With the help of a months-long training program, a senior member dedicates himself to volunteer with people struggling with sickness, old, age, and death
A couple years ago, I noticed that my collection of books about illness, end of life, dying, and death had overflowed from a third shelf onto a fourth. Around the same time, I had started following the Facebook feed of New York Zen Center for Contemplative Care (NYZCCC); an announcement appeared there that applications were being accepted for their annual training program, Foundations in Contemplative Care (“Foundations”). After reading the course description, I checked travel and lodging logistics and costs for the nine two-day weekends in NYC (plus a four-day retreat at the Garrison Institute), looked again at all those books, and said to myself, “Why not?”
This was about a year after I had moved my wife, Jane, into “memory care.” She had been symptomatic with Alzheimer’s Disease for more than ten years. With the exception of twelve to sixteen hours a week of respite care (that allowed me to keep working at my career in insurance), I had been her full-time caregiver. Concurrently, my mother was fading slowly through her last five years, in an assisted-living/nursing-home facility nearby. I came to know, as I was moving through those experiences, that I would not have handled them as well, or perhaps could not have handled them at all, without the centering stability and energy that years of Zen practice had made accessible to me.
What is that power of a persistent contemplative practice that oils the wheels of life, that cools the fires of illness, loss, and death? Through the Foundations course, I meant to dive into those questions, not just through reading and talking, but also through experiential training, through “risking it” in real life, through the practice of the practice itself.
Among the requirements to complete Foundations is to undertake 100 hours of supervised clinical care in a hospital, hospice, or nursing home. After being accepted to the 2018-19 Foundations class, I elected to do volunteer work at Brookdale Hospice in central Indiana. Starting late last August, I was assigned four hospice patients to visit on a weekly basis, at two different multi-level care facilities. As I turned into the driveway of an urban nursing home for my first visits, a large snowy egret (a rare sight in Indiana, let alone in the city) flew over just in front of the hood of my car. I am always grateful when, as one of Carlos Castaneda’s characters said, “The world confirms me.”
I needed that encouragement, as it turned out (this was before I had attended my first Foundations class), as my assigned patient (let’s call him Elwood) turned out to be very shy, very reserved, extremely soft-spoken, almost non-verbal. What to say? What to do? What was I there for? I felt pretty useless, until the music therapist from Brookdale coincidentally arrived and set up to sing a few songs—at least I could sing along on some of them. I had no idea how I would handle another visit with Elwood, or with anyone else, on my own.
Twelve years ago, the co-founders and guiding teachers of NYZCCC recognized that compassionate caregiving in the U.S. was a widespread chronic need, one not being adequately or appropriately addressed. Sensei Koshin Paley Ellison and Sensei Chodo Robert Campbell had each been active in pastoral counseling, hospice work, Zen teaching, and hospital consulting. Wherever they went, they encountered populations of sick, lonely and/or dying children, men, and women who had been waiting, often hopelessly, for a sympathetic ear, a warm hand, a kind voice—simple human needs. They determined together that as a society we need to be taught, or to re-learn, and to practice, these critically important, very basic human skills. How can we be with each other? How can we care for one another? Koshin and Chodo had observed that their best pastoral encounters arose from their Zen practice, from a place of not knowing, from “just this,” from not judging, not expecting, from plain old “just being there.”
The prospect of providing such care appealed, in one way or another, to 44 eager folks from around the country who showed up on a Friday morning early last September at the fourth floor zendo/classroom on 23rd Street in Manhattan. Through the open windows the raucous sounds of the city rolled in: jackhammers, horns, sirens, and a multitude of voices. Inside, we were folks from 22 to 77 years of age, with many shades of skin and many accents (including Slavic, Norwegian, southern drawls, Bostonian vowels, and all varieties of “the voice of the City”). Medical doctors, nurses, and counselors were balanced with artists, entrepreneurs, and retirees—each with some form of contemplative practice, whether Zen or Vajrayana Buddhist, Jewish or Christian contemplative prayer, yoga meditation, icon drawing (or other art forms), or simply going to the park every day to sit quietly.
Classes ran through the day on Friday and Saturday. We always started each morning and afternoon session with five or ten minutes of silent meditation. After that, we went around the room and individually “checked in”: “I’m Larry. I’m feeling excited and grateful to be here.” “I’m Kendra, I’m feeling happy, but a little scared.” These check-ins included the four class leaders.
