Living in the Light of the Lessons from Death and Dying

Frank Ostaseski in an interview with Rheanna Hoffmann about death and the process of dying, mentioned his book based on his experiences of being with a thousand people as they died.  His book, The Five Invitations: Discover What Death Can Teach Us About Living Life Fully, provides five principles or guides for living life with integrity, meaningfully and in alignment with our true purpose.  Frank was the co-founder and director of a thousand-bed hospice, so his book is based on lived experiences and real stories of how people faced death, as well as the distillation of the “wisdom of death” from these deeply personal and moving experiences.

Frank maintains that death is the “silent teacher”, imparting understanding and wisdom about how we should live.  He expounds his ideas and principles in a number of recorded podcast interviews, including What Can Death Teach Us About Living Mindfully. His recoded talk at Google focused on his book through the theme, Inviting the Wisdom of Death Into Life.   A succinct explanation of the principles in his book, which he describes as “invitations to living”, is provided in his 26-minute edited interview with Steve Heilig of Palouse Mindfulness.

The five invitations to living learned from the dying

Frank emphasises that these invitations to living have been taught to him by the dying and by compassionately helping many hundreds of people with the process of dying.   Understanding the following five principles and putting them into practice enables us to live life fully and mindfully:

  1. Don’t wait – we assume that life will go on as it always has, that our health, wealth and relationships will persist into the future.  If nothing else, the Coronavirus should disabuse us of this belief and the associated perceptions.  There is a tendency to put off changing the way we live because of this belief in continuity.  However, living is precarious, nothing is certain.  We can become absorbed in the busyness of life and put off any change – avoiding the need to slow down and really experience life and relationships.  We can spend so much of the day planning our next activity or sequence of events. Frank maintains that we are reticent to fully “step into life” – “waiting for the next moment in life, we miss the present”.  Frank urges us not to wait till our death to find out the lessons of dying.
  2. Welcome everything, push nothing away – whether it’s grief, loneliness, boredom or suffering, there is a lesson to learn if we don’t push away the feelings, emotions and thoughts that pervade our life.  Frank suggests that we should welcome grief and fear and difficult feelings because these “moments” of discomfort are pivotal in our life for developing sustainable personal change, if we fully face them.  He spoke of the grief he experienced working with the dying and how he adopted meditation, bodywork (the touch of a practitioner on a source of physical pain in his body) and holding and rocking newly born babies (a life-affirming activity) as a way to face the full emotional, physical and mental experience of grief – it’s as if he ritually experienced the life cycle of birth, living and dying as a way to manage his overwhelming grief.  
  3. Bring your whole self to the experience – Frank made the point that in his work with the dying, the part of him that was most helpful was his vulnerability and helplessness because it acted as an “empathetic bridge to their experience”.  These “weaknesses” became his strengths and enabled him to be fully present to them, to be-with-them.  He has stated previously that authentic presence and compassionate listening are healing and supportive of people’s transition in both the challenges of living and of the dying process.  He asserts that none of us is perfect but that we can bring our whole self to whatever we are experiencing – leaving no part of our self out of the interaction.
  4. Find a place of rest in the middle of things – we can find a place to rest amidst the turmoil and tenuousness of life and despite overwhelming emotions that beset us.  The “place of rest” could be a breathing exercise, a ritual, mindfulness practice or reconnecting with nature.  Finding such a “place” is critical as a self-care approach for healthcare professional, particularly in these challenging times. Rheanna Hoffmann, who volunteered to work in the Emergency Department of a New York Hospital during the height of the Coronavirus, stated that this principle, explained in Franks’ book, helped her deal with the exhaustion, grief and overwhelm she experienced in helping suffering and dying patients while working under unimaginably difficult conditions. Frank also recounts the story of how he helped a woman to find a place of rest who was dying and experiencing extreme difficulty breathing, a struggle to breathe exacerbated by fear.  He asked her, “Would you like to struggle a little less?”  He then helped her to put her attention to the gap/pause in her breathing and began to pace her by breathing in and out with her.  He reports that “fear left her face” and she died peacefully.  Frank pointed out that none of the conditions had changed for her (including difficulty with breathing), only her relationship to her experience of dying.
  5. Cultivate a don’t know mind – this is not designed to encourage ignorance.  Frank quoted a Zen saying, “Ignorance is not just ‘not knowing something’ but the right thing”.  Ignorance is knowing the wrong thing and insisting on its truth and universality.  The principle is not about accumulating information (the “what”) but cultivating a mind that is “open, receptive and full of wonder” – a mind that is curious and pursues the truth and understanding in everything.  Frank suggested that we should talk with our children about death and, in the process, learn from them (not tell them).  He recounts his experience as a Director of a pre-school when he organised for the children involved to go and collect dead things in the woods nearby.  He marvels at the insight of the children and their perceptiveness.  They had been discussing the theme of endings becoming beginnings, e.g. a caterpillar becoming a butterfly, when a four-year old girl said, “I think the leaves on the trees are very, very generous – they fall and make room for new leaves”.  Frank maintains that a “don’t know mind” is fluid and flexible and “infused with a deep interest to know” and to know what is true right now.

