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Death, dying, and the Dharma

To the city’s credit, and in particular thanks to its gay population, San Francisco responded to the “gay plague” with courage, compassion and even humor. The city seems to understand that we all live on a fault line, regardless of our personal characteristics. After being in San Francisco for six months I wanted to play a part in the city’s response to AIDS, and I found myself applying to be a volunteer at the Zen hospice.

Although some of us will die suddenly, many of us will at some point require a place to die. A hospice is a place for the dying, an alternative to hospital when medical science has given up. To be admitted the client agrees that no further medical intervention will be administered, other than for the relief of avoidable suffering. Many of those who have occupied the beds behind this door for a few days, weeks or months might well have died on the streets if they had not found refuge here. Most of the guests are men dying of AIDS.

I hear Tod (the nurse with whom I share my shift) coming down the stairs. He opens the door, welcomes me and explains that Keith has just died. It was strange coming each week to this house of death. Whenever I stood on those steps and rang the bell I felt a disruption in my guts as I wondered who would be left in the house. I tried to rationalize those feelings in a Buddhist way, as insights into impermanence, but fear would have been nearer the truth. It was good for me when I was drawn out of my fear of death into the intricate web of relationships that were forever forming and dissolving in the house.

Often I was unable to be in that state of grace. Most of the time I felt inadequate and clumsy. Sometimes I felt numb, as if my emotions had retreated. There is something frightening about caring for the dying. When I felt fearful I would try to remember how Frank, who was then the hospice director, replied to our anxious questions during our training: “What’s the worst that can happen — someone dies?”

The first time someone dies with whom you’ve made a connection is a rite of passage. You realize that the more you come into relationship with the terminally ill the more you will grieve at their passing.

In my time as a volunteer I never felt that I was up to the task of caring for the dying. I was not good at making small talk. I never found the right words. The platitudes you resort to when visiting a friend in hospital — “Don’t worry, you’ll be back on your feet in no time” — are inappropriate in a hospice. I was most comfortable with those very close to death. Between life and death, they existed in a twilight world, drifting in and out of consciousness. Sitting without words, holding an emaciated hand, listening to the rasping breath. I found this situation easy to stay with.

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