Dr Rama Prasad

A Matter of Life and Death
Caroline Robertson ND



How can we prepare for death in a way that will enhance our life and ease our final moments? Rather than waiting for the unpredictable 11th hour we can start to ponder these questions today. Awareness of our mortality puts our life into clearer context, inspiring us to savour every second whilst helping us to face our final moments with calm, courage and confidence.


Never say die

My first encounter with death wasn’t pretty. He lay on a steel table like a bizarre buffet at a surgeon’s convention, leathery skin sliced from throat to groin exposing every gory detail. Lifting the cold hand which had once held life in its grasp, I thought of all the impressions it had left behind. Now it was like a macabre horror prop, dropping with a dead thud. Fellow students responded to this morbid reminder of their mortality with shock and disgust. Later talk quickly digressed from the deadly serious subject of death to a livelier discussion of the latest movies. Why dwell on the depressing, anti-life topic of death when it poses such an unsolvable, unstoppable, unbearable quandary? As cancer survivor and cyclist Lance Armstrong remarked, “Death is not exactly cocktail-party conversation.” So to allay the unanswerable anxiety it arouses we voluntarily impose a state of self-induced ‘death amnesia’ on ourselves.

However hard we try to evade death, with over 250,000 people dying daily and over 5 million annually, it resurfaces unexpectantly through occasions of personal loss or global grief. The Mahabharata called this the greatest wonder in the world – that people are dying everyday yet we delude ourselves into thinking we can escape death’s clutches. Our death-denying, death-defying society is expert at shunning the stigma of dying. The media either oversimplifies it or dresses it up. The overkill of detached press coverage on death and the cool executions played out in video games and movies compound to deaden our empathy with life’s great adversary. Society also conspires to keep death cloaked. Today we are much less exposed to people dying with it generally confined to hospitals, hospices and funeral homes whereas in the past most people died at home. Avoidance of death lies in society’s unwillingness to face the dilemmas of aging, disease and pain as these are contrary to the valued assets of youth, health, productivity, wealth, beauty and power. Since old age, disempowerment and suffering are intolerable concepts, we distract ourselves by disproportionately focussing on pleasure, longevity and health. Dylan Thomas’ advice to “rage against the dying of the light” is a positive survival instinct but is simply denial if not tempered with the sobering acknowledgement of our inevitable demise.

Still, the search for eternal ambrosia continues with some convinced they can conquer death through cryogenics, cults of immortality or medical miracles. But by hoping we can cheat death we are only cheating ourselves of a valuable life-enhancing perspective. Death will darken our door one day and, ready or not, we can’t ignore its knock. With the wisdom to tackle the deep import of our own deaths we realise that

our enemy is not death, our enemy is ignorance. As Deepak Chopra suggested- “fear of death should be renamed ignorance of death.”  The light of understanding guides us through this dark, unfamiliar territory so we make out its life- affirming message – to appreciate the promise in every moment thus avoiding what Norman Cousin’s called the greatest tragedy, “not death, but what dies inside us while we live.”


Time flies

Winged clocks once adorned funeral parlour walls, a reminder that time flies so we should utilise it well. Death’s time bomb is ticking in all of us, rarely giving warning of when it’s going to detonate. Most deaths are sudden and unexpected with heart attacks taking the highest toll in Australia. We can’t always count on our doctors telling us when we’re likely to go either with only 20 per cent saying they’d give this information voluntarily despite 80 per cent of patients wanting to be informed (Powers & Butler).
 
If we fail to acknowledge the fleeting nature of life, believing things will continue indefinitely, we can postpone and procrastinate dreams for an anticipated future that may suddenly foreclose on us. If we think we have forever, we are more likely to take things and people for granted, delay dreams, hold grudges and leave issues unresolved until tomorrow. Survivors of near death experiences often return with a life-changing realisation that life is fragile and transient and are grateful for every bonus moment as an irreplaceable gift and opportunity. They also tend to be more compassionate, patient, humanitarian, intuitive and loving according to Raymond Moody’s extensive surveys. After glimpsing their mortality they acquire a more serene acceptance of death and less attachment to material things, valuing life’s depth above it’s length. This echoes the Buddhist axiom that we should love people and use things rather than use people and love things.