Reflection

Frank’s approach to fully facing all that life presents (both discomfort and joy) is in alignment with Jon Kabat-Zinn’s concept of Full Catastrophe Living and Frank’s personal process for handling his grief accords with Deepak Chopra’s recommendation that we adopt a ritual to symbolise our release from the stranglehold of grief.

Frank epitomises in his life and work what he advocates through his talks and video podcasts.  He pursues a life that is meaningful and purposeful.  For example, in addition to his book and public presentations sharing his knowledge and experience of the dying process and its lessons, he has established a creative approach to educating end-of-life carers through the Metta Institute.  His words and actions manifest a life of integrity, compassion and wisdom.

Steve Heilig, the person who interviewed Frank in one of the video podcasts mentioned above, has also found a way to live a life full of meaning and purpose.  One of his many mindfulness endeavours has been to collect resources and permissions from leading mindfulness practitioners, including Jon Kabat-Zinn, to enable him to provide a free, 8-week, online course in Mindfulness-Based Stress Reduction (MBSR).

As we grow in mindfulness, by employing the five principles that Frank espouses, we can live our lives more fully and expansively and truly aligned to our energy and purpose.  We can find our expansiveness and spaciousness which Frank evidenced with people who were dying – their capacity to find the personal resources to face their fear and death despite their belief that the challenge was beyond them.   We can also become a calming presence to others who are experiencing difficulties as we progressively overcome our own reactivity. If we develop the discipline of the daily practice of meditation, we can live in the light of the lessons of dying and death.

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Image by mostafa meraji from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Self-Care for Healthcare Professionals

Dr. Reena Kotecha presented at the 2020 Mindfulness & Compassion Global Summit on the topic of self-care for healthcare professionals.  Reena highlighted the irony of healthcare professionals caring for everyone but themselves and, in the process, suffering pain, disillusionment and burnout.  She shared her own story of depression, mental illness and suicidal thoughts resulting from working as a young doctor in an emergency department in a hospital.  She was drowning in self-doubt, suffering anxiety about the future and trying to cope with her present level of stress symptoms such as palpitations and sleeplessness.  Reena found her way out of the dark hole of depression through meditation.

She highlighted the stresses that healthcare professionals are experiencing in these challenging times of the Coronavirus.  Reena spoke of frontline healthcare workers who had to move out of home to protect their family and/or elderly parents, of the sadness and grief they experienced with the death of patients, of the frustration of having inadequate resources (such as personal protective equipment) and of their fear for their own safety in terms of the impact of their work on their mental and physical health.  Frontline professionals experience the intensity and immediacy of Coronavirus-related stress and emotional inflammation as a result of the risks to the life of their patients and their own life.

