Buddhist Care for the Dying and Bereaved : Global Perspectives

Chapter 13
“Listening to the Dharma”:
Integrating Buddhism into a Multi-Faith Health Care Environment
(USA)

By Rev. Julie Chijo Hanada

In many ways the chaplain’s contribution to the medical environment is to balance the emotional and intellectual reactions for staff. Chaplains work as part of the medical team for the benefit of both patients and staff. They help support the medical team to stay connected, compassionate, and focused, and to provide a balance between the medical and the religious or spiritual. When staff feel settled, they are more efficient and effective, and this decreases burn out. The medical education of doctors and nurses has evolved to include more training in being attentive to the emotional and spiritual needs of the patient and family. They understand the value of offering empathy and compassion, but often find the support for themselves lacking.

Currently, I am the director of the department of spiritual care at Harborview Medical Center in Seattle, WA. In addition, I am an educator with the Association of Clinical Pastoral Education program. Clinical Pastoral Education (CPE) is a graduate-level program with clinical opportunities for students of all faith traditions who are interested in ministry or health care chaplaincy. The educational process bridges their academic theological foundation with ministry situations to people who, because of life’s circumstances, are questioning meaning in their lives, their faiths, their spirituality. For example, up to this point in their formation as ministers, they have been studying how their religion understands human suffering; applying this understanding to people who are actually suffering often requires them to translate their intellectual understanding through their heart experience.

CPE is where students integrate the heart and the head, the intellect and the emotional, their academic understanding with their emotional stirrings. When students enter into a relationship with a patient and are willing to hear his or her pain and suffering, their own stories surface and things start to get messy for them. The educational experience for certified chaplains is designed to support this parallel process. In order to support them to do the reflective work necessary to grow and change, I have to create an environment that feels safe. I use concepts of play, art, film, and books. I also share my own stories, vulnerabilities, foibles, and idiosyncrasies. They know how human I am. My own personal work is to be willing to enter the chaos and mess. I walk alongside students who are willing to grow and change so they can be of service to others.

Just as my patients are usually not Buddhist, neither are my students. The Buddha’s Four Noble Truths outline my work in all spiritual care encounters, whether with patients, staff, or students. When my students see patients in physical, emotional, or spiritual pain, it touches an emotion and can stir up a memory from their own lives. They experience dis-ease and I need to respond empathetically. We identify their dis-easeand begin to explore the cause or causes. When they are ready to move forward, we imagine options and outline a plan for when these same feelings come forward again. This is how they learn the craft of chaplaincy.

In the case of my student John, as he touched on his grief, I shifted into the role of his chaplain, offering empathetic responses so he felt known and companioned. This created a space for him to feel free to identify his dis-easeand explore its causes. He was open to exploring if there might be more to his sadness than his feelings for the parents of the deceased baby. He realized that these feelings were on the surface and that there was a deeper sadness that was getting stirred up. He was aware that he wanted to do something more for the couple that was different from his previous other death situations. His real feelings were of grief that his dreams of starting his own family were growing dimmer. Recognizing the deeper grief, John wept. When he was ready, he began to explore again the causes of his dis-ease. He said he was angry at God, at first for the parents’ loss. Then he went deeper and said he was mad for his own loss. How, he wondered, could God give a precious baby to this young couple then take it away, and how could God not hear the cries of his own heart? Back and forth we roamed between identifying dis-ease and exploring the causes. When he sighed deeply and wondered if he would ever find his life’s partner, I heard him open up to imagining possibility. He was not demanding, angry, or absolute. His tone was not “Will IEVERfind someone?!” Rather, it was “Iwonderif I’ll find someone.” To which my response was that perhaps it was a feeling he had in the moment, implying that this was not a consistent feeling for him. John could imagine that he would feel differently in the future. Possibilities exist for him.

In working with students, a key component to their professional development and growth is the ability to reflect on the encounters and integrate their new awareness into the next opportunity. In John’s situation, he outlined a plan that included a sign in his cubicle that said, “All in good time.” Additionally, the anxiety he felt to do something extra for the couple could be put into context, and he could release his need to over-function in this situation. In this way, he did not deny feelings of sadness as they arose but rather acknowledged them and soothed them simultaneously. Through the process of compassionately moving into our dis-ease, our suffering has the potential to be transformed. What we experience is an unlimited potential for relating to others and for growth and change in ourselves. In supervision, I facilitate the learning environment where students grow in awareness of dis-ease, within themselves and with patients. I support students to use their own understanding and experiences with the source of compassion from their own faith tradition. By doing this, they are able to explore their potential as spiritual care providers.

