Dying, Death & Grief

“At the moment of death, there are two things that count:
Whatever we have done in our lives and what state of mind
We are in at that very moment” Sogyal Rinpoche

“In our society, it’s easy to learn how to accumulate… but how do we learn to let go?”
David Bressler

There was a time when life began and ended in the home, when both journeys were understood to be as inherent to our humanity as the trees cyclically shedding their leaves in response to winter’s advancing cold and awakening with new growth as the weather warmed. Historically, however, with the advent and growing acceptance in our culture of modern biomedicine as the norm, bringing life in and sending it off soon became a medical procedure, often aggressively treated as a feared pathology instead of supportively allowing intrinsic processes to unfold.

Over the last several decades, in matters of birth, we have witnessed the pendulum beginning to swing again. Attention to both the environmental and personal comfort of the laboring woman—and the life being birthed— increased while, concurrently, supportive assistance by licensed midwives and certified birth doulas became more popular as viable options—or at least adjuncts—to conventional medical care. I was witness to this shift personally; after utilizing natural childbirth with my daughter in 1981, being so enthused by the process, I trained to become an instructor of the Bradley Method of Husband-Coached Childbirth. For years after certification, I taught 12 week classes to pregnant couples and periodically attended births, observing first-hand the benefits of an educated, conscious approach to birthing for all participants.

On the opposite end of the spectrum, a return to recognition of, and respect for, the natural process of dying began to slowly move to the forefront during the approximate same timeframe. The hospice movement, first introduced by Dr. Cicely Saunders in the late 1950’s, advocated increased focus on the care of the dying by utilizing an interdisciplinary team to provide palliative (comfort) care to a patient once it was determined that recovery was improbable; this was in direct opposition to the previously more acceptable conventional approach of subjecting the dying patient, often unwillingly, to continued futile attempts at curative treatment. With the dedicated involvement of Dr. Elizabeth Kubler-Ross and others, the movement grew and by the late 1990’s, major efforts to improve quality at end-of-life and bring palliative care into mainstream medicine were launched.

I had the gratifying opportunity to place myself at the forefront of this shift as well. In the late 1980’s, having assisted my mother in her dying process and seeing the power of facilitating a conscious death, I was moved to further pursue ways to work with dying, death and beyond. Once licensed and established in private practice as a Doctor of Oriental Medicine, I became hospice certified in 1996 and, later that same year, attended a teacher’s training at the Upaya Institute and Zen Center as part of their “Being With Dying” project.

In 1999, through my association with the American Academy of Pain Management, and with a grant provided by the Robert Wood Johnson Foundation, I continued my training, becoming certified in the “EPEC” program (Education for Physicians on End-of-Life Care). A project aimed at educating physicians and other medical personnel how best to provide comfort care to dying patients, as trainers we learned that, prior to this initiative, the average hospice stay was a mere three days. Research findings indicated that many physicians delayed placing their patients into palliative care; in accordance with their medical education was a commitment to prolong life and, without proper training in palliative care, many felt that releasing a patient into hospice was an admission that they had failed in their duties as physicians. With the development of the EPEC program, the potential for new conversation was initiated amongst physicians and within medical schools and nursing programs, one which allowed for broader perspectives and promoted greater understanding of, and care for, a dying patient.

Since that time, palliative care and hospice programs have continued to grow in acceptance, as the number of related organizations, specialty certifications, such as “death doulas” and “palliative care specialists,” and education opportunities for professionals, caregivers and patients increases steadily. I, too, joined this expanding arena by receiving further certifications as a Death Educator and Grief Counselor (CDE) and a Hospice and Palliative Care Acupuncture specialist (CHPACS), teaching day-long programs to nurses and hospice staff on nonpharmacological pain management and palliative care (American Academy of Bereavement), and offering professional workshops in a variety of venues (see “Classes & Events” for details).

In addition to formal training, I have spent over 20 years periodically studying with Dr. Michael Harner and the Foundation for Shamanic Studies (FSS), Sandra Ingerman and teachers of various indigenous spiritual traditions to learn other perspectives on death and dying. I have also personally experienced the beauty and depth of tradition surrounding death from my own Jewish heritage as I participated in the passing of my sister and father, as well as gratefully gleaning insight from each encounter I had with individuals and families who were, are, or will be, facing issues associated with dying, death and/or grief.

During the years I taught natural childbirth, I utilized a phrase found in my readings as a guideline to my expectant mothers. This was: “As a woman lives, so she births.” I almost always found, life-threatening emergencies notwithstanding, that women who were trusting and open to fully experiencing their lives without rigid expectations of self and/or others, and with enough fear to be discerning and alert but not enough to get stuck, would have a positive birth experience, even in the face of medical intervention. An underlying emphasis, then, throughout my childbirth classes, was to encourage my couples to be open to changes in body, psyche, and relationship, sometimes in spite of their past experiences.

Given what I now know, I also believe the phrase: “As a person lives, so they die.” Parallel with my birthing women, a person that lives their life with responsibility (seen as the “ability to respond”) can also, with their impending death, at the moment of death, or even perhaps just beyond the event of bodily death, choose to respond, open up, and move forward. And how much easier it might be to have a supportive guide or facilitator during that process. The use of birth classes and birth coaches is now widely accepted and options flourish. Perhaps now, as witnessed by the ever-growing interest in death and increasing numbers of those willing to support an individual in their death process, it is time to encourage acceptance and standard utilization of death preparation classes and the training of death coaches.

What I have gained from my explorations and experiences has been uplifting and life-changing. To witness, facilitate and share in the evolution of consciousness and subsequent paradigm shift that occurred for many of my women, my couples, my doctors, and my patients provided me, both professionally and as an individual facing my own inevitability, a level of understanding and trust that extends far beyond mere cognition. affirmed my life as I am living it now and validated my ways of “seeing” in the world.

One of my teachers, in referencing what I do, once jokingly stated that I work “womb to tomb,” to which another replied “No, I would say that it is more like sperm to worm.” Humorous though it may be, it is true. I have been shown and learned how to stand comfortably at the door between life and death, watching as it swung both ways and, in the process of acting as a guide for others, I have been given a glimpse and have gotten to touch the ineffable, feeling on a cellular level the all-encompassing love from which we have come and to which we will all return.

I realize I have been given a gift and, in its reception, a responsibility. Now that I have learned where to go and how to get there, I have chosen to respond and will continue supporting others in their journey to and from that place. Consequently, this choice contains inherent within it continued exploration, potentially resulting in an expansion of current workshops, a death facilitator certification, and a manuscript, tentatively entitled “From There to Here and Back Again: Journeys of a Deathwalker” which will share portions of my own story and those of others I have assisted over the years.

In addition, I have been hearing whispers on the ethers of a future project, one which will necessitate collaboration and assistance, that ultimately will allow a dying person to more creatively and less fearfully step across the veil. Placing the intention, we will see what the future holds……. Stay tuned!