← Tenzin Chogkyi

Dying Well Weekend (3 November 2007)

Tenzin Chogkyi · 3 November 2007 · 5 h 10 min · Tse Chen Ling via Internet Archive

Download audio

Automated transcript, estimated accuracy about 90% for this source; report an error.

Words the recogniser was unsure of are underlined with dots. Use “Report an error” beside any passage to tell us what the teacher actually says.

Key passages

The teacher's own words, quoted from the transcript below and chosen automatically as representative.

  • 21:05

    So, of all of the world religions, Tibetan Buddhism has the most complete A set of writings, teachings, logic about the death process has been developed over centuries. And we have a lot to learn from this tradition and a lot to teach others. And the traditions that Tibetan Buddhism teaches us about the dying process are extremely different from the Western view of dying.

  • 2:15:19

    What we're going to do next is to work with this document called the Five Wishes. Should we pass it around? If everybody just takes one and passes it around. Everyone take one. Should we do the supplement or later? In a little while, yeah, when we get to that part. I'll just start telling you that this document has been out sometime in the last decade we heard about this, probably in the last five years, I would say.

  • 2:25:45

    As Betty said this morning, the difficulty of speaking to family members under many circumstances is very challenging. So I think it will be hard for her to know that as my second agent, I've chosen a friend, not her. It's going to be hard for her to know that. So this is a difficult task in many ways for each of us.

0:01 So good morning everybody. Sorry we're a little bit late in starting. Parking is always an issue on Saturday mornings. Okay, great. My name is Tenzin Chogky and this is my friend Lenny. Welcome to the Dying Well two-day workshop. What we'll do first is start by setting our motivation. So if everyone will just sit in meditation posture as comfortably as possible. Report an error

0:34 And then just take a minute or two to focus on your breath, either the sensation of the breath going in and out, your nostrils or your chest rising and falling, just to sort of center yourself, get yourself here in your body, in this room, off the road. And Report an error

1:17 then just take a minute to reflect on your motivation for coming to this workshop this weekend. It may be that you are involved in work. With people who are dying, you'd like to expand your knowledge about Buddhist methods, techniques for assisting people who are going through the dying process. Report an error

1:49 You may just want to expand your knowledge for your own sake, realizing that we all will face this ultimate transition at some point. Report an error

2:05 The highest level of motivation according to the Mahāyāna is to develop spiritually so that we'll... Be able to have the capacity to be of ultimate benefit to all sentient beings. Develop all of our knowledge, wisdom, capacity. Report an error

2:24 Become a fully enlightened being for the benefit of all beings. Just take a minute to reflect on your motivation. Report an error

2:46 Now slowly open your eyes. Report an error

2:57 Okay, we're going to begin the day by introductions. There are some old friends here and a lot of people that I don't know and so we'll do a go-around. Report an error

3:07 First, we'll introduce ourselves. My name is Tenzin Chogkyi and I'm one of the resident teachers at Land of Medicine Buddha in Soquel, California, right outside of Santa Cruz. I've been living and teaching there for a little over a year and came there following a solitary meditation retreat that lasted six and a half years. Report an error

3:29 Meant to be three years and then I wasn't done yet. I'm still not done yet. Far from it. But I continued for six and a half years and then before that was involved in various centers in the Santa Cruz area under the direction of Lama Zopa Rinpoche. I've been involved since coming out of retreat. I've been very involved in... Report an error

3:50 A residential care facility that we have at Land of Medicine Buddha that substitutes as a primary care facility for people who are dying. And I've sort of midwifed about five or six people through the death process at that time, people who like Buddhist prayers and practices to be done at the time of death. Report an error

4:07 And I'm the main person on call for that. And we're going to be talking a lot about that this weekend, about what's actually done, the practical. Things that are done in our tradition at the time of death. My interest in the... Death and dying process goes way back and in fact Lenny and I are old friends and in the early 90s started meeting with Lama Zopa Rinpoche to discuss the idea of having such a facility that people who wanted to go through the death process consciously, you know, as consciously as possible with all of the circumstances that are suggested in our tradition would have a place in which they could do that. Report an error

4:44 Especially we had a friend who is a monk who died in an intensive care unit at Dominican. And they were wonderful, but we could only keep his body and do the appropriate practices for about four or five hours after the time of death. And we were told by Lama Zopa to do these things quite loudly so that his consciousness could be aware of it. Report an error

5:06 And here we are in the intensive care unit just surrounded by these little flimsy curtains and it just was not the most conducive. Conditions to kind of do our thing. So that was one of the big triggers for us developing this care facility at Land of Medicine Buddha. So we've both been involved together with that since the early 90s. And you'll hear a lot more of the story of the evolution and what we do as the day goes on. Report an error

5:33 And my name is Lenny Kronish. Is that better? Yeah. Report an error

5:40 So my career has been in nursing and psychology. And in 1991, I completed what, of course, at the time I thought it was a long retreat of almost six months, but that's just like the entry for Tenzin Chogky. But for me, that was the longest retreat I'd done. And I came out of that retreat with this gripping interest in AIDS. And I read everything I could get my hands on. Report an error

6:10 Very soon afterwards, I was invited to interview for a job at the Hospice Caring Project in Santa Cruz, which is our local hospice. And I took that job, and I worked as a nurse case manager for four years at that hospice, visiting dying people in their homes. And at that time, this was in the early 90s, some of them were AIDS patients. And when that got too much for me physically, because it's a very hard... Report an error

6:38 To be so deeply involved with dying people exclusively, I became the coordinator of volunteers at the hospice. So I did that for another three and a half years before I retired. So I have both of those types of experiences and prepared me very well for being able to launch Tara Home. Report an error

7:04 And we began meeting for Tarahum in the mid-90s, and we were really stuck in committee for quite a few years because there was nobody on the scene that seemed to have the ability and the time and the impetus to actually launch it. I felt at that time that my responsibility was to make sure that it happened, but I didn't think that I could do it. Report an error

7:31 But then about Five and a half years ago, a Dharma sister of ours became ill with ovarian cancer and a late diagnosis, a bad prognosis. And she knew that this was going to take her and she knew she wanted to die at Land of Medicine Buddha. And so we both, we talked about it very openly and I became her person. Report an error

8:00 Her main person, I went to her doctor's appointments with her and through chemo and so forth. And at some point in there, she asked me to be her durable power of attorney for health care decisions, which I accepted to do. And right around that time, she took ordination. So she wanted to die as a nun. So we agreed she would be the catalyst for getting Tarahum out of committee. Report an error

8:25 And that's how it happened. So we did our first training four and a half years ago. We trained 42 volunteers and were able to secure the use of a small cabin at Land of Medicine Buddha, which we have done extensive work with to make it much more suitable, the funky old summer cabin. And so we took care of this woman for two months. Report an error

8:56 With our pool of volunteers around the clock and provided her, we acted as the family. And it's one of our requirements that everybody we take care of needs to be a hospice patient. So we established the relationship with our local hospice and they take that kind of responsibility and we get to take care practically and spiritually of each person. Report an error

9:25 So for the sake of our friend, I was able somehow to summon the energy and the stamina and was able to be the director of Tarahum for the first couple of years and then pass the baton on to Karen Shems, who some of you may know. And I'm very actively involved behind the scenes now on the steering committee. Report an error

9:51 And so let's go around. And if everybody could just say your name and maybe just a couple of sentences about why you're here, if you're actively involved as a hospice caregiver or just interested or whatever your background in the process may be. So yeah, we can start over here. Hi, I'm Carla and I'm interested in learning what is the point of view of dying process through Buddhism. Report an error

10:18 My name is Charlie. I'm in my first few months of studying Buddhism. This course just came up. I'm Report an error

10:35 Kathy and I work as a psychology intern with the elderly and hospice patients. I have studied Buddhism for quite a while, different schools of Buddhism. Report an error

10:56 Hi, my name is Keith Henriquez and I'm a clinician. I work in a maximum security prison where I work with men who lose family members, probably at least one of them. One minute a week would do, and they can never have any contact, and also men die in prison, so I have contact with them during that process, so I'm here to learn something about that. Report an error

11:19 I'm Amy Kwan, and I'm a social work student, and I have a strong interest in, I've always had strong interest in the death and dying process, and I will have a chance to work with people who are terminally ill, make sure I want to prepare myself as much as possible. Report an error

11:38 My name is Betty, and I've been a hospice nurse for 13 years and here to learn more. I've been a student of Buddhism since 99, so here to combine the two. Thanks. Hi, my name is Rick. I'm a somatic stress and trauma practitioner, so I work with people that are sometimes maybe dying or illness, had a lot of that in my family and life, and I'm also in a Buddhist chaplaincy program, and so I'm moving. Report an error

12:07 More towards that in interfaith chaplaincy. So I want to gain more ways to work with people when they're going through death. Report an error

12:21 Hi, I'm Lisa. And my reason for being here is because I accompanied my father in the dying process nine years ago. And it was a very moving experience and one that I realized I didn't have a complete skill set. to be there but was very present nonetheless and would like to be more prepared and Hi, my name is Report an error

12:57 Angela. I've been studying Buddhism on and off since the 1980s. I'm a nurse and I'm going to be around dying people, I'm sure, and I want to be able to do my best to integrate inner and outer. Report an error

13:18 My husband died eight and a half months ago, and I was able to have some Buddhist ceremonies at the time of death and able to keep him home for a few days. And I'm hoping to prepare myself as much as possible for my own death and to be able to teach my son to be a caregiver for me and initiate these processes as I was able to do for my husband. Report an error

13:50 I'm Janet and right now the only involvement I have with death is that I'm going to die. My friends and my mother are all going to die. We don't know which order. I'm interested in the practical side of death and dying. How you manage the person, help to manage the person's mind. So that they can be comfortable and maybe somewhat coherent. I don't know if you're going to cover that type of thing or not, but I was hoping that... Report an error

14:26 I just definitely need more realizations and more experience personally with death and dying. Report an error

14:40 Hi, my name's Paul. I'm hanging out back here to register late covers. I'm a philosophy student at San Francisco State, and I just started taking the death and rebirth workshop that Chogky mentioned at the beginning, and I just wanted to be here this weekend to explore that in more depth. I recently found out that my grandfather's dying, so I feel like this is a good time to really learn a lot about the Tibetan perspective on death and dying. Report an error

15:10 My name's Don. I'm a registered nurse for 22 years, about 15, 16 as hospice nurse. I'm hoping I can learn some specific techniques to help my patients as well as myself. Report an error

15:30 Hi, I'm Ann and I'm a Buddhist practitioner for about 15 years and I'm at the stage where a lot of friends and family are dying and I will be too soon, so it's time. Report an error

15:47 Hi, I'm Claudia and I've been interested in death and dying ever since I was really young. and so I've had I've been studying it in different ways and I've read the book that Chogky wrote. I was showing a few times and I'll probably read that many more times by His Holiness. My mother is in her 80s and I walked with her through breast cancer and with some of my other friends through cancer. Report an error

16:14 I'd really like to be more prepared to help my community. I work with a lot of young people and I'm aware of a lot of the violence in my community. I'd just like to be more present and be available for people and also for myself. Report an error

16:30 Hi, my name is Donna. And I'm just here just to get some practical information as well as spiritual. Report an error

16:39 Hi, my name is Chris, and I need to know more about the process for both for myself and for others. And more practically, I'm hoping that learning about it will help me to be able to concentrate on the person who's dying rather than letting my emotions carry me away. Because I think I'm of no use to anyone who I'm close to at this point. So I'm hoping to get better at it. Report an error

17:06 Hi, I'm Allison. I was here in June, but I was only able to stay for the morning session because I had a memorial service for a friend that afternoon. And it just seems that I've reached the age where a number of my friends who are older than I, but actually some of my own age, in the process of dying, I was brought up as a Christian. Report an error

17:32 And I've been studying Buddhism now for about seven years, but I just wanted to become more familiar with what the process is. I mean, in Buddhist philosophy and then actually the process. And I suppose at this point, because I've been thinking about the practical as well, whereas in June I was more interested in the philosophy. Report an error

17:56 But also, you know, how it connects really with the living, with living. The karmic aspects and past lives and then future lives and the benefit of having this one precious body and what to do now, you know, in terms of preparing for the process of death. Report an error

18:18 I'm Michael and I'm coordinator, manager of a little itty bitty saṅgha up the coast and just early this year finished my master's in clinical psych. And rather than taking my internship, I've decided to kind of pursue exploring Buddhist chaplaincy, among other things. And actually, sort of right as I signed up for this class, I found out a family member is terminally ill with months to live, and so it kind of comes at an appropriate time. Report an error

18:55 Great. Thank you so much. Report an error

19:12 We were just doing introductions, and so if you'd like to just... Just say your name and what brought you here in a couple of sentences. Welcome. Sorry to put you on the spot right when you walk in the door. My name is Sarah and I do elder care and my father's turning 85 today. Oh my goodness. So I just want to also prepare for the end of my own life. Good day to everyone. Okay. Thank you. Report an error

19:41 Okay. Well, it looks like... You cover the entire gamut of the curriculum of this course, which is perfect. Thank you for telling us about yourselves. Report an error

19:58 So death is universal. It's one of those universal tribulations that unites all humanity. And it's a pressing concern for each and every individual who's alive. Nobody can escape thinking about it. Worrying about it, wondering about it, being frightened about it or curious or even excited. So that's one of the things that interests me about dying and death is the universality of it, like birth and happiness and the ways in which we're all alike. Report an error

20:42 So just as each and every living being wants to be happy, wants to avoid suffering does each and every human being want to have a peaceful death tormented or physically wants to just on So, of all of the world religions, Tibetan Buddhism has the most complete A set of writings, teachings, logic about the death process has been developed over centuries. Report an error

21:31 And we have a lot to learn from this tradition and a lot to teach others. And the traditions that Tibetan Buddhism teaches us about the dying process are extremely different from the Western view of dying. And as we get further into the course, you'll have an opportunity to draw your own conclusions about those differences. Report an error

21:58 And furthermore, the attitudes about dying in the West, and I would say all Western countries, the emphasis is really different that any of you have been at a death. Will understand that very little attention is paid to the dying person except for their comfort, except for their physicality. But once the last breath occurs, all the attention is on the survivors. And it's almost as if there's an inanimate corpse on the bed with no further attention required than to call the mortuary. Report an error

22:45 That's the Western attitude. And so there's a lot of bridging to be done between what is the prevailing standard in our society and what we as people that are Buddhist students or interested in that perspective have to bring to the situation. Report an error

23:08 So anyone that's had the very first Buddhist teaching will know that death is certain. We are all going to die, as Janet said, and the time of death is uncertain. So everyone lives with that. And we all think, we all hope, and we mostly assume that we're going to live to a ripe old age. But brothers die inordinately young, and sometimes children die before parents do, and husbands die. Report an error

23:46 Many people do not live out a full lifespan. And so this uncertainty that we try to push away because it's so uncomfortable, I mean, we don't really know if we're going to make it home tonight. That's the truth. Fact of life. So we all live with that uncertainty. And again, in Tibetan Buddhism, we're taught that at the time of death, As we are making the transition into the next stage, there exists a window of opportunity, a window of opportunity for the trained mind to use the death experience to make great spiritual leaps. Report an error

24:35 And most of us... In the untrained state won't even recognize that opportunity. We won't recognize the signs and we will be too confused and bewildered and perhaps terrified to utilize it. So that's why it's so important. It's so wonderful to see such young people interested in embracing this topic now because the time to begin to prepare is now. Report an error

25:06 The time to begin to face our own uncertainties and fears is now, so we can get that out of the way and prepare ourselves for hopefully what will come many decades from now. Report an error

25:23 Now the next rebirth, which we will all take, depends on two factors. It depends on the accumulated positive The meritorious actions or virtue that you have created in this lifetime, in your daily life, your day-to-day life. Report an error

25:45 And then the second condition is the state of your mind at the moment of death. So in a way it's much easier to take care of the former and to live a good life and to work towards being a good person and do... Virtuous actions than to control the mind at the moment of death. So people who die a sudden death, for example, might very likely die in a state of great fear if they're the victim of an accident or the victim of a crime or a murder. Report an error

26:28 And people that die suddenly, let's just say, from a heart attack. Much more of a propensity for the mind of like that. So we don't have quite so much control over that. And one of the things we can pray for is a not sudden death because everything happens so quickly in that situation. But still, if the mind is trained and there's some preparation, one can exert some control, even though the stages of death happen very quickly. Report an error

27:04 Now there are many methods within Tibetan Buddhism that help us during the life to purify the negative energy that we have within us from past actions of this lifetime, past negative thinking, delusions, confusion, mistake. There are many, many practices to purify and transform that negativity into positive, meritorious, energies. Excuse me. Report an error

27:37 And then there are practices that we can do which will help develop the ability to influence the mind at the time of death. So, as I said, the time to begin is now, not on our deathbeds. And that's what the conventional wisdom is. The conventional way in our society is to put it out of our minds. We are a death-avoiding, death - Denying society. If any of you have been to Asia, where bodies are carried on beers by grieving relatives through the streets and funeral processions are just part of life. Report an error

28:19 And certainly in Nepal and India, where the cremation of bodies goes on out in the open. Some of you have seen this or experienced this, but death is... Out in the open, death is part of life, which of course it is, but we don't acknowledge that. And even our funeral practices are to cover the hole in the ground with artificial grass so that our sensitivities won't be offended by seeing an open grave. Report an error

28:48 So there's no encouragement for facing the facts of life. So I want to say, in addition to... Thanking you for being here this weekend, this beautiful day, and for you to be indoors for two days to contemplate and practice dying is extraordinary and brave. It's brave, courageous of you, and I commend you for that. I thank you for that. And this is the way that changes can begin, you know, one person at a time, just being the truth. Report an error

29:28 That's the way changes happen, and then we influence the people in our families, and that spreads out in a ripple effect, and slowly, slowly changes are made. And the drive here, I was saying that when I was a child, I don't ever remember hearing the word cancer. I'm old enough to not remember hearing people talk openly about cancer. Report an error

29:52 It was in the closet that grown-ups used to hush. Maybe sometimes you would hear, well, He has a tumor. He has a growth. But the C word was absolutely verboten. And now it's, you know, just kind of an ordinary, unpleasant fact of life. And one day, death and dying will be the same in our country. But not yet. So we are going to cover several aspects of dying and death. Report an error

30:28 The actual preparation of each one of us. So just by the fact that we're here at Sei Chen Ling means that you have either an active involvement with Buddhism or an interest and that you have a practice or that you will one day develop one. And you're probably, probably, not definitely, but you're probably going to take in some of the information you'll learn this weekend and want that to apply to your own death. Report an error

31:00 Probably not everybody in your family is Buddhist, so they're going to have different ideas than you do. So there's going to be preparation for death in the Buddhist tradition and the details of what to expect during the dying process, methods to attain the most beneficial state of mind possible for you to go through your own death. Report an error

31:29 As I said, practices to help transform or expiate negative states of mind, negative actions. But then it's necessary to... Address your own personal wishes. We each have personal wishes about what we might want at our own deaths. We each have a different cast of characters. We each have a different personal drama that needs to be attended to compassionately, the people that love us. We need to educate them as to what we want and what to expect and somehow bring all that out into the open with people who don't want to talk about it. Report an error

32:10 So it's a big assignment. And then we want to place these wishes of ours into a legal document so that we can assure that when we die the conditions that are so important to us and that will protect the hard work we've done in our personal practices. To attain the states of mind that we want to expand upon, that that will be protected and we won't be slapped with heroics and measures to extend a finished life. Report an error

32:47 With no quality. And we need to educate the people that are going to be making decisions for us and communicating with our doctors about what we want to be done and what we don't want to be done. And we want to educate them about what kind of things are going to happen that are going to feel really foreign and weird to them. Report an error

33:08 But they're important to us like that. And then we're going to talk further. About how to be with someone who's dying. How to be useful to them. How to be comfortable with them. And how to bring what we know into the situation without laying a trip on someone who's not Buddhist and where these things would not be welcome. Report an error

33:38 But how can we help like that? So it's a tall order. And many of us... We'll be involved in other people's deaths, plural, you know, long before our own. So we can be helpful if ever you've been at a death. It's often very chaotic emotionally, physically, and we can help. Individuals can help change the situation into one that's much more peaceful, much more conducive to the dying person having a peaceful end. Report an error

34:17 Because as you know, energy is contagious and the vibes in a room are felt by everybody. And it's very, very possible, just in the privacy of your own meditation, to change the energy in a room and help everybody. So we'll be talking about all of these different things. There'll be a long opportunity today for questions and answers and discussion, and a shorter, more informal one tomorrow. Report an error

34:44 Our ending time tomorrow is 3 o 'clock, so there's not going to be a scheduled opportunity for a long question and answer period, and I think we'll check in with you tomorrow to see if there's any softness around that ending time so that... Any loose ends that you have, there'll be time to address. Report an error

35:08 So I wanted to just kind of go over the schedule piece by piece with you. I think you've all gotten a handout of what the schedule is. And just to kind of give you a little bit of background, Lenny and I did this workshop together for the first time in May at Land of Medicine Buddha just this year. And it was sort of an experiment. And we tried to really... Report an error

35:30 Merge both the sort of Tibetan Buddhist theoretical and the practical. So I heard that when people went around that they wanted both of those pieces. So hopefully we'll be able to fulfill that need. When we did it, Land of Medicine Buddha, it started on a Friday night and then was a very intensive Saturday, 9 a.m. Report an error

