A True Act of Love

by Nina

Most of the time when I’m writing a blog post, I’m sitting at my desk in my cheerful office in Berkeley, California overlooking a large camphor tree. Today I’m sitting on a couch in my aunt’s apartment in New York City, writing on and off between short visits with her, as she lies dying in her own bedroom, being cared for by hospice workers, caregivers, and family members. A while back she told me that this is what she wanted—that she never wanted to live in an assisted living facility or a nursing home—and she has been able to get her wish. But that only happened because when her doctor told her it was time to discuss end of life options, she was open to hearing that and willing to discuss the possibilities. That’s also true of her daughter, my cousin, who—despite her sadness over the impending loss of her dear, dear mother—has been able to face the situation with clear eyes, and admit that to herself that her mother is indeed dying and that hospice with comfort care is the way to go. So my cousin is now able to provide her mother with what she explicitly requested, and to make adjustments on an as-needed basis by discussing them honestly with her mother. A true act of love.

I’ve written about the importance of facing our mortality a couple of times before, in my post Meeting Death at the Front Door and Welcome to Your Mortality. I said then that encouraging people to face their own mortality (and the mortality of their loved ones), helps us cultivate satya (truthfulness) in the face of abhinivesah (fear of death/clinging to life). But now that I’m seeing it in action again, I felt like it might be good to bring it up once more. 

Before I got started writing, however, I decided to check with my cousin to see whether it was all right with her for me to write about her and my aunt. She not only said, “Of course!” but she added, “I think it’s really important to discuss this. Not only within our family, as we have been doing, but with all our friends as well. Because so many people get involved in a kind of magical thinking that ends up backfiring on them in the end, and it just makes everything worse.” So even in the midst of our sadness, she encouraged me to write this post, to let people know how beneficial it is to be honest and straightforward about death, both for the person who themselves who is dying, for the people who are caring for the dying person, and for all the people who love them. 

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David Bowie, Satya, and Impermanence

by Nina

Mmm, yeah I watch the ripples change their size

But never leave the stream

Of warm impermanence

So the days float through my eyes —From “Changes” by David Bowie

I decided that I needed a break—and that maybe you did, too—from all the technical posts Baxter and I have been doing lately. And since I can’t get David Bowie’s video for “Lazarus” out of my mind, I thought I’d write about that. First of all, for those of you who haven’t seen it, here it is.

During the 18 months that Bowie knew he was dying of cancer—which he kept private—he made this powerful work about his impending death. And I have to say, this video has impressed me more than any of his other work that I’m familiar with. As I wrote in Meeting Death at the Front Door, I feel that, along with being able to do what you love as you age, being able to die the way you want is an essential part of healthy aging. In order to make that happen, truthfulness (satya) both with yourself and with others about your impending death is necessary. And if you are helping someone else who is dying, facing the truth about their condition is necessary for you to be able to provide them with the help they need.

Truthfulness (the yama satya) is a central part of yoga practice—one aspect of the universal “great vow” that is the second branch of yoga.

Yoga Sutra 2.36 When one is established in truthfulness, one ensures the fruitions of actions. —trans. by Edwin Bryant

And to me Bowie’s video is a brilliant example of satya. Not only is Bowie clear about the fact that he will soon be leaving this life, but he also doesn’t shy away from portraying the difficulty of illness and loss of ability that comes near the end. He also invokes a compelling beauty in it all, like a Japanese haiku that celebrates the transitory nature of existance. 

Ch-ch-ch-ch-changes

Turn and face the strange

Ch-ch-changes

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The Death of a Friend: Karma Yoga, Non-Attachment, and Truthfulness

by Nina

At Home with Buster

I had sad news on Friday, January 9: Tama Blough, the woman with terminal cancer for whom I was fund raising—and who happened to be one of our readers—died that morning. Although the news was sad, I was comforted by the thought that Tama died at home, in the company of her beloved cat, Buster, and tended to by the caregiver we had hired with money that I help to raise. (And thank you so much to everyone who donated. It has been a profoundly moving experience to see so many people rally around a friend in need.)