Every month there were two, or three, or four books to read, and one or two short papers to write. Our core text, discussed throughout the year, was Reb Anderson’s Being Upright: Zen Meditation and the Bodhisattva Precepts. At the start of the year perhaps a third of the class hadn’t heard the word “bodhisattva” before, but by the end, my sense is that each one of us would now affirm, “Yes, that’s a good description of what I’m trying to do, or to be.” There were one or two Dharma talks each weekend, and several enthralling guest speakers through the year. We’d say Zen meal chants before breaking for lunch, and recite The Four Vows at the close of each day. So for me, so far: no big surprises.
But then, in the middle of the first morning of the first day of class, the hammer of reality fell. After a Dharma talk by one of the teachers on the first Grave Precept (Not to Kill, but To Cherish All Life), we were asked to pair up in dyads, with the stranger sitting next to us, and to sit knee to knee, facing one another squarely. We were asked to look into each other’s eyes for a minute. Then, one of the pair was instructed to ask the other, “How do you kill?” The other would provide a brief answer (at the start, probably, a superficial one). Then the questioner, without nodding, or gesturing, or saying anything else, would simply say, “Thank you. How do you kill?” Another answer would be followed by another “Thank you. How do you kill?” Over and over. Again and again. For ten minutes.
It got pretty deep, pretty quickly. Then a bell was rung, and we were asked to sit looking at each other silently for a minute, and the questioner would then offer the respondent a blessing, based upon what they had heard. Then, switch! Roles reversed, the other would ask, “How do you kill?”, and be answered by their partner, and say “Thank you,” and would ask again, “How do you kill?” And again.
This hammer of reality came down regularly throughout the year; two or three times each day of class we’d break into dyads, or triads, or quads (almost always with someone we hadn’t worked with before), and we would inquire, or probe, or role play. Intimately. Vulnerably. With all the humility we could muster, with strangers who often quite quickly became beloved, known friends. A community was rapidly forming. It was precious, unique, constantly evolving, and, as we soon became aware, impermanent.
The purpose behind these well-planned exercises, of course, was to wear down our walls, explore our stuck places, examine our prejudices, and accustom us to being open and available to another human person. This may sound familiar, because, perhaps without the same outspoken intentionality, it’s part of what happens to us also when we sit in meditation every day, day after day, year after year, decade after decade. Both are training us for no more (or less) than to be able to walk into a room and be truly present.
We were reminded of this repeatedly in class, of how important it is to check our mind-state before entering the patient’s room. We were told, “It’s not about you!” We explored how critical it is: the way we carry our body, the way we walk into the room, the way we say “Hello,” and the way we sit down.
I remember Roshi Kapleau sharing with us in a talk how the teacher really hears the quality of the student’s ringing of the bell before dokusan, that he watches “like a hawk” how the student walks into the room, makes her bows, adjusts the pillows. Already, the teacher knows intimately the condition of the student’s mind. As caregivers, we learned in class, we would be fools to imagine that our patients, even if blind, or deaf, or with dementia, or perhaps even in a coma, were less sensitively aware of what kind of energy and presence we are bringing into their space.
In Case 46 in The Mumonkan, Sekiso said, “How can you step forward from the top of a hundred-foot-high pole?” In part, working on that Case revealed to me how even (or especially) my Zen practice isn’t about me. What good is it? Who is it helping? What do I have to offer back to the countless millions of beings who made this life possible?
I think there are two primary keys to the door of helpful contemplative care. The first is this simply being present, being real, being clear, being energetically available for whatever the patient might need in that moment. This key is turned every day when we sit in meditation and then carry that simple, unified presence with us everywhere.
The second key is a far-ranging set of professional skills and practices that were merely introduced in the readings and in the twenty-one days of class instruction and practice in Foundations. It was a good introduction; it presented the scope and range of the field of pastoral counseling, which would take years more of study and training for one to even approach a journeyman’s competence.
Each student was assigned one of the four class leaders as mentor for the year, with whom one met (or Skyped) at least monthly to discuss coursework, volunteering activities, and emergent issues. We each also got a new “buddy” each month, for emailing, conversing, and sharing issues related to the work. Monthly study topics included the power of prayer (from many traditions) and poetry, dealing with diversity, recognizing and interpreting symbolic communication, spiritual assessment tools, dealing with loss and grief and mourning, the process of dying and death, post-death practices, advanced directives and funeral planning, recognizing and staying with feelings, power dynamics in relationships, visitation guidelines, working with “unresponsive” patients, therapeutic interpersonal techniques, and much more.