35:48 to 9 p.m. And people felt kind of bludgeoned by all the issues they were asked to deal with. So we tried to create a little bit more space in the schedule by... You know, putting it over two days so you just have a little bit more time to process. Because as Lenny said, you're very brave to be taking on these subjects. Report an error

36:06 And it's really intense. And a lot of this, you know, we sort of mix the practical and lead you through certain exercises that you may be really facing things for the first time. And it's quite intense. So we've tried to, you know, weave in a lot of processing time. We're from California, so we're really into processing. Report an error

36:25 We try to have a lot of time to process and discuss and enough breaks, you know, so that you get some space and so forth. For both of us, our teaching style is very interactive. So by all means, during every session, not only do we have a whole space devoted to question and answer and discussion, but at any point when something's coming up for you, by all means, please raise your hand. Report an error

36:46 If we use terminology, you know, a lot of times I find that I'll slip into using some terminology That isn't clear to people who are So beginners, by all means, don't feel stupid. No question is stupid. I hate it when people start and say, I have a really stupid question. I go, no, you don't. No question is stupid. Report an error

37:03 So just please, you know, raise your hand. And if there's anything unclear, you know, let us know. And we'll just try and give you adequate breaks. And like I said, it's quite intense material. And we'll try and really, you know, allow for time. We did this sort of intense day. And at the end, we asked for a lot of feedback because it was the first time we'd really done it. Report an error

37:24 And some people said, oh, the intensity was really good because you just had to be right in it. And a lot of people are like, oh, my God. We checked and it took them like two or three days to recover, including us. Report an error

37:36 Not a good schedule. So we're trying to be a little more spacious about things. We'll see how it goes. Okay, so... We're clearly in the first session after overviewing the course. What I'd like to do is lead you through a meditation. We're going to try and do a lot of experiential meditation during the weekend also. Report an error

37:58 Impermanence and death is one of the main meditations, especially of the Tibetan tradition and of Buddhism in general. So we're going to have a guided meditation and then we're going to have a little tea break. And then a meditation that Lenny's going to guide called Approaching Death. And this will actually, you know, you will be sort of visualizing your own future death process. Report an error

38:21 And the point of that is that, you know, for most of us, it's the first time that we've ever done this and things will come up that may be quite surprising to you in terms of what you would like to have be happening at that moment. You know, you can predict something theoretically, but actually sort of... Report an error

38:38 Visualizing that whole process, some new things might come up. Now this tends to be quite a challenging exercise and so we'll follow it by breaking into pairs to discuss and sort of debrief what happened and then we'll all come back together to just talk about what came up for people. Then we'll have our lunch break and then in the afternoon we'll go over this document called the Five Wishes where you actually will specify what conditions that you'd like at that time Take you through the exercise first, because then these things will come up that may be quite different than what you would have thought, and then we'll actually go through preparing this document that's a legally binding document that you share with the people who will be taking care of you and so forth, detailing your wishes. Report an error

39:26 So we'll do that in the afternoon. So if I can just say that you are definitely not required to fill out that document in this course. We'll go over it point by point. Report an error

39:38 This is something that you want to think about at home and figure out who you want to appoint and get their permission and think carefully about that. But it's not something you have to make quick decisions about, nor should you. But it'll be kind of reviewing the different sections of that document and what's covered and also getting in a little bit to what's sort of suggested in the Tibetan Buddhist tradition as far as conditions at the time of death. Report an error

40:08 And it's interesting, I was taking, are you in the Sati chaplaincy training? Okay, I was in that program and during this Buddhist chaplaincy training and during the death and dying day, you know, it's sort of a day that focuses on different issues. Of course they had to bring it. a Tibetan Buddhist in, even though the leaders are mostly from the Zen and Vipassanā tradition. Report an error

40:28 A lot of recommendations about what should be done at the time of death and we'll go into a lot of that including... during the time that we go over this five wishes document. So then we'll be discussing that also, you know, because some questions may come up or people might want to share what they decided that was quite different than what they thought. Report an error

41:06 And then at the last session of today, we're going to go over this teaching that comes from the Lojong or thought transformation tradition of Tibetan Buddhism. And this is a genre that was practiced, you know, very beloved in the Tibetan tradition. And there's a teaching called the Five Powers. And there's a Five Powers for life and also Five Powers at the time of death. Report an error

41:29 And we're going to go over both of these because many of the Tibetan Lamas say this is the best way to prepare for death. Period. You know, all of these fancy things and these initiations and this and that and the other thing are all well and good. But if you have to depend on one thing, it's this five powers at the time of death. Report an error

41:47 So we're going to go over that and then end the day with Tonglen meditation, also known as giving and taking that many of you may be familiar with because it's part of this practice to be done at the time of death in relation to these five powers. And then tomorrow we'll start in the morning with the stages of death. In the Tibetan tradition, which deals a lot with this subtle body, you know, and there's certain stages of death that correspond to dissolution of winds and so forth in the subtle body. Report an error

42:20 So what we're going to do is present that and then go through a meditation. Based on the stages of death presented in the Tibetan tradition. And this is a very useful thing to get familiar with because if you're caregiving for someone who's going through these stages, you can identify exactly where they are in the process of dissolution, how close they are to death. Report an error

42:41 Also, it keys you into certain ways that you can take care of them and make them more comfortable. We had a student of Land of Medicine Buddha who was passing away about three weeks ago and we were together with her in the middle of the night with Lama Zopa Rinpoche who just arrived that night. It was this amazing story, I'll tell it later on in the weekend. And we were together doing practices with her for about three or four hours in the middle of the night. And there's a certain point in the death process where it's called the earth element sinking and the people feel that there's... Report an error

43:11 Weight pressing down on them and they usually start flailing around and pushing the covers off. If you don't know that it's that stage, you might think they're in a lot of pain or they're really, you know... Freaking out or something. And at that point, her relatives got quite alarmed. What's going on? And Lama Zopa Rinpoche and I were telling them, no, no, it's just this stage, this natural stage where they feel a weight pressing down and they're just trying to kind of push the covers off. Report an error

43:39 No, she doesn't need pain medication. It's not about pain and so forth and so on. So it's quite useful to be familiar with what's going on physically with the people at these stages of death. So we'll go over that and go through. And then the second morning session will go through the four opponent powers, which is a method of purifying old negative karma, you know, and preparing for death in terms of purification of karma. Report an error

44:05 And I think it was Allison that said that was something that she was interested to hear a little bit more about. And then we'll go a little bit more into Lama Zopa Rinpoche's specific instructions for the time of death. There's a book that I should grab and show to you after the break just called Death and Dying. Report an error

44:23 That's a big binder of all of the practices that, you know, are done at a traditional sort of Buddhist. Deathbed scene compiled by Lama Zopa Rinpoche with lots and lots of instruction in that and so we'll just go through some of the highlights of that present Lama Zopa specific instructions and then after the lunch break we have one more session and we'll go into some details about after death and after cremation some of the things that are suggested in our tradition as far as what's done with the ashes and other Practices that can be done actually after the time of death and even after the body's cremated. And then one final practice, a very simple transference of consciousness practice that's actually, this one is taken from Sogyo Rinpoche's book, The Tibetan Book of Living and Dying, which for many of us was our Bible for years and years about. Report an error

45:19 How to deal with the death process. And so within all of those later sessions, we'll have time for more questions and discussion and so forth as things come up. So are there any questions now or any... Have we left anything out that you've come to learn this weekend? That you can tell from the... Yeah. Oh, we need to get it all recorded. Thanks, Betty. Report an error

45:50 You were talking about, you know, the practices for the ashes and things that have happened after death. And I'm just thinking about any practices that we can do for if there was a period in the dying where a person was really unpeaceful in their death. If there's anything that we can do for that. Yeah, and we'll talk about that too. Yeah, yeah. Because there's a traditional period after the... Report an error

46:15 The actual kind of Western medical time of death, there's quite a period. Then we'll talk about different practices that can be done for that whole period. Report an error

46:29 Yes. Yeah. We'll talk about that. Yeah. Yeah. Report an error

46:38 So I know sometimes when you're dying, you actually may think someone's in the throes of they're actually going to die. So in this practice, so let's say you're getting ready, you're doing it, but they actually aren't there yet. I don't know if you'll be speaking. Report an error

46:52 We can talk about that. Or how we're working that, because I know that happened many years ago when my mother was passing. Sometimes we thought, this is it. And it's just like, nope, next thing, perk back up. And that happens. That uncertainty is very common. It's very common. We had a friend who passed away just about a year ago. Report an error

47:13 And she wanted specific practices done by monastics especially. So there were three of us living at Land of Medicine Buddha. And I think we were called to her bedside maybe three or four times by even the nurses who were saying, yes, her feet is getting cold, you know, da-da-da-da-da, her breathing's changed, quick, come. Report an error

47:30 We'd come in the middle of the night. We'd sit there for hours and hours and hours. And then, you know, it changed and we went home. And then weeks later, we'd get called again in the middle of the night. And this went on for months. And I have a friend whose mother has been dying of heart disease. She's been on hospice for two and a half years. And she keeps coming to the brink and then recovering and start walking around the house and eating huge meals. Report an error

47:56 I think that relates to, of course, good karma, or maybe not so good. It relates to karma and a strong constitution. Those words that we don't hear in Western medicine so much, a strong constitution. And the mind is so powerful. This woman that we kept getting caught, I mean her body was completely decimated with cancer. I couldn't believe it. Once I was there and the nurses were changing her, she had to have these big pads because it was basically just this open, she was like a skeleton covered with skin, but her mind was so powerful and she just wasn't letting go and you couldn't believe that she could even still be alive. Report an error

48:34 And she just died. A year ago was it? Yeah, it was just about exactly a year ago. And she came over four years ago and got on hospice. She came to die at Land of Medicine Buddha. So she kept having... Bounce backs and recovers. And her mind, her constitution was strong, a very feisty person. And she had a son who was 17 at the time of her death. Report an error

49:01 And she was determined to live long enough until he graduated from high school. She didn't make it. I mean, her body gave out before them. But I think she kept herself living by sheer grit and determination. It was amazing to behold. So it's often not, you know, generally within... Ten minutes or so you can tell there's changes in the breathing and so forth, but it's often really difficult to tell much longer before that that it really is time and there are many false alarms. Report an error

49:32 But we'll talk about that more too when we talk about the stages of death and just different experiences. Any other questions? Special requests? Okay. Do we need to get up and stretch for a minute before the meditation? Okay, why don't you just get up and stretch for a minute because we're going to be going into a meditation period. Report an error

50:09 And if anybody is in a chair and would rather sit down for meditation, you can switch in that direction also. I think there's room. Report an error

50:26 Okay, well, many of you brought your drinks back in with you, so sip quickly now. Because we're going to have another meditation, and this one will be a longer one. So I really mean it, just enjoy a few sips while your drink is hot. And what we're going to do now is go through an experiential meditation. Really, sometimes... Report an error

51:02 I've heard this meditation entitled One Year to Live. It's not something that we think about very often, what we would do. What would it be like if we ourselves actually had that experience? So this may be unsettling a little bit. So I just checked. I see several boxes of Kleenex around. And feel free to... Report an error

51:38 Grab a few. Report an error

51:44 So begin to get yourself settled into a meditation position. You can sustain for half an hour or so. Report an error

52:03 You won't need to take notes. This is all experiential. Report an error

52:16 And so now, Report an error

52:20 just let your eyes gently close and begin to sink deep into the center of yourself. Report an error

52:34 And spend a minute or two watching your breath, breathing normally. Report an error

· · ·

53:31 And so. I'd like you to imagine that about three weeks ago you had your annual physical examination in your doctor's office. Report an error

53:48 And a week later the nurse called and asked you to come in to discuss some findings with the doctor. So that in itself was enough to give you a little alarm. And Report an error

54:10 when you got there... Report an error

54:14 The doctor entered. You were ushered into her office rather than the examining room, which made you even more anxious. And then the doctor came in looking rather uncomfortable, looking more at the floor than looking into your eyes. And she proceeded to inform you that the test showed that you have a severe... Report an error

54:53 It's a form of adult leukemia and it's in a rather advanced state. Report an error

55:04 So with a feeling of despair, with a great deal of concern, she referred you to an oncologist, a cancer specialist, to discuss what your options are. Report an error

55:24 So you make the appointment. And you have to wait a while to get into this busy office and have to suffer a week or so of dread and anxiety. Report an error

55:43 And then when you get to your appointment, you Report an error

55:52 find that there's not so much that can be done, not so much that's going to help. Report an error

56:04 Perhaps chemotherapy would be useful, but Report an error

56:11 it doesn't look too good. Report an error

56:15 And when you press for more details, the doctor will finally say that she thinks that you have not more than a year to live, at most. Report an error

56:33 So as you leave the office in a very confused state, your mind is racing to comprehend all that you have just heard, all that's been happening. Report an error

56:51 Your thoughts are in a jumble. Report an error

57:02 For the next few minutes, try to experience the thoughts and the feelings that are arising in you now in your mind and the sensations that you feel in your body. Report an error

· · ·

59:50 As you contemplate your situation, how will you tell your family and friends? How will they respond to your illness? So one by one, picture each... Of your loved ones and imagine his or her response. Report an error

· · ·

1:02:44 So try and imagine who your support system will be. Which of the people in your life will be most likely to come closer to you, stand by you at this time? And who will be most fearful and pull away? Picture your partner, your parents. Children and friends. What feelings do you have about each person as you imagine how they will be there for you or not during this time ahead over Report an error

· · ·

1:05:56 the next few months? It seems that your life has become about doctor's visits, lab visits, hospital visits. And you've had weeks of chemotherapy treatments. And they've left you feeling weak and sick and exhausted. Report an error

1:06:24 You barely have the energy to keep on fighting this. And it's difficult to remain hopeful. Report an error

1:06:51 And then during your last visit, the doctor told you regretfully that the chemo has not done much to slow down the cancer. And in fact, it's progressed. And he suggests that it might be time to get your affairs in order and time to call hospice. Report an error

1:07:22 So how do you receive this news, this bad news? And Report an error

· · ·

1:09:22 as this unwelcome news sinks in, is there anyone that you want to be with at this time? Or would you rather be alone as Report an error

· · ·

1:10:38 you lie awake? Night after night, unable to sleep, many questions arise in your mind. What has been the purpose of my life? Report an error

· · ·

1:11:41 What do I regret? Who Report an error

· · ·

1:12:46 do I have unfinished business with? Report an error

· · ·

1:13:51 What can I do about these things now when Report an error

· · ·

1:15:10 I get to the point where I can't make my own decisions? Who do I want to do that for me? Report an error

· · ·

1:16:35 As the weeks turn into months. You're experiencing more and more pain and other physical symptoms and that creates more questions in your mind. Report an error

1:16:52 How do you feel about taking narcotic pain medication? How do you feel about taking strong drugs that are meant to relax you, sedate you? Report an error

1:17:10 How do you feel about... The fact that these drugs may affect your state of mind. Report an error

1:17:25 How hard is it for you to deal with pain? How Report an error

· · ·

1:18:17 do you feel about life support and other measures that could keep you alive at all costs? What Report an error

· · ·

1:19:35 are your spiritual wishes for the time of death? Special prayers you once said? Report an error

1:19:47 Teachers? Other clergy to be contacted? Report an error

1:19:55 What rituals might you want performed? What do you want done with your body? Report an error

1:20:22 Do you want a funeral or memorial service? Report an error

· · ·

1:22:01 Now you're feeling very sick. You're so weak you're unable to get out of bed any longer. You know there's not much time left. Report an error

1:22:14 You'd better start saying goodbye to all your loved ones. Report an error

1:22:22 Is there anything that's been left unsaid between you? Report an error

1:22:29 Call each person you love to your bedside, one at a time, and say what you wish to say to each one. In your own way, say goodbye to each one as you experience letting go. You Report an error

· · ·

1:26:24 feel your life force ebbing away and you know the time of death is near. Report an error

1:26:36 Just opening your eyes or moving takes an enormous effort. Report an error

1:26:46 Picture where you are and who is with you and what is the feeling in the room. Report an error

· · ·

1:28:56 As your life force recedes, you're feeling extremely relaxed, extremely peaceful. Report an error

1:29:11 Your body feels light and blissful, your mind serene and clear. Report an error

1:29:26 So dwell in this state. For the next minute or two. Report an error

· · ·

1:31:29 And so we'll conclude this meditation by dedicating the inner work that you have just done, that it may benefit all who will die and that they may experience peace of mind at the time of death, experience the wish to benefit others at the time of death. And to recognize the clear light and attain full and complete enlightenment for the benefit of all beings. Report an error

1:32:17 So when you feel ready, please open your eyes. Turn Report an error

1:32:41 to somebody next to you. Report an error

1:32:46 And in pairs, spend about five minutes each just sharing what that was like for you, what went on for you. We'll ring a gong after the first five minutes. And then there'll be an opportunity to come back together and share in the large group. Report an error

1:33:15 number you can do a trio. Report an error

· · ·

1:35:19 Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Report an error

1:36:43 Thank you. Report an error

1:36:56 Thank you. I know who I want. Report an error

1:37:13 Thank you. Report an error

1:37:27 Thank you. Thank you. Thank you. Thank you. I was talking about how you can use your guidance as an experience for your love. Report an error

1:38:17 Thank you. Report an error

1:38:44 Thank you. Thank you. Thank you. Thank you. Thank you. Report an error

1:38:51 Thank you. nice to see you now. It's good to see you now. A lot of different ages. Thank you. Thank you. Hey, change part, Harrison, if one person's been doing all the time. Report an error

1:40:02 Thank you. you get there, I'll be able to see if she needs that one. I get my job briefly because I thought she was going to get away. Yeah, that's what I thought. Report an error

1:40:17 It's a waste for all the long lives. I'm not taking care of you. I have to figure out how much more. Yeah. Thank you. Yeah. Report an error

1:40:37 Thank you. Report an error

1:40:45 All right, nice to ride. Thank you. you. Thank you. Thank you. We'll be right back. Report an error

1:41:35 Thank you. Thank you. Report an error

1:42:05 Thank you. Thank you. Report an error

1:42:28 Thank you. Thank you. Report an error

1:42:56 Thank you. Report an error

1:43:23 Thank you. Thank you. Report an error

· · ·

1:43:29 Thank you very much. Report an error

1:44:00 Thank you. Report an error

1:44:26 Thank you. Thank you. Report an error

1:44:58 I was trying to place your eyes. Report an error

1:45:12 Thank you. Thank you. Thank you. Thank you. Report an error

1:46:12 So perhaps Bring your conversation to a close now and resettle yourself. And Report an error

1:46:29 let's just open it up now. And anyone that would like to just say what this was like for you, what came up, what you realized that you didn't know before, what you need to do in your life, please just share whatever you will. Report an error

1:46:47 Yes. Report an error

1:46:53 As a nurse, a hospice nurse, it's one thing, but being the patient is something else. And how I would talk to my kids and my granddaughter, it's a reality check. It's easier to come at it from the nursing perspective and take care of somebody else, but when it's actually me and my family, it's very scary. Report an error

1:47:15 Very scary and quite different. Totally. Totally different. Yeah. It's like you feel, it's a whole new feeling. It's like I'd never been there before, but I have. Yes. In relationship to somebody else. Yes. But this is me. Yes. These are my kids. That's right. You know, my granddaughter. Yeah. You know, what would I say to them? Yes. I don't know. It's, you know, I'm going to wing it. Report an error

1:47:39 Well, I mean. If I have a chance. Yeah. Yeah. It's a conundrum. It is how to break it, how to bring it up. Nobody wants to hear it or talk about it. Yeah. And who would I appoint to speak? Who would you appoint? Durable power of attorney. Yes. Not my kids. Well, you know, it often just goes to the children because they're legally... Report an error

1:48:08 Your heirs and relatives and in general it goes to the children. And that's something we need to spend some time thinking about. None of my children are Buddhist. They're very supportive of me and my practice and they're fairly familiar and they've nibbled around the edges but they have no idea of really what I'm doing and the particulars. Report an error

1:48:30 The particulars at the time of death are very... Different, you know, they're very different from what might be in the general knowledge of spiritualism, like that, very different. And it has come up at Tarahum and it can easily come up that the person who holds the power of attorney to make the decisions. Report an error

1:49:00 Doesn't know all the particulars of what you want done because they don't know your practice. And often things change really fast at the end. So there's not time to educate the family properly as to what might take place because the dying person has requested that. So that's one situation where it's really quite important to have that conversation. Report an error

1:49:24 And the other one is that practices in hospitals are very different. The mission of doctors and nurses outside of hospice and palliative care, the mission is to save lives. That's their job, you see. And so it is not unheard of, it's not uncommon for durable power of attorneys to be overridden by doctors. Report an error

1:49:54 Hospital administration and even family members happen sometimes. So the personal conversation is crucial for you to convince and gain the cooperation of someone in your family who might not be Buddhist to where you feel assured that they're going to carry out your wishes or, as you say, the power of attorney may need to go to someone who's not a relative. Report an error

1:50:19 And then that can create problems for the family. We'll talk about this more as we go on because some of the practices to protect the mind of the dying person seem to exclude the family. So this is very rich with food for thought. Yeah. What else? Who else? Report an error

1:50:48 I just wanted to express my gratitude to everyone here and to your teaching. Because I could feel the cumulative grace of all of your intention and what I experienced. Thank you. Report an error

