I write as a physician, not as a moralist, but any physician working in modern civilization cannot help noticing our cultural deafnss to the wisdom of the body. The path to health, for an individual or a society. must begin by taking pain into account. Instead, we silence pain when we should be straining our ears to hear it ...

- Dr Paul Brand

the gift

By Gilles Bédard

Christine Longaker has been a student of Sogyal Rinpoche (author of The Tibetan Book of Living and Dying) since 1980, and served for nine years as the principal coordinator of Rigpa Fellowship, the association sponsoring Buddhist teachings under Rinpoche's guidance in the United States. Her direct experiences of caregiving, and of healing her grief after her husband's death twenty years ago, led her to become a pioneer in the hospice movement; she helped to establish the Hospice of Santa Cruz County in California, and became its president.

Since ceasing her hospice work, Christine has given hundreds of training seminars on the care of the dying throughout the United States, Canada, and Europe. She has taught college courses on death and dying, provided training for nurses, ministers, and hospice caregivers, and counseled the dying and their families for many years.

Currently, she is working closely with Rinpoche to develop the comprehensive education and training program Spiritual Care for Living and Dying, which applies the compassion and wisdom of the Buddhism teachings to the needs of people today: living, dying, and bereaved. In addition to Christine's seminars, the program supports a growing network of study and practice groups for health-care professionals who are integrating the teachings into their life and work.

Q: You wrote in your book - Facing Death and Finding Hope: "In truth, facing illness, suffering or death is a fall into Grace." How can we see death as a gift, a very special gift, indeed?

A: We often go through life half-asleep.

We don't really know what we are doing, or what we want to accomplish.

We haven't clarified what our values are.

We often take our life and our relationships for granted.

We get lost in so many distractions and interesting things.

We always have a sense that there's something important and special about life and even about death but we fail to really take the time to look at it.

And normally, from that point of view, when we fall ill, go through some sort of crisis or are facing death, we think that this is the worst thing, that it's a tragedy. But if we keep our mind open when we enter an experience that I would call "falling out of the healthy world", we can ask ourselves:

What benefit can this bring me? Can I find a gift in this illness?

I don't believe there is a gift or a lesson already given in suffering. But if we ask ourselves: How can I learn or grow, even as I go through this change or this loss, we often find very unexpected wonderful treasures that come to us.

We realize how precious every day and every relationship is, how important our choices are, how important it is to remember our true values and really make the time to live according to them. And as we do, we find a richness and meaning that we hadn't even suspected were there before.

Q: You also said "Pain is inevitable but suffering is optional". What is the difference between the "unavoidable suffering" and the "unnecessary suffering" we experience through our life?

A: Because we are born into this life, we obviously will have experiences, for example, of physical changes and suffering, in the process of aging or with illness or even with a very dramatic accident. We can experience discomfort and even a massive amount of pain. As we are facing death, our body begins to deteriorate and we lose our power to do the things that we enjoy in life.

None of this is personal, it's not happening to us as some sort of punishment or as a sign we have the wrong kind of personality, because in fact, suffering is universal. Every human being goes through unwanted physical pain as well as the deterioration of aging. All of us experience losses in which we either don't get something we want or what we most cherish is taken away from us, for example, when the people we love leave or die. And this is not easy to go through but it's part of human life.

What becomes unnecessary suffering, the optional part of that pain, is if we don't learn from the losses that we go through in life, if we continue our old habits of grasping, or neediness, feeling that we have to have certain things in our life to be happy, then we build for ourselves inescapable cycles of suffering that keep us going round and round.

Our needs can never be satisfied and even if they are, it's only temporary. Everything that we grasp after eventually changes, dissolves or dies; thus we keep setting ourselves up for disappointment, pain, anger and hurt.

Yet experiences of suffering can open doors for us, and help us to see there is another way to approach life besides cycling from grasping to loss and disappointment.

Instead of looking to the external world for lasting happiness and peace, we can turn our mind inward and discover the part of our being that is beyond change, loss and grief - our skylike essence that is already whole, peaceful, radiant with compassion and love.

Then the losses and deepest pain in our life can become a gift, propelling us forward in our spiritual path and helping us feel richer as we go through life, because we become more and more free, at ease, and naturally happy.

Q: How can we change our suffering into a positive action and see the possibility of liberation in our life?

A: When we are in the midst of very great suffering, sometimes it is hard to get another perspective, to find a feeling of spaciousness or kindness towards ourselves as we go through the suffering. But in fact even though it's hard, we must find a way to do it. Otherwise we just become more contracted and more frightened as we go through our life, resisting and having an aversion to the different changes and losses we go through.

So, what I found helpful in my own life was to approach through meditating, through listening to teachings, through talking with friends, always keeping this question in mind: "How can I understand my suffering in a different way? How can I shift my perspective and find spaciousness, freedom and peace again in my being?"