You might recall that I wrote a post Karma Yoga Opportunities about why I decided to take on the task of raising money for this woman who learned she had terminal, non-treatable bile duct cancer and who was also destitute. It was her wish that she be able to die at home rather than in a hospital, and I decided to try to make that wish come true. Because there was no one to take care of her when she needed 24/7 care and also because she was no longer able to work to pay her living expenses, the thing I needed to do was raise enough money to pay for all of that. But the question was: exactly how much money would be enough?

It was actually stressful to try to estimate the total amount of money that would be needed. While I could look at predictable expenses such as her rent, utilities, food, and so on, as well as the typical hourly rate for a caregiver, I had no reliable estimate for how long she might live and for how long she might need paid caregivers. 

Obviously just thinking about how long someone might or might not live is stressful in and of itself, but trying to make impossible estimates for how much money might actually be needed for various scenarios was even worse. What if we used up all the money we’d raised (over $20,000) and she was still alive and needing care? Or, conversely, what if she died more quickly than expected and we had a lot of money left over? I had some private conversations with her elderly mother and the friends who were helping me raise the money about these possibilities and we made some contingency plans. And I had to face the fact that if we ran out of money, she would have to go to a hospital, where her health insurance would cover the final costs. 

I’m bringing this all up because when you’re helping someone who is dying, obviously you don’t get all wrapped out in hopes for another possible outcome. But you can get wrapped out in your hopes and expectations for how the whole process unfolds. And in this particular case, I obviously had a strong attachment to making Tama’s wish to die at home come true. However, as you can see, I really had no guarantee that things would work out as I hoped. So I often reminded myself that I was doing my best, and because I had no control over the outcome, doing my best was all I could do. So when Ram wrote his post about karma yoga last Monday (see Altruism (Karma Yoga)), it struck me that my situation was a perfect example of what he meant by saying: 

"Selfless service requires an individual to perform any service without attachment or expectation, and remain unaffected by the results of such service." 

Of course, I didn’t do the “without attachment” thing perfectly, either. But, again, even with our efforts at being without "expectation" or "attachment," all any of us can do is our best.

I’d also like to say that Tama bravely faced her death with truthfulness (satya). As I wrote in Meeting Death at the Front Door, I feel that being honest about death and dying is the only way for us to die the way we say we want to. You have to face the truth yourself. You have to tell your family the truth. And you have to insist your doctors—and your loved ones—tell you the truth. And Tama did all those things, sometimes even with humor. So I thought I’d end with this story about her that her friend Joe Allegretti shared on Facebook:

My last conversation with Tama was in early November, I think, when she told me about the diagnosis. At one point, she was talking about how she had been hoping for months that she'd be able to get out of SF, move to another city, figure out a way to reinvent herself. The employment situation and everything else was really hard on her and I totally understood her wish for something new. Finally, she summed it up by saying, "I wanted a reboot."

Then she said, "Well I guess now I'm gonna get the BIIIIIIIG reboot." We both immediately laughed a lot.

And Joe's sharing of his story led to this beautiful one from her friend Drew Zeigler:

One of the last interactions she and I had was when my dog had gone missing and she kept popping in and making lovely hopeful comments to me, so I reached out to her. Her response was, "Well, just because I'm dying, that doesn't mean I can't still have compassion for others." 
 
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Welcome to Your Mortality!

by Nina

“New scientific studies allow us to predict who will die in their lifetime.” —Caitlin Doughty

A while back I wrote a post Meeting Death at the Front Door, in which I said I believed that truthfulness (the niyama satya—see The Second Branch of Yoga) will help you face your death and die the way you want to, and will enable you to help your loved ones as they die. Facing death is not usually a fun topic to write about, but considering what I had learned from helping both my parents die, I had decided it was important for me to address the topic.