1:51:15 I think I surprised myself because I entered Buddhist practice with death as a Dharma gate. I had a really, really close family member die. And I entered that kicking and screaming. So I thought, oh, I'm going to enter this just absolutely having a hizzy fit. Report an error

1:51:32 I did it first in the meditation when you find out, it's like, oh, this is awful, this is a train wreck. But that ended really quickly. And I think I really surprised myself because in the end, I didn't want to have anything to do with the hospital. I didn't want to have anything to do with drugs. I just wanted to help other people and to make sure that it's like, you know, I'm going to die anyway. Report an error

1:51:58 You're screaming and me screaming isn't going to help me at all. So I just wanted to, I found, just help other people as much as I could. And that surprised me because I thought I'd be screaming. Well, that's good to have a look at your mind and be surprised because obviously you've shifted already, which is very helpful. Report an error

1:52:23 I think I was surprised a little too. I felt it was a good meditation. I felt a great sense of relief. Yeah. Report an error

1:52:29 With the understanding that I was going to die. And it really felt good. Almost like knowing that something's going to happen and then all of a sudden you know it's going to happen. I know it was a wonderful feeling. I certainly wanted to then proceed with that good feeling. And I was thinking, I don't think I really want to get involved with doctors and treatment and hospice. Report an error

1:52:56 I know I want to take care of myself. Take the money that I have and make sure that I have an account so that I can be independent. I guess and die with a sense of independence. Report an error

1:53:11 These things bear some thinking about because not every family is up to the job of taking care of someone to the end of their life. Unfortunately, as the body goes, lots of unpleasant things happen. And lots of functions. I mean, one system after another breaks down. And the care can be daunting. And so things often break down at that stage and your idea of establishing is wise. Report an error

1:53:45 But thinking about... Where might I die if I don't want to die? And it's a very important thing. And who will be there? Do the people in my family need to go to work every day? Who could it be? This is a fact of modern life, which is why we established Tarahome. Many people don't have someone. Someone might want to do it, but they don't have the ability either physically or emotionally or mentally. I could never do that. I've heard so many people as a hospice nurse, I've heard so many people say, I could never do that. Report an error

1:54:19 Or people thought they could do it, but the actual physical breakdown, it's just overwhelming. Like that. So it's good to think of different contingencies so that not everything is left to your family to have to figure out when you want a particular set of conditions. And it's almost like once you take it in that this is going to happen. Of course, we can't picture how. This is just one scenario. Report an error

1:54:47 And oddly enough, this is a fortunate scenario because there's time. I had a revelation once. We know everyone's going to die. But it takes a death event to kill you. And there's going to be something that takes your life. And it's going to look at it many different ways. It's like a menu of options that you don't get to choose. Report an error

1:55:16 But something is going to take your life. And this scenario that we visualized turns out to be a fortunate one. Preparation, time to think about it, there's time like that. So, yeah. Yes. The mic? I Report an error

1:55:39 think the hardest question you asked was about pain relief. Yeah. Because I don't think that, I certainly can't know what's unendurable. Right. In the true sense of the word. That's correct. And so that one is really tough. And whether or not one could have it part-time. So part of the time you could do your practice, but you would at least have some kind of chance to recover during the night or something. Report an error

1:56:10 And I don't know enough about those kinds of things to do that. But that one's very tough. That one is very tough. So just skipping ahead a little bit, something I would touch on later. Report an error

1:56:25 Well, first of all, there's a very famous letter that is circulating in the Dharma community that was written by Lama Yeshe to his longtime spiritual brother Geshe Wangdu, I think it was, and outlining what it was like to be so physically ill and he couldn't focus on his meditation and how many pills he had to take a day and how terrible it was to be declining like this. Report an error

1:56:52 And it's just as you say, we can't know. And another thing that I learned for myself when I was a hospice nurse is that I have no idea how I will respond were I to have a terminal diagnosis and a painful illness. I don't know. I can't know. I cannot know. And every different type of malignancy, for example, brings a different kind or level of pain. Report an error

1:57:20 And some of it is really excruciating and probably intolerable. So as you say, you cannot make up your mind in advance about things like this. And Lama Zopa, I've had quite a few conversations with him about these topics in regard to Tarahum. And what he said early on is that it's okay to medicate pain. Report an error

1:57:46 as a hospice nurse, I have seen that people who have... Ongoing, increasing pain. They tend to adapt to morphine, for example, so that after a couple of weeks of drowsiness, perhaps, you tend to adapt to it and can function. Report an error

1:58:08 It's the sedating drugs that are used from very well-intentioned, very well-meaning people to help with the apparent suffering. can function. Report an error

1:58:22 Medication like Ativan and tranquilizing drugs, which sedate. Those are the drugs that zonk you. And here's the thing. Lama Zopa said that for a Dharma practitioner, the suffering, the mental suffering you go through is the experiencing of the negativity in your mind stream and... Expunging bad karma, negative karma, and that it's important to go through that process for a practitioner. And so not only don't you want to medicate that, but he also said you can't medicate suffering. Report an error

1:59:02 You can medicate the appearance of suffering so that the nurses and the doctors, everyone who wants well for you... We'll see that you're resting peacefully, you're sedated, and it looks like you're not suffering. But the mind is going through the same thing. It has to, because that's what comes up at the time of death. So there's a distinction between medicating for pain and medicating for suffering. Report an error

1:59:29 You cannot meditate. You can meditate for suffering, but you can't meditate. Meditate for suffering. We should make a new bumper sticker. Yeah, Report an error

1:59:40 so any of you who have done retreats know that it's not all la-la bliss land, and often what comes up is really, you feel rotten, you know, and that's what negativity feels like as it's coming up and purifying. You can feel anywhere from very uncomfortable to sick to in pain to agitated to sleepless. I mean, there's a long list of symptoms that are beautifully outlined in Alice Wallace's book called The Attention Revolution about meditating on shamatha meditation. Report an error

2:00:26 Calm abiding and the kinds of things. When you get advanced, that's a short list of what might come up. And that's what that is. It's the suffering of the negativity in the mind stream, which on the road to enlightenment, it has to be purified and then expunged from you to leave the spaciousness of positive energy and awareness. Report an error

2:00:50 So that's what is seen at the agitation at the time of death. Compounded by regrets, unfinished business, uncommunicated feelings, resentments and on and on like that. That's why the time to start thinking about these things is now when you can do something about it. And then of course the object is to get current in your life and your relationships since we never know when death will occur. Report an error

2:01:24 So now is the time to think about these things and hopefully this weekend will spark some interest in doing that because only you know what needs to be done. Report an error

2:01:36 So anyone else? Report an error

2:01:43 Do you have any thoughts on working with people who are psychotic? People who are? Psychotic? People who are psychotic. As they're going into the dying stage? Report an error

2:01:59 Well people who are psychotic are... In the vernacular, out of their minds. So they're not going to be able to concentrate and focus or do any kind of practices for themselves. So what you can do for them, depending on the circumstance, is anything at the least from sitting at the bedside, meditating, doing prayers, saying mantras, all the way to doing practices allowed for their benefit. Report an error

2:02:30 there is Lama Zopa Rinpoche has advised us at Tarahum that it's extremely most beneficial for people in the dying state at the time of death and afterwards to hear at Say the Medicine Buddha Mantra. And there is a CD called Reign of Blessings. Reign of Blessings. And it is by a French musician named Jean-Paul Raquel and Lama Gourmet. Report an error

2:03:07 And the musician has set a kind of lovely music. Not music, but a tonality. It's not just Tibetan. Chanting in a minor key, which most people who aren't Buddhists don't relate to. This is melodic. And over and over again, he chants the Medicine Buddha Mantra in a lovely tune, which we always introduce in Tarahal. Report an error

2:03:36 And we say, you know, do you like listening to chanting? And most people will give it a try. And if they like it, we endeavor to play it as much as possible as background or foreground until they request us to turn it off or turn on the TV or whatever. So this is something that could definitely be useful for a psychotic person if they're Buddhist or not. Report an error

2:04:02 If they are Buddhists, certainly calling in saṅgha to do prayers, practices, rituals, pujas, could be very beneficial and will be received in their essence, whether they understand it or not. So like that. Report an error

2:04:21 Yes. This may be a little bit off topic. One thing I've been thinking about is Alzheimer's disease. In some ways I think it's the cruelest because... The person goes away, the person that you know goes away, and then there's a person living, and they can actually live for quite some time. A long time. Any thoughts about, and it also brings up what the nature of a person is, what you grieve when a person leaves. Report an error

2:04:59 Yes, I do. I've thought about it a lot. I've thought about Alzheimer's a lot. I've worked with Alzheimer's. I worked in a skilled nursing facility as the evening supervisor, and many of the people had Alzheimer's. Report an error

2:05:13 I think it's generally the same as I just said about psychosis because people who die of Alzheimer's, by the time they reach that stage, they're definitely psychotic and they're not there. So the same thing would obtain. But along the way, it depends on the person. Report an error

2:05:32 There's so many stages, but a person with Alzheimer's generally reverts to early childhood, and they are reachable in many of the same ways their children are. And they're very open and loving, can be, they can go the other way, but that's part of the psychosis aspect. So it's different at different stages. Report an error

2:05:53 But people with Alzheimer's generally respond to music. And so this particular chant, they can have the Medicine Buddha mantra in their mind stream. It can be taught to somebody if they're willing and they can mutter it, you know, like that. Mutter something beneficial than just drivel. I don't think of anything else that I can say because people... Report an error

2:06:18 They wither away if they're dying of Alzheimer's and they, you know, it doesn't matter at that point what they're dying of. They become emaciated and so forth. Report an error

2:06:31 How are we doing on time? We should probably take a break. Is there anything else? Anyone else? Any questions? So my advice to you in this hour and a half break is to continue talking if you like. If something comes up for you that you want to talk about, just grab somebody and I'm sure they'll lend an ear. And then I also suggest you get outside a little bit, walk around the block, change your scenery, because this is pretty intense stuff. Report an error

2:07:05 And there's more to come. So bon appetit and thank you for your attention. Two o 'clock. We will start at two because we're not parking. Report an error

2:07:30 Look at her apron, the audiovisual. She meditates, she does retreats, she teaches classes. Report an error

2:07:46 We'll just wait a second for everybody to sit down and get started again. Report an error

· · ·

2:09:06 Yes, did Chogky say something this morning about that to you? Okay, before we came in, yeah. Report an error

2:09:21 Yeah, it's true, it's true. Okay, yeah, I knew with the doors being shut it was definitely going to get close, so we'll just try and work with it. But it's just so noisy with the windows open. So we tried to reorganize it. Actually, after Lenny and I realized what was happening this afternoon, we tried to reorganize the schedule a little bit, not to have too much deep meditation with the memorial service and everything going on, because it's going to be a little bit maybe noisier than usual this afternoon. Report an error

2:09:54 Welcome back. Hope everybody had a nice lunch and a little break. So one thing that I forgot to go over this morning that I wanted to touch on were some of the books in the suggested bibliography, which I believe you have a handout also. And I think Chogky mentioned this book variously known in hardback as Advice on Dying and Mind of Clear Light. Report an error

2:10:16 And this is the same thing. So two different titles. It's a marketing thing. They called it Mind of Clear Light, which I think is a lot more ambiguous than Advice on Dying and Living a Better Life. I kind of prefer this title. Anyway, that is an amazing book. I know several of you have it already and have read it. Report an error

2:10:37 Just so clear, so clear and so amazing. It goes through both the practical advice and also sort of the Tibetan Buddhist approach and the stages of death and so forth that we're going to be talking about tomorrow. So that's a wonderful recommended reading. Also, we have Death, Intermediate State and Rebirth by Lati Rinpoche, which is a lot more of the technicality of the stages of death and the intermediate state and so forth. Report an error

2:11:03 The Tibetan Book of Living and Dying, which is one of, you know, there's a big resurgence of interest in the whole death and dying because of the AIDS crisis in the early 90s. There were a lot of Buddhist interest in the death and dying process. And so this was one of the first books, the Tibetan Book of Living and Dying, that became very popular and I think was on the New York Times bestseller list for ages and things like that. Report an error

2:11:29 And it's wonderful. It's really wonderful. Facing Death and Finding Hope, A Guide to the Emotional and Spiritual Care of the Dying. Christine Longacre is one of the foremost students of Sogyul Rinpoche and one of the people who has pioneered a lot of that work that Rigpa, Sogyul Rinpoche's group, is doing around death and dying. Report an error

2:11:49 And then the next two, Stephen and Andrea Levine, are long-term advocates of sort of conscious... And these are just two of the many books that they've come out with. And then Final Gifts, Understanding the Special Awareness Needs and Communications of the Dying is a wonderful book. In fact, when my father was dying, the hospice workers working with us gave my family this book that we read. Report an error

2:12:18 It's very interesting, we were talking a little bit earlier about people needing to really be ready to let go. And this book is full of all kinds of stories of people, you know, needing to finish business before they can actually depart and let go. And it kind of gives us all a clue as to how subtle this process is. So that's a wonderful book. And then two others that haven't made it onto this list. Report an error

2:12:43 This is this book that we mentioned before, Advice and Practices for Death and Dying. Put together by Lama Zopa Rinpoche and this is the traditional prayers and practices that we do at the bedside of someone who's dying, especially Buddhist practitioners that request. These specific practices. So this is sort of the Bible, this compendium of all of these practices that we do. And also a lot of Lama Zopa Rinpoche's specific advice about how to create the most conducive circumstances at the time of death for people. Report an error

2:13:19 And this is a wonderful book, especially if you are a Buddhist practitioner and are going to be dealing with people who have that special request. Personally, myself, I'm in that position a lot because people, not only the people that are dying at Land of Medicine Buddha in our, you know, caregiving situation, but also people will call and say, you know, could you come? Report an error

2:13:39 I'm in the hospital. Could you come at the time of death and do these prayers? So this contains all of that. And there's also a recent publication called Practicing the Five Powers Near the Time of Death by Lama Zopa Rinpoche, teachings that he did. This is available. There are a couple of copies out there from the FPMT Education Department. And later this afternoon, I'm going to be doing a whole segment on the five powers at the time of death. Report an error

2:14:06 And this is some advice that Lama Zopa Rinpoche dictated to several of his students following the death of this friend that we were talking about. Talking about who died about a year ago, the one that was hanging on until her son graduated from high school and sort of inspired by her practice, Lama Zopa Rinpoche put together this booklet of advice. Report an error

2:14:28 That sort of covers a lot of the recommended readings. So if you're going to get more involved in this type of work, these are some of the resources that you might want to avail yourself of. And by the way, the books of Stephen and Andrea Levine and the Tibetan Book of Living and Dying and Final Gifts. Report an error

2:14:49 There are a broader range of advice that are more applicable to the general public. When I was a hospice nurse in the early 90s, I saw the Tibetan Book of Living and Dying and Stephen Levine's books in many homes of non-Buddhists. So there's very helpful advice there of things that can be done for people who are not Buddhists. Report an error

2:15:19 What we're going to do next is to work with this document called the Five Wishes. Should we pass it around? If everybody just takes one and passes it around. Everyone take one. Should we do the supplement or later? In a little while, yeah, when we get to that part. Report an error

2:16:00 I'll just start telling you that this document has been out sometime in the last decade we heard about this, probably in the last five years, I would say. And before this, there was a document called a living will. There are several different types of living wills. And there was another legal document called the Durable Power of Attorney for Healthcare Decisions. When it came down to it, very often living wills were not respected at the time of death in hospital situations. Report an error

2:16:39 And like that. The Durable Power of Attorney was the only really legally binding document at the time. And it's, you know, it's a cut and dried legal document. So in the mid-90s I had some thyroid surgery. And just with the prospect of having my throat slit, it made me feel it's time. To make my wish known to my family, just in case. That's what it took for me. And I put together a one-page document called The Spiritual Instructions for the Time of My Death to supplement the durable power of attorney for health care decisions, which did not cover spiritual directives. Report an error

2:17:30 And so I had to make a separate list. Then this document came out and it has space for that. It has space for that. And Venerable Dreamy and I put together an addendum for more specific spiritual instructions that might prompt you for what you might need to know and a checklist. And we'll distribute that later when we get to that part. Report an error

2:17:58 We're going to follow along all together. I ask you to just go back to page one so we're all on the same page, literally. And we're going to go through this since we're not going to fill it out now, but we'll have a chance to discuss as we go along, okay? Report an error

2:18:13 So this is a legal document in the state of California and 35 other states. And it is a living will as well. And it was written with the help of the American Bar Association. Now, there are people who are insecure about the legality of this document. I've spoken to several of them. I mean, they've spoken to me about their concerns. If after you've read this through thoroughly or you have the feeling yourself, I would encourage you to fill this out as a supplement. Report an error

2:18:59 To a durable power of attorney for health care decisions. Or if you're working with a relative who lives in one of the states where it's not legal, again you can use this as a guideline and put it in the same packet with the durable power of attorney for health care decisions. Report an error

2:19:17 Now there's on the bottom of page three, if you already have a living will or a DPA for health care. And you want to use this instead, then all you need to do is destroy the old one and this will supplant it. Report an error

2:19:38 And of course then you need to inform your family and your physician and get copies to them of this new one. So on page four, we'll begin with wish one. The person I want to make health care decisions for me when I can't make them myself. Report an error

2:19:58 So a list of conditions which would apply. The person that I would appoint as my agent will make choices for me if both of these things happen. My treating doctor finds I'm no longer able to make health care choices and another health care professional agrees that this is true. So this would apply in a situation where you were comatose. Report an error

2:20:26 Or in many illnesses that are going to take your life, your bodily systems have broken down and are not processing the toxins that they normally eliminate. And so you are in a situation of toxicity. Your blood chemistries are not in balance. You're not secreting the right things. Your bowels and bladder may have stopped functioning. Report an error

2:20:52 Your lungs are not exhaling properly. And so the body chemistry has changed to a point where you can become literally psychotic or you cannot think straight or you're not in your right mind. So you don't need to be in a coma to be unable to make sound decisions. And people can tell. And often it happens that, of course, the dying person is trying to hold on, to grip on to reality as long as possible and don't want to give over control. Report an error

2:21:25 But the people in their life, and particularly the person who holds the power of attorney, may know them enough to realize that their answers are confusing. They're not themselves. So their judgment is impaired. And at that point, the medical opinion may be sought and then corroboration. And at that point, the DPA would take over the decision-making process. But you don't only have to be comatose for that to happen. Report an error

2:22:03 In the situation of our very first Tara Home resident, where I held the DPA for health care decisions, I had to superimpose her will and make some decisions against her will because she did not and would not realize that her judgment was impaired and she felt she was capable of doing things which I and... Report an error

2:22:28 The hospice nurse and other people who knew her realized were so. So, for example, I needed to, she fell several times and she's very independent and very feisty and insisted on getting out of bed by herself, wouldn't allow anyone to help her and, you know, she was a very private. And very used to living alone and didn't like having someone around all the time hovering and spotting her like that. Report an error

2:23:03 So she preferred to be in the bedroom with the door closed much of the time. And then the next thing we would know, she had taken herself to the bathroom. She fell a couple of times. And so... I talked to her about it and she didn't want it, but I felt the need to go ahead and ask the hospice nurse to assess this and side rails were ordered. Report an error

2:23:28 And she just hated it, hated it, and started climbing over the side rails and fell again. Now, you can take the attitude that it's the person's right. To be independent as long as they want, and if they fall and if they break a bone or cut themselves, that's their choice. One could say that because they're dying anyway, and in a way what difference does it make? Report an error

2:23:59 I don't mean to be crass here, but following this reasoning... One could say that a person could choose to be independent as long as possible. But in our situation, where volunteers are the caregivers, and it would be just tragic for somebody to fall and break a bone on your shift. If you were a Tarahome volunteer, you would feel so terrible. Report an error

2:24:25 No good could come out of that situation. So it seemed in that situation necessary to make a decision like that. Then she was climbing over the side rails and fell again, and I needed to make another decision, which was to obtain a string of jingle bells and tie them onto each side rail so that if she tampered with them, it would make a noise. Report an error

2:24:53 And it worked, and she hated that, just hated it. And I chose to bear the brunt of her anger in order to provide safety for her. So those are the kinds of decisions that someone might need to be in a position to make. It's not always easy. Report an error

2:25:16 Okay, so then you choose somebody. In my case, I've chosen my son. This is my middle child. He lives five minutes from me, and he's a physician. Report an error

2:25:30 My daughter lives an hour and a half away, and my other son lives in Colorado. And my daughter is very, very attached to me and very emotional. And I have not had the conversation with her yet. As Betty said this morning, the difficulty of speaking to family members under many circumstances is very challenging. Report an error

2:25:54 So I think it will be hard for her to know that as my second agent, I've chosen a friend, not her. It's going to be hard for her to know that. So this is a difficult task in many ways for each of us. In our own particular family situation. Now picking the right person. So it needs to be someone that knows you very well and of course who cares enough about you to take on this responsibility and who can make difficult decisions in your behalf. Report an error

2:26:31 Even so far as quote pulling the plug. I have made that decision for my cousin and it was a very difficult decision. To make and then to have to let the family know that I felt was the right decision because his wife would not have been able to make that decision. Report an error

2:26:52 And as it says here, a spouse or family member may not be the best choice because of being too emotionally involved. And then sometimes they are the best choice. So I feel that because my son is a physician and has been in situations of holding a lot of responsibility and he's been trained to be caring and dispassionate as a health care professional. Report an error

