Electronic Journal from Sakyadhita USA

Issue No. 16 Winter 2018

Mary Doane is a lead instructor of Mindful Caregiver Education and New Volunteer Training at Zen Hospice Project in San Francisco, CA, where she previously served as Volunteer Program Coordinator and was a volunteer bedside caregiver for over a decade. She is also a Compassion Cultivation Training (CCT™) instructor, certified by Stanford University Center for Compassion and Altruism Research and Education (CCARE). Ms. Doane has completed Buddhist Chaplaincy training at the Sati Center for Buddhist Studies in Redwood City, CA, and is a graduate of Mills College, Oakland CA.


No Self and the Use of Self

by Mary F. Doane


“Who are you when you approach the bedside?” When I pose this question to hospice volunteer caregivers, it is meant as a reminder that to bear witness at the bedside is to engage in a practice: that of serving ourselves as we serve others.


It may not always be what we intend, but it is unfailingly so: we find ourselves at the bedside of those who are dying.


Many things can compel someone to volunteer in hospice, as many as may draw us to chaplaincy. It might be the call to spiritual exploration, or the hope of becoming more accepting of one’s own mortality. Some seek inner balance after a difficult or traumatic experience. Still others show up to soothe regret, or to atone for what they felt was the needlessly stressful dying of a loved one. Some may wish to "give back", inspired by gratitude to those who tended to a dying family member or friend. And there are other reasons as well; really as many possibilities as there are people.


In all these cases, however, one thing is certain; the heart is involved.


Trusting the heart and following its lead is noble, authentic, and compassionate. Throughout the ages, poets, artists and mystics all have sought to express the heart’s wisdom. Trusting the heart is also essential for any spiritual practitioner.


If we seek to understand each facet of our motivation however, or to discover “who we are”, we must consider, along with the heart, the mind.


In words familiar to many students of the dharma, Zen Master Dōgen taught:


To study the Buddha Way is to study the self. To study the self is to forget the self. To forget the self is to be actualized by myriad things. When actualized by myriad things, your body and mind as well as the bodies and minds of others drop away. No trace of enlightenment remains, and this no-trace continues endlessly.


“To study the self is to forget the self.” This potent puzzle of a sentence reminds us that while the self is primary, it is a vehicle or a means rather than an end. In other words: let us seek to know the self, but let us be diligent as we undertake this effort, remembering that it is always for a larger purpose. We want to be so familiar with our own self-story that we no longer need it in order to feel whole, and can open our being to receive the world. This is the essence of No Self.


It can be tempting to view dying as a purely physical event, particularly in a clinical setting. Whether the dying person’s physical suffering is acute or relatively mild, inevitably, their self-identity is what undergoes the greatest change. For most of us, the end-of-life journey will be one of adjusting and readjusting to self-identities as they rapidly fall away.


To glimpse this, recall a time when you were ill, or injured - you had the stomach flu, a toothache, a broken bone. Remembering your physical discomfort, perhaps you will also recall a feeling that you were not wholly yourself. Do your body and mind remember waiting and hoping just to get back to normal? That sense of normalcy is a construct of self. If you have been a hospital patient, you likely know this loss of self well: the freedom to choose what you wear and eat, when you sleep, to whom you talk and when, your boundaries for physical contact; all these are taken from you, for a time.


Our abilities, our autonomy, these are the stuff of who we know ourselves to be. A dying person must navigate the ever-shifting contours of an unstable landscape and when we sit at the bedside, we must navigate them too. When we register these changes as diminishment, they cause us to cling even harder to what is falling away. A dying person is likely to be struggling to retain, or return to, self-identities that are dissolving at a dizzying pace. The suffering this struggle produces is, for many dying people, the greatest they will endure.


Paradoxically, as we serve in hospice, we step towards wholeness. It is a wholeness made possible as we open to the struggle and loss happening before us, and allow that we are subject to the same losses. Opening to what is present, with a willingness to hold all that we find in equanimity, rejecting none of it, are practices that allow our healing and wholeness to emerge.


Perhaps even now in your own mind as you read this, objections and protestations arise. “What kind of healing could there possibly be, someone’s life is ending?” you might think, or “How selfish to just sit there practicing equanimity while someone is in pain.” I am not suggesting that we do nothing to respond to the needs of a dying person’s body, spirit and mind, nor I am suggesting that we are not vigilant in adapting to how those needs change – pain, fear, confusion, anger, despair – all these and more require skillful and agile responses.


But I am referring to a more subtle level of response, one that requires no skill beyond that of being human. While volunteer caregivers and chaplains may have the luxury of being mostly free of a clinical to-do list at the bedside, every nurse, physician and social worker can cultivate an essence with which they carry out their duties. To be with a person and not need nor even wish that they be different, is to draw upon the wisdom of no self. No self knows that we lack nothing, that we are not diminished, even as death approaches.


When I ask my original question, “who are you when you approach the bedside”, the intention is to bring awareness to the ways, as caregivers, we bring our ideas of right and wrong, of acceptable and unacceptable; essentially our preferences and biases, with us to our hospice service. And to highlight how these preferences stand in the way of healing. I want to take a moment here to state that there is no fault or failing in a volunteer who brings her biases. There is no other way. We are all human. As we investigate these mental formations, by taking the “backwards step” of a moment of self-awareness, we can begin to see how they influence our feelings and responses.


Take as an example a hospice patient who is in denial about the advanced stage of his illness, which happens to be cancer. His medical chart and records clearly state disease progress and metastases. He arrives at a residential hospice with a hefty inventory of foods, herbs, supplements and supplies to maintain the regimen of healing rituals and the precise diet he has been devoted to for several months prior. He is consumed with activities he believes are keeping him alive and may yet cure him of disease. He requires assistance to perform all his activities, and maintain a rigorous schedule. He is very direct about whether those offering support and preparing foods and tonics are doing so correctly or not.


Such a patient can elicit an array of responses from volunteer caregivers. Some will criticize the patient’s insistence on keeping up his practices, which they view as evidence of his willfully unrealistic view of reality. Others may feel he doesn’t appreciate their presence and kindness when he instructs them to do things in such an exacting way, or simply tells them to leave if what they did wasn’t just so.


None of this is unusual, but it is avoidable. If we, as caregivers, are blind to our biases and preferences – in this case about how accepting one should be of a terminal diagnosis, or how obliged we are to be gentle and warm toward anyone who cares for us in a place we have no wish to be – and thus blind also to how those preferences give rise to ideas about what is right, wrong, good, or bad, then we close off the healing spaces no self can open.


If instead we are able to recognize our preferences, able to know the self we ride through this world, we then can name her and set her aside for at least a time, while we invite no self to the bedside. When we stop looking for anything to confirm or refute, we can fully meet the dying person before us, and fully meet our self as well.


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