Notice I said that facing death is not “usually” a fun topic to write about. That’s because yesterday I was delighted to discover that there is a young woman out there, Caitlin Doughty, a mortician by trade, who is not only on a similar mission to encourage people to face death honestly but who is actually using humor to spread the word. I became intrigued by her work when I heard her being interviewed on Fresh Air yesterday about her book Smoke Gets in Your Eyes And Other Lessons from the Crematory.

Although she wasn’t exactly cracking jokes during her interview (which I only heard part of), I liked her right away for her straightforwardness: 

“Death is going to happen to you — whether you want it to or not — and you're never going to be completely comfortable with it. But it's an important process, and please consider facing it.”

But Terry Gross mentioned Doughty’s videos and how humorous they were, so I went to her website to check them out. The first one I watched was her welcome video. Wow, she uses such a great mixture of wit, humor, and directness to get her message across—I had no idea that death kills so many people in the US alone. Welcome to Your Mortality! (I'd link to the video on youtube but can't get to it for some reason.) So, in general, I recommend her work, and in her other videos she has a lot of “death answers” for “death questions” that you might also have.

But what does all this have to do with yoga? Well, first of all, we’ve been writing about the klesahs lately, the five afflictions that cause human suffering (see Attachment (Raga) to Our Ideas About Ourselves and Attachment to My Face). One of the klesahs is abhinivesah, which B.K.S. defines in Light on the Yoga Sutras both as “clinging to life” and “fear of death.” So I think the work of someone like Doughty, who is helping to dispel some of the fear around death by answering common “death questions” and encouraging people to face their own mortality, helps us cultivate satya (truthfulness) in the face of abhinivesah (fear of death/clinging to life). 

But really I decided to write about Doughty because of something surprising she said during her Fresh Air interview. After being asked by Terry Gross whether her job as a mortician—and being around so much death—was stressful, she admitted that it was:

"Not only are you dealing with the dead bodies, you're dealing with the incredible sorrow of the families and the fact that they can get very mad at you. ... They're angry that somebody has died and they're looking for somebody to take it out on."

But then she went on to say something like (and I’m quoting from memory now):

"I do take good care of myself. I have a therapist, I do yoga…."

Yes, Doughty is not only practicing satya (truthfulness) to combat abhinivesah (fear of death), but she also does yoga, which I take to mean asana, to support herself in her work. And, of course, we here at YFHA all know how an asana practice—the combination of exercise and time spent focusing on mindful movement, with hopefully, some relaxing practices added into the mix—can help people deal with difficulty and stress and to support them in the important work they have committed to.

You know, I never expected that I would become such a dedicated yoga practitioner. Yoga practice was not even something I chose intentionally—it was just the most convenient exercise class for me at the time. But after I kind of fell into yoga, I slowly began to realize how much it was helping me. And I eventually began to understand that it was exactly this combination of a yogic attitude toward life and an asana practice to fortify my body and my nervous system to help me maintain that attitude that I found so compelling. So here I am, still practicing—and writing about it—after all these years.

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Meeting Death at the Front Door

by Nina 

by Melina Meza

"Research shows that most Americans do not die well, which is to say they do not die the way they say they want to — at home, surrounded by the people who love them. According to data from Medicare, only a third of patients die this way. More than 50 percent spend their final days in hospitals, often in intensive care units, tethered to machines and feeding tubes, or in nursing homes.” —Dan Gorenstein from “How Doctors Die”

Yesterday I heard a very moving piece  How Doctors Die on NPR that made me think again about an issue close to my heart: being able to face death with courage.

My mother died of breast cancer at age 85, and she was able to die with hospice care at home without any invasive procedures, any time in a nursing home or being “tethered” to any machines. Because I was talking to her doctors for her and coordinating her care, I can testify that this was only possible because my mother was clear-eyed about her condition and was willing to admit she had a terminal condition. In fact, one of the requirements for beginning hospice care is for the patient to agree to no more potentially “curative” treatments (hospice provides comfort care only). So this means being willing to face the fact that you are dying.