2:27:17 And I feel like... He could be level-headed, but he's very supportive of my Buddhist practice and I feel could insist on what I want being done. So that's the kind of person you need to choose, someone who can speak up and buck the system if necessary. Report an error

2:27:42 And of course it should be somebody nearby, not in another state. Just the logistics and difficulty of travel. And, of course, if the person you choose is someone who travels a lot on business and, you know, a good chance they won't be around when needed, then your alternate should be somebody who's pretty much around, maybe with a 9 to 5 or somebody retired or like that, who you have a good likelihood of them being a backup. Report an error

2:28:12 And, of course, you're not going to just show them the document. Have nice long talks about what's important to you and why and really educate this person. This is the person who may have to interpret your wishes to the rest of your family. So you want to make sure if you don't have the opportunity or can't do it. Report an error

2:28:42 So I tried to broach the topic about six months ago with my daughter because I've been feeling the signs of aging increasing in this last year. And as a Dharma practitioner, that has been wonderful in terms of motivating me to strengthen my practice and to start concentrating on the... Death and dying meditations and so forth. It's been good in that respect, but it's brought up that it's really time to talk to the family, unwilling or not. Report an error

2:29:17 And my daughter's reaction was very emotional, and she asked me not to talk about this with her. And, you know, she was crying, very, very upset. And I backed off and realized that I had not been skillful. In the way that I broached it, I don't know if there's a skillful way, but I do, you know, some of you may be acquainted with the Swiss cheese approach to time management, meaning that if you have overwhelming load on your desk and you have no idea how to complete this project, the first thing to do, like Swiss cheese, is to poke a hole in it and just pick up anything, do anything. Report an error

2:30:02 So like that, I have... begun badly and then the I know it's in the back of her mind. And basically she said, you know, this is very upsetting to me, and unless you have a terminal diagnosis right now or you know something that I don't, I would really rather not talk about this because it's really upsetting to me. Report an error

2:30:24 Like that. So what to do? Do I force it? I don't know. And then in my family, because we are only every two or three years all together. And when we're together, it's to celebrate something. And it's really hard. Okay, now, let's sit around the family dining room table and have this. Report an error

2:30:50 This discussion that nobody wants, you know. They don't. I want to have it. But it's very challenging. I'm just being so frank with you because this is my work. I've been working with hospice since 1991. And yet in my own personal life, I'm not complete yet with this because of the circumstances and that my kids aren't Buddhist like that. Report an error

2:31:19 So some of you will have your own version of this. Also, one thing I wanted to mention because it came up when we did the workshop at Land of Medicine Buddha and one of the students there had a very close Dharma friend that she felt knew her wishes and knew the things that were recommended to do. And her husband was not Buddhist at all and she felt because of being diplomatic that she had to make them joint agents. Report an error

2:31:46 But that was really difficult because they're... The husband didn't have any kind of Buddhist worldview at all, but she kind of felt like she had to have him in there because he was her husband. But then we were kind of cautioning her and just saying, if you make people joint agents that have completely different viewpoints, then what happens if it's a real urgent situation? Report an error

2:32:06 You've got your two closest people fighting with each other, disagreeing, and it just becomes a big mess. And so for her, she had to really face the fact that her husband was not the best choice and she had to have that difficult conversation with him because she really wanted it to kind of... Go in accordance with her Buddhist view, a very devoted practitioner, and her husband let her do her thing and respected it to a certain degree, but it certainly wasn't his mindset, so he wouldn't have done those practices that she wanted done at the time of her death. Report an error

2:32:38 So often, as Lenny says with her situation with her daughter, it's not easy. You really have to explain to people diplomatically why they are not the best choice, even if they may be the closest person to you. Report an error

2:32:51 Being diplomatic in this respect can kind of set up problematic future scenarios when they've got two people with different views looking after you at the time of death. And at the time of death, one's husband or children, as long as you are as comfortable as possible when dying, their primary concern is with their loss. Report an error

2:33:16 They are losing you. Their concern is with... You, I mean with the loss of you. And it's absolutely foreign to think about that the person that's obviously dead lying in the bed is doing meditation unbeknownst to everybody and that that's who the attention is wanted to be focused on. It's completely unheard of in our culture. Report an error

2:33:47 So there's a lot of education to be done as much as you can, as much as you can. And in the heat, I mean, for example, when I made out my durable power of attorney in 1996 before my surgery, and I'm explaining to my son about what mantras... to be done and who to call and whatever and that I didn't want any emotional outbursts over my body should I die as a result of this surgery. Report an error

2:34:18 And I said, well, I don't know if I can do that, Mom. He said, you know, you're my mom, and I think when you die I'm going to be pretty broken up, and I don't know if I can do this. so cute. He was so sweet. He said, Report an error

2:34:30 There's nothing to worry about, honey. There's going to be other people there that are going to be called in. And you just need to know what I want and make sure it happens and make sure not to do this and to call here or make sure that person is called. Because I also stipulated in my spiritual instructions that I did not want... Report an error

2:34:56 histrionics or emotional outbursts over my body but that more nerves could be comforted in another We have to allow for the grieving. I mean, my concern now in all of this is dual. My concern is for my spiritual work at the time of my death and my concern for my children who are going to be bereaved. Report an error

2:35:22 And these... Wonderful sentient beings need care appropriate to their level of understanding and should not be neglected in favor of a spiritual agenda that they don't understand or they're going to be really soured for the rest of their life. Report an error

2:35:44 And they're going to feel like someone else took over because they don't know this part of my life which has become of paramount importance. In their world, they should be of paramount importance. Do you see what I'm saying? I know you all have some version of that going on, more or less. And in my view, I want them cared for in the best possible way. Report an error

2:36:13 Like that. And actually, I'll mention now as an aside, to that end, I think that I'll just have to do it. I had hoped that someone else would do it, but I think that I will have to do it, which is that we need a Buddhist-based bereavement program and grief counseling that incorporates loss and attachment. Report an error

2:36:42 The bardo and the stages of dissolution and reincarnation. And it is done in universal language, not Buddhist language. There's plenty of material for Buddhists. But for the non-Buddhists whose loved one is Buddhist, we need a bridge that cares for them appropriately, but it just doesn't exist. Because I know something about the bereavement and counseling programs that are available through hospice. They're only helpful up to a point, and actually they come at it from an entirely different direction. Report an error

2:37:17 So it doesn't suit. So I think that we need to institute something like that, which will be added to and refined in future years as we all age and die, kind of the first and second generation of American Buddhists like that, but it needs to be done. Report an error

2:37:38 Okay. All right. So then, on page five, it lists that... What you want your agent to be able to do, and then you cross out what you don't want them to do. So make choices about your care, including tests, medicine or surgery, etc. And if care has been started, treatment has been started, the agent has the authority to keep it going or have it stopped in accordance with your wishes. Report an error

2:38:14 For example, if you... Are not coherent and it's not working. They can say, that's enough. Let's just leave him in peace. It's not working. Report an error

2:38:27 Interpret any instructions that I've given and I've already mentioned that. They can arrange to have you admitted to a hospital or a hospice or a tar home or a nursing home. on your behalf. And they can hire anybody. If you're being cared for at home, they have the authority to hire any kind of health care worker that they may deem suitable, anywhere from an acupuncturist to a home health aide or like that, and can fire somebody also. Report an error

2:39:00 And this is not a small thing, managing the care of someone who's dying at home. It's not... A small thing. And often when someone is confined to the bedroom and slowly declining, people in that state can become very cranky and irritable and find fault with everybody that's taking care of them. Report an error

2:39:23 It can be quite difficult. They have the authority to fire and hire. Report an error

2:39:34 They can request or take away or not give medical treatments including artificially provided food and water. That would be like tube feedings or intravenous feedings like that. They are allowed to go into your medical records and they can sign your name for you on anything that's needed. They can move you to another state if needed to get better treatment or to carry out any wishes you might have to die in your home state or to go back to the farm, whatever it is. Report an error

2:40:11 They can request or authorize any medication or procedure for helping with pain. Take any legal action. They can apply for any... Any assistance or Medicare, any kind of insurance or aid programs for you and get into your financial records in order to qualify you for these things. Now there's space for you to list anything you don't want this agent to have access to that we've just gone over, if there are any reservations or limitations you have. Report an error

2:40:50 And then if you change your mind about who you've appointed, which will probably happen. Hopefully this is something that's going to be in effect for you for the next 50 years. So maybe the person you've appointed has moved out of state or who has died or has chosen not to do this anymore. So how to change your mind is so you either revoke, write revoke across their name. Report an error

2:41:18 Or destroy this page or start all over again. And then of course you have to inform the people that you know that have copies that you have made that change. Report an error

2:41:31 So communication, communication, communication. Alright, so we get to wish to. What kind of medical treatment you want or you don't want. So there's a few general directives of what... Caregivers should keep in mind that you don't want to be in pain and I want my doctor to give me enough medicine to relieve my pain even if that means that I will be drowsy or sleepy. Report an error

2:42:03 Now if you know for absolutely sure that you're not going to want that under any circumstances and how can you possibly imagine how you're going to feel but if it's a strongly held opinion that what you have to do is just cross that out. I don't want anything done or omitted in terms of the intention of taking my life. Well, that's probably a given in this room. Report an error

2:42:28 It means euthanasia, mercy killings, with the intention of taking my life. So omitted would mean to, let's say, if you were dying of a certain heart disease and you were on medications that were keeping your heart. Stimulated, then you don't want that medication omitted so that you will die like that. You don't want anyone to make that decision for the intention of taking your life. Report an error

2:43:00 Now, that sounds very far-fetched, but apparently it's not. We all read in the paper about elder abuse. I mean, I doubt that that's germane to this group, but it happens more frequently than you would think. For example... Let's just take the situation I told you about already of my friend's mother who's been on hospice for the last two and a half years and sick for about the last five years, needing care and appearing to die every few months. Report an error

2:43:31 And the family's been on tenterhooks for years. It's getting old. And in situations... Now, in this family, fortunately, there's money for caregivers. But in situations where there isn't and there's a son or a daughter who's borne this burden for years and years and years and is not happy about it, then this situation could kick in. Report an error

2:43:58 I read about it all the time and I hear about it. So this is not your wish. And it's highly unlikely in this group, as I said. Report an error

2:44:08 That's what this means. And you want to be offered food and fluid by mouth, kept clean and warm. Now, to comment on this situation, as a hospice nurse, and the other hospice nurses in here I'm sure have seen it, there are situations, particularly when someone is dying of, quote, old age. You know, just a slow deterioration. And sometimes people make the decision in rational mind that they want to hurry up the process and they decide to stop eating and drinking. Report an error

2:44:42 And they die after a few weeks. You can go for a long time without food and about two weeks without water. So I have actually taken care of people who have made that decision. And it's perfectly fine and it's perfectly legal. And in all the cases, they've been very elderly. They don't want to be a burden anymore. They have no more quality of life. It's over. Report an error

2:45:07 Let me go. There are many more people who will say, I just want it to be over. I wish I were dead. But they don't make that choice. They don't actively initiate hurrying up the process. And then, particularly in California, there are many people who believe in euthanasia and it's been... Up for vote twice and narrowly voted down. And I think it's going to be on the ballot again before long. Report an error

2:45:39 But you may run into that, not in your own life, but in your circle of acquaintances. There are many people that think that should be a right. And so that's very controversial. And in terms of bioethics for Buddhists, this is a very, very loaded situation. As a hospice nurse, on a few occasions I have attended somebody who had chosen to do that, and since it's against hospice policy for any of us to do anything to hasten the end of life. Report an error

2:46:20 It was pretty much hush-hush, but in one situation where I took care of someone who had Lou Gehrig's disease and her paralysis was gradually rising upward and she was absolutely terrified of suffocating or choking to death. And at some point she had apparently made a pact with her niece. And I kind of knew about it, but I didn't know about it. And they couldn't tell me because it was my mandate to try and dissuade them. Report an error

2:46:50 So one day I just heard that she had died and that's what happened. So I'm only bringing this up now because in your circle of acquaintance or people that you know, relatives, whatever, this situation may come up. It's not uncommon. Okay, Report an error

2:47:14 where are we? What life support means to me. Okay, so life support treatment includes devices to help you breathe. So it could be respirators or partially assisting respirators. Food and water supplied by devices. CPR. Report an error

2:47:39 Major surgery, blood transfusions, dialysis and in some cases antibiotics. This one's a little tricky. If I wish to limit the meaning of life support because of my religious or personal beliefs, then you're going to write this situation in here. All right, so let's suppose that you've just received this terminal diagnosis from your doctor and let's say you're six months into this one year to live. Report an error

2:48:08 And you develop an infection outside of the adult leukemia. You develop an infection. And a massive dose of heavy antibiotics would cure this very likely and prolong your life. And you still have some quality of life. You still have some unfinished business. You probably want that. On the other hand, if your life is totally about suffering, And you're not dying quick enough to suture because you're in terrible pain or you're zonked all the time because you can't bear what you're going through. Report an error

2:48:47 You may wish to let the infection take your life. Before antibiotics, many, many people died of pneumonia. And at one time it was called the gentleman's death because it was kind of a natural and not too uncomfortable way to go. Report an error

2:49:11 So these are all, there's a lot of gray area here. That's why it's so important to discuss all you can think of with your agent, but the main thing is that they know you well. Now, for example, I was just realizing, just reviewing this, and this, by the way, this is a work in process because we change every seven years or every two days or whatever. Report an error

2:49:36 And what I was just realizing when I reviewed my health care agents is that my alternate is someone who really doesn't like doctors and hospitals and avoids seeking those kinds of opinions for herself. Report an error

2:49:54 Very frightened of this and that. And, you know, I'm a person with a foot in both camps, you know, penicillin and arnica over here like that. And I go back and forth and I choose judiciously. But she's in the totally arnica camp and my son's in the totally penicillin camp. And I'm just realizing I have to rethink this because I'm in the middle. Report an error

2:50:21 And I don't reject anything categorically. And I think that we have the karma to be born in a Western country at the time of surgery and antibiotics and anesthesia. That is our karma. And actually when I was taking care of Lama Eshi, the night... Before it turned out he died the next day, but he was, we'll get to this in a minute, he had a do not resuscitate order in the hospital. Report an error

2:50:54 He was in the coronary care unit of Cedars-Sinai Hospital in Los Angeles. And he had a DNR order. And I don't remember the circumstances, but for some reason we decided, I know, Lama Zopa called Song Rinpoche. In Switzerland and told him about Lama's condition and there was some question that made all this come up. And Tsong Rinpoche said, do everything in Western medicine's power to save his life. Report an error

2:51:28 Do everything possible to save his life. And this was a surprise to both of us. But nevertheless, we called the doctor in. And I remember it was a Saturday night, and the doctor was at a dinner party. And the do not resuscitate order in the hospital cannot be revoked over the phone. The doctor has to come in and sign the order in person. And this doctor came in. He was wearing a dinner jacket. He was at some kind of a formal... Report an error

2:51:59 Saturday night event and he came in close to midnight and signed the order to remove the do not resuscitate order and then at 5.30 in the morning, 5 o 'clock in the morning, Lama's heart started fibrillating very, very rapidly and then everything went haywire and the doctor was called in and his chest was open and a pacemaker put all... Report an error

2:52:28 All the heroics were done for two hours and 20 minutes. And then the doctor came out and explained that he wasn't responding. And Lama Zopa said, what's the longest that you've ever worked on somebody in this situation? And Dr. Corday said, this is it. And then Lama Zopa said, well, we just let him go. Report an error

2:52:53 Like that. It was so interesting to me that this happened. And I feel that the reason this happened was for our education. And I feel that Lama Yeshi chose to die in a Western hospital. He was actually in three different hospitals in the last two weeks of his life. I feel that he put himself through all of that for our sake. Report an error

2:53:19 And that all of the practices, the end-of-life Buddhist practices that were done for him, they were all observed to show us that it can be done in any situation. This is where we are. This is what we're doing. So we just have to use our wisdom here. And it's very important. And it's important we have to rethink my secondary agent here. Because I just don't want pat decisions made like that. Report an error

2:53:46 I want it to be... Considered and considered about who I am like that. Any questions so far? Report an error

2:54:06 I have a little bit of confusion about at the end of life and the extraordinary means or prolonging, like what you said, prolonging someone's life. I can understand giving medicines, but if... Report an error

2:54:27 Somebody's dying and they have very little time left and they're having an IV of water and such that would prolong their life and there's no, I don't know, there's no, it doesn't appear from our side to be any quality of life there. Is that, I mean, I'm a little confused about, is that like saying stopping some of that? Report an error

2:54:58 When they have a do not resuscitate order, is that extra? Do you stop that or do you keep that kind of thing going? That part's a little gray for me. Right. It depends on the circumstance. If someone is fortunate enough to die under hospice care of a full service hospice, so hospice does not use IVs. Report an error

2:55:27 a hospice person Personnel are really the experts in things that many hospital doctors don't understand. So IV fluids at the end of life actually make you suffer more. If your lungs and kidneys have shut down, then it just makes you bubble full of water or more uncomfortable because your kidneys aren't working. Report an error

2:55:51 It's not helpful. In the hospital, they just tend to do... Everything possible, often urged on by the family, do everything possible. Family doesn't want to let the person go and it kind of looks like in a hospital situation they know what they're doing and there's all these wonderful measures that can save lives and everybody watches ER on TV and we're just all drama and heroics are in the common vernacular. Report an error

2:56:27 So that's often the situation that happens in the hospital, like that. Is having that excess fluid, is that what causes that kind of, my mother calls it the death rattle. The death rattle is once someone loses the ability to swallow, then the secretions just puddle in the back of the throat, and that's what you're hearing, nothing more. Report an error

2:56:54 The dying person is not suffering. I thought maybe it was fluids. No, no, that's just phlegm that can't be coughed up. Yeah, yeah. But it's very disturbing and distressing to the family. Report an error

2:57:09 You see, education is everything. Yeah. Okay, Betty had a question here. Report an error

2:57:22 Actually, Lenny, it was a comment because when I do hospice openings, that's one of the topics that I go over. I go over extensively with the family as the heroics of IV fluids and like if they had a G-tube or an NG-tube. Well, you have to say what that is. Oh, tube feeding. And a tube in the nose, like if a patient had a tube in the nose or if a patient had a tube in the stomach so they could artificially get fluids or food or whatever. Report an error

2:57:47 So I go over extensively with the family about what that really does mean. That it really doesn't bring them benefit. It can prolong and it can fill up the lungs with fluid because they're not able to excrete it through the urine, etc. So I personally go over that quite extensively. The best way for someone to have a death that is monitored, what I mean by that is that it's a planned death. Report an error

2:58:15 That's why I said... The situation that we meditated through is actually fortunate. The best thing to do is have hospice involved. It's an amazing service. Report an error

2:58:29 Amazing service. And any of you that have ever been around a death where hospice was involved, you can see what they do, what they bring, what they give, and it's so extraordinarily helpful. Making sanity out of chaos and putting things into a different perspective and tending to everyone's needs in a really, really helpful way. Report an error

2:58:52 And I think, you know, part of it is just the difference in view, which is why the hospice movement started of, gee, guess what? Death is natural. It's okay. You don't have to, you know, the whole Western medical establishment is all about, you know, death is a disaster. Death is failure. And the whole hospice movement started from this realization that it's natural. Report an error

2:59:15 Things are prolonging through tube feeding and all of this stuff. It's just this acceptance that it's a natural process and to let it unfold as naturally as it will and painlessly and so forth like that. And like Lenny said, the scenario that we went through earlier this morning in the meditation is a really great way to die. Report an error

2:59:37 We had one student at Land of Medicine Buddha who had his first heart attack when he was 42 years old. His father died. At the age of 40 of heart disease, and he's had about four stints put in. And, you know, after we went through this meditation we did this morning, he said, you know, I'm going to dive the big one in the middle of the island, Safeway, on the cold linoleum, like with strangers staring at me. Report an error

3:00:01 What do I do? You know, so we have to kind of... Provide for all possible scenarios. It's not just that we're going to be quietly in this Buddhist hospice with a bunch of monks and nuns doing prayers. I mean, that's what many of us want, but there's no guarantee there too. So we're going to try and kind of present things to be done throughout the whole continuum because, of course, this is the lucky end of the continuum, what we've presented so far. Report an error

3:00:32 When we were going through one of these pages, the one... Item that you didn't mention as you were reading through them was the donating organs and tissues. I wondered if you could just talk a little about some of the conversation that you've engaged in around that because that seems like a very complicated step. Report an error

3:00:55 Yeah, it is. And Lama Zopa actually in this book, in this death and dying book, and also it's one of the questions, there's a new book by Lama Zopa called Dear Lama Zopa, it's all these questions and answers on various topics and he's addressed this and it is difficult because we all want to benefit sentient beings as much as possible and if there's a way that you can go through the death process consciously and we're going to talk about this, leave the body undisturbed for as long as possible after the breathing has stopped and of course for organ donation they generally need to take the organs right away. Report an error

3:01:33 And can't leave the body undisturbed. So Lama Zopa has kind of said, you know, you have to balance out how much benefit would there be, you know, can they leave the body undisturbed for as long as possible, you know, how important is that practice and how much do you believe that you can actually consciously undertake those practices at the time of death. Report an error

3:01:54 So it's not really a cut and dried thing, but the general rule of thumb that Lama Zopa presents is, you know, If there's a way that they don't have to interfere with the body for as long as they possibly can. And of course, as we know in Western medicine, that's not very long at all if you've said that your organs are to be donated. Report an error