At my volunteer job at the hospice, case discussions would go on, and on, for two more hours at least, until it finally completely sank in and saturated my awareness: we’re all dying, right quick, right now, all over the world. Some cared for, some forgotten, but no escapees… not a single one of us. I know that for several days after these meetings, when I sat, I sat a little taller, I leaned into it with a little more intentionality and purpose, thinking at the start that, “I, too, am soon to be gone.”
The second patient I was assigned to visit weekly (let’s call him Fred) had been residing on the same assisted-living wing for five years. Fred keeps his room at 87 degrees Fahrenheit or higher. He isn’t too fastidious about personal hygiene. He is very hard of hearing, even with his two hearing aids turned up to the max, so when I visit, he navigates his walker from his bed or chair over to the small couch in his room, and we would sit almost head-to-head and shout at each other.
We learned early on that Fred was from a small town in southern Indiana that also produced my best friend’s grandfather, and that one of his good friends moved to my hometown years ago, to work on the local newspaper. So we would shout about that, every week. Almost every visit he would ask me if I thought “they will ever catch the killer of those two girls” (referring to a local news story from a couple years back). And about every week he would tell me again about the high school teacher from his town who, years ago, “got in trouble with the gamblers up in Terre Haute.” That teacher heard the gamblers were sending someone down to rough him up good, so he took himself out to the railroad overpass one night and hanged himself. “You could see him dangling there, clear from the highway, the next morning,” Fred shouted. “They said when they cut him down, he had torn all the skin off his hands and fingers on that rope. He must have changed his mind, but he couldn’t save himself!” Every week I nod, shake my head, and shout, “That’s really too bad!” We eventually say goodbye, and he shouts as I leave, “Come any time!”
Even though a hospice placement is for folks medically expected to live fewer than six more months, of the four gentlemen I was assigned late last summer, only one has died as of this writing in mid-May. I was with “Byron” five days before his passing, and we had a decent conversation, mostly about all the people in his independent living neighborhood who had “already died.” I’m realizing now that I can look around at any apartment building, or cul-de-sac, or town, and confidently state that most of the people who ever lived there have already died (or at the very least, are close to doing so).
In addition to inspiring me to sit zazen more ardently, the Foundations course and the hospice work have reinforced other elements of Buddhist practice for me, including chanting. Leading up to my mother’s death in December, as she was starting to actively die, I would recite various mantras, prayers, and dharani for her. I also undertook for the first time in my life, starting on her death day, to hold daily funeral services, and did so for 49 days (the period of time, as it appears from “this side,” that it is said to usually take for a being who departs this world to traverse the “bardo of becoming” before attaining a subsequent rebirth).
Caregiving can uncover some of the koans lurking in real life. Someone is dying. What can you say? Someone is crying. What do you do? Another screams in impossible pain. How will you be with them? Somebody else is telling you the same story for the fifth time. Can you listen with fresh ears and bright eyes, eyes that invite another telling?
The Buddhist teachings point out that our heart-mind, our essential nature, is naturally wise and compassionate. Wisdom and compassion are what is most needed in caregiving encounters. This naturally warm and tender heart can be more readily opened and shared if one is immersed in a contemplative practice such as Zen. Make this practice your entire day-and-night life, as I now am aspiring to do. Reach out. Knock on the door. Say “Hello.” Walk in. Sit down. Smile, and breathe. Save another life, even as we all die together.
Foundations 2018-19 is over now, the classes are done, the group—our precious group of special, wonderful, like-minded, fearless, and tender bodhisattvas-in-training—is no more. Like everything else, “the class” never really existed as an independent entity. The 44 “clouds” seemed to float in one day last fall from all over; we changed, mixed, merged, flowed, and dispersed, each one now different, of course, each cloud miraculously altered by the experience, each one taking something from all the others to bring back as blessed rain, as cooling shade, as uplifting beauty, to our own temporary floating spots. There was a wonderfully bittersweet parting party after the last class, and a Facebook page is in place to help keep us in touch, but I’m also moving on. I’m excited to be able now to join in the next sesshin at Chapin Mill (my time and the travel budget have made it impractical for me to participate there since August). Thanks to Foundations, and thanks to volunteering at hospice, I have a much clearer sense of why I will be sitting at upcoming sesshins; thanks to the daily practice of zazen, I also have a keen appreciation of why I am now going to keep on as a volunteer. I care to sit. I do, indeed, sit to care. / / /
LARRY MCSPADDDEN feels grateful he learned to read when young, as books on the Dharma in English started appearing when he was old enough to buy them. He first found his way to the Zen Center in 1969.