Though our physical presence may not endure eternally, our contribution to the world can. The death deadline can be a driving force, a muse inspiring us to greater heights, as Michelangelo confessed - “no thought exists in me which death has not carried with his chisel”. For those who believe in karma or an afterlife, death is a moral watch guard, eventually holding us accountable for the consequences of our actions.  We can view death as our final feast, a spread of dishes from our life’s deeds. If we have lived a satisfying life we will relish the meal with pride, feeling nourished from meaningful memories. If we die dissatisfied we may leave with a bad taste and emotional indigestion. Elisabeth Kubler-Ross, pioneer of the Hospice movement put it succinctly – “ if we really want to live we must have the courage to recognise that life is ultimately very short, and that everything we do counts. When it is the evening of our life we will hopefully have a chance to look back and say, it was worthwhile because I have really lived.”


Preparing for the deadline

After an elderly family member suffered a near-fatal stroke I asked them if they felt prepared for death if it came. “Don’t be such a pessimist” they said shocked by my enquiry, not considering the eventuality of death as realistic. Whether we’re 10 or 110 its never too late or too early to ponder death’s influence on our life. On the Dalai Lama’s 58th birthday he was asked what he was going to do with the rest of his life. When he replied, “I plan to prepare for death” the reporter enquired with concern “are you sick?” The Dalai Lama chuckled “no but physical dissolution is inevitable.” The more prepared we are for death the less shock impact will be felt at the sudden halt. As Fontaine said – “death never takes the wise man by surprise, he is always ready to go.”
 
The main approaches to daily death preparation can be summarised by the five R’s.

  1. Refine character and values
  2. Re-evaluate priorities
  3. Redefine goals
  4. Resolve issues
  5. Remember death


1) Refine character and values

Honestly examining our character flaws can be a bit confronting. However our continued evolution is dependant on an acceptance that there is always room for improvement whilst forgiving ourself for failings. If we are too close to see ourselves objectively we can consider observations valued people have made about our nature. Much of our personality and values are moulded by external influences – either social or familial - where we unconsciously acquire traits or ideals through others. We sometimes compromise our true self and values because we want to be loved, accepted, successful, powerful and secure. It takes courage to release ourselves from what Thoreau called “the curse of conformity” and live in accordance with our authentic self. We need to disregard others approval or disapproval and judge our success in terms of our inner voice. This may lead to so-called eccentric choices at times but others will eventually respond positively to the genuine joy springing from our self-actualising life.  To refine your character, pose the following questions:

“Am I living in accordance with my authentic self?”
“When I’m dying will I regret the way I am now?”
“Am I happy with the way I treat myself and others?”
“How can I be a better and happier person starting today?”

After you have formulated clear answers devise a plan to address each issue. If you violating your inner voice, how could you start to honour it? How could you treat others with more love and respect? Resolve to initiate changes now as the quality of tomorrow is determined by your today’s choices.

2) Re-evaluate priorities  

Our vision of life’s big picture can get distorted if we’re too short sighted. The great leveller of death brings everything into perspective, posing the focal question “did I use my time well?” We can constantly examine our priorities in light of our true character and values. For example, is it important that we work ourselves to death in a destructive job just for money given there are alternative options? As Stephen Corey put it “how many people on their deathbed wish they had spent more time in their office?”  Sometimes we neglect our health, relationships and spirituality in pursuit of more tangible rewards like wealth, prestige and power. We may need to prioritise with a long-term sense whilst enjoying the present. Helpful questions we can answer to re-evaluate priorities include:

“Will this matter if I die tomorrow?”
“What could I do that would matter?”
“What areas of my life bring me joy?”
“How can I bring joy to others?”

Integrating some selfless priorities into our life doesn’t have to mean cramming every moment with philanthropic feats. But what’s vital is that even if we can’t actively help others we are cautious not to harm them, extending kindness and compassion whenever possible, remembering that every loving thought or deed is a seed sown for a favourable future.

3) Redefine goals

If you only had two years to live what would you like to achieve?  How would you contribute to the world? The universe has a very specific job vacancy tailored for each individual’s unique skills and qualities. Our task is to discover how we can make a positive impact on this world, leaving it a better place through our presence. In this way awareness of death can be a constructive rather than a catastrophic impetus.