3:02:15 Now, we'll go through this tomorrow when we talk about the different stages of dying. In something like a violent accident, the stages of dying are speeded up and the chance that you would be able to be in some kind of a meditative state. Through the death process are, you know, if you're in something like a car accident, which also happens to be usually when organ donation would be more of an issue and that they would be more interested in. Report an error

3:02:39 Or they don't want your diseased organs. Yeah, yeah. So if it were sort of the best case scenario of a Buddhist practitioner dying in a hospice situation and being able to have the body kept for days so you could go through the process, chances are they wouldn't be so interested in those organs, whereas if you died suddenly, in which case that whole process would be speeded up and it wouldn't be so necessary to leave a body that had died in a car accident, they'd probably be more... Report an error

3:03:09 More interested, so a little bit like that. We had two different residents in Tarhome who had donated their bodies to medical schools. And both of them were up here. One was in Berkeley and one was in San Francisco. And, I mean, the mortuary, they had arranged to pick up the body and deliver to UC San Francisco. Report an error

3:03:34 And so in both of those cases, the body had to be removed fairly quickly. But we did have a couple of hours because the mortuary was up here. So to drive down to Soquel took a couple, three hours. And we had that amount of time. Neither of these people were Buddhist practitioners. And so we just did the prayers that we do at Tarahum. We did it quickly like that. Report an error

3:04:00 So that's a more common situation that we run into rather than organ donation. I think basically if someone has cancer, they're not interested in the organs because of the toxicity, etc. like that. I also work as a transplant nurse. That's my primary job. Hospice is second. The body clinically has to still be alive to harvest the organs. Report an error

3:04:25 You know, they're essentially brain dead, but they are kept alive and they are harvested at the time. And then they're let go. But the body is still alive with blood pumping. They can't harvest it without. The body is on life support and kept alive until the organs are harvested. So it's a very different scenario. And my understanding is that one has to be quite an advanced practitioner in order to attain the state of mind to work with... Report an error

3:04:59 One, bringing oneself into the clear light like that and staying there. And if you don't know what that means, we'll get to that tomorrow morning. We kind of have to, you know, it's kind of hard to present everything in a linear fashion. So don't worry if you don't understand what that means. Take this last question and then I'll go on because we will have time for discussion afterwards. Report an error

3:05:25 I just wanted a little bit further clarification. Okay. As a Buddhist practitioner, I mean, I have for years, before I became a Buddhist, am an organ donor. So it sounds as if the situation takes care of itself. I can still be an owner, because the situation in which they would want my organs... I'm not going to be able to be practicing and going into the clear light. That's more for a sudden death. So it's okay to continue being that, an organ donor, but then hopefully I will become advanced enough before I die with the hope that I can be in a hospice situation. Report an error

3:06:16 Exactly. Know what the right practices are. Exactly. And Betty would know more of this than I do. So I can leave a double life at the moment. A double life, that's right. Because I don't know if somebody dies of a coronary attack if their organs are harvestable. Yeah, that's what I thought. But that's a sudden death. That's a sudden death. Report an error

3:06:49 So yes. Yeah. Yeah. Yeah. Very interesting thing. And actually, I believe it was Riba Rinpoche who said that donating your organs is the ultimate bodhisattva act. And that's a very highly commendable thing for someone who can't work with the practices themselves at the end of their life. So I think that's enough on that topic. Report an error

3:07:14 We'll continue on page 7. So close to this, there's four situations now. Here's the kind of medical treatment that I want or don't want in these four situations. And you want your health care agent to know these directions. So if I'm likely to die within a short period of time, life support treatment would only delay the moment of my death. Report an error

3:07:42 Then you choose one of the following. And I have chosen, I do not want life support treatment. If it has been started, I want it stopped. And you can review these situations, they're very self-explanatory, and give them the necessary thought. Report an error

3:08:04 And the third one leaves it up to the doctor. Now, if I'm in a coma and not expected to wake up or recover, if these two, healthcare my doctor and another professional, decide that I'm not expected to wake up nor recover, And I have brain damage and life support treatment would only delay the moment of my death. Then you have three choices. Report an error

3:08:33 I want it. I do not want it. And if it's been started, I want it stopped. And that's when I chose. Or I want to have it if my doctor believes it would help. So it's leaving it up to the doctor, and I don't want to leave it up to the doctor. Some people might. Many people feel the doctor's the ultimate authority. Many people do. Report an error

3:08:52 You know people like this, if it's not you. But I, in that case, I definitely do not want it. And, you know, there are many people who have been kept alive for years in a coma. And, you know, there have been court battles over, well, I think she recognized me, or she squeezed my hand, or I saw her blink her eye, you know, that one. Report an error

3:09:16 Permanent and severe brain damage and not expected to recover. So, if these two decide that I have permanent and severe brain damage, for example, I can open my eyes, but I can't speak and I can't understand. It can be confusing. And I'm not expected to get better. Life support treatment would only delay my death than the same three choices. And guess which one I chose? Report an error

3:09:45 Now, in another condition under which I do not wish to be kept alive, then I will describe it below. And in this condition, I believe that the cost and the burden of life support treatment are too much and not worth the benefits to me. So, therefore, in this condition, I do not want life support treatment. And, for example, you may write end-stage condition here. Now, you know, that might mean something that refers to dialysis, which is extraordinarily burdensome and expensive and the only thing that can keep certain people alive. Report an error

3:10:22 And they undertake this for weeks, months, years. And after a while, it gets... To be too much in every respect and they want to give it up knowing that they will die. So that person who has that situation might write that in here like that or anything else that might be germane to you. Could someone pass the mic back here? Report an error

3:10:52 This might be a place, this area to define what kind of quality of life means to you. That's right. For example, if you couldn't be independent or you couldn't enjoy certain things, that you would want to continue with dying. And be aware that for most people, we don't have time in this weekend workshop, but in our Tar Home training, we do a particular exercise where the participants get to experience gradual losses. Report an error

3:11:29 And of course we've seen so many times, those of us who've worked with hospice, that as your choices and as your pleasures get fewer and fewer, you adjust to that as being normal and you accept the reduced quality of life because it's all you've got and you want it. Right now you may not think you want to stay alive if someone has to change your diapers. But if it comes to... Report an error

3:11:58 The time, you can get used to that. Lots of people wear it depends, you know. It's on TV. We can adjust to what we need to in order... The instinct to remain alive is the strongest one. And that's why I said earlier... I came out of being a hospice nurse knowing that I don't know what I will do. And that has helped me to respect everyone's choices, whether I understand them or not. Report an error

3:12:26 But I know I can't say that because my friends talk about it. You know, well, I would never have chemo. I would want to just live out my time and not be sick the whole time. Well, I know my cousin who died of stomach cancer. Lived for 16 years and he had three rounds of chemo and it was worth it to him to undergo that torture in order to have 16 more years with his wife and sons. Report an error

3:12:54 So one changes one's mind as we go along and in the comfort of this room, one thing may look like, oh for sure, I don't want that. But when the time comes, you want to see that kid graduate. You want to see this baby that your daughter's pregnant with. You want to go to this wedding. That's what you're staying alive for and that's quality of life to you. Report an error

3:13:24 These wishes that we're putting down like your friend for the 16 years was cognizant. These wishes that we were putting down here is this is if we lose our... Report an error

3:13:39 That's correct. So it would be at a point where we may not be too cognizant any longer. So it's a different situation. Otherwise, you just change your mind. I changed my mind. I want to keep living. Yes, there's no need to legalize anything. You're in control. You're the master of your own. Report an error

3:13:59 Because hearing these other stories, I thought this was just when we were totally out of it. Well, you know, sometimes, particularly elderly people, get totally out of it as a result of surgery or as a result of medication. They lose their ability to think clearly, but they come out of it and they live for years more. Report an error

3:14:19 So there are many, many situations, and those of us that are in the healthcare professions have seen a wide range of them, and the lay population that's not in healthcare can't imagine the variety. And as you can probably tell, I'm a strong advocate for Western medicine. It does save lives, and life is the most precious thing. So, like that. Report an error

3:14:44 Okay. All right, so we are now on page 8, wish 3, and this deals with personal, spiritual and emotional wishes. Report an error

3:14:59 Now, sure, we should start with that one. Yeah, I think that's the least noisy. Report an error

3:15:14 You just lost one wish. Just kidding, just kidding. You have all five, it's really okay. Okay, so wish three, my wish for how comfortable I want to be. And then the way you amend this is by crossing out anything that you don't agree with. I do not want to be in pain, and I want to have enough medicine to relieve my pain, even if that means I'll be drowsy or sleep more than otherwise. Report an error

3:15:40 If I show signs of depression, nausea, shortness of breath, or hallucinations, I want my caregivers to do whatever they can to help me. Well... I had crossed out hallucinations because, as you will learn, or not necessarily in this workshop, but if you read Final Gifts, there's a lot in there about not necessarily hallucinations, but people have visions and see things that other people can't see. Report an error

3:16:09 And the medical community, very often if they're not trained in end-of-life situations, think that this is hallucination. Report an error

3:16:21 But just when I was reviewing to prepare for this class, guess what? I changed my mind about something from when I went over this in June. And I don't want to be treated if I show signs of depression. I think that I don't want to be treated with medication for that. I think that's part of the purification and the suffering that we talked about earlier. Report an error

3:16:45 This shows you, this is two things that have come up for me since June. You need to keep reviewing this because our minds change. I wish to have cool, moist cloth put on my head if I have a fever. Well, duh. I want my lips and mouth kept moist to stop dryness. Some of this is a little silly. Warm baths, kept fresh and clean at all times. Report an error

3:17:10 I wish to be massaged with warm oils as often as I can be. I have crossed that out. I I have come to not enjoy being massaged for various health reasons, and I probably, given that, when I'm near death, I probably don't want my body tampered with in that way. So that's why I crossed that out. I wish to have my favorite music played when possible until the time of my death, and I don't want that either. Report an error

3:17:43 Some people might want that, but I don't want that. I wish to have personal care as long as they do not cause me pain or discomfort. That's good. And then I wish to have religious readings and well-loved poems read aloud when I'm near death. Report an error

3:18:05 I think I'm going to cross out poems. I think when I'm near death I want to stick to religious readings. Report an error

3:18:14 Yes. Report an error

3:18:23 I just wondered how you have changed... The first one, which is the drowsy or sleep more than I would otherwise, because of our discussion this morning of sedatives versus pain medication, as well as the religious readings, I assume both of those you have made some extra notes or something to try to get your point across. Report an error

3:18:45 Well, as I mentioned, people that are on long-term narcotics, long-term for the management of chronic increasing pain, The body tends to adjust to it, and there are people who continue working or continue being active, taking long-acting morphine. They can't function. Initially, it may make you drowsy or sick, and then you adjust to it. Report an error

3:19:13 And the benefits of having no pain, it's very, very hard to meditate, to do anything when you're in extreme pain. But what I was wondering was whether or not... This would say to a doctor or your caregiver that you don't mind being sedated. It says pain. Okay. It says pain very clearly. Okay. Yeah. So they wouldn't think that a sedative would keep you from pain. Report an error

3:19:42 It is necessary to have this conversation. I know that the standard of care in hospice is to give Ativan. In most hospices it's a standing order. Is it in your hospice? It's a standing order. Get out real early because agitation, restlessness, anxiety. Most everyone who's not spiritually trained, most everyone is afraid of dying and there's a lot of anxiety at the end of life. And that manifests in agitation, sleeplessness, restlessness, fear, out and out fear. Report an error

3:20:19 Looks like a good thing. It makes everybody happier when people calm down and they're sleeping instead of being miserable. For a Buddhist practitioner, it's not indicated. That's what we're told. And also more, just to answer your question too, at the end of page 9, to skip ahead, it says, please use the space below for any other wishes so you could... Report an error

3:20:44 Think more clearly, put anything else that you want at that point, like if you weren't comfortable with this or even comfortable with just crossing it out or crossing out part of it, you could think really clearly about maybe even details about which drugs are acceptable and which ones aren't in consultation with a hospice nurse or something like that. Report an error

3:21:04 So there you can put anything extra. This is just really practical. As we're going along, you're talking about how you monthly or every three months have changed different things. So do you make this out in pencil in the beginning? Or each time where you have ink, you'd have to have a stack of these things. You know what? Report an error

3:21:30 You're not going to do it every three months. I assure you, you're going to forget about it after you fill it out. And then it's going to come to your attention a while later. It comes to my attention more frequently because I work in this field. But I'm remiss in communicating the fine points and the changes to my family. And right now, only my son, who holds the DPA, is aware of all of this. Report an error

3:21:55 So that's a lot. But I still have work to do. It's an ongoing process. Yeah. Okay. So this essentially, we just keep ourselves. You keep yourself. Rather than giving it to them. To the person who has the DPA or in my case. No, you give a copy of this to your DPA and your alternate and your doctor. And we'll get to that on the last page. On the last page it tells who you've given it to. So then what you need to do, because I've revised mine several times also, is inform those people. Report an error

3:22:32 Changed my mind, got a new copy, you know, these are available and you just make out a new one and then make sure that they destroy the old copies and that, you know, I mean, it's only two or three people that you're dealing with most likely and that they destroy the old copies when you update your wishes. Report an error

3:22:52 Okay, let's go to wish four. My wish for how I want people to treat me. And again, you cross out what you don't agree with. I wish to have people with me when possible. I want someone to be with me when it seems that my death may come at any time. I personally have crossed out, I wish to have people with me when possible. I'm a person who spends a lot of time alone. And I don't like having people around me all the time. Report an error

3:23:22 I just get starved for solitude and I think when I'm dying I will want even more of that. So that does not apply to me. But some people who have fear don't want to be alone at all. So it all depends. But I do want someone to be with me when it seems that death may come at any time because I want those religious readings. Report an error

3:23:45 I want those prayers being said. I want that meditation being done. I wish to have my hand held and to be talked to when possible, even if I don't seem to respond to the voice or touch of others. And I've crossed that one out, too, for pretty much the reasons I just mentioned. And I have to explain this to my family. This is one of the hard things. They may want to hold on to me as long as possible, and I have the feeling that that's the situation. Report an error

3:24:13 Often is. And also there's so many people in the world and the American version of a good death is to be surrounded by your loved ones and they're all touching you, holding your hand, maybe singing or whatever. And this is like, you know, the good death. And it may not be what you want. According to your practice. Report an error

3:24:39 It may be better for you to have something else. So, yes, you can specify what you want. That's not quite close, Janet. Oh, sorry, Betty. Yeah. Report an error

3:24:53 There we go. Report an error

3:24:58 Well, it stayed before. There we go. Report an error

3:25:05 I lost my thought. The good death. Oh, the good death, yeah. Yeah, yeah, yeah. And I mean... We see that in hospice works sometimes where people get very, very involved in the death scene that's happening. It becomes the center of their life and everyone wants to come and everyone wants to be there. And it's what many people want. Report an error

3:25:35 And so you need to think clearly about this one. Do you want everyone there and what do you want them to be doing? Report an error

3:25:46 I wish to have others by my side praying for me when possible, and the members of my faith community told that I'm sick and asked to pray for me and visit me. I wish to be cared for with kindness and cheerfulness, not sadness. I wish to have pictures of my loved ones in my room near my bed. So I've crossed that one out too, and that's another one I have to explain to my family. Report an error

3:26:13 But, as a practitioner, I feel that that will increase my attachment and longing. And I wish to be in a room that's only filled with Dharma pictures and Buddhas and like that. Report an error

3:26:31 This next one, I want to be kept clean if I can't control myself, yes. And I want to die in my home if that can be done. And, I mean, actually, I think I would rather die in Tara home, but I haven't. I haven't gotten all the way there yet where I've crossed this out. Report an error

3:26:51 Now, wish number five. My wish for what I want my loved ones to know. All right, this is another generic thing, which is kind of like a Hallmark card. I wish my family and friends to know that I love them and to be forgiven for when I've hurt them, etc., etc. I do not fear death itself, but I think it's... Report an error

3:27:15 Not an end, but a new beginning. And my family members to make peace with each other before my death. Now, you know, if your durable power of attorney is the one that's holding this document, this is not going to do much good in all these situations. And what's best is for you to read them over and tell this to the people you love. This is the unfinished business area. What is your agent going to do? Report an error

3:27:44 Read this aloud? When you're dying or after you've died, Jane forgives you for all the times that you've hurt her. It's like reading a Hallmark card, literally. Not so good. But still, it's a wonderful guideline for what you may have left undone. And I know among people my age, most men around my age or ten years younger, most men... Report an error

3:28:15 Have been brought up in a time when men didn't tell other men they loved them. And I've heard quite a few male friends say, my father never told me he loved me, and I wish that he had. Like that. So these types of things are critically important for your survivors. And they'll remember it all the rest of their lives. Report an error

3:28:39 And those few last words, they will be remembered and treasured. By your loved ones. Important to say what you want to say, what you need to say. Report an error

3:28:54 Okay. I wish for my family and friends and caregivers to respect my wishes even if they don't agree with them. This is a hard one and again it's best discussed by you in advance. Now this is one that is potentially loaded for Dharma practitioners whose relatives are not. Because You may be doing things that they don't agree with that make them feel left out or unconsidered. And also, well, this is a little ahead of myself. Report an error

3:29:30 Never mind, I'll mention it later. But I've said enough about that. There's a lot of room here for misunderstanding. And as I said, when you are dying, your loved ones are concerned with their own loss. And so they're going to take everything personal. It looks like a rejection unless they understand why you are not engaging, why you don't want them to touch you in a certain way or to cry over you. Report an error

3:30:02 You know, in many cultures, there's a tradition of wailing and keening. And if that's not done, the loss hasn't been properly grieved. Report an error

3:30:19 We Buddhists don't do that, but maybe we come from a tradition which does, an Irish tradition, a Hispanic tradition. As a hospice nurse, I took care of a Hispanic woman, 36 years old, and she died and left six children. Report an error

3:30:38 And when I made the visit at the time of death, and I walked into the house, I heard this wailing and this keening, and as soon as I entered the room where the body was, everyone stopped. I was the outsider. So I'm only saying that if this obtains to your culture, that the people that are grieving for you may feel that the right way to honor your death is to do exactly what you don't want and to make this big commotion, unless you tell them otherwise. Report an error

3:31:18 I wish for my family and friends to see my dying as a time of personal growth for everyone, including me, and that's the gift I talked about earlier. And this will help me live a meaningful life in my final days. And then for them to get counseling if they have trouble with my death. Report an error

3:31:40 Then, after my death, I would like my body to be buried or cremated, and you circle your choice. My body or remain should be put in the following location. Now, what I have here is C attached spiritual instructions. Report an error

3:31:59 And I guess I could write it down here or you can add a separate sheet, which I've done. And, you know, then I have that I would... Report an error

3:32:13 I want my remains to be cremated and that some of my cremains to be incorporated in a statue or stupa and to be placed in the memorial shrine at Vashopani Institute. So it doesn't exist yet, but we have plans for it. And if it's not there at the time that I die, then I'm sure it will come to Land of Medicine Buddha where it does exist like that. Report an error

3:32:39 So you'll need to think about what you want. And then the following person knows my funeral wishes. And I again have written C attached. And here I have what I would like. I would like for a ceremony to be held at Vashrapani Institute for my Dharma family. Close friend and practitioners, whatever practices are advised by my teachers. But I would also like a public memorial service. Report an error

3:33:09 And I know who I want to officiate it, which is the former spiritual coordinator at the hospice that I worked for. And she is the most skillful person that I've encountered in my whole life at conducting memorial services that speak to the needs of the survivors. This is what I was talking about before. I've expressed that I have a very strong view of taking care of people that are really grieving and they don't have the Dharma to fall back on. Report an error

3:33:41 And she is so unbelievably skillful at saying the right thing for everybody. That's who I want. And so I put her name here and her phone number. And then I said it should also include some Buddhist practices with universal appeal. Because I want my memorial service to be an opportunity to bring Dharma to the people that I love and who love me. Report an error

3:34:07 And I particularly want two different services because I have a wide acquaintance in Santa Cruz. And Vajrapani is very remote. And I want all the bells and whistles of the traditional Buddhist practices, but I think I've been to many memorial services and I've conducted a few myself. And my experience so far is that in many of them, it's difficult for some of the attendees to be subjected to very long prayers, as we have in our tradition. Report an error

3:34:45 and in some of them there had not been enough time for For people to voice and speak about the person who's died and to share personal, it hasn't been personal enough. And also there hasn't been enough variety of parts of the memorial service that would be of comfort to everybody that was there. So it's kind of like planning your own wedding, you know. And my reason for doing this is out of... Report an error

3:35:18 Concern for the survivors. Now, the friend that Tenzin Chogky keeps referring to with the 17-year-old son, she had a brilliant memorial service. It was brilliant, and it was Atlanta Medicine Buddha, and it had enough personal touches. There was a video that her brother brought from England with pictures from her whole life. Report an error

3:35:41 So I got to know her as a person. I've only known her for the last ten years. I got to know a lot more about who she was and her fullness. And that's what I have found missing very often. And there was a chance for people to tell stories about her, which was good. Report an error

3:36:02 I think we recited the King of Prayers. That was the only one, I believe. And that seemed good. That seemed good. But we get used to very long prayers. We get used to them. And many other people are not. And it's not comforting to them. Anyway, I think you get my drift. I have a strong personal opinion about that for myself. Report an error

