Presenters: Dale Borglum, Ph.D., Myra MacPherson, and Jean Watson, RN, Ph.D.

Moderator: Shanti Norris

Commentator: Michael Hawkins, M.D.

Session: Su7; June 13, 1999

Shanti Norris shared a memory she had experienced in India where a teacher recounted a story of a great sage who was asked at a certain point: "What is the most remarkable or amazing thing that you have ever seen in your life?" He said, "The most remarkable thing I’ve seen in life is that even though we see people born, live, and die each one of us thinks that that will never happen to us." Meditation and thoughtfulness about our mortality and issues at the end of life is often given as a spiritual practice, something to be thought about and meditated as a way to live better.

Jean Watson began with a centering exercise with music in the background. This will allow us to be more present, available in the moment. A most profound questions asked by the Dalai Lama: "What are the practices that we cultivate to practice caring and compassion?" It’s not something that we can ignore and expect ourselves to just have access without cultivating some kind of practice. The same is true for caring and healing models. All of this begins with self. When we are truly present to ourselves, we are connected with something greater than ourselves. We begin to see that we share consciousness connecting ourselves with the divine. When we do these practices, we return to our hearts and heartfelt practices.

When we move into the domain of mind/body medicine it has a truly spiritual underpinning. It reminds us that we are spiritual beings having a physical experience. From the Native American perspective, we all come from the spirit world. We come with a soul purpose. We choose when we come and fulfill something that is related to our soul journey. When that work is done, we return home to the spirit world. We have to change our reality, our worldview about how we look at ourselves in relation to the universe. We should consider this to understand what we mean when we say care at the end of life. We are beginning to ask new questions as to what it means to be human, compassionate, caring, healing, dying. We are at the point of evolving our human consciousness beyond the expected. Perhaps death is expanding our consciousness.

We need to be authentic and no longer separate our personal life from which we are as practitioners and professionals. We have stood behind these roles far too long. We need to see that we are the instruments. We are the tools, practices, consciousness. We have to have frameworks and intellectual understanding that guide us. Ultimately, this kind of work requires that we go back to our heart felt practices in the very center of our soul. William James reminds us that we will do anything to avoid our souls -- run marathons, do aerobics, shopping, etc, just keep busy to avoid our soul.

Caring is actually a sacred practice. This work is sacred work. One of the dangers of a complementary/alternative medicine movement, without being conscious and without looking at this at the moral and ethical level, we see that this is just another add-on to the conventional model thinking. This is not a real transformation of something that goes much deeper that gets into this very deep spiritual dimension. Caring is sacred because we are dealing with people when they are the most vulnerable. It’s sacred because we are dealing with the energy, the soul, and the spirit of another person that we cannot control nor try to control. Caring and healing deals with the spirit first, everything else will fall into place. When the spirit comes first we also deal with the unknowns, a mystery. We become part of the mystery, part of the process, becoming part of the journey. Caring is also a sacred cradle for healing because it manifests as a gift. It allows us to use our talents and gifts to move into many directions constricted before. It also allows us to return to our human center where all transformation takes place. Caring also requires reflective practice. Observe and critique to see where the human aspect is in the system. A caring moment can actually be an existential turning point. It can be a call to a higher consciousness and different kind of authentic choice that we begin to seek, trying to connect the divine with the earth plane. This is a new way of thinking of what it means to be human.

Our country is not very good at dealing with grieving and death. We would much rather deny to the very end that it will not happen to us. We don’t like to discuss these issues. Through her personal experience with her mother’s death, she started her path to investigate death. The way we die is the way we live. When the care giving time comes, it is best to make decisions that are family oriented. In her book, Ana chooses to die at home but was concerned for her children. She was advised that the children should be brought into the decision making, and not to keep them out because they are young. Denying the children part of the decision is paying later with unresolved loss and unresolved grief. Ana and her children decided that she would stay home. She was also advised that whatever she wanted to do to write it down in pencil and not in pen because that way no one feels that it’s hammered in steel. You can always change your choices.

Through hospice, the process of dying can be a very meaningful and joyous experience. As a hospice volunteer, one can help diffuse situations in the family by being an outsider. The most positive experience is the approach to palliative care. When Ana came to her death awareness, she was able to talk to relatives and friends who had passed away previously. Thus, there was this comforting moment of limbo where Ana was able to be between two worlds. We are not alone in this process, there seems to be someone out there helping you cross. Remember that we can all learn to be good caregivers.