To check that your goals are aligned with your values and priorities enquire:
“Will my present goals make me happy at my deathbed?”
“What could I achieve that would enhance my life now and at death?”

Take time to fill in as many details as you wish. Think in terms of aims in the areas of spirituality, career, relationships, creativity and pleasure. Take daily steps towards these goals so every sunset sees you closer to your destination. 

4) Resolve issues

We all live with regrets, guilt, shame and grief from past events and behaviour. Carrying this burden only becomes heavier as we are dying. To lighten our emotional baggage we can extend forgiveness, gratitude and apologies to others and ourselves. If we postpone this it may be too late. When issues remain unresolved, grief is deeper and closure more difficult. As Hospice advocate Christine Longaker said, “After a loved one dies the pain that stays with us is the love we held back.” Why wait until our deathbed to open up to people when, if we do it now, we can live with a clear conscience and develop deeper relationships over time.  Ask yourself if you were to die soon whom would you want to express the following to:

“I’m sorry”
“I forgive you”
“Thank you”
“I love you”

Communicate these sincerely to your list of people at the next opportunity. Irrespective of their response you will feel a load lift and greater ease with open communication. Most importantly say these things to yourself with an accepting and loving attitude. Sogyal Rinpoche emphasised forgiveness as the key to a peaceful passage,“Through forgiving and being forgiven we purify ourselves of the darkness of what we have done and prepare ourselves for the journey through death.”

5) Remember death 

We avoid with equal dread the two definite things in life  - death and taxes. But, unlike taxes, most of us are already experts at dying. As the Zen Master Dogen said “We are being born and dying at every moment.” Every second thousands of our cells are disintegrating, minor dress rehearsals for the final dissolution. Simultaneously thousands of cells are being created, reminding us of the cosmic cycle of degeneration and renewal. If you believe in reincarnation it is possible you’ve died thousands of times already. Though, in daily life we easily forget death’s lessons. To remind ourselves we can view every setback and loss as a minor death. Coping with difficulties in an equipoised and detached way helps us to face death with serenity and courage. Though we crave constancy, life and death are rife with uncontrollable and unpredictable challenges. Hardships are catalysts for us to grow in a direction that aids us to die with strength. They are rungs in a ladder, raising us to a heightened awareness of the fluctuating human condition. Embracing impermanence can help us to adapt to change, finding consolation in the realisation that “this too shall pass.”

Growing old is nature’s way of preparing us to face loss as we often progressively lose certain capabilities, looks, position and sometimes loved ones. Practical ways to grow accustomed to death are to volunteer at a hospice, view a cadaver, attend funerals, visit graveyards and assist the elderly. Studying death in greater depth through books, teachers and films can also give us reassuring wisdom about what to expect. The journey to a fulfilling life is directed by the compass of death. We know we’re heading on course if we can answer yes to the question, “if I were to die tomorrow, would I feel prepared?” If not, we still have some distance to cover.


A dying art

George Harrison knew his time was drawing close. He took a spiritual pilgrimage to Varanasi, said farewells and thanks to his loved ones, reconciled with his long estranged sister and spent quality time with his family. After settling financial affairs and confirming his funeral wishes, George’s final hours were spent chanting with friends.  Like George, when death is looming we need to be ready to cope with many decisions and sources of discomfort – physical, emotional, spiritual, financial and social. For most it takes time to adjust to the fact that they’re dying while others never accept it, feeling bitter to the end. The path to accepting death may lead one through routes of denial, anger, bargaining and depression. It is a difficult shift from feeling one is living with a disease to the recognition that one is dying from it. Often people invest so much energy in the fight to stay that they have no resources left for the departure.  If we are lucky we get enough warning to use the remaining time to transform habits, relationships and attitudes, but we can’t count on this. Morrie, in Mitch Albom’s “Tuesdays with Morrie” remarked, “It’s terrible to watch my body slowly wilt away to nothing. But it is also wonderful because of all the time I get to say goodbye.”


Feeling ostracised is one of the worst aspects of dying. Christine Longaker points out “to be told you’re dying isn’t the worst thing – to be abandoned in time of crisis is.” Illustrating this is the raised suicide rate of HIV patients due to the social stigma associated with the condition. People are uncertain of how to relate to the dying, sometimes avoiding them or keeping communication awkward and artificial. People may die socially before they die biologically because of society’s general ineptitude in approaching death and the dying.