3:36:31 And you need to give thought for yourselves in that way. Report an error

3:36:38 Okay, now we're going to pass out. Janet has a question. Report an error

3:36:56 Which one is this? Which one? The last... I wish for my family and friends to think about what I was like before I became seriously ill, and I want them to remember me in this way after my death. Well, I didn't mention that because it seemed self-evident to me. Many, many people with long-term illnesses who barely resemble... Report an error

3:37:25 How they were in health. They don't want to be remembered and actually some dying people don't want these last visits from some of their relatives because they don't want to be remembered that way. Because the reason I asked about it was just from the point of view of how in the West we often sanitize the natural occurrences of life and death so much that That we don't want to even face it. And I've seen it some in my family, because the first time I saw a body was when I was about 30. Report an error

3:38:02 And a dead body. And so I was curious about this, if it was like a way of kind of glossing over the idea that people get old, they get sick, they die. Report an error

3:38:16 It's a very personal thing, Janet. It's a very personal thing. For example... The woman we keep referring to who was a skeleton at the end of her life. Why I enjoyed seeing the video of hers. I never met her in youth and in health like that. It was just wonderful to round out my acquaintance to see this person. Report an error

3:38:43 Yeah, I know exactly what you're saying because to me it seems really kind of contrived. Like the real me was the young, beautiful, healthy one and this other one wasn't really me. And so for me, I would cross that out. I mean, I think it's up to people, you know, the whole range is who you are. And certainly from a Buddhist perspective, it's not like, you know, you're only really you when you're kind of fully functional because like we were saying before, it's this continuum of constant. Report an error

3:39:12 And so to deny the latter part of it and to just say like that seems to me kind of contrived. When you put it in that way, I would cross it out too. I mean, I want my family to remember me as a growing, changing person representing all the stages of life. I just never gave much thought to this one. This is actually one that I thought of in terms like in talking with my parents about what they would want and in thinking what, personally I would want I actually didn't want to think of them as being the old sicky looking awful person you know and have maybe a nice picture of them you know I've gotten more involved with Buddhism, that view has... Report an error

3:40:03 How can you say what people are going to think anyway? How can you just say, oh, only think of this and don't think of that? They're going to think whatever they think. So in a way, it's contrived that way, like you're saying, oh, please be in denial about this other part of me and don't think about that. Report an error

3:40:22 That's going to help. But this has broader application. We don't tend to think about how most people have to make the decision of whether to have an open cap. casket or a closed casket. Many people who die of these types of illnesses look really awful at the time of death compared to the way they used to look and they don't want that dead body on display or embalmed or any attempt to fix it up so it looks more like the person used to. Report an error

3:40:51 We're not even considering that because of our Buddhist practices. Okay, so has this gone around? Not yet. Not yet. All right. So this is the little checklist that Venerable Dream A and I developed, and it will tweak your mind about some of the choices you may make that are specific to us Buddhist practitioners. Report an error

3:41:16 And then you can add things and check what you want. So I'll just start reading. You'll catch up as I'm dying. Put holy pictures and objects around me where I can see them. Let me hear the Medicine Buddha mantra and puja. And that can be recited or you can play the CD that I told you about before, The Reign of Blessings. Report an error

3:41:40 Remind me of the virtuous actions I have done and to rejoice in them. This is very good for the dying person to be... To rejoice in all the benefits they have done to others in their lifetime. And remind me about Tonglin practice, taking on the suffering of others and giving them happiness, my happiness. Report an error

3:42:00 And if one can't do that, at least a general meditation on compassion. Oh, I've got one. Remind me of my regular Dharma practice, which is, and then there's a couple of lines here for you to add that. Let me listen to spiritual teachings either from recordings or by reading to me from a book. And especially helpful would be teachings on letting go of things and on compassion and on the wisdom of ultimate truth or emptiness. Report an error

3:42:37 Now, that's as I'm dying. After my last breath, Stay calm and quiet. Leave my body untouched for as long as possible. We'll be, by the way, enlarging on this tomorrow when I go through Lama Zopa's advices and what we do into our home. Touch the crown of the head before any place else and before moving the body, pull hard on the hair at the crown or tap the crown of my head. Report an error

3:43:07 Notify my spiritual master or friend who is in room. And definitely phone numbers. Definitely you want to tell the contact details. That's in the next line. Shout loudly into my ear, reminding me of refuge in the Buddha, Dharma and Saṅgha. Well, that is sometimes done and not always. And I don't know why. But when the first woman, who was a nun, was dying, and I called, when she died, I called Lama Zopa, who was in town. Report an error

3:43:40 Had just arrived the day before, just like in the last situation. So, by the way, both Buddhist practitioners that we've had that have died at Tarahum were attended in the 24 hours before their death or after by Lama Zopa Rinpoche who had just pulled into town that day. Think of it. For both of them, within hours. For each of them. Amazing. Kind of amazing. Maybe not so amazing. Kind of reassuring. Report an error

3:44:09 Anyway. Anyway, so I called him to inform him that she had died. And he's on one end of the phone and he's telling me to shout into her ear at the top of my lungs over and over and over and over again. Take refuge, Jan. Jan, take refuge. Remember to take refuge. Jan, to repeat her name and those words over as loud as I could for about five minutes. Report an error

3:44:36 And I've never been part of anything like that. And it hasn't happened. In most of the other cases, and I have no idea. It's happened in a couple of the other cases when you haven't been around. When I haven't been there. He'll say something really specific to shout into their ear. Yeah, but not for everybody. That's what I'm saying. It's not for everybody. Report an error

3:44:59 So the amazing good fortune of having a Lama to guide, to from afar know exactly what you need is so fortunate. So fortunate. Report an error

3:45:14 Recite aloud to me the five great mantras. And here I have it. This is available and I don't know if you have it in the bookshop here. We have it at Land of Medicine Buddha. This is the five great mantras and they've been laminated on here. And they're in English and Tibetan. And then on the back, I want to read this to you from Lama Zopa. My most dear kindest brother and sister, please look at these mantras quite often. Report an error

3:45:58 Especially look at these mantras when you are leaving from this old body. Dear one, please don't cling to anything and let yourself become completely free. In this most important moment of life, You don't need to be afraid at all of being born in the lower realms and so forth. I give all my merits, past, present and future to you to have a happy journey and a happy, wonderful, sun-shining future. Report an error

3:46:36 I give my big love to you. All the Buddhas and Bodhisattvas love you and you are in their care. May anyone who sees these mantras be immediately reborn in the pure land where one can become enlightened or receive a perfect human body by quickly actualizing the causal vehicle, the three principles of the path and the result vehicle, the secret mantra Vajrayana based on correctly devoting and only pleasing one's own holy guru. Report an error

3:47:14 You can also pray in this way, may I take rebirth in whatever place is most beneficial for sentient beings, no matter where it is. To think this thought again and again is extremely good. The other choice is to think, may I be born in Amitabha's blissful field to quickly benefit all sentient beings. Thank you. Report an error

3:47:42 With much love and prayers, Lama Zopa. Report an error

3:47:49 So you might like to secure a copy of this and start learning these mantras and, you know, maybe keep this in the place where you keep your five wishes document so that it's right on hand. Report an error

3:48:05 Put a page of mantras on my chest to go to the mortuary. So in your spiritual community, If you have a slower death, a planned death, there's going to be someone in your community who will know all the things to do and have access to them. So there are printed sheets of pages of mantras that are the correct ones, and I don't know which ones they are. At Tarahum, we have made a box, which we keep right above the desk, and it's called the Last Breath Box. Report an error

3:48:44 The last breath box. And everything is in there that's needed at the time of death, including pages of these mantras, including Lama Zopa's book, including a stupa that goes on the crown of the head and so forth like that. So you can either... Direct someone in your life to obtain these things for you or make your wishes known like that or rely on, because you're connected with, say, Chen Ling or whatever your center is, that these things will be done and your wishes will be carried out. Report an error

3:49:24 Put other holy objects, especially a stupa, on my head or chest after touching the crown of my head first. Read out loud to me my regular Dharma practice, which is... And then, in the days and weeks after my death, arrange for prayers and pujas to be performed for me by, and you can write that in there, make donations in my name for these prayers and pujas, make other charitable donations in my name for the sake of my karma. Report an error

3:49:57 And again, after Venerable died, our very first... Our only Saṅgha. Venerable Drime, who was her close friend, and carried out all of her spiritual wishes. So she had left a list of every place she wanted her money distributed and the amounts. And she divided it up so that she could make all of these contributions to increase her merit in the bardo. Report an error

3:50:32 And, you know, positively impact her future rebirth. And so those wishes were carried out and you may want to give some thought to that. Report an error

3:50:44 And then finally arrange for me to be included in the next jiangwa ceremony, periodically held at LMB. So there's a section on this tomorrow about what can be done after the death and the various practices and pujas and so forth. I won't go into that now. And we'll also explain, as Lenny said before, more about... Report an error

3:51:06 What all of these things on the checklist mean and the recommended practices and what actually to do right before the breath stops, right after the breath stops, while the body is still there. So don't freak out. We're going to explain all the details. This can't quite be linear. Yeah. Are there any questions at this point? Report an error

3:51:26 Yeah, Michael. Where's the mic? Report an error

3:51:34 Oh, I was just going to say the little laminated card there is really good. Actually, my friend Harland, who you know, I gave him a copy of the card and he's becoming more and more interested in his last few months here of really learning to meditate. And so he looks at the card every day and just does sort of his own version of a meditation, which is just, you know, looking at the images on the card, looking at the mantras and imagining great healing and bliss. Report an error

3:52:03 And he's benefited so much, just his mind is being transformed. So it's nice to see the way it's structured by Lama Zopa. So-called non-Buddhists or Buddhist friendlies can really get into it. Yeah, because it's so beautiful. He designed it with all these images that are attractive no matter what. You're like, ooh, what's that? It's so pretty. And actually this friend who died a year ago that we keep talking about who had the 17-year-old son was not in a hospice situation. Report an error

3:52:36 She was actually in intensive care for a while and then they transferred her to this rehabilitation. She was in a... Report an error

3:52:43 And of course she wasn't going to be rehabilitated at all, but it was just sort of a minimal care facility. And Lama Zopa had said whenever her eyes are open, she was sort of in a semi-coma for about the last week or so of her life. And he instructed us, whenever her eyes are open, whether it looks like she's focusing or not, just stick the card in front of her face, you know, so we did that. We would just notice when her eyes were open and kind of prop it up on pillows or somehow have it within view. Report an error

3:53:09 Yeah, and then a long time ago, must have been in AD. Report an error

3:53:17 1983, a member of our community at Vashrapani died, and there were six of us who took care of her. We just moved in and took care of her so that her husband could just be a husband. This was before any of this material was out and it was long before I was interested in hospice. But she was in bed and she was at home and there was an enormous tanka of Vajrayogheni, which that was her practice. Report an error

3:53:51 And it was suspended from the ceiling. To the foot of the bed at an angle so that just she was lying down and whenever she opened her eyes, that's what she saw. It was very, very, it made a deep impression and I'm sure it made a deep impression on her. So some version of that. And when Lama Yeshe was dying, He always traveled with a particular tanka, which is now hanging in the gamba of Vajrapani, but it's a beautiful rendering of Chittimani Tara. Report an error

3:54:25 And that was in every hospital. That accompanied us everywhere and was displayed wherever he was. So that apparently is very beneficial to look on these images. Report an error

3:54:39 Okay, so they're just continuing down. Bottom of page 9. Don had a question. Oh, sorry, I didn't see that. Do you want to? Report an error

3:54:52 Just a couple of things on the Five Wishes paperwork itself. It specifies somewhere towards the end about keeping this someplace safe in the home. Yeah. And just for everybody to know that, yeah, you need the original. We had a case where the paramedics wouldn't honor a DNR because it was a photocopy. Report an error

3:55:14 It was signed about a month ago. Yes. My other question is, you're not considering this to replace the DNR? No, no, this does not replace the Do Not Resuscitate order. No. You have to have that as well. It's a completely separate document. The other question I've got, and I don't know if this is appropriate time or not, but I'm curious about what sounds like a blanket statement you've got about not using anti-anxiety agents. Report an error

3:55:39 Specifically, we're talking about Ativan. I didn't mean it to be a blanket statement. I meant it to be a blanket description of what Ativan does. And that it sedates you. And when used in the amounts that hospice uses, it zonks you. And that appears to make the person comfortable. And sometimes larger and larger doses are required to do that. Report an error

3:56:08 And that would be counterproductive to doing any kind of practice oneself or to understanding anything that was done with you. It's a personal decision. And again... I tell you right now that would be my wish, but I don't know. I have a chronic disease and often I have pain and sometimes I just can't stand it and I think to myself, I want to do anything to just feel better. Report an error

3:56:35 I don't know how I'm going to feel when I'm dying. I mean, basically you're deathly ill. So we can say things, but we don't know at the time how much we can endure and how much mental power. We're going to have. It's a big unknown. I don't know. What's your experience with Ativan? I think a lot of it is dose-related. Report an error

3:57:00 I tend to be light. I always feel like I can give them more, but I can't pull it back once they've ingested it. Because for me, if their mind is running and anxious and out of control, then they're doing themselves harm, so they can chill their mind out a little bit with the taste of Ativan. They're ahead of the game as well as the caregivers and all that. Yeah. Yeah, everybody's unique and it's a balancing act. I think that much of that agitation is either expressed or subconscious terror. Report an error

3:57:35 Sure. Now, I'm assuming that each of us here, we're talking about death. We're talking about our own death. We're beginning to... Punch that hole in whatever fears we might have. And presumably by the time we get to our deathbeds we're not going to be set with that kind of agitation and anxiety. So it's kind of a moot point. Report an error

3:58:02 I'm not sure. I disagree. I have no idea. Here I am, a Buddhist nun, and I have no idea how terrified I'm going to be when I'm at that point. So I would just disagree by saying just because we're practicing, it's necessarily a moot point. Well, by the way, I've used lots of Ativan with people, and I think it's a wonderful drug, but I'm just telling you what Lama Zopa has said. Report an error

3:58:28 This is the instructions he's given us for Tarahum. We don't make decisions for other people unless this is what they want. They have stated that they want to be lucid. And as I said, we've only had two Buddhist practitioners, and we had one woman this year who was with us for six months. And right as soon as she came, she became very interested in Dharma. She had an amazing... Report an error

3:58:55 Remission, you could say, and she had a prognosis of two or three weeks, but she lived for six more months in Tenzin Chogky. I came to see her and gave her some private instruction and she became very interested and she had enough ability to go to Sunday morning meditations for quite a while like that. Report an error

3:59:15 And so she probably would have wanted to, well she wanted everything done in the Buddhist way at the end of her life and I wasn't there at the time of her death and I don't know if she was sedated or... Well it was interesting because the last few days we just kept making... Choices about Ativan, like, you know, and really adjusting the dosages of those and her pain medication, just, you know, having to just kind of make these fine mid-course corrections all the time. Report an error

3:59:43 Oh, she's really agitated, give her a little bit, you know, and I mean, she was in a semi-coma at that point, wasn't really so lucid. But yeah, it was difficult. And even when she was conscious, it was difficult for her because she wanted to be aware enough to be doing these practices. But she had liver and colon cancer and was in a tremendous amount of pain. And so she was kind of trying to self-adjust her own medication. Report an error

4:00:09 But of course, in the last couple of weeks, it kept changing. So it's not so cut and dried at all. And I remember with the Ativan in the last couple of days, there were times that she was just so agitated, she was just about to kind of jump out of the bed. And we just felt like it wasn't so beneficial for her to be that agitated. And we give her a tiny amount. Report an error

4:00:27 I was with her at the time of death and she was incredibly peaceful. Like everything in the last 24 hours, she had gotten so peaceful we didn't have to give her any medications at all actually for that last day. And even though she wasn't conscious in the traditional meaning of the word, I feel like she was really... Report an error

4:00:47 Going through some kind of process and her son and I were able to be with her when she stopped breathing and then stay with her for a couple of days afterwards. But yeah, it's not so easy. I just want to mention that we're kind of running way over. So I'll just quickly finish this. Report an error

4:01:09 If anyone asks how I want to be remembered, please say the following about me. If there's to be a memorial service for me, I wish this service to include the following. Music, songs, readings, any other particular requests. And then there's a space for anything else you may wish. This is about organ donation. Report an error

4:01:29 And attach a separate paper if you need more space. And then at the end, there's your signature. Two witnesses and we did a separate workshop at Land of Medicine Buddha around the five wishes document. We did it in two sessions separated by two weeks so people had a chance to think about it. In the second session we filled them out together and one of our Tar Home volunteers is a notary public and we notarized all of them. Report an error

4:01:59 I would recommend getting it notarized just because It's fairly new and I would just do everything to make it a legal document. I'd get it notarized. And then it tells you what to do after this is completed about the witnessing, who to talk to and give copies to. Keep the original copy, as Don said, and keep it in a special place in your home and do not put it in a safe deposit box. Keep it nearby so it can be found when you need it. Report an error

4:02:29 And then there's a wallet card on the bottom, which I have been remiss and not cut out and put in my wallet, but one should do that. And then during your next visit with your doctor, talk to him or her and give them a copy and have it put into your medical records and make sure your doctor understands what your wishes are. Report an error

4:02:50 And then ask him if there are other treating doctors, for example, an oncologist or a radiologist, whatever. Your doctor to tell other doctors who treat you to honor your wishes. And then if you're admitted to a hospital or a nursing home, you take this document with you and have it put in your chart. Report an error

4:03:10 And finally, I have given the following people copies of my completed five wishes. Like that. So, Report an error

4:03:24 yes, Janet. A question about the notarizing and the problem that you said about having a... A photocopy that wasn't accepted? Yes. If you're making, like, say, three or four copies of this to distribute, would you bring all of them and just have each one notarized? No, no. This is the one. The original is the one that needs to be in your home, or if you go to the hospital, it goes with you, or a nursing home, it goes with you, and it should be put in your chart if you're not at home. Report an error

4:03:59 The people that have the copies, they have them so that they can read and review and have your wishes right on hand. But this is the binding one. So like if you move from a hospital to a hospice or nursing home, you take this with you? Yes. And if you go from a hospital to a nursing home, it will go with your chart. Or it's the responsibility of your... Report an error

4:04:26 You or whoever's with you to make sure it goes. Yeah. Yes. I was talking about this this morning with my boyfriend and he's Tibetan and I asked him when you die do you want to be cremated or do you want to be buried and he said it's not up to me. He said it depends on the time of death and some other factors. He said it depends on what Rinpoche says. But he's in the Nima tradition so maybe it's different. Report an error

4:04:57 Maybe it's different. Okay, so I'll mention one more thing that's come up a couple of times at Tarahum. And recently I talked about this with Karen, the Tarahum director, and I haven't even had the opportunity to talk with you about this yet. But I think we need to consider adding something, or I need to consider adding to my document that I want everything that I've put in here to be superseded. Report an error

4:05:26 By the wishes of Lama Zopa. Yeah. Because sometimes if I'm fortunate enough to have the Lama come on the scene and he gives a set of directions that aren't in here and my kids don't know, it's not that meaningful to them. I want to be sure that that is what's followed and that there's no resentment about it. Report an error

4:05:50 That happened to another friend last year who actually had an asthma attack and was rushed to the hospital and by the time he got there he was brain dead and only lived for two or three days and luckily Lama Zopa was being consulted but could give all of these specific instructions. He'd been put on life support and then Lama Zopa Rinpoche said, He could be on life support for ages. It would be a great expense to his family. And, you know, so take him off. But before you take him off, do all these practices. Report an error

4:06:21 And so he recommended all these practices. So it was quite different than anything that could have been predicted or written down ahead of time because of the situation was so urgent. And so it was really fortunate that, you know, his family were also practitioners and honored Lama's opus wishes. But it's really good to have, you know, some sort of a... Report an error

4:06:41 There's no provision for that in your documents because you just don't know what it's going to be. And for him, he could have said, don't put me on life support in the beginning or never take me off or whatever. But as it was, Lama Zopa said, no, there's more ultimate benefit in not... Using the money and then the money was to be donated to something else and all these prayers to be done and pull the plug at X time that Lama Zopa is going to be in Nepal doing practices and things like that. Report an error

4:07:10 So it is always good to sort of, if you can, if you have that kind of relationship, to have something like that in there. Okay, well let's have a break. You know, I was going to go into new material, but I'm almost feeling like it would be better to continue the discussion and maybe talk a little bit more about what the practices at the time of death would be instead of going into the five powers. Report an error

4:07:37 And I don't know if you feel prepared to go over. That and kind of change the schedule around a little bit of Lama Zopa, since it seems up instead of kind of launching into a whole new bunch of materials, since we're talking about what do you do at the time, you know, nearing the time of death, maybe we'll just switch around a little bit. Report an error

4:07:54 But let's take maybe 15 minutes break. Now we've got this memorial service over there and they said they'd bring tea in here, but of course go out and use the restroom if you need to, but it's just that the bookstore is closed for us right now, so you can't get your double mocha cappuccino. We'll be able to continue our discussion while you're drinking your tea. And also, by the way, I've left open on my table up here Lama Zopa's instructions on organ donation called Practicing Charity with the Body. Report an error

4:08:25 If anybody's interested to read that, it's open right here while we're having our tea break. Report an error

4:08:40 First of all, what other questions do people have when you're contemplating these five wishes? Charlie. Let's see. Got the mic. I Report an error

4:08:57 wonder if we might spend some time just briefly discussing honoring other people's faith. My family is deeply religious Christians. Report an error

