Just received a very nice mailing, a call for candidates for the year long Metta Institute EOL program which consists of six residential intensives (3-7 days in length) around the SF Bay area starting January 2009 with extensive phone mentoring available as well. The program is primarily designed for those working in the EOL field but it looks like the leaders are willing to take this work in new directions, so those with creative and entrepreneurial interests are invited to apply as well. The emphasis of the program is reclaiming the spiritual dimension of dying.
“Dying is much more than a medical event. It is a unique opportunity for growth and transformation for all involved.”
This looks like a terrific program and the testimonials on the flyer show that it has transformed the work of those who have taken it. More information at:
www.mettainstitute.org

I’m on a plane flying back from Spain and dreaming of the Sagrada Familia. This cathedral of mass proportion is Antonio Gaudi’s most famous work in progress where there are currently hundreds of stone masons, carpenters, architects, artists, plasterers and other artisans working under the sacred influence of its towering vaults.
Gaudi was a master of space and design far beyond any we have seen or can see today. It is amazing to think that his work alone can propel a project as huge as the Sagrada Familia and influence millions and millions of people…it’s visitors and almost all of the residents of Barcelona from the 1920’s until today. For yes, anyone who sees or visits the Sagrada Familia will be influenced. As one stares up in wonder at the 4 Cathedral towers or enters and climbs the spiraling stairs inside of them, they confound the intellect and allow a profound mood to overcome one. The beautiful and compassionate figures on the outside inspire gentleness, and as one enters and climbs making his way up to the dizzying heights he starts laughing and smiling at others, complete strangers who are there climbing in the labyrinth along with him. Somehow it is quietly known that we are all here in the same predicament…stuck on the earth but subject to strong divine influence.
The residents of Barcelona are a deep people. Serious and quiet, courteous to a fault, proper and elegant, they take their time to enjoy life. Even a cup of espresso is a cause for revelry; made, served and sipped with care and attention. I actually went to Spain attend a multi-disciplinary workshop on death and dying and developing of the powers of presence and attention, (this will be explained later). But what I truly learned was that here are people of intensely acute intellect who at the same time are able to offer warm heartfelt hospitality. The workshop aside, isn’t this what effective and compassionate care giving is truly all about?
The workshop was actually on the Isle of Ibiza, one of the Balearic Islands in the Mediterranean south west of Barcelona. The ferry trip to get there is 8 hours of generally smooth sailing, with an early morning landing in a busy resort city which was quieted by the “cold weather” (60o F) of the winter months.
We were to drive 20 miles or so outside of the city to a villa outside of St. Joan, a tiny town to the north, and as I was traveling with kids the importance of the proximity of this town with its excellent little grocery store was not to be underestimated!
Our workshop approached the question of “How can one develop his or her presence and attention so as to be able to work more effectively for the benefit of all beings every where,” from many different angles, one of which was work in the field of death and dying. This work is high attention work as all hospice workers know. It comes under the category of high compassion for another being through times of extreme physical hardship or distress. We all know that it usually isn’t a matter that he or she who is dying is so incredibly distressed. We also know that the dying are the real guides in the process. But we can only realize this if we are maintaining an atmosphere of high attention and equanimity in ourselves. This is a skill which can be taught and learned, the only prerequisite being the desire to care.
The skills of the terminal midwife were taught by Patricia Elizabeth. We learned about keeping our physical bodies relaxed and free of habitual tensions and gestures or movements. Some part of us wants to get fidgety, make movements to cover the uncomfortable and mostly fearful feelings that accompany these spaces. But we are better off and can offer more to the person who is dying by tolerating a non-reactive space. We will survive. We will eventually be in a more highly observant, less reactive state and we needn’t worry, we will definitely go back to our habitual patterns when the situation is over. We don’t have to worry about that. But while we are spending valuable time with some one who is leaving this bundled nervous system we can try to be in their space. Be a good observer. Not stern or critical but tolerant receptive and compassionate. If you free your energy from your own unconscious twitterings you will be able to apply higher concentration on the needs of the one who is dying. A real gift.
Now there are some practical tips about doing this. Continually check and scan the body for tension and breathe it out or let it pass out into the ground through the feet. Maintain a “wide angled” vision, keeping the eyes aware of the periphery and not getting overly focused on any one detail. This allows for a higher sensitivity to the space and greater “sensing.”
Now what exactly is “sensing?” After this workshop, I have come to view it as one of the most important faculties that we can develop as compassionate caregivers. There are many ways that we can try to get an answer to this question if we think that it is an important one. One can observe oneself and in this way develop a higher sensing ability. He or she can observe while going through his or her daily routine or while doing group exercises such as Tai chi. Keeping the mind alert and focused on the movement, keeping the body relaxed, (the face is a good indicator for this), and being aware of the leader and the others in the group, this will give one an idea of what sensing is. But here I must apologize to my readers for as skilled hospice workers, you are already most certainly aware of these concepts, if not in this exact language.
In the workshop we also learned about maintaining contact with the “voyager” or one who is dying. Relaxed and maintaining diffused vision, we stay alive to the space and open to any possibility but it is really no big deal. If the person wants to talk we are there to listen, if they want to listen we can do a reading from any text that they might prefer or we can tell a story. But while doing any one of these things we are working on maintaining a posture of high attention…we try not to let our minds wander too much. One thing that we can be sure of is that there is some part of the person lying near us that is fully aware, fully present and comprehending aspects of the situation that we can’t hope to know ourselves.
It is as if we are approaching Gaudi’s great cathedral. We are sometimes given opportunities in life, reminders to be in a state just a degree or two different than the normal day to day. As hospice workers we can continually thank our patients for this gift to us.