There is also a process of grieving for oneself. Our self-esteem is often pinned on our capabilities, personality and looks.  As dying can strip us of all these things we must embrace a new, deeper source of self worth. This is based on who we essentially are - a human being rather than a human doing. If we can invest our experience with value we come to realise that as we were born for a reason we will also die for a reason. This can help us to accept physical constrictions. Some find dying increases their faith, strengthens relationships, releases them from life’s burdens and will allow them to reunite with departed loved ones. Others use death to teach others how to die well, love more and dedicate their suffering to alleviate others.

The life/death limbo period urges us to attend to unfinished business, gain emotional closure and express our dying wishes. Ideally we can address all the following issues before we are too mentally or physically incapacitated.  These pragmatic and esoteric concerns are categorised into four areas – medical and legal; funeral; emotional and spiritual.

Medical and legal

We can feel buried alive if during dying we concede total control to others. This is exacerbated when we are excluded from important conversations, not consulted on vital decisions or kept uninformed about developments. To remain involved in our own future we can tend to the following issues.

  1. Develop a trusting relationship with a dependable doctor.
  2. Ask your physician the following –
  3. Approximately how long do I have? What symptoms may come as the disease progresses? What medicines should I have handy? What home help can I get? Who do I call for 24 hour emergencies? How can I make my wishes regarding CPR and Breathing machines known? What pain relief can you give me with the least side effects?
  4. Establish basis for life support.
  5. Check that the medication is the correct dose, time and mode of administration and ask about possible side effects.
  6. Consider complementary healing systems.
  7. Find a good hospital, hospice or nursing home
  8. Decide if you want to donate organs.
  9. Name a legal representative to act as an advocate for you to relay directives to medical staff.
  10. Establish a living will and a deceased will.
  11. Prepare for your children’s physical, financial and emotional welfare.
  12. Have a list of numbers by the phone with instructions including the doctor to call in an emergency, relatives and funeral home.
  13. Keep a list of medicines, dose, timing and illnesses by the phone.


Funeral

Why not leave the world in a final farewell as individualistic as your unique character. Spike Milligan asked to be buried in a washing machine, William the Conqueror was dismembered and parts buried in different places, golf enthusiast Thomas Cardonia was recently buried in all his golf gear – putter in hand! The Greeks left with coins in their mouths to pay Hades’ ferryman. Chinese are sent off with paper possessions and the Jains and Tibetans are dispersed as vulture food. Provided it’s legal, the possibilities are endless. What kind of wake would you like? Maybe you’d prefer a living wake while you’re there to soak up the love and appreciation.

Unless you’re happy to leave your death in other’s hands you should decide the following details.

  1. How would you like to be ‘disposed’ of - cremation, burial, water, mummification …
  2. Would you like any special clothing or mementos to go with you?
  3. Would you like a particular coffin, urn or headstone? Something witty like Spike Milligan’s “see, I told you I was sick” or uplifting like Martin Luther King’s “Free at last, free at last.”
  4. What type of service, prayers and songs would you like?
  5. Who would you like to conduct and participate in the ceremony?
  6. Who will you ask to oversee details, ensuring your wishes are met?
  7. What kind of wake /life celebration would you like?


Emotional

Realising we’re dying motivates us to seek emotional closure with others and ourselves. It gives us license to open up and express feelings from our authentic self. Friends and family can be pillars of support at this time if we let them know what we need. Sadly many people don’t ask for help, as an extensive Lutheran General Hospital study found the dying’s greatest concern was that they were a burden to others.

We can boost our emotional morale when dying by accessing anything that pleases or distracts us. Natural mood elevators include uplifting music, guided imagery, aromas, movies, exercise, prayer, laughter, nature, stories, photos, slides, presents, affection and food. If we are incapacitated we can ask others to organise these things for us and to minimise anything that upsets our peace of mind. To assist emotional closure and fulfilment consider the following ideas.