Barriers to healthcare professionals seeking help

Reena emphasised that healthcare professionals not only tended to overlook caring for themselves but also failed to seek help for their mental welfare when they really needed it.  She spoke of the barriers that stop healthcare workers from seeking professional support (some of which she experienced herself):

  • Training focus – all the focus of their training is on how to care for others, very little of the training is focused on caring for themselves or how to seek professional help for themselves
  • Priority focus – healthcare professionals are singularly focused on caring for others and they fail to give priority to their own mental and emotional health that would actually enable them to care for others more effectively and in a more sustainable way.  As Reena points out, healthcare professionals are much more comfortable and more proficient in the role of caregiver than that of “care-taker”.
  • Career focus – healthcare professionals become concerned about what others, including management, would think of them if they admitted to not coping and experiencing some form of mental illness (which still carries its own stigma).  They can be concerned about how others will judge them and what impact this would have on their career.
  • Expectations focus – the community has highlighted the heroic efforts of the frontline healthcare workers but this brings with it an unrealistic set of expectations that they are all strong and courageous, free from normal human emotions of fear, anxiety and self-doubts and the resultant experience of depression with its concomitant impacts of inertia, exhaustion, reticence and lack of energy.  In the light of this community expectation set, they are reluctant to admit to “weakness and fragility”.

Young healthcare professionals may begin their career with an unerring focus on their patients, giving priority to their caregiver role and ignoring their own needs.  They may feel really uncomfortable about being seen as “needy” or becoming a “care-taker”.  Professionalism is interpreted by them as being strong and efficient, able to cope with any situation.  Gradually, however, the singular focus on patients begins to take its toll and is compounded by the fact that no matter how hard or fast they work, demand continues to outpace resources and capacity.  They begin to experience stress, fatigue and sleeplessness.  Despite these signs of not coping they push on – driven by their own expectations and the perceived expectations of others, including the “worshipping” community.  Burnout results when the gap between what they are putting in and their intrinsic satisfaction with their work widens to the point where they lose belief in the value of what they are doing – burnout occurs on the physical, emotional and spiritual levels.

Mindfulness as self-care for healthcare professionals

Self-care for healthcare professionals is a lifetime passion for Reena, partly generated by her own early professional experience but also reinforced by the healthcare workers who seek her help and support during these highly stressful times.  She is the founder of Mindful Medics – an 8 week course for healthcare professionals incorporating mindfulness, emotional intelligence, neuroscience and positive psychology. Participants in the course have experienced significant benefits for their mental and physical health as well as in their overall personal and professional lives.

Reena is also a highly recognised public speaker on the topic of her lived experience.  For example she presented at the Happiness and Its Causes Conference in 2018 on the topic, Personal Story: Healthcare Starts with Self-Care.   In her Summit presentation, Reena provided a gratitude meditation designed to focus on appreciation for what we have in the present to displace a focus on a disturbing past or anticipatory anxiety about the future.  There is so much that we can be grateful for and savour in our life – nature and our environment, the development of our children, our achievements and rewards and the space of being alone

Reena in an article, titled I am grateful…, recommends strongly that we develop a constant practice of expressing gratitude for the simple things that we have in our lives and highlights the neuroscience research that supports the benefits of gratitude for mental health and wellbeing.

Reflection

It is important to express compassion for others, especially healthcare professionals and those directly impacted by the Coronavirus.  However, we have to recognise the enormous stress healthcare workers are experiencing in these challenging times and be more aware of not adding to that burden by perpetuating the expectation that they, individually and collectively, can cope with any challenge at no cost to themselves.  We can also offer our support for people like Reena who are helping healthcare professionals to develop mindfulness as a means of self-care.  The Mindful Healthcare Speaker Series is one ongoing event that we can support.

As we grow in mindfulness by focusing on self-care through mindfulness practices and gratitude meditation, we can become more conscious of what we are thinking and feeling and be better able to appreciate the present moment and all it has to offer in terms of overall wellness and happiness.  Mindfulness enables us to identify our barriers and expectations, acknowledge when we need help, develop strategies to cope more effectively and progressively build our resilience.

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Image by Petya Georgieva from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.