Serving The Ill And Dying

I began working as a healthcare chaplain in 2005, the same year I was ordained in the Order of Interbeing.  For those unfamiliar with the role, healthcare chaplains help patients cope with their changing lives using the patient’s own language of meaning, whether that language is religious, scientific, philosophical or based upon their life experiences.  This requires the chaplain to listen with compassion and respond appropriately, without proselytizing the chaplain’s own beliefs.  My chaplaincy and OI practices have grown and supported each other over the years and I’d like to share some insights into how they work together to help me serve the ill and dying. 

Precepts

Thay’s poetic and deep rendering of the 14 Mindfulness Trainings have been a constant source of inspiration, support, and correction for my chaplaincy practice.  I’ve recited the precepts every other week since becoming an aspirant, and with each recitation the precepts reveal something new, guiding me back when I’ve strayed or reminding me that, contrary to self-judgements, I’m doing ok. 

While all the precepts have at one point or another enlivened my chaplaincy, I’d like to mention a few that come up again and again. 

Community and Communication:  The hospital, cancer care center and hospice where I’ve worked are staffed by good people working under tough conditions.  Most healthcare workers hope to make a difference, yet their good intentions are sometimes overwhelmed by productivity goals, administrative tasks and interpersonal conflicts.  I’ve witnessed and experienced the compounding grief felt by care providers as patient after patient arrives, declines and dies.  When these care providers are not given the skills and time to cope with their accumulating losses they sometimes create toxic work environments by lashing out at each other. 

Our 8th precept reminds us to resolve all conflicts, however small.  This has challenged me, particularly when I’m overwhelmed by my own grief and have trouble seeing my contribution to the problem.  When I’m able to stop and listen to my coworkers, we can resolve problems together.  But there have been times when I’ve not done this, when my pride has prevented me from listening to someone I ‘know’ is wrong, and so I create suffering.  This precept frequently invites me to look at the views I hold, to question my openness, to see my own suffering and to be honest with myself about my own unrecognized feelings. 

Reverence for Life:  A hospital patient once asked if our conversation was confidential, to which I replied ‘Yes.’  He then told me that he planned to kill himself after leaving the hospital.  Despite our 12th precept reminding me not to kill or let others kill, the confidentiality I’d promised this patient seemed to be pulling me into collusion with suicide.  What to do?  In another example, people with a terminal condition in the State where I live can legally end their lives with prescribed medication.  I’ve supported and been present with many people who’ve made this choice.  Does this violate my precepts? 

Buddhists are increasingly becoming healthcare chaplains because our practice invites us to face death squarely.  As a society, we deny death by professionalizing its care and hiding its reality behind institutional doors.  Those who are able to transform their own relationship to death become valued caregivers, and since our practice fosters this transformation, Buddhists are increasingly important members of the caring professions. 

But this also brings us disproportionately into contact with dying and asks us to counsel patients from diverse backgrounds and belief systems.  Whereas most people face a few deaths over their lives, healthcare chaplains face many deaths each week.  The 12th precept invites me to remember that birth and death are two sides of a coin, inseparable realities that inter-are.  By witnessing this interbeing, I can provide a calm presence to ground patients and families during the turbulence of dying, one that isn’t swept away by a grief that sees only loss.  And in those situations where I risk being accessory to death (such as in the examples above) I return to the spirit of the precept, which is to refrain from killing in order to foster understanding and compassion.  By grounding myself there, rather than in fear or loss or legalistic interpretation, I trust that I will know what to do when difficult situations arise. 

Dwelling Happily in the Present Moment:  Being present for loss is hard work.  Yet healthcare institutions often dehumanize, demoralize and exhaust workers, leading to burnout and cynicism.  In this environment, dwelling happily in the present moment isn’t a platitude, it’s a necessity. 

When I worked at a hospital, I asked my physical surroundings to help me dwell happily in the here and now.  I asked the carpet outside my office to remind me that, even when I’ve just jumped up to respond to a high-adrenaline ER page, I can simply walk:  One foot; another foot; slowly receiving the carpet’s calm energy.  I asked the shining nickel plated handles on patients doors to remind me to stop, breathe and feel their cool stillness before entering, which helped me remember to look deeply into who I was visiting and why. 

But when I began working at hospice, I lost the companionship of my hospital surroundings and instead spent my days driving from house to nursing home to trailer park visiting people where they lived.  It took some time to find new mindfulness companions willing to invite me back to my breath.  And in that time of forgetfulness, I suffered.  I felt more overwhelmed, more exhausted, less able to offer care from the Self that is beyond self.  I learned that dwelling happily in the present moment not only helps me, it helps those I serve.