  1. Ask for help and support whenever needed.
  2. Reconcile with yourself and others. This can be done through a note or a visualisation where we see the person soften and forgive us.
  3. Spend close time with loved ones.
  4. Say I love you, thank you or goodbye to the relevant people.
  5. Reassure everyone you’ll be fine and they will be too.
  6. Create a legacy for loved ones such as a memorable story.
  7. When needed distract your mind with pleasurable activities.
  8. Seek assistance from a counsellor, spiritual healer or support group.
  9. Enjoy a final trip perhaps seeing favourite people and places.
  10. Contemplate the good you’ve experienced in the world.
  11. Deepen compassion by thinking of others who are suffering.
  12. Share the wisdom of your life’s realisations.


Spiritual

When the mind and body are dwindling beyond repair often the only respite is to nurture the spirit. Some find solace in sectarian religion though they may not have been particularly pious in their life. Others have established very strong spiritual convictions throughout their life, which can provide hope in what sometimes feels like a hopeless state. They find comfort in knowing where they are going and how they are reaching there. Irreligious people may draw emotional strength by focussing on uplifting thoughts or images. The following are some ideas to access spiritual sustenance:

  1. Perform a spiritual practice that is easy and enjoyable such as prayer, chanting, meditation, rituals, worship or visualisation.
  2. Visit places that soothe your spirit such as temples, churches or parks.
  3. Seek the uplifting association of spiritually advanced people.
  4. Use sacred pictures or music to connect with a higher power.
  5. Get help through ceremonies such as communion or group meditation.
  6. Pray that your divinity will give you strength and courage at the time of death and that you will be guided and protected on your journey.


TLC

Mother Theresa’s advice in assisting the dying is simple, “the dying need tender loving, nothing more”. We may feel totally unequipped to help others die but once we understand what we’d want we can easily apply it to others. Aiding people through this crucial transition is an invaluable way to develop compassion and gain familiarity with death. It is an honour to share people’s most profound experience of dying just as it is wonderful and awe-inspiring to be present at a birth. Sometimes we can help oversee practical matters and at other times our unconditional loving presence is all we can offer. Even this can be trying at times as the dying person may become depressed, angry, irrational and distant. We can’t expect anything from a dying person but must withhold judgement and criticism considering their circumstances.

Ways to assist the dying emotionally include:

  1. Open the lines of communication. Tell them you will keep everything confidential so they can feel safe to share anything with you.
  2. Ask them if there’s anything they need, making suggestions if necessary.
  3. Listen to them with an open and non-judgemental heart.
  4. Acknowledge their fears, concerns, distress etc.
  5. Don’t gloss over important issues with superficial small talk.
  6. Encourage them to prepare for dying (legal, financial, funeral, emotional and spiritual concerns) without alarming them.
  7. Liaison with medical staff, family and friends if required.
  8. Tell them they lived well and were loved.
  9. Reassure them you want to be with them because they are contributing to the quality of your life.
  10. Don’t react to their negative moods.
  11. Communicate anything that will ease their concerns over physical, emotional or spiritual issues.
  12. Without enforcing your beliefs encourage them to do their spiritual practice.
  13. Think of ways to make them more happy, peaceful and relaxed.
  14. Ensure their wishes are fulfilled to the best of your ability.


Going, going, gone …

Theoretically most people would say death is a natural event but in harsh reality it can seem totally unnatural and unexpected. Even Elisabeth Kubler-Ross who had worked with death for decades describes her own dying as a nightmare- “It saps all your faculties, especially patience, endurance and equanimity…death will come as a warm embrace.” But inherent in the challenge of dying lies a unique spiritual window of opportunity. Many faiths believe the moment of death is pregnant with unprecedented possibilities. Tibetan Buddhism says our consciousness at this time can lead to either complete enlightenment or complete confusion. The sum total of our entire life experience adds up to this powerful moment, leading to either liberation or determining our next incarnation.

The process of uprooting our earthly attachment starts with physical disconnection and progresses to a severing of mental and spiritual ties. Physically, as death encroaches we instinctively withdraw from life in an attempt to conserve energy and access inner strength. Vedanta (Indian philosophy) and Buddhism describe death in terms of the dissolution of the five elements –earth, water, fire, air and ether. As earth crumbles we loose our sense of stability and groundedness. Water dissolving creates dryness and rigidity. When fire diminishes our warmth and energy dissipates. Air reduction causes breathlessness, restlessness and shifting pains. By the last phase of ether depletion we are generally unconscious however the last sense to remain is hearing. Hence the emphasis on chanting and prayer at the last moment as an aural aid to elevate the consciousness.

