those who got both types of care had a better quality of life and fewer bouts of depression, were less likely to be hospitalized, and also lived on average 2.7 months longer. There is a belief among physicians that with palliative care, one may die better but one also may die sooner. This study suggests that this belief is incorrect.

The question is, then: what kind of care can not only prolong life, but can also provide one with the strength to understand, accept, and see what has gotten entangled in one’s life journey? The answer is, living with an enlightened perception. The care that provides such a perspective is called contemplative care, or spiritual care. But contemplative care does not have to be given only at the end of life. It is a lifetime lesson.

The essence of spiritual care is contemplating what is real and developing awareness of the present. The Theravada Buddhist teachings encourage people to prepare for the end-of-life journey. Why is meditation of any form such an important part of this journey? It is because people who meditate regularly will generally have less fear of death. The have developed an inner sense of balance and equanimity. Mindfulness brings a deep appreciation of moment to moment impermanence.

The editors of Awake at the Bedside have put together a profound collection of readings. These essays and poems introduce us to a deeply spiritual aspect of care. On a personal note, Awake at the Bedside came as a great gift for me. Inspired by Stephen Levine’s book A Year to Live, I am living this year as if it is the last year of my life. This book has become a new companion on my own journey.

Stephen and Ondrea Levine have a chapter in this book titled “Don’t Wait for Tomorrow,” which gives six meditations on death and dying. This is contemplative care for oneself and others, as the end-of-life journey will inevitably commence for everyone sooner or later. We listen to the one who is dying. A hand held sometimes brings better relief than strong medicines. We live with forgiveness in heart and resolved regrets. We mirror lovingkindness and compassion. We don’t wait for tomorrow but learn to live in the present.

In another article, Anyen Rinpoche talks about creating a “Dharma Vision.” We take great efforts in our everyday lives, and we should make similar efforts in our preparation for the end of life. Living with Dharma Vision means that there is no difference between our everyday spiritual practice and one that we engage in at the time of our approaching death. We create a Dharma Will, store it in a Dharma Box, and share it with our trusted Dharma Friends. This is the spiritual directive that we share with our core group. It provides a skillful means for navigating through the dying process. Anyen Rinpoche also provides guided meditations on contemplating impermanence as an integral element of our lives.

Larry Rosenberg offers three aspects of death awareness practices: awareness of the inevitability of death, awareness of the time of death, and awareness that only insight into Dharma can help us at the time of death. These reflections can be practiced daily. The caregiver can practice these with the dying person. It is not morbid; it brings peace in the face of pain and suffering.

No collection of readings on contemplative care could be complete without teachings by Elisabeth Kübler-Ross. “Dying patients are the best teachers in the whole world and they teach you not only about the process of dying, which is very easy to understand, but also about the process of living,” she says here. “To live fully means not being afraid of living and not being afraid of dying.” The caregiver should take care of the person’s physical needs first and then take care of the emotional needs—the unfinished business. This is the crux of contemplative care. It means letting what is natural take place, as well as allowing grief and anger to exist as natural phases and not to be suppressed. Dying is not the nightmare, she says; it is what we make for one another right here that is the nightmare.

This is not a book that is to be read once and put aside. It is a companion to be taken along wherever we go. Ultimately it is not about dying. It is about caring, both for ourselves and others. The pioneers of contemplative care offer us words of wisdom, stories that inspire, and poems that make us cry. Keep this book at your bedside. It is a presence that can inspire awakening.

Dhananjay Joshi

The reviewer, a professor of statistics, has studied Hindu, Zen, and vipassana meditation for the past forty-five years. He is a regular contributor to the Indian periodical Lokmat.