If we really keep asking this question and try to learn from life experiences, from stopping and spending the time to just look at a beautiful flower or sit on a hillside gazing into the sky, we start to realize that there are other possibilities.

We can let each moment of joy nurture us and remind us that there is another way to approach life. And slowly, when we keep these questions in mind, more and more gifts come into our life that will enrich us and help us to find a spiritual path.

Q: You started your spiritual path through a dramatic event, the death of your husband. Could you tell me about it?

A: In a sense, that was a perfect example - when you get really stuck and there is no way out - then sooner or later, you have to open yourself to realize that there is another reality, another way to see the meaning of your life and go through it.

When my husband was first diagnosed with acute leukemia, we were both very young, I hadn't had any direct encounters with death before and I realized that we were facing the very real possibility of his death. I remember thinking to myself that all I ever heard about death is that it is something very tragic and unfair, it's the worst thing that can happen to you. I said to my husband, "If that's all that death is, then no matter how long you have to live, we're just going to be in this tragic story and we're going to feel helpless and victims of our circumstances."

Neither of us, at that time, had a spiritual path, but I remember saying to my husband, "I don't know exactly what death is or if there is anything after death but maybe we can try to view the fact that we're facing death as a gift in our life."

So, even though it seems like a huge package of unwanted suffering, if we view death as a gift maybe we can find out what the gift is. We didn't have an answer at the beginning. But we knew that we had been taking our lives for granted, not communicating well in our relationship and not really appreciating that our life had any meaning or direction.

By deciding to view death as a gift, even though during that year we still had a lot of suffering, we made mistakes and often still hurt each other unconsciously in the things that we did, we had to work through those mistakes very quickly. We had committed to our intention to change and live in a more meaningful and loving way.

So, just changing our view point about death was an incredible gift for us; even the mistakes that we made became gifts because they forced us to connect with our love and communicate more genuinely.

At the time my husband died, I felt that part of the relationship was complete, that we had done the best we could. Even before he died, we were able to apologize to each other for the hard times we'd given each other and also express our gratitude for the year that we'd had, the love that we'd shared and how much we had grown. So when he died, I felt very peaceful and I could really let him go with all my love because I knew we had lived his last year of life really well, even with its mistakes.

At the same time, I sensed that there was another, deeper dimension to death, and that something important was happening in that transition. And I didn't have a clue what to do for him, how to support him spiritually, both before and after he died. My desire to understand the deeper dimension of death launched me into doing hospice work as well as finding an authentic spiritual path.

Q: You mention an aspect which I found very significative: "Gazing continually into the mirror of death during the year of his illness encouraged us to find and commit to a meaningful direction in our lives. Rather than feeling we were helpless victims, we committed to creating the kind of life we truly wanted in our final year together. This change came about in the way we decided to view death on that very first day in the hospital."

A: It is making that commitment to life. That's what I found beautiful in this quote by Brother David Steindl-Rast: "You're not just given life, you have to actually choose life, you have to make a commitment to live and to find a meaning and a direction." And until you do, you're just half alive, you just feel like you're wandering around. I felt that way as a young person. I thought life was just to enjoy and to have fun. It didn't really matter what you did, what you valued. You could just fool around, nothing really counted.

But suddenly, when you are face to face with death, you realize that this is a really precious time, this chance that we have in our life is not going to last.

What we do in this life is very significant.

So, if we are already on a spiritual path, we can learn to see that everything we do in life is part of that path, every act, every communication and choice we make helps to form the meaning of our life. Every experience we have, whether happy or painful, and how we understand and go through our experiences is an expression of the ultimate meaning or destiny of our life.

As we become more aware of the sacred context of our life, we start to realize that even talking with a stranger on the street or washing dishes could be a sacred act if we do it with a motivation of compassion, with all our presence and awareness and authenticity. We need to establish this integrity in our mind and heart, seeing that everything we experience can become part of our personal and spiritual evolution.

There are many people who don't have a religious path yet have an intuitive feeling that there is a deeper dimension to death as well as to life. One way of making a deeper contact with the sacredness of life is to contemplate every morning on the suffering unfolding on a daily basis to so many people throughout the world, on the suffering we witness in our friends and family, and even on our own suffering.

As we contemplate on all of this suffering and allow it to touch our hearts, then we feel more of a connection to others, more compassion, more committed to making our lives meaningful and evolving personally and spiritually, so that we might be of service to others. So, that is another way to begin experiencing the sacredness of what we do.

We can actually contribute to other people's happiness or to relieving their suffering by living in a meaningful way, by giving to life rather than just taking.

Instead of blaming our circumstances, we can look inside and ask:

What is the most important thing, what am I really doing with my time and my energy that will make a difference?

Slowly we understand that our worldly situations and pleasures are not lasting, and that we cannot ultimately hold onto them or take them with us. This realization helps us learn to let go with grace, and to begin grasping less in the first place, which is even better.