Just discovered these programs at the Upaya Center, www.upaya.org which also offers offers a two-year Certificated Buddhist Chaplaincy Training Program in End-of-Life-Care.

Jul 10, 2008 — Jul 13, 2008 COMPASSION AND WISDOM AT THE END OF LIFE: Practices and Perspectives
Frank Ostaseski, Roshi Joan Halifax

Sep 28, 2008 LIVING WITH ILLNESS: The Nature of Change and Transformation
Roshi Joan Halifax (when available), Susan Benjamin, Jean Wilkins
Donation to teachers and Upaya.
Registration & Program Details

Oct 01, 2008 — Oct 05, 2008 PRESENCE AND COMPASSION: Contemplative End-of-Life Care

Upaya also hosts a women’s retreat, IN THE SHELTER OF EACH OTHER: Power, Compassion, Resilience and the Shadow: July 16-20, 2008.

Just back from the White Mountains of New Hampshire where we had a table at the Holistic Nurses Conference. The energy of this conference is incredible. I don’t say that lightly…it really is a terrific event and I highly suggest that if you are involved in any kind of healing or patient care work that you make plans to attend next summer’s conference in Madison, Wisconsin. You come out of this conference refreshed and inspired to continue with your work and with the sense of being part of a much larger community. See AHNA.org for details.

Got this notification from a friend. I haven’t examined it in detail but on the surface it looks like a good thing…if it can get through the legislative channels…

We are excited about progress in the California Legislature and want to
share the good news with you right away. If it passes in the full
Legislature, Compassion & Choices’ Right to Know End-of-Life Options Act
will be the first law of its kind in the nation. Patients will gain the
right to receive full and frank disclosure of all their legal
end-of-life options, if they ask for this information. Our usual
opponents, Right-to-Lifers and radical disability activists, oppose even
the right to a candid conversation! But with the state’s medical
association at our side in this fight, we believe we will be able to put
this bill on Governor Schwarzenegger’s desk by autumn.

The California State Assembly voted 41-32 Wednesday on the Terminal
Patients’ Right to Know End-of-Life Options Act, AB 2747 (Berg-Levine).
Upon a dying patient’s request, the Right to Know End-of-Life Options
Act requires a physician to provide counsel on the range of care options
available. These options include hospice care, voluntary stopping eating
and drinking, refusal or withdrawing of life-sustaining treatments,
palliative care and palliative sedation.

The bill will serve as a national model for conversations about
end-of-life care.

“We know from research terminally ill patients do not always get all the
information they want,” said Assemblywoman Patty Berg, a bill co-sponsor.

In California, she pointed out, three out of four terminally ill
patients don’t access hospice until just a few days before they die.

Thirty years ago, California led the nation by giving people the right
to express their wishes for health care in advance. It’s time to take
this next step to ensure that terminally-ill patients have all of the
information that they need to make timely and informed decisions
regarding their care. Information and counseling regarding end-of-life
care options is essential for many terminally ill patients and their
families. It can help the patient weigh all of their options and make an
informed decision that best meets their needs. It gives the physician an
opportunity to discuss the benefits and disadvantages of all available
treatments, and it can facilitate earlier access to hospice care.

“Dying patients needlessly suffer due to a lack of essential
information,” said Compassion & Choices President Barbara Coombs Lee.
“As a result, many spend their last days in agony. Too many patients
make the most important decision of their lives — how they will spend
their final days — without being fully informed of their legal rights.”

The Right to Know Act will now go to the California Senate for
consideration.