What the dying then experience in the mental and spiritual realm can only be gauged by studying near death experience accounts. These mostly positive reports feature many common elements. The frequently mentioned aspects are feelings of peace, serenity, floating out of the body, love, joy, boundless expansion and travelling towards a beneficent deity or light. Some talk of a life review or of being interrogated about their life. In rare cases people meet deceased loved ones in a blissful reunion. Though the percentage of near death experiences are happy, some recount terrifying visions, frightening forms, dissolute landscapes, threatening animals and feelings of guilt, shame and the pain they inflicted on others. Whether these are genuine experiences or biochemical and psychological phenomena is up for debate. Though there are medical arguments that these visions are dissociative hallucinations caused by abnormal brain activity and endorphins, they generally have a life-changing impact on the survivor. Often they no longer fear death and have a more spiritual and philanthropic outlook on life.

Subramuniya Swami, who died after a self imposed thirty two-day fast, following a terminal cancer diagnosis, said “To leave the body in the right frame of mind is the key to spiritual progress.” Considering our last thought may direct our future destination it is vital to focus on something positive at this juncture, though this is easier said than done. Vedic scriptures describe it like consciously reciting a poem in our dreams or focussing our mind when we are drowning. The mind stubbornly resists detaching from the body and there is an influx of crazy visions and uncontrollable feelings as one struggles to remain equanimous. To meet this transitional phase successfully the Dalai Lama offers some sagely advice – “Work on your own awakening with diligence.” We need to train and tame the mind throughout life to recognise the illusory mental projections that arise at death and to focus on a spiritual source. If we react with fear and grasping we will have to reincarnate with all our conditioned baggage. Kriya Yama Yoga is the specific art of preparing for death but simply remaining detached from material things and alternatively forming an attachment to spiritual truths throughout life is an invaluable practice. If we consistently cultivate this we will have conditioned ourselves for a smooth transition at the moment of death, drawing from spiritual strength to pull us through.

The secret, offers Tibetan Buddhism, is to focus on a divine form or sound, which has ideally been programmed into the deep psyche as a reflex response to any difficult situation through out life. To fortify the connection with our chosen divinity we can ask them for help and guidance. We may also visualise rays of light flowing into us from them, filling us with their unconditional love, protection and strength. This Buddhist practice called ‘phowa’ can also be done for others, imagining the divinity above their head streams of love flowing into them as we see their fear and anguish dissolve. To create a serene mood try meditating beside a dying person, synchronising your breath with theirs whilst sending reassurance and love. Remind them that a unique opportunity is dawning and that they should keep focussed on their spiritual practice. People are extra sensitive to subtle energies in this semiconscious or unconscious state so one must be very vigilant against negative thoughts such as anger, grief and attachment.

Dying to know

Where do we go from here –heaven, hell, dust or reincarnation? Is there light at the end of the tunnel or just a gloomy dead end? Only a genuine ghost writer could say for sure. Some are satisfied to return to dust, attaining immortality through the distinctive mark they leave behind. Others create their own concept of the afterlife, as philosopher Ashleigh Brilliant admitted, “I’ve abandoned my search for the truth and am now looking for a good fantasy.” Different religions have varying destinations. There’s the amorphous impersonal light of Buddhists, the heavenly pleasure planets of Christian, Catholic and Hindu belief or the possibility of a sequel. The reincarnation philosophy of Eastern religions seems more consistent with a forgiving god than the pass/fail/sentenced to eternal damnation scenario. Perhaps that’s why 67% of Americans believe in reincarnation and why it’s integral to the world’s oldest religion, Hinduism. Though there is some research to support reincarnation we can’t guarantee our karmic fate. As Socrates said on his deathbed “It is now time to depart –for me to die, for you to live. But which of us is going to a better state is unknown to everyone but God.” We can be assured however that by living life with love, compassion and wisdom we will create a mental heaven on earth. Then hopefully when our time comes we will realise Leonardo Da Vinci’s belief that “just as a happy day ends in a happy sleep, so a happy life ends in a happy death.”

Caroline Robertson is an Ayurvedic consultant, Naturopath and Homoeopath practising and teaching from her Sydney centre, Ayurveda Elements.
 

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