The piece on NPR and the companion piece in the New York Times article How Doctors Die: Showing Others the Way made the same point. The doctors in the article were able to choose the way they died—and lived while they were in the process of dying—because their medical knowledge helped them face the truth of their situations. Realizing that her condition had become terminal, Dr. McKinley decided to turn down more treatment and to begin hospice care.

"What Dr. McKinley wanted was time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean. But most of all, she wanted “a little more time being me and not being somebody else.” So, she turned down more treatment and began hospice care, the point at which the medical fight to extend life gives way to creating the best quality of life for the time that is left."—Dan Gorenstein

While some people do very much want to die in a hospital, I believe that most of us do not. And to make that happen, either for ourselves or for our loved ones, we must be as clear-eyed and honest with ourselves as my mother and the doctors portrayed by NPR and the New York Times were. That takes a lot of courage.

"BRAVE. You hear that word a lot when people are sick. It’s all about the fight, the survival instinct, the courage. But when Dr. Elizabeth D. McKinley’s family and friends talk about bravery, it is not so much about the way Dr. McKinley, a 53-year-old internist from Cleveland, battled breast cancer for 17 years. It is about the courage she has shown in doing something so few of us are able to do: stop fighting." —Dan Gorenstein

How can yoga help you be brave? Of course I can’t write about my own death, but I did help both my parents die at home (and have all the clear-eyed conversations that entailed), so I know it is a very stressful process. So I expect that stress management, of whatever kind works for you, would be valuable. I tried to stay as calm as possible when I was helping my mother and found myself every day doing very long sessions of Legs Up the Wall pose combined with breath work (extended exhalation). And sometimes when I’m doing my breath work these days, I consider that this is a practice I will probably have access to until the very end. For information on various options for stress management, see The Relaxation Response and Yoga. Anxiety—which is fear of things to come—can also be a problem, and yoga can help soothe you when you’re anxious. Baxter and I have done a whole series of posts on anxiety, so see Yoga Solutions for Anxiety and check the index on the right side of the blog under the label "anxiety."

I also hope that yoga philosophy will come to my aid. The Yoga Sutras actually describes abhinivesha or “clinging to life” as one of the impediments to samadhi, describing it as inherent tendency.

Yoga Sutra 11.9 [The tendency] of clinging affects even the wise; it is an inherent tendency.  —trans. by Edwin Bryant

But the Yoga Sutras also tells us that truthfulness (the yama satya) is a crucial part of yoga practice. This is one aspect of the universal “great vow” that is the second branch of yoga.

Yoga Sutra 2. 36 When one is established in truthfulness, one ensures the fruitions of actions. —trans. by Edwin Bryant

And it seems that truthfulness—being willing to hear the truth as well as to tell it—will help you face your death and die the way you want to, and to be able to help your loved ones as they die. Just the other day a friend told me how she was trying to help a friend of hers who was dying. “But he won’t admit it to himself,” she told me. “And that makes it impossible for his friends to help him."

So it's my feeling that you have face the truth yourself. That you have to tell your family the truth. That you have to insist your doctors—and your loved ones—tell you the truth. And if you are helping someone else who is dying, facing the truth about their condition will allow you to provide them with the help they need.

In the audio version I heard, Dr. McKinley called her approach to her impending death as “Meeting Death at the Front Door.” Besides being able to do the things you love as you age (see Being Able to Do What You Love), isn’t an essential part of healthy aging being able to die the way you want?

"The front door at Dr. McKinley‘s big house was wide open recently. Friends and caregivers came and went. Her hospice bed sat in the living room. Since she stopped treatment, she was spending her time writing, being with her family, gazing at her plants. Dr. McKinley knew she was going to die, and she knew how she wanted it to go.

“It’s not a decision I would change,” Dr. McKinley said. “If you asked me 700 times I wouldn’t change it, because it is the right one for me.”

Dr. McKinley died Nov. 9, at home, where she wanted to be." —Dan Gorenstein

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