Chapter 8
Actualizing Understanding:
Compassion, AIDS, Death, and Dying among the Poor
(Cambodia)

By Beth Kanji Goldring

Within the development of this vastly increased range of activities, the question of what it means to us that we are a Buddhist organization has also undergone radical change and development. In some ways, what it means to be Buddhist is straightforward. With some exceptions, we work as closely as possible within the Khmer Buddhist tradition. My staff is trained in the Khmer and Pali chanting done in the temples. We study meditation in thevipassanatradition of Sayadaw Mahasi from Burma, the same general Theravada tradition of Cambodia and Southeast Asia. We chant and meditate every day before going out to see patients. We chant on major precept days and several times a month in the Chea Chum Neas Mortuary. We give precepts and chant for patients who are dying and give eight-precept ordination when appropriate. We conduct funeral chanting for the dead and sometimes join in funeral services for families that cannot afford to bring in monks. We continue to give precepts and chant for people for forty-nine days following patient deaths. We sometimes provide small statues of the Buddha for patients. We provide a little money for families to go to the temples seven days after a death, along with urns for the bones of the dead. We continue to conduct ghost ceremonies when asked.

For our own development, we study Buddhist teachings and do extended meditation on Wednesdays. At least once a year, we hold a ten-day staff vipassana retreat. We train in the precepts, the perfections (paramitas), and the Four Noble Truths, as well as in other aspects of the Buddha’s teaching. The training in the precepts and paramitas is vital. First, the precepts help provide inner safety by preventing us from doing harm. Second, the paramitas not only help us develop the necessary qualities of character for the development of insight, they are also profoundly important in allowing us to continue what is sometimes extraordinarily difficult and painful work over time and to be strengthened rather than weakened by it.

When I began this work, my unofficial supervisor and the head of the Maryknoll project used to say to me, “If it is not life affirming for you, it will not be life affirming for the patients.” I used to respond, “Just because it is hard, doesn’t mean it isn’t life affirming.” He would agree. After some years, there was a kind of sea change, and I began to experience a deep intimacy and peacefulness with patients, even under the most difficult and terrible circumstances. Even later, I began to trust and expect this intimacy to emerge. All of us currently on staff have long, deep familiarity with times—sometimes moments, sometimes longer—when both we and the patients (and families) are being held in something profound, wordless, intimate, and deep, when we are as much the recipients as the agents of sustaining compassion.

It is this experience of time and compassion that sustains the work and sustains us within it. All our training, our work on the development of character and insight, and our religious practices have both their testing ground and their fulfillment in this intimacy.

This intimacy is not restricted to our work with patients; it is the supporting fabric of every aspect of our lives. However, it is most fully tested in the work with patients. It is here that we not only experience intimacy but experience, see, and explore the barriers that keep us from it. The more fully we become capable of experiencing intimacy, the more aware we become of the many times when we are preoccupied, annoyed, resistant, distracted, and unable fully to be present. “The patients are our teachers,” is a favorite saying of one of my oldest staff members. The longer we work, the more fully we realize how deeply it is we who are in the patients’ debt.

Our formal study and practice of Buddhism provides us with both a container to hold this experience and a means of understanding it. Without the container, we would quickly reach and exhaust the limits of our own strength in the work. Without the understanding, we would not know what to do with the experience as it occurs. Because we work in extreme situations, directly in contact with life and death, and often under terrible conditions, we fail often. However, because we study the Buddha’s teachings, not only formally but with our whole hearts, we live continually in the possibility of transcending our failures, and sometimes in the experience of that transcendence.

The Buddha often said to place nothing before one’s own highest welfare. The Dalai Lama calls compassion “enlightened selfishness.” Our work gives us the daily practice in learning the meaning of these teachings and of testing our limits by putting our compassion into practice again and again. As we continue to work in this way, over time our life becomes very ordinary to us. As Suzuki Roshi wrote about Zen Practice, “If you continue this simple practice every day, you will obtain some wonderful power. Before you attain it, it is something wonderful, but after you attain it, it is nothing special.” This ordinariness is one of the greatest gifts we receive.