Saturday, August 4, 2012

"We're all going to be dead a long time," so live!

Ira Byock
I listened to the most beautiful interview yesterday -- a podcast of On Being with Krista Tippett interviewing Dr. Ira Byock who specializes in hospice and palliative care medicine.  He's talking about death as a developmental stage, and "dying well" meaning something like "dying whole, with relationships restored and at peace with your life..."   Here are some highlights:

Tippett:  You've identified four sentences, 11 words.

Byock:  Yes.  "Please forgive me." "I forgive you." "Thank you." "I love you."

Tippett:  No relationship is perfect and many are troubled, especially with our families, and these words, in a lot of families there will be real work in being able to say those things and mean them.  As I really thought about them, I wondered if there's something about being in that extreme moment of life -- as you say, normal, but ultimate -- that creates an opening for some people to do that work, when it hasn't been possible in other points of their lifespan.

Byock:  Exactly.  Exactly.  [Death, end of life, terminal illness, an serious accident] shakes us free of the veneers, the layers of personality, of who we think we are, of protecting ourselves.  Life threatening illness or injury, in a sense, makes Buddhists of us all.  Wakes us from this illusion of immortality.  It really shows us how much we care for one another; our connections with each other are the things that matter most.

Tippett:  I love this quote you have from Paul Tillich. You know, we carry superficial understandings of forgiveness,--forgive and forget-- but he gets at the complexity of this, when he says: 
"Forgiving presupposes remembering, and it creates a forgetting not in the natural way we forget yesterday's weather but in the way of the great In Spite Of that says I forget although I remember.  Without this kind of forgetting, no human relationship can endure healthy."
Byock:  Isn't that incredible?  You know, Lilly Tomlin, another great philosopher of our time, says that forgiving means giving up all hope of a better past.  She's nailed it. It involves accepting that the past cannot be changed, while seeing that it need not control our future....The choices is between protecting ourselves, which is out of fear, or keeping our hearts open.  Fear of being hurt, of being used up, fear of dying--all of those rational fears--is embedded within us, but we still can choose to keep our hearts open.  And often in so doing, what we do is so much richer and effective and growth-promoting for all of us.

Tippett: ...You're saying that we need to seize Death as a part of Life, as an opportunity for some of this incredible work to happen...Why is that so hard, why do we resist this?

Byock.  It's complex. We live in unprecedented times.  In the past, it was different; people died at home, women died in childbirth, of appendicitis, serious infections...these days those aren't that big a deal. We fix these things and people go on to live.  That's a remarkable, wonderful thing, life is precious, and we're all going to be dead a long time, there's no need to rush it!  ... We have these wonderful scientific tools; and we need to use and celebrate all of that.  But we also need to hold in our consciousness that we've yet to make even one person immortal.  We have to balance these two.  Celebrate life, but also think about what it really means to Die Well.

Tippett:  ...This term "dying well" doesn't sit easily in 21st c. vocabularies or imaginations.  Can you tell me a story to give me a picture of someone who has died well.  What are the contours of that?

Byock:  Alice, a pseudonym, comes to mind.  She was a 47 year old woman with an advance cancer who was admitted to the hospital. She knew she [was terminal] but she expected that she had several more months to live.  She was admitted to the hospital when her right leg became blue and cold and painful and she had a procedure to have a clot taken out of her leg.  I visited her on a Sunday, making rounds, alone, for my team, and as I came into the room, (I knew her from before), and we talked about her physiological stuff, and then I noticed this book of Rumi poems by her bed, and we read a couple together. And then on a whim, I shared a poem from memory for her:
You do not need to leave your room...Remain sitting at your table and listen. . . . Do not even listen. . . . Simply wait. . . . Do not even wait. . . . Be quiet, still and solitary. . . . The world will freely offer itself to you to be unmasked. . . . It has no choice. . . . . It will roll in ecstasy at your feet.
That's a poem by Franz Kafka, this great existentialist who portrays the world as cold and sterile, and yet here's this remarkably spiritual poem. And Alice and I ended up talking about fractals and chaos theory and randomness and she told me that she felt whole even in the face of loss.  As we were visiting, in the midst of this reverie, in walks her husband Tony. And she and Tony had fallen in love and married after her diagnosis, and had been together for several years, and was this remarkable love story.  [sighs]  As I left her room that morning, I have this image in my mind, of Alice and Tony beaming into each others' eyes, and for me, THAT is this whole notion of wellness.  There are two things going on -- dying and being well at the same time.  Even becoming MORE well during this process.  And also there was this sense of healthy defiance -- that they evinced this notion that their love for one another in the face of mortality is a statement that Love is stronger than Death.  Even death can't take this from us. To me, this is such an example of the fulfillment of the human condition in the face of death.

Tippett:  You've also said that one thing mortality teaches is that human life is inherently spiritual.  Tell me about that.

Byock.  Well, the confrontation with death lays bare the spiritual core of the human condition.  Death acts like a hot wind to strip away any pretense a person has for any sense of self and exposes our personal essence, our elemental core.  What I call spiritual is our innate response to at once awe-inspiring and terrifying fact of human life.  In many ways we're just all hurtling through deep space on this tiny rock we call earth, you think think about it, protected from the frigid galactic void of the Milky Way by a blanket of air, held on the surface by gravity -- whatever the heck that is!  [laughing]  And here we are!

Tippet: So with all this work you're doing, what do you think it means to be human?

Byock:  Well...It calls me back to realizing that every moment is sacred, if I have the presence of mind and the openness of awareness to recognize it. ... I'm aware every morning as I meditate the challenges of that awesome consciousness.  And you can't do this work without recognizing that life is unbelievable in its history. It's terrifying and awe-inspiring, and truly awe-some.  My goal is to live as fully as I can in the present, and enjoy all of it, because we're all going to be dead a long time.

I couldn't help but compare this with another presentation I heard on TED, a talk by inventor Ray Kurzweil who is making a bid for immortality through the use of technology and hundreds of supplements/vitamins every day.  

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