4:09:14 And I'm new to Buddhism, so even the process of thinking about how I'm going to incorporate all of this is a little bit intimidating. Report an error

4:09:27 able to honor somebody else's Feelings about what happens when you die and their cosmologies. And I think in the cases that I've been involved with, for example, in Tarahum, when people's families are of another tradition and even the person themselves has become interested in Buddhism only... In the process of their residence in Tarahome and become interested, it's really all about communication and respect, you know, and that's the thing, like if the person can talk to the family about what they want, and for myself, I really try and develop a relationship with the family of the people who are there. Report an error

4:10:07 In residence, and I think it's just, you know, a lot of times if you can develop a rapport with the family, then they just have a lot of trust in what you do. And I also really explain and ask for permission. For example, in this recent case we had a couple of weeks ago that this woman, who was a student at Landa Medicine Buddha, and actually was a close friend of mine, was dying. Report an error

4:10:28 And she'd been struggling with breast cancer for many years and then she declined quite rapidly in the end and was only a resident in the hospice for two days before she passed. At Tarahum. At Tarahum. And, you know, she had made her wishes known to her family. Lama Zopa came in the middle of the night. It was this thing. Report an error

4:10:47 He arrived at the airport and then I got back and she had started to have the death rattle and I called him right away and said, you know, come and he came. And a good friend of hers and her sister-in-law were in the room. He comes in, all these monks and nuns kind of march in, and I just explained to them what was going on and said, like, we're going to do these practices, is that okay with you? Report an error

4:11:11 And just, you know, kind of didn't ignore. And they were fine because they knew her wishes and just having asked their permission because it got quite amazing. And here it is three or four hours with Lama Tsongkhapa and six monks and nuns in this tiny little room. And it was quite amazing for all of us. But I think just because I had been working with them for a couple of days and developed a relationship and then it went well. Report an error

4:11:36 So it just feels like that to me of communication. And then if people really are resistant, just backing off, you know, not having such a heavy agenda. Like, for example, when my father died, my brother and sister-in-law and my father's girlfriend were there, and I just did things quietly. Like, I just did a bunch of practices quietly. I did some things to his body to set it up that were unobtrusive. Report an error

4:12:05 Just did my practices. I sat by his bedside for hours doing practices quietly. I read one prayer out loud. My brother thought it was really beautiful. So I was like, great, I can read it a couple of times because, you know, this works for him. But I didn't do any big juju, you know, weirdo stuff, which I was fully prepared to do and have done many times. Report an error

4:12:26 But I just kind of said, no, that's going to create this really... Disharmonious relationship in the room, because that's the thing, is just to have this, you know, harmonious, calm, you know, non-confrontational atmosphere in the room. And I just didn't want to push any buttons at this crucial time. And I just said, you know, of course I ran out and called Lama Zopa within three minutes of my father's breath stopping. Report an error

4:12:47 And then part of me was like, Lama Zopa is dealing with it. Whatever I do is like just icing on the cake, you know. But yeah, I think a harmony. But the communication and respect and the communication from the side of the person who's the patient makes a big difference if they want those kind of practices. Report an error

4:13:04 You've touched on a really, really important point. So in your case, for example, you're a new Buddhist and you're taking this all in and over time it will sort out what is relevant to you and what's not. And then they'll be the task of your family coming to understand that you've changed courses. And for you to, you know, hopefully they'll honor your choices, but they're going to have their opinions. Report an error

4:13:32 And so the communication that you have with them is going to prevent a lot of misunderstanding and difficulty. And of course in some Christian traditions they may feel that you're doomed or damned and that that's going to disturb them very much because they love you and they want the best for you. So somehow in your Buddhist studies and in your conversations with your family you're going to need to find a way to bridge those two things if it's possible. Report an error

4:13:58 And it may not be possible. Without going back to the fold, their fold. I don't know. So these are challenging issues. Challenging issues. And then also on that topic in terms of the practices done at the death time. So since I've been involved with this. I mean I've been a Buddhist student, Tibetan Buddhist student since 1975 and in the earlier days we didn't have this book. Report an error

4:14:28 We had odds and ends of pamphlets and Xeroxed pages and this and that and when our first person died we did what was recommended but it was far short of now the much more elaborate. So that tells me there's just not a plan that everyone has to follow. And it depends who it is that dies. This is my attitude, totally my opinion. Report an error

4:14:57 So when someone's in Tarahome and because of the way circumstances are and what their family is and what their religion is and the strength of the family's influence and the circumstances at the time of death and which prayers get said and which don't and what, you know. I feel that it's the person's karma that's died to have it be absolutely perfect. If they're Buddhists, now in the steering committee of Tara Holm, which is like the board of directors, and I mentioned we're all Buddhists, and then we've created this joke so that I know that when I die, what I want is what we call the deluxe package. Report an error

4:15:42 No, I want my tour to be on the deluxe package. And there are gradations of that, and anything that's done in a positive direction is beneficial to the person who's died, who's not Buddhist. And we feel strongly, but so do the Catholics and so do the Christians feel like they're not going to go to the right place unless you do this and this and this. So it's karma, I feel. Report an error

4:16:05 And we can't go too far wrong. We do our best and we take into account the other sentient beings in the room who love this person and they have just as strongly held convictions as we have and their person has chosen to come to Tar Home. So we walk a really fine line and that's where it's important to develop skillful means. Report an error

4:16:30 And in Tarahum, we deal with this all the time because we're a community service and we're non-denominational. And only about half of our volunteers are Buddhist. So we have to be very, very careful, sensitive. And as fast as we gain in wisdom, we put it right back in there. But we've made lots of blunders and that's how we learn. Report an error

4:16:57 Mike? Report an error

4:17:01 Seishin Ling here has a group that have come together, about six of us I guess, a therapist, a couple of nurses, people that have been trained in hospice. It's our death and dying group and we're putting together a dying kit, if you will, to where we have certain prayers that we're going to want to do at the bedside of a practitioner or to be able to advise a practitioner if it's another family member that's not a Buddhist. Report an error

4:17:26 Chookie's involved and I'm involved and there's various... People that are involved with this. And, of course, we're going to be looking to Lenny and Venable Tenzin Chogky about the advice to do that. But this is something that Seishin Ling is working on right now. Yes. Very important. And we did have our first experience of one of our members here actually. Report an error

4:17:49 And with the advice of Lama Zopa, we went to the hospital and they welcomed us. This was a hospital in San Francisco and totally welcomed us coming in to do the prayers. And it was really, it was almost... Karmic, obviously. The nurse that was taking care of the patient was a Buddhist, and the doctor that was taking care of the patient was also a Buddhist. It was like, whoa. You know, like, whoa. Report an error

4:18:12 We've had that a couple of times, too. The nurse comes in and she's like, oh, I know not to touch the body. Okay, I just need to check the pulse, but, you know, I'm hip. I know what to do. And it was just a trip how it all, and they were just so accommodating. It was really wonderful to have that experience. Report an error

4:18:28 I want to suggest that in your kit that you put together, we have a lovely wooden box with a hinged lid. And inside the lid of the box, we have taped the steps of what to do, who to call, and it's permanently part of the box. And I would recommend that you do that because there's always a flurry. There's always a flurry. And then, of course, as you know, it's very important to remember that at the time of death, there's no emergency. Report an error

4:18:56 There's no... Urgency, there's no emergency. There's time to do the prayers within hours, you know, and it can be done from a distance. So what will help the most is that calmness and lack of emergency and urgency. Report an error

4:19:16 And we found too in Santa Cruz there's a lot of the, well the main hospital down there has been trying to do all these workshops in being more open to people of different faiths and different cultures and we found that greatly to be to our advantage because they just sort of let us do what we need to do, even keeping the body for much longer. Report an error

4:19:38 You know, then they're supposed to if you talk to the right nurses and they're on the shift. We had this one who just kind of said, I go off at 3 o 'clock until 3 o 'clock, do whatever you want to do. Then I can't guarantee it, but you just do your thing. And so, you know, they've become much more open to different things lately. And I think a lot of hospitals and medical establishments are becoming more open. Report an error

4:20:00 I think they're generally trying to serve their public and respect the different traditions. I've never had any problem. Except in the case of Lama Yeshi, when he died at Cedars-Sinai Hospital in Southern California, we had a bit of difficulty. I was the one that dealt with the hospital administration and everybody, everybody had the attitude of three days, well, isn't that dangerous? Report an error

4:20:26 Isn't that toxic? You know, isn't that, it's like, ew, that kind of a, you know, like we were going to contaminate. But they did give us the use of a room in a closed-off wing, and we were able to transport his body to do the prayers and the practices because he was in the coronary care unit. And so the bed was wheeled very slowly through the hall so as not to move the body. They wouldn't let us push the bed. They had two orderlies, and I tell you, these two orderlies looked like Martians. Report an error

4:21:00 They had on caps, surgical masks. Gowns, booties and gloves to push the bed through the hospital. But they let us do it, but they wouldn't let us keep the room beyond that day. And Lama died, he was pronounced dead at 7.30 and the mortuary came and picked up the body at 10 p.m. And that was really a concession for them to let us stay there that long. Report an error

4:21:31 But other than that, there was nothing but cooperation. And one of the things that I've done myself, maybe I shouldn't recommend this, it's probably against the law or something, but I don't really care, is just when the person quits breathing, just don't say anything. Just don't tell anybody. And you have to tell the person's friends. Like, this is not an emergency. We will be able to keep them here longer if nobody knows about it. Report an error

4:21:57 You don't really have to say. And our friend who died in the rehab unit, she... Quit breathing, I think, at like 3.30 in the morning. Somehow, miraculously, Lama Zopa swept in, all these monks and nuns, nobody checked the room. At 11 o 'clock, seven hours after she quit breathing, I went out to make a phone call, and this nurse came up and said, how's she doing? Report an error

4:22:22 Does she need her pain meds? And I was like, I have no idea what to say. And then I was like, no, she really doesn't need any more pain meds. And she freaked out really briefly because I said, oh no, she passed away. And she's like, when did she pass away? Report an error

4:22:43 She goes, like hours ago. There goes my job. And then she was the one that actually said, you have till three o 'clock. She did this whole freak out thing. It only lasted about five minutes. And then she kind of got a grip and just said, okay, you guys do your thing. You've got till three o 'clock. And which was amazing, you know, but yeah, so sometimes you just, you know, people think, oh, you need to call. But like Lenny says, it's no longer an emergency. Report an error

4:23:12 You don't need to call anybody, you know, and sometimes people will freak out and run out like that happened to me once to this woman quit breathing. She had a brain tumor and I was there doing practices and three of her friends were there and she, you know, she quit breathing. I got that there was no more breath coming and I just kind of turned to them and I just said, That's it. We don't need to inform anyone. Let's just keep praying. But one of her friends kind of freaked out and ran out and then the nurse came in and then we had a deadline, you know. Report an error

4:23:43 So it's nice if it's in one of these circumstances. Like I say, I probably said something that's totally against the law, but that's just been my experience. It's not against the law. It just reflects poorly on the personnel to not know. And like I said, there goes my job, you know. know. Report an error

4:24:02 Yeah, that's what I mean. They're negligent. I just want to share a recent story. I had a death. Well, it was somebody who I lived on the street with for 20 years here in San Francisco. And he died about a month ago. Catholic. One of the three daughters is a Buddhist. Little bit of problems when he died because it was totally unexpected. Report an error

4:24:27 And, um, And Irish Catholics, so lots of passion about the event. And their best friends across the street just happened to be Irish Catholic judges. And so when the daughters arrived to go to breakfast, as planned on Friday morning, they found their father quite peacefully dead in his bed. And then what ended up happening is... Report an error

4:24:55 He was allowed to stay there until 5 o 'clock at night, which doesn't usually happen. But I think there was a lot of passion expressed on the one Buddhist daughter's side to allow the father to stay in bed. And that was shared at the Catholic services and no mention of Buddhists, but I knew the situation. Report an error

4:25:20 And I just thought that was amazing. Yeah. Well, there's no rush, and the mortuaries are not in a rush. Usually when the body's whisked away, it's because the family wants to just get the death out of their face. Report an error

4:25:37 But there's a lot of cooperation out there, actually. Report an error

4:25:44 I had more of a practical question. When my husband died, I wanted to keep him in his bed at home for three days. He had already been chanted over by Geshe-la, who had said that his... Report an error

4:25:58 Energy had left his body. And before the third day, his body decay started happening. And I'm wondering, is that an indication enough that he has left the body and it's okay to move? That's the time. Okay. Yeah. Yeah, the only, and we're going to get into this tomorrow morning when we talk about the stages of death, and there is... Report an error

4:26:21 A period of time for most peaceful deaths that can last anywhere from hours to days, even for ordinary people who aren't necessarily consciously practicing any meditation, that according to Buddhism, even after the breath and heartbeat have stopped, the consciousness is still in the body. And then that's the crucial time to do practices and leave the body undisturbed. Report an error

4:26:45 Often you can just see a shift, and there are signs that I'll talk about tomorrow, but for sure when the body, you know, you'll often see the skin will be, you know, quite rosy and flexible, and then all of a sudden it'll turn gray and look quite waxy, that's one of the signs, and then when you can actually smell the decay, generally then the consciousness has left and it's okay to move. Report an error

4:27:08 Move the body and deal with it that way. And it's difficult unless you're really trained in the stages of when the consciousness has left the body. But often you can just sort of sense it and look at things like the color and the odor and things like that and tell. So it doesn't need to be, I mean three days is sort of an average but it's not at all that it needs to be three days if it feels that the consciousness has already left the body. Report an error

4:27:35 And if... You are keeping a body at home that long. It helps to keep windows open, to keep a fan or an air conditioner going. That will slow down the process of decay and it's very difficult on a hot summer day for the process not to be hastened like that for ordinary people. Report an error

4:27:56 And Don had asked earlier, and I just wanted to address this for the whole group since we're talking about the temperature of the body. Don had asked, you know, do you put the body on dry ice or do anything like that to preserve it? But you don't actually. When the consciousness is still in the body, if you do things like that, it may cause the consciousness to desire a state of warmth, which can direct the rebirth into a hell realm. Report an error

4:28:20 So you don't do a lot in terms of adjusting the temperature apart from... You know, opening the windows and making the room just sort of an even temperature, not too hot and not too cold, because that's said to be not so beneficial either. So I just wanted to mention that since it came up. Yeah, Allison. I was just curious, because we talked about in the hospital if you die and the nurses are needing to check every hour. Report an error

4:28:45 So if someone does die at home, what's the law in California or whatever in terms of no to... Having to notify and remove the body. Right. If it's the hospice case, there's lots of latitude. If it's a hospice case, the coroner doesn't need to be notified. The doctor needs to be eventually notified. Hospice needs to be eventually notified. Report an error

4:29:11 But there's no immediate need if it's over. So hospice likes to be notified. Soon after the death, but unless you require a visit from the nurse at the time of death, which some families want either for support or verification, whatever, then you would call hospice. But there are many families where the person dies and if it's in the middle of the night or they want a few hours alone with the body, they don't call. Report an error

4:29:45 There's a lot of latitude when hospice is involved. If hospice is not involved, then if somebody dies at home, it's always a coroner's case. And then who gets informed is your doctor. And the doctor, if it's an unexpected death like that, then the coroner has to get involved, et cetera, et cetera. And then, you know, soon after death. Report an error

4:30:12 If you're a Buddhist practitioner and you want those hours, nothing's going to happen to you if you wait. You can plead ignorance or whatever, but that's the chain in that way. Report an error

4:30:27 Don. Report an error

4:30:33 Just one point, clarification is each county is different in terms of whether or not the coroner needs to be notified. San Francisco requires a nurse visit to every death and contact and they get a release number. Marin is, if they haven't seen their doc in 20 days, you've got to call a coroner. Even if hospice is involved? Oh my God, okay, you know, I didn't know that. Report an error

4:30:57 Thank you. Thank you. Never heard that. Report an error

4:31:09 Yes, that I know. Communicable diseases need to be coroner notification in all cases. That's different, yeah. Any other questions? Yeah. See, this is too involved. You're just dying. So I have a question, and it goes to my question, because I've been in the Buddhist practice but never really looked at dying that much. Report an error

4:31:33 And my background was Jewish. And it's like I just feel like I die and my consciousness is going to go. If I'm working on my karma here in this life and trying to really be present, it's listening. You know, it's... Report an error

4:31:52 And it's like I'm looking at how much we want to do these practices, but also being aware, and you're kind of making the point, how much we cling if something doesn't get done in the right way to what grief that may cause the living. Oh, yeah. And also what grief the person is trying to set up that's going to go through their death. Sure. And maybe none of this may happen, you know. Yeah. Maybe in that accident you're dying, you're done, something happens to your body. Report an error

4:32:19 Yeah, absolutely. Just to be clear, you know, to have a clear mind at that point no matter what's happening. You know, I guess it's, I don't know if it fits with where we're going here, but there's a question within me. It's just like, do I have just clarity in my mind no matter what? Where it's like as I'm hearing all these questions, it almost begins to feel overwhelming for my body. Report an error

4:32:41 It's like, it's too much for me. It almost feels like it's like, okay, I'm dying. Just live here, live clearly and live in a clear mind and that karma is setting itself up that no matter what's going to happen to me, you know, I'm going into the universe to... Be a positive force. And I think tomorrow what we're going to do is go into a lot of practices that you can do for exactly what you've said. You know, set yourself up so that you are in this clear place. Report an error

4:33:14 Practices that you can do to prepare yourself for death. Because I know sometimes, for example, this woman who was at Tara home for six months came, wasn't a Buddhist. Someone showed her the card with all these mantras. She couldn't really think clearly anymore. She was in a lot of pain. And she started to feel a lot of anxiety. Report an error

4:33:32 I'm not doing it right. I'm not doing it right. I'm going to fail at the time of death. And she had so much anxiety initially. And I worked with her and taught her a couple of really simple practices. And I said, don't worry about, you know, the mantras. I'll do those for you when you die. Don't worry about it. I know those. I know the drill. I'll do that part. Report an error

4:33:52 All you need to do is prepare your mind this way. And I gave her. Some simple practices that we're actually going to do this afternoon, but this conversation got quite involved. So tomorrow that's going to be a lot of the focus is, okay, how do you prepare your own mind for that point where you can go into it with that kind of clarity and that kind of focus? Report an error

4:34:12 Because all of the rest is details. It's icing on the cake. It's great if you can have a situation like that, but not to make you anxious that there is like the way to do it. And if you can't do it like that. Somehow it's all going to go wrong. You know, it's that balance between sure, if you can, you know, this is what's recommended. And then, you know, given that to have a peaceful mind and to die with the mind of bodhicitta, which is what we're going to do this afternoon and we'll get to tomorrow. Report an error

4:34:42 And practice is to just ensure that you have that mind that once for the benefit of all beings, if you die with that mind, you know, with that familiarity, there's no way that you'll go. And that's the most important thing, which is why it's called the essential transference of consciousness practice. And we'll get to that more tomorrow. Report an error

4:35:02 But I'm glad that you brought that up because it's true. It can make people anxious. Ooh, what if they don't? What if they move my body too soon? What if they do that? What if Lama Tsongkhapa is not around? What if they don't call this Lama? And, you know, there's definitely, that's not the most important thing. And that's what I was trying to say before, that this book got thicker and thicker. Report an error

4:35:22 It appears to be more and more complicated, but apparently there's parameters and you're not going to do everything in the book. And as I said before, it seems like there's different things recommended in different situations like that. Report an error

4:35:43 Is that helpful? Yeah, I mean, it is. Report an error

4:35:50 Yeah. Report an error

4:36:01 Yeah, and the state of mind of the person is the most important parameter. For sure, you can have lamas doing all kinds of practices, but your own state of mind. So we're practicing. I mean, a lot of the emphasis in Tibetan Buddhism is to practice for death for the rest of our life, to prepare for that moment so that we can go into it with the realization of impermanence, with bodhicitta, with all of these things. Report an error

4:36:26 It's really the point of our practice to be able to make that transition. With as peaceful of a mind and with those realizations as much as possible. So these are some of the specifics, but it's really our practice for the rest of our life to prepare for death and prepare our minds spiritually. Report an error

4:36:46 But we'll get to more of those practices tomorrow. That's going to be the better part of tomorrow's discussion. Thank you for bringing that up. Michael, did you ask? Okay, we've done. One more question. Report an error

4:37:05 Are there practices that can be done for animals? All of these practices can be done for animals, yeah. They're sentient beings with a consciousness, and so there's nothing that we're going to be talking about in relation to humans, but all of these can be done for the benefit of animals also. Thank you. As extensive as you want to go. For your beloved pet, go for it. Report an error

4:37:12 yeah, there's no, yeah, they Report an error

4:37:34 Okay, well I think that I'll begin this and we'll see how far we can get. I've mentioned some of the points already and one thing that Lama Zopa mentions is that every minute so many sentient beings are dying and that death is not so special. We're all going to die and every minute someone else is dying and we're not so alone in that situation. Report an error

4:38:04 Now, at the time of death, a most important thing is to refrain from anger and attachment. That's why I said I don't want photographs of my children and grandchildren around my bed. That's the attachment part and the anger part. Report an error

4:38:23 I'll quickly go back to the example of our first Tar Home resident and the side rails and the bells. And so a lot of the anger was aimed at me. I mean, I was the object of her anger and all the anger of the helplessness and the loss of independence and everything. And raw, naked anger. Glaring like that, way out of proportion to the situation, but not. She was dying, you know. And what I elected to do in that situation, even though I had the power of attorney, and even though I had so much wanted to help her with the transition, what I chose to do, and it turned for the rest of her life, was not show my face to her. Report an error