Meditation is how he started with this work. One of his first meditation teachers said that until we come in intimate contact with death, spiritual practice is dilettantish. If we only meditate and do practices for tomorrow, so that we may be a better parent, friend, caregiver, in actuality we are very far from the truth. Having an intimate relationship with death shows us that the only work to be done is right now.

In his earlier days, he began the Dying Center with Levine believing that he was helping people die. After a year or two, Dr. Borglum realized that everyone lives and only are dying for few hours. They are not really interested in dying, they are interested in healing. He realized his work had more to do with healing than dying. Healing is what brings us into spiritual practice. Spiritual practice tends not to be fun, at least in the beginning and intermediate stages. We are asked to be quiet when in reality our minds want to wonder around, to look at things that are difficult. However, at the end of this process we trust that there will be some healing.

As caregivers for people at the end of life, there is a real danger in feeling that we are there to care for other people. The training that he does at his center for the volunteers is clearly designed so that the caregiving is done as work on us. Their primary job is not even to help the other person but to wake up in the process. The belief is that working on ourselves is the best way we can serve our patients.

There are two levels of practices: one, doing skillful means and the second, the quality of our presence. If we as caregivers can lose the identity and not see the patient as a dying person and be able to rest in presence, whatever that may mean to us, then he believes that healing takes place for both the people in that encounter. Societies that reject the feminine have a very difficult time in dealing with death and with grief (i.e. Western Europe, USA, Japan). Societies that embody the feminine principle, knowing how to be with the planet, with each other, they know how to receive, death is a mystery that is received, then death is part of the normal unfolding of life. In those societies, typically at the end of life a lama, priest, shaman, comes to the bedside of the person who is dying and guides that person into the next life. Therefore, the Living/Dying Project trains their volunteers to fulfill that function as best as possible in our society.

Being around the dying, Dr. Borglum feels he has received the following gift: he has began to see that there is really a way to healing that he has been shown by his clients over the last decades. There is a path to healing that is embodied in psychotherapy, in Christianity, in Buddhism, in the twelve step program in which all pretty much say the same thing.

There are a few steps when we are present when someone is dying:

A. Initially when we are present around suffering or someone who is dying, we are just standing there being caught as the speaker or feeling that this is a cold, dark room. The first step is to invoke. To invoke that which we trust to heal. Even those who do not believe in anything, it is still trusting that even though we do nothing there is an unfolding that will eventually lead to healing. So first invoke that which heals (i.e., goddess, sacred, presence, Buddha, Christ consciousness) But because we have a shadow, we invoke, we have a taste, we touch, we have a presence and then our shadow begins to arise. Now the second stage is required which is awareness.

B. Awareness follows the appearance of the shadow. The awareness must be clear and unbiased awareness of what material begins to arise. There a few qualities of the shadow as it begins to present to us as someone is dying.

C. When awareness deepens it becomes compassion, we become compassion, and we are compassion. If we expect healing, a dropping into empowerment must take place. Compassion is a unidirectional event including myself, the community, and the patient with the environment. Empowerment being the final event.

If we can bring all this together then healing can take place and not necessarily a physical healing. At this point suffering and dying in the old ways, in a way that they are solid and real cease to exist. Death is two fold. In a sense we are losing someone we love and the dying is losing everything they have and know. At the same time from the absolute or spiritual side, death becomes part of the next process. The work is a balance between the human and the divine, the absolute and the relative. To not lose the human dimension and be aware that this is all taking place within the context of a vast spiritual reality.

Many patients are put off when discussing end of life issues. They want to know treatment and therapies for the cancer. Even though you are talking about dying issues, it doesn’t mean you have given up on the patient. This difficulty arises because the ground has not been prepared. The interactions are dealing with the patient treatment and what can we do to maximized their physical healing.

It is important to learn the lessons of the dying patients and move them up earlier in the process. It seems that the lessons of dying patients are lessons on how to live. A way to use this on a practical sense is to set a value based practice. This would have two components: first, the values must be generated within the group itself; second, with some leadership and some vision taking people beyond what they think is possible. One principal is the resting in presence, a relationship centered care. A second principle is that caring is a sacred act. Third, find your own truth and be able to express it. Fourth is the aspect of compassion, to be present with the patient. Using all these principles we can create an environment for the dying patient where it is not such a huge transformation but that there are vehicles in place to allow that discussion to take place.