Days of Mindfulness

Chaplaincy training is built upon an action/reflection model.  We engage with patients and then set aside time to reflect on that engagement, often with the help of peers who wake us up to nuances we may have overlooked.  Thay set up a similar model when he created the Order of Interbeing.  To support Order members who spent their days serving in the war-ravaged villages and countryside, Thay asked them to return home for a weekly Day of Mindfulness.  He knew that without this day of rest they could not sustain their work.

Order members agree to spend at least 60 days a year in mindfulness.  This is sometimes a barrier for those considering ordination.  We live in a busy, efficient society and some wonder how this ‘indulgent impractical down time’ could ever fit into their lives.  I remember wondering how I could ever justify ‘days off’ to my wife and family given their commitments to working 50 hard long weeks a year.  Now, after practicing this way for many years, I can’t imagine living sustainably without it. 

My weekly sabbath has to come first.  I work at most 4 days a week (more recently 3) and consider my Day of Mindfulness off-limits to other commitments.  It requires good boundary setting as request after request arrives from people who’ve learned I have a ‘free day’ that I could use to benefit their important causes.  I carefully consider which of the day’s activities water seeds of renewal and which drain limited stores.  I ensure that the day nurtures my mind, body and spirit.  I’ve felt strong societal habits working to undermine my weekly mindfulness day, but as with all our Order’s practices, this feels vital and so I continue.

Sangha

The Buddha once told Ananda that admirable friendship is the whole of the spiritual life.  That certainly accords with my experience, both with chaplaincy and with the Order.  We can’t do this alone.  We are not separate selves.  Despite our cultural emphasis on individuality, we are one with others in a deep and profound way. 

Order members build Sanghas both to help others and to make our own practice possible.  When we create and sustain Sanghas, we make practice available for new and old alike and create brotherhood and sisterhood throughout the Fourfold expressions of practice.  But Buddhist organizations are not the only places to build Sangha.  The wider society can benefit from secular Sanghas that support transformation and service.  Sangha is very important to my chaplaincy practice.  I’m part of several groups that meet regularly to offer mutual support.  We practice deep listening, share our clarity and confusion, learn new skills, and marvel at the creativity called forth from diverse chaplains serving myriad settings.  These chaplaincy Sanghas offer concrete support in a way that theories or books cannot, and mirror the way Order members make the practice real for those we lead by speaking from our experience rather than our ideas. 

These are just a few of the Plum Village practices that support my chaplaincy.  Long retreats, Touching the Earth, Beginning Anew, chanting, sutra study, mentoring aspirants and other practices also play vital roles.  If I look deeply, I can’t separate my OI practices from chaplaincy:  They arose together and continue to support and express each other.  OI practice gives rise to chaplaincy and chaplaincy gives OI practice a concrete expression.  In Thay’s familiar words, these paths inter-are.

  • Jon Prescott – True Recollection of Radiance

8 thoughts on “Serving The Ill And Dying

  1. Jonathan Prescott Post author

    Hi John – I’m glad you enjoyed the post. My hope is to encourage others to share how practicing within the Order gives them tools to engage the world.

    Reply
  2. Joann Trinh

    Hello Mr. Prescott,
    Thank you for taking the time to share this. The world is a better place with you and your constant practice of compassion and mindfulness. You are truly a continuation of Thay. A lotus to you Buddha to be.

    Reply
  3. Stephen Pradarelli

    Jon, thank you for the care you provide, and for your honesty in this essay about the challenges of giving flesh to the beautiful bones of the 14 Mindfulness Trainings. Today is my own Day of Mindfulness, and I feel deeply nourished for having read your writing.

    Bowing,

    Stephen

    Reply
  4. Minh

    I believe everyone should know for certain that they left something permanent in this life.

    Do you see it this way as well? I want to work with your group to get insight into this.

    Reply
    1. Jonathan Prescott Post author

      Thanks for your comments, Minh.

      Since you asked, I’d like to suggest we wonder whether there is anything certain or permanent in this life. Many of us spend our lives pursuing these elusive qualities, but my dying patients often tell me that this has been in vain. The ground they thought was solid is now falling away and they see that uncertainty and impermanence have been their companions all along.

      Knowing that all things are impermanent can be liberating. It brings the preciousness of life clearly into focus and helps us live freely in the present. We no longer try to make permanent that which naturally changes and feel more gratitude for the people, objects, and situations right before our eyes.

      If there is anything permanent we leave behind, maybe it is the results of our thoughts, words, and actions. We create conditions in our lives based on what we allow our minds to think about, what we say to others and how we behave. We can see that our actions impact us, but since everything is interconnected, we can also see that they impact others, even after we die. But this can also be liberating because it means we have the opportunity to create lasting beauty by thinking, acting and speaking with kindness.

      I wish you well in your explorations of this important topic, Minh.

      Reply

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