4:39:10 I kept out of her view until she died. I was at Tarhome every single day I went, but I was careful to not let her see me, and I didn't approach her, and other people did everything because I knew that it was important to preserve her from objects that created anger, and I was that object like that. Report an error

4:39:36 Now, how to help the dying person achieve a peaceful mind. We've already touched on many of these things. One of the things we haven't touched on is the environment. And the environment should project order, spaciousness, beauty, calm. It shouldn't be cluttered, and if you've ever been in a sick room, it can get cluttered in five minutes. So much stuff everywhere, every surface covered with the paraphernalia of sickness. Report an error

4:40:08 And it's better as much as possible to clear the decks and organize it so that the view is as spacious and peaceful as possible, because a peaceful view encourages a peaceful mind. Report an error

4:40:26 Sacred objects we've talked about being displayed and removing objects that arouse attachment. We've talked about hearing the Medicine Buddha mantra or saying it and I've told you about the Reign of Blessings CD and there's teaching tapes, tapes many, many... CDs of teachings of the Dalai Lama or anybody else that the person is feeling a connection with. And for non-Buddhists, the same thing goes for their own tradition, whatever they might like to listen to. Report an error

4:41:04 Non-Buddhists enjoy having prayers read to them or Bible readings. That's a very helpful way to spend time with someone who's not a Buddhist, to read to them from whatever prayer book that's comforting to them. Report an error

4:41:22 So when you're with someone who's dying that's not Buddhist, what you can do with everything that you're saying is just instead of using the word Buddha, use the word God or Mother Mary or Jesus. Whatever their language is for the highest power, you can use that. But in a certain way, at that level, it's all the same. Report an error

4:41:48 Whatever will bring spiritual comfort. When the dying person is sleeping, it's beneficial to sit with them and do your own practice quietly, your own prayers, your own visualizations, and they will be impacted by that and they'll be helped by that. Report an error

4:42:08 This is an essential part of our Tarahum training and it applies for anyone that's going to visit a dying person or be one of the caregivers or be just a concerned, loving friend or relative. And that is what's called spiritual presence. Spiritual presence. And in hospice and in Torah home, we considered this to be the most important quality for volunteers. Report an error

4:42:37 Now what presence is in this situation, it is the ability to be present with suffering. To be rather than to do. To be able to be there. And to be present, not distracting yourself or changing the subject or turning on the TV or anything to get out of there. Many people find it terribly difficult to be in the face of impending death. It reminds us of our own mortality. Report an error

4:43:15 Many people stay away. They can't be there all the way. It's too frightening for them. the ability to be Present with suffering without trying to fix it, without trying to change it, and without trying to distract from it, make light of it, make jokes, cheer the person like that, but to just be with them in whatever state of mind they're in and be able to just hold that and be there. Report an error

4:43:48 Sometimes it's appropriate to cry together. Sometimes it's appropriate to share memories, talk over old times or review family photographs, tell stories like that. Sometimes to just sit quietly and be together but they're too exhausted to talk and that your chatter will be disturbing. So it's very important as you develop this presence to refine your ability to tune in to the other person. Report an error

4:44:18 And actually what Frank Ostaseski says, the founder of the Zen Hospice, is that when he is about to enter the room of a dying person, what he does is just stand in the doorway and observe and wait for the person to make the first overture, like that. And for our Tarahome volunteers, who change every four and a half hours, we have shifts, four and a half hour shifts. Report an error

4:44:46 What we train them to do, first of all, this is very important for all of us, is to leave your agenda at the door. Don't bring your agenda with you. You may have had the agenda in your mind of how you're going to help. You're going to rub their feet, or you're going to do this reading, or you're going to tell this joke or tell this story. Report an error

4:45:09 Leave it at the door. And just attune yourself to wherever they're at and join in their process. Be with them in that way, walk with them in that way or sit with them in that way. That's the most helpful. If you've ever been sick and had visitors come, you know that what you generally need to do is get yourself up to be with people and to be on. Report an error

4:45:38 And it's a burden and it's tiring, especially when you're dying. So the most helpful thing you can do is just be with them like that. Report an error

4:45:56 And developing the ability to really listen. If you've ever had any training in active listening or read something about active listening, we train our volunteers in how to be a good listener, how to ask leading questions, how to give feedback and verbal and nonverbal cues that you're right there with them. Report an error

4:46:18 I heard you say that. Yes. Oh, I understand. That sounds right. Good. Like that. To just be right there with them and listen and not have to talk about yourself, certainly, or tell your own story, but find ways. Become a skillful person in listening and drawing people out. Very helpful. And people that are dying, by the way, The personnel, if they're in a hospital, are always overworked and overbooked. You know, too many patients to take care of. Report an error

4:46:58 So they're not able to give that kind of time. And as I said, many people are very uncomfortable and avoid. We don't know what to say, so they stay away. So the dying person is often very lonely. Very lonely. Report an error

4:47:17 To just have somebody who's able to be there is the greatest gift. Greatest gift. Report an error

4:47:31 So I've already mentioned about medicating pain and that the mental suffering at the end of life is the opportunity to complete some of the negative karma. So it won't accompany one into the next body. Report an error

4:47:50 Now, general instructions for at the time of death. General instructions. So as we'll learn tomorrow more completely, when the last breath is noted, in Western medicine that's the end of life. But in the Buddhist philosophy, there are four more stages of completion before one is finally really dead. And that can take hours or even days for the skilled practitioner. Report an error

4:48:21 So, for this reason, it's best not to touch the body after the last breath because the consciousness is still intact. And particularly not to touch the body below the waist. And the feeling for that is that at a touch, and of course the dying person is very sensitive, the touch may encourage the consciousness to exit from that point. Report an error

4:48:50 As you may know about the energy system and the chakras and the lower chakras that are connected with elimination and sexuality, this type of thing. This is not the optimum place for the consciousness to exit. The optimum place is the highest. Shocker, the crown of the head. And that's why if the body must be touched, whatever the circumstances might be, then before it's touched, it's best to pull the hair on the crown of the head or tap the crown of the head. Report an error

4:49:24 And it's not here. It's further towards the back, just about back here, right near the highest point of the head. Report an error

4:49:41 Also, as Tenzin Chogky said before, of course, if... The body is on dry ice and is freezing, then the consciousness might be attracted towards cold and that will direct the rebirth into a cold hell. Report an error

4:50:02 And in the same way, if somebody dies with anger or attachment, that's going to affect. The course of their rebirth. And so this is the reason it's important to not have emotional scenes, hysterics, sobbing, histrionics, particularly grasping at the body because who knows where they're going to touch. Report an error

4:50:27 And that's especially so of all the friends and relatives encircling the body and everyone having a hand on the part of the body that's in front of them. Report an error

4:50:38 And I mean no disparity here, but this is a very new age, highly desirable thing to do, is to encircle the body and everyone touching, the feet, the legs, the belly, like that. And in the Tibetan Buddhist philosophy, this is highly undesirable to do that for the reasons that I've just explained. Report an error

4:51:01 Now this doesn't mean, as Tenzin Chogky said earlier, that grief is not appropriate. And sobbing. I mean, when my mother died, and I was not close to her, but when she died in a coronary care unit, and she had been in that unit three days after her heart attack, her death was expected. But even so, when they told me that she had died, I just... Report an error

4:51:28 Completely spontaneously I burst into tears. I wasn't in the room. I was in the waiting room. And, I mean, it's normal to do that, and people are going to do that, and then they should just be gently ushered into the next room. And, of course, in Tarahum, we've trained our volunteers to care for the family at the time of death, as well as what needs to be done for the resident. Report an error

4:51:52 And, actually, we, as I said, we keep learning from each. And what we have just recently decided to do is that when the death is imminent to make sure that there are two volunteers there so that somebody is totally assigned to be there for the family and others with the body and calling the people that need to be called and so forth. Report an error

4:52:17 So just not at the bedside. Report an error

4:52:26 So a stupa. A Dharma text or other holy object should be placed above the crown of the head. And what we usually do is put a stupa on the pillow. But at other times we've also used a text. And what I've just chosen to use is liberation in the palm of your hand. Report an error

4:52:49 And then I mentioned about the special mantras that are placed on the chest and that goes to the mortuary with the body and instructions would be given to the mortuary when they pick up the body that that sheet of mantras is to remain on the body through the cremation or burial, whatever, that just stays with the body. Report an error

4:53:12 Sometimes... In certain situations, or if a Lama suggests it, that a blessed pill is placed inside the mouth before the body goes to the mortuary. Report an error

4:53:26 Or it's stuck to the crown of the head with a bit of butter or ointment of some kind. And sometimes there's a situation where sand that's been obtained from a Kalashakra mandala after it's swept up, sometimes that's placed on the crown of the head, again with ointment or butter. And in Tarahome we have an envelope of Kalashakra sand. Report an error

4:53:52 The five great mantras we've already referred to that are on that sheet of paper, along with the Medicine Buddha practice, and then other prayers or practices that are advised hopefully by your own Lama or by whatever spiritual attendant is there. Report an error

4:54:09 And in our pre-admission visit to every Tarahum resident, we tell them several things about why we're there. We are there to help people die. A peaceful death. Now, what Lama Zopa has told us is a peaceful, happy death, but we don't say that to the general public because nobody believes you can die in a happy state of mind. Report an error

4:54:36 We don't say that. It freaks people out. But that is part of our mission, a happy, peaceful mind, to say Buddhist prayers at the time of death, and we tell the prospective resident, These prayers do not need to be said at the bedside if that's not your wish. They can be said in the next room or in the temple. We don't even use the word gampa. Report an error

4:55:01 In the temple. They don't need to be said at the bedside because furthermore, we will assist you in getting a clergy person of another faith if that's what your wish need is. Nobody has ever requested that, but it's our job to offer that and to provide that. If that's what they want or if a family member wants that. And we made a big mistake in one case a couple of years ago. This is what I'm saying. Report an error

4:55:30 We learn in each case. So the person had died and this was a lapsed Catholic elderly gentleman who was Portuguese. The only member of the family that wanted to come and make a visit right after the death was his son. The wife and the daughter didn't want to see him in death. They didn't want to remember him that way. But the son wanted to come, and he came. Tenzin Chogky was in her retreat at that time, and there was a visiting Swiss nun at Land of Medicine Buddha. Report an error

4:56:07 By the way, not all monks and nuns are interested or feel suited to be the ones to do the prayers and practices, and for whatever the reasons are, they are not interested nor willing to be called. But this particular nun was very interested in being part, and she was at the bedside doing the prayers. Report an error

4:56:31 And there was the volunteer that was on and the director were doing prayers along with her. And the son came and he came into the room and he saw what we were doing. And somebody said to him, would you like us to leave? And he hesitated and he said, no, no, that's all right. You just go on. And he stayed for 15 or 20 minutes and then he left. Report an error

4:56:56 And we realized that we had seriously... Erred in not giving him some time alone with his father's body to say goodbye. And it's our responsibility to get up and just go in the other room and make sure that any family member that's there has their time with their person. And we felt really awful about it for quite a while. But from his side, he didn't have that chance to say his private goodbye. Report an error

4:57:26 And that's very important to survivors. Unless they're saying the prayers right along with you and that's their tradition as well. And it's nice too if you can develop a relationship with the person's family if you are in that position to ask them what they want. The person who was there for six months, I'd grown quite close to her young son who was her closest relative and came to see her all the time and I said, You know, know what you want when your mother's last breath. Like, who do you want there? Do you want us all down in the meditation hall? Do you want us up here? And he goes, I want you here with me and everybody else can go down. Report an error

4:58:04 You know, I just want it to be you and me. And I said, that's okay. And then I let everyone know. And so a lot of the volunteers who'd looked after her for six months, so she had these close relationships and about ten of them showed up and did practices down in the meditation hall. And at a certain point he and I... Report an error

4:58:20 Went down with some of her belongings and a picture of her and kind of set up an altar in front of them. And then we went back up with the body. So if you have that kind of rapport with the family, you can just kind of ask them, you know, do you want me with you? Do you want me in another room? Do you want me out of the situation altogether? And that's really nice because then it can just be exactly the way they want it to be. Report an error

4:58:42 But as we've been saying, you don't always have the luxury of time. In many situations, including people who are dying of cancer, there's often abrupt changes at the end, and things change very fast, things move fast, and there's not the time that you would wish for the communications to take place. And particularly, we often get people two, three, four, five days before they die, and we're hardly... Report an error

4:59:11 We hardly have everything in place when the death happens. And each day they're declining rapidly, so there's big physical changes every day. And it's not what one would wish, but it's the norm. It's more the norm. So there's not that luxury. And each and every situation, each and every death is different. Report an error

4:59:31 Each and every death. So it's not possible to make hard and fast protocols of any kind. That's why there's no one right way. There is no one right way. And if your motivation and your attention is to benefit, there's no wrong way. Report an error

4:59:51 No wrong way. So you're not going to fail, just like Bonnie was worried about. You're not going to fail at this. Report an error

5:00:07 Yeah, that's it. That hasn't happened yet, but I don't know. Report an error

5:00:15 So, in summary. know. Report an error

5:00:18 What Lama Zopa has stated again and again, that when you're in attendance with a dying person, the very best thing is for you to have a good heart, a peaceful state of mind and a wish to benefit others. That's the most important thing. And if you're the dying person, the most important thing is for you to die with a state of mind that wishes to benefit others. Report an error

5:00:48 That's the most important thing. All Lamas will agree to that. Report an error

5:00:55 So are there any questions about what we've just briefly covered? And more details are in this book. As I said, you know, there's a whole front section that's advice from Lama Zopa Rinpoche and then the rest of the book is the specific practices that he recommends doing. There's also a lot of... Wonderful advice in Sogyo Rinpoche's book, The Tibetan Book of Living and Dying. So a lot of this advice that we've just given you is repeated in these two sources and other sources as well. Report an error

5:01:31 And we also have a handout of this. We changed things around and I didn't bring the handout down, but we'll give you a handout for tomorrow. We'll have you a handout of this last section. Sorry about that. And one more thing, and I just thought of this this moment, so Tenzin Chogky doesn't even know what I'm going to say. Report an error

5:01:47 I'm at liberty here. But I never do anyway. Well, this is the second time we've done this course together and I just have the feeling that we'll do it again. And I already realize that we haven't enough time to cover all of this properly and that there are so many questions and there's always so many questions. Report an error

5:02:04 So we don't have an evaluation form made out for this course. It would be helpful for us if... When you're going home tonight and when all this is settling in and then tomorrow, any feedback that you have for us of what worked, what didn't work and what could be added to make it better will help us as we further develop. Report an error

5:02:28 And I am aware that we could use a little more time. Already. You know we've skipped a whole section just because we didn't have enough time for what we've done already. But we made up the curriculum. And yet it's your questions that are so important. So we have to have time for that. Report an error

5:02:54 I was just wondering on that note if maybe the people in the class could come to some agreement about what time we wanted to end tomorrow then. Nine o 'clock is as early as we can start. No, end. Because she always said, you know, because it's three. It's meant to be 3 o 'clock. We've gone over today already about 15 minutes, and I apologize. I like to try and keep to the time agreements as much as possible. Report an error

5:03:21 If people would like more time tomorrow, I don't know if there's a consensus. Is that what you're suggesting, that maybe add a bit of time tomorrow if people are open to that? If people are open, the room is available. Report an error

5:03:36 Maybe a show of hands, would people like, okay, how about, let's ask it like this, are people flexible if it feels that there's material and we need to go over, let's say, till four? Do people have that flexibility? Great. Okay, many, most, everybody? Betty? She's working tomorrow. Oh, you're working tomorrow. Okay. So does anybody who's intending to be here tomorrow not able to have the flexibility of an extra hour? Report an error

5:04:03 Okay, well, great. That's very helpful. Oh, you do. Okay. You have to leave at noon. Okay, so we'll maybe see how it goes and if we need that extra hour for discussion because that seems to be the most useful. Yeah. Report an error

5:04:21 We, yeah, we should be able That's a good idea. Report an error

5:04:30 That's a little hard. I personally kind of need a break at lunchtime, but we could shorten it to maybe an hour. We could shorten it to an hour if that would work for you. Take questions together. I mean, eat together... Report an error

5:04:40 Okay, so what we're going to do, I want to just go over the schedule for tomorrow and then we'll just dedicate the merit just to review. What we're going to do first thing in the morning is go over those stages of death that we spoke about, both for your own practice to become familiar and also to be able to recognize when they're happening for people that you're taking care of is important. Report an error

5:05:01 And we'll do that as a, I'll go over them theoretically and we'll also meditate on those. And then the second morning session was meant to be the four opponent powers and Lama Zopa Rinpoche's instructions, which we've just done. So I think what we'll do for that session is the five powers at the time of death. We haven't done the four opponent powers yet. I'm not quite there. So what we'll do is the session that we're going to do at the end of today plus the four opponent powers since we've already gone over Lama Zopa's instructions. Report an error

5:05:32 Then in the afternoon, What we'll have left is details about the ashes and the kind of post-cremation rituals, which we can go over quite quickly, which would leave us time for discussion. And then a final meditation, again, on another practice that you can do on your own at the time of death. Tomorrow will be more about practices that you do to prepare. Report an error

5:05:58 That's going to be much more of the focus of tomorrow's. And then we can go up till four if people have some discussion and so forth. And so we'll prioritize more discussion in the afternoon and then this one final practice and just a few details about the post-cremation. And it's very likely that questions will occur to you tonight. Report an error

5:06:20 Yeah, write them down. Like if, you know, whatever comes up for you in terms of both feedback about how, you know, what we could need to give more time to. And also at the end of tomorrow, hopefully if we have a little more time, we can have time for verbal feedback about, you know, the order, what was useful, if things were confusing because we talked about them today and we could have rearranged the schedule. Report an error

5:06:43 So any of that kind of feedback, by all means, please. And I'd like to say one more thing. On a practical level. Which is that your mind may be reeling from everything you've heard and experienced today. And be gentle with yourself tonight. Be very kind to yourself tonight. Eat what you like. Take a bath. Report an error

5:07:07 Talk to a friend. Just be gentle with yourself. Because this may really have just pushed buttons and stirred the pot. You can expect that. And that's why I said you're very brave. So, and whatever questions come up, do write them down so we can continue. Report an error

5:07:27 Okay? So let's just take a minute to sit and just, Report an error

5:07:40 at the end of any Buddhist practice we do, just as we set the motivation at the beginning, we dedicate the merit, dedicate all of the virtue. So let's just think of all the positive energy that we've accumulated today by spending the whole day trying to prepare our minds, Report an error

5:08:04 trying to get skills and techniques and information to be able to help the people that we're taking care of through their death process and to help to prepare for our own. Incredible, to spend a whole day in this culture that denies death so strongly. To really face it, as Lenny has said, we're quite brave to be doing this work. So much virtue. Report an error

5:08:33 So let's take that virtue and put it towards our future enlightenment for the benefit of all beings. Take that incredible store of virtue and just aim it, direct it towards our future Buddhahood, our future enlightenment and not just to be free of suffering for our own sake. But for the benefit of all beings. So let's just take a moment to reflect on that. Thank Report an error

5:09:19 you for your bravery and your attention. And we'll carry on tomorrow at nine. And if people could kind of arrive on time and, you know, with time enough to park, I have no idea what the parking is like on Sundays here, but be helpful to start as close to nine as possible. Thank you. Report an error

5:09:53 want to leave Yeah, so that's where the next one's in Thank you very much. Thank you. I'm sorry that I have to leave tomorrow. Oh, too bad, yeah. So if there's any documentations that I should be bringing them with me, could you make a copy of the card by 11pm? Yeah, we got all of the copies now, so we can get those to you. Report an error

Report an error

Passage at . Please listen to the audio before you suggest a fix.

Suggest a fix

Passage at . Please listen to the audio before you suggest a fix.

Related talks

  1. Dying Well Weekend (4 November 2007)

    Tenzin Chogkyi · 4 November 2007 · 5 h 14 min

  2. Discovering Buddhism - Death and Rebirth (6 November 2007)

    Lobsang Chokyi · 6 November 2007 · 1 h 43 min

  3. Discovering Buddhism - Death and Rebirth (13 November 2007)

    Lobsang Chokyi · 13 November 2007 · 2 h 8 min

  4. Sunday Morning Service (10 August 2008)

    Tenzin Chogkyi · 10 August 2008 · 1 h 43 min

  5. Introduction to Basic Buddhist Thought (3 October 2009, 2a)

    Tenzin Chogkyi · 3 October 2009 · 2 h 36 min

  6. Discovering Buddhism - Death and Rebirth (27 November 2007)

    Lobsang Chokyi · 27 November 2007 · 2 h 11 min

Talk by Tenzin Chogkyi, recorded 3 November 2007. Original at Tse Chen Ling Center for Tibetan Buddhist Studies via Internet Archive: https://archive.org/details/Dying_Well_Weekend_Ven_Tenzin_Chogkyi_Lennie_Kronisch. Licensed CC BY-NC-ND 3.0 US. Transcript generated automatically and may contain errors; the audio is the authoritative version.

Recorded at Tse Chen Ling Center, San Francisco, and archived by the center on Internet Archive. More from Tse Chen Ling

Listen on Internet Archive · CC BY-NC-ND 3.0 US