CONNECTING THROUGH THE HEARTDr. Charles A. Garfield

The following article is excerpted from a talk given by Charles Garfield to End-of-Life Counselors at Zen Hospice in San Francisco in a training on service.

The purpose of this program is to train spiritual counselors to be teachers, advocates, and guides at the end-of-life. In a sense, all of this talk about end-of-life care is an excuse for talking about conscious living. I don't mean to avoid death and dying, and I'm not downplaying it. This is a very important and necessary task we're embracing here together.


But in fact what we're saying is this work is about living more consciously. Everything you'll hear regarding the work in this training is really about living. All the discussions on love and intimacy, compassion fatigue and burnout, healing and community, even the talk about anxiety and denial. If you temporarily erase the "dying" connotation from all of it, you're left with the question: "What do we mean by conscious living?" This training is about living the full life, realizing that nothing so terribly mysterious happens at the end-of-life that isn't consistent with what has been happening all along. Perhaps there are a few experiences that are new to a specific individual. I would venture to say, however, that the more we see dying as part of the life cycle, the more we can embrace it as part of an ongoing process that has a logic and integrity of its own.

For instance, I think how one commits to people who are dying is very similar to the way you commit to relationships in general. There's not some mysterious difference that automatically appears when we relate to someone who is dying. How committed do we allow ourselves to be in all our relationships? What is the nature of our commitments to those who need us most in life? How do we hold our commitments to those we meet briefly in life? I'm not making judgments here, but rather I'm saying: the quality of your commitments to dying people and your work with them will be very similar to the quality of your commitments to friends, loved ones and acquaintances.

People die the way they can, affected in large measure by where they are and who is present to care for them. Many times people die the way they've lived. In some cases, people make radical departures from lifelong norms. Time after time I've sat with people at the end of their lives who were sorry that they had led their lives the way they did, or that their values had been what they were. And I've seen people blossom into wonderful spaces before they died. Sometimes there are even miracles I'll never forget. A few times there was such magnificent growth and development that it seemed it was hardly the same person.

So I asked myself while witnessing such stunning transformations: "Why would I have to be sick to change this way?" After all, I've learned that life is not a rehearsal. This is it. I can be authentic. I can be both compassionate and direct. I don't have to wait until the end of life to reap the benefits of heightened awareness. This realization changed me in a profound way. Actually, I don't know if it changed me as much as it began to unlock me. The dying process can offer us a compelling context for mindfulness practice and the emergence of talents and sensibilities that were there all along, and which may have already appeared in your life in other situations.

However, as much as we would like people to die in a way that is appropriate to them — appropriate meaning in the way they themselves would choose — many of the deaths that happen in this country or elsewhere are appropriated. That is, the person's dying time and process are taken from the person, by forces beyond their control such as family needs, healthcare rules and regulations, religious imperatives motivated by values, beliefs, approaches, and procedures that interfere mightily with what the person dying would prefer. Creating the psychospiritual space in which the dying person can die in the way they choose, not according to any other standard but their own, is a core part of this work. Of course, you can see this principle as basic to a life well lived throughout one's life span.

By connecting through the heart, we can not only ease a person's fears of dying, but also serve as a role model for appropriate and compassionate care.

Let's talk a bit about the raw emotional experience of dying. Let's consider five primal fears of dying, remembering that these can also be fears associated with living.

First, fear of the unknown. What's going to happen to me, do you know? We can say what we know, but the great loving contribution, the gift that we offer, is a willingness to join the dying person in that place of not knowing. It is a precious present, a pearl of great price, this willingness to be there despite not knowing so many things.

Fear of abandonment. I don't mean gross abandonment. You'll see that sometimes, but more often you'll see the unintentional little abandonments. I talked to my dying friend's wife the other day and asked her how their friends were responding to their situation. She said, "Some people just disappeared. Some people come over, but it's better if they don't." I was curious about that and asked her what she meant. She said, "It's all so strained. It's work to have them here." What she meant was that their friends' little abandonments were hurtful; it was the little changes in their relationships as they pulled away and communicated their discomfort nonverbally.

Fear of loss of control. People will tell you that independence has been a primary value for a lifetime. As they are dying, however, what people have control over may change. The scope of their world may shrink dramatically. Being dependent can be the most horrific outcome for some people, related directly to a loss of control over their lives. When my father was dying of liver cancer, I asked him if there was anything he really wanted. And he said, more than anything else, he wanted to go home, to the familiar place, to be with those he loved most, to sleep in his own bed and eat his wife's cooking. And he got to go home. It's important to ask people what they need in order to preserve as much of their sense of control as possible.

Fear of pain. It is a very peculiar thing, why a culture like ours, so sophisticated in the use of drugs, so skilled in biomedical technology, has not yet made commonplace the art and science of effective pain management. The simple truth is that if you let people control their pain medications they don't have to go through the anxiety associated with the anticipation of the reemergence of the pain. What's most important is the deep commitment of everyone to maximizing the comfort of the person dying.

Fear of bodily deterioration. Body image and self-image are intimately connected. In the dying process, the body starts changing in major ways that can be quite threatening. Can we embrace someone who is feeling unwanted as a consequence of bodily deterioration? I use the word "embrace" in its fullest meaning. Of course, not everyone wants to always be touched and hugged. You can communicate caring and connection through a handshake or a glance. So much is communicated through simple subtle gestures that can make a seismic impact on the dying person's wellbeing.

© Charles Garfield Group 2000, 2001