Zen and Hospice

Editor’s Note: This post originally appeared in the MKZC Zen Journal, Volume 12, Number 1 Winter 2007

At the very beginning of my medical practice, when I was fresh out of medical school and residency training, I got involved in Hospice care. Although the bulk of my practice involved Family Practice — providing general medical services for adults and children — I started seeing a few nursing home patients a few blocks away from the MKZC zendo then located at Grace United Methodist Church. I hadn’t planned to make a career out of nursing home work, but the most wonderful, dedicated and stubborn social worker I have ever known in my life, Martha Carver, dragged me into it. Every time I told her no, I didn’t want another nursing home patient, she assigned me another. To Martha, each one was special and she assured me that taking care of another one would be easy for me. Before long, I had 150 geriatric patients, 104 mentally retarded adults and I had been made the Medical Director of the facility.

The patients represented the full range of stages from good health to dying. Some walked, talked, played bridge, went for outings and kept up with friends and family. Some participated in therapy to assist in recovery, some needed assistance with feeding, dressing, toileting, and other personal habits. Some needed total care and some were dying. I had been trained in all the aggressive modalities available to help support those with an acute disease process but I had not been trained in how to take care of the dying. To modern medicine until the 1960’s, death was the enemy, to be fought with every possible drug, surgery, extensive repeated hospitalizations, ICU admissions. Death was seen as unnatural and could only be the result of a failure of the medical system.

The Hospice philosophy had been developing in Europe, notably England, over the previous half century. It offered a humane and compassionate way for people facing terminal illness, people who had no hope of a cure, to die with dignity. The emphasis of medical and nursing personnel became palliative. Effort was directed at relieving suffering, whether physical, spiritual, social, emotional or psychological. Death was seen not as an enemy, but as an inevitable and natural part of life. Care plans were designed to relieve the dying from suffering by providing a team of trained professionals — doctors, nurses, chaplains, social workers and personal care attendants — whose goal was to assist each individual to experience his/her death in the most positive and meaningful way possible.

I started referring patients to Hospice. I was amazed at how accepting patients’ families were in placing their loved ones in the program. Most were relieved that they would not have to push their family members into more and more painful and distressing medical procedures that offered no real hope but might just push back the date of death a few agonizing weeks.

Most families are relieved to know that when the time comes, there is a service available to support their loved ones and provide a soft landing for them. Hospice services are provided not just to the one facing death, but to their families. Often, there are unresolved social issues among families that need to be resolved. There are estrangements that need to be resolved, forgiveness that needs to be offered, and wounds that need to be healed. Much of Hospice social and psychological work is in helping the dying find a meaning in their life and death that will give them a sense of accomplishment and peace. Since I began caring for Hospice patients, I’ve shared in the deaths of thousands of individuals. My patients have suffered from many causes of death: automobile accidents, cancer, AIDS, suicide attempts, drug overdoses, alcoholism, violence and abuse, accidental electrocutions, falls from buildings, Alzheimer’s disease, and those who are simply “debility unspecified.”

And what is the gift of Zen to Hospice work? It is simply in being present. It is being present to the individual and his/her own particular needs. It is listening to the dying one and discerning what is important to them to give their life meaning. It’s not always a major need, like adequate pain control. It could be something as simple as getting them to the beauty shop, or making sure they don’t run out of cigarettes over the weekend. Recently, a woman was made very happy on her last day on this planet because a Hospice worker got her a baked potato from Wendy’s. It’s amazing how “little things” can make a huge difference in someone’s life.

Although the majority of my services are provided at the bedside, I take a lot of phone calls nights and weekends. I may be at the grocery store, movies or enjoying the company of friends when I have to take a phone call dealing with someone’s dying process. I have to check my messages in between zazen periods at sesshin or zazenkai. Years ago, I found it a bit uncomfortable to take these calls while enjoying myself. It felt a little odd to have my off-duty, private moments punctuated by these calls dealing with death, but I’ve become quite used to it. After all, isn’t that how death itself comes sometimes? Unexpectedly, while at a grocery store, driving down the road, soaking up the sun on a beach, reaching to turn on an electrical appliance. Each moment, death is possible. It’s the price of birth. It’s the payment at the end of the check-out line. After a life spent shopping for — whatever — love, happiness, peace, enlightenment, we have to “check out.” It is our debt for all the joys, happiness, ecstasy, and love we’ve been given throughout our lives. The cost of each life is exactly one death. May all beings get their money’s worth!

Joe Benenate, DO Board Certified in Hospice and Palliative Care Board Certified in Family Practice

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