This is how we become more and more free The most important thing is discovering the deathless, unchanging, innermost essence of our being, which is already whole, peaceful, open and free. Looking within and getting in touch with this essence, which is perfect wisdom and infinite compassion, is the source of the true happiness and well-being for which we have been yearning.

Q: Over your years of working with death and dying, you developed the Four Tasks of Living and Dying - Understanding and Transforming Suffering, Making a Connection, Healing Relationships and Letting Go, Preparing Spiritually for Death and Finding Meaning in Life. Could you summarize them and tell us how we can integrate them not only into our work but also into our daily life?

A: It's an interesting story how I came to describe these four tasks. I was starting to give some in-service workshops for hospice caregivers and I realized that they were already experts at understanding the needs of the dying and the family dynamics.

What they needed was to talk about the really tough situations: how to deal with angry family members, what to do in cases when nobody will let the persons know that they're dying, how to help somebody who feels depressed and hopeless and has no spiritual faith, how to support a parent leaving behind young children, and how to connect with a patient who has dementia or is comatose.

In examining the source of these problems, I started by naming them The Four Principal Difficulties or Fears of Dying. And then I slowly realized that actually, these problems reveal what we need to do in order to conclude our lives well; so I re-named them the Four Tasks of Dying.

Dying is not a passive time where you give up and give in, it's actually a very active time, our last possibility for growth. I realized that they were only the tasks of dying if we never took care of them when we're living, which is why I now call them The Four Tasks of Living and Dying.

We face these same tasks when we are told we have a life threatening illness and are still working toward healing, when we are going through bereavement, or experiencing a major life loss; these are the same tasks for caregivers as well as for those who are facing death. They include the need to understand and transform our suffering, because we experience suffering, pain and loss, throughout our entire life - not just when we face death.

We need to have a more positive context or way to understand why we suffer, and what opportunity lies in suffering.

One of the worst parts about an experience of suffering is our fear that it is meaningless, and that we are helpless to overcome it. The Buddhist philosophy of connectedness and compassion helps us see that we are not alone in suffering. By reflecting on the suffering of others and dedicating our own suffering or spiritual practice for their benefit, we can dispel much of our own misery, and give a deeper meaning to our suffering.

As we generate deeper feelings of love and compassion this way, it opens and heals our heart, helping us evolve as we go through life, and ultimately, by connecting us to our innermost essence, which is wisdom and compassion, we can remove the causes of suffering and attain liberation.

The second task, the need to heal our relationships, make a connection and let go, refers to our need to have authentic communication with others, based on mutual respect, acceptance and understanding. The dying especially need frequent and genuine reassurance of other's love and affection - but unfortunately, they often get the opposite. During life, but especially before we die, we need to heal past wounds in our relationships, drop all the conditions we normally tack onto our love, and learn to accept and love each other exactly as we are.

The third task, the need to understand death and prepare spiritually for death, shows us that death in fact mirrors the meaning of our life. What have we really come into this life to do? What is the most important thing, after all, when we come to die? All the religious traditions of the world describe that there is an aspect to our being, a spiritual essence, which is deathless. And the nature of our existence after death is connected to two things - whatever we do in our life, and how we are just at the moment of death.

Finally, whether or not we have a religious or spiritual orientation, each of us needs to find a meaning in our life.

We must find a thread or context which allows us to know that we are using our life well.

That context might be a wish to evolve into becoming more whole, a better human being, the wish to heal the wounds from our life, or to give something back to life, and to our community.

We need to feel our existence has meaning to at least one other person. that we are cared for, or that we are capable of giving love to others. This is possible, with good communication and connection, at any stage of life, regardless of our physical or cognitive limitations. And it is vital to find a meaning in our life as we face death, so that we will not die empty-handed.

Q: Could you tell us about the Tonglen and Self-Tonglen?

A: True compassion, known in Sanskrit as Bodhicitta, is unconditional, limitless and unbiased in any way, shape or form. Bodhicitta means "the heart of our enlightened mind." The wisdom and compassion that radiates from our true nature is compared to the sun: the radiance of the sun is wisdom and the warmth of the sun's rays are the compassion and love which are given out freely toward all creation. That is the way the compassion of our wisdom nature really is.

The compassion practice known as Tonglen, which means "giving and receiving," encourages us to connect with our wisdom nature, with this pure and profound compassion that is the core of our being. As we connect with that indestructible wisdom in our meditation, we slowly find the courage and the joy to relieve the suffering of other beings.

In the Tonglen practice, with each in-breath, we imagine taking in the suffering of other beings in the form of a dark cloud, and as it touches the radiant, sun-like bodhicitta in our heart it is transformed. Then, with each out-breath we give out, in the form of light, all of our love, all of our forgiveness, all of our happiness and joy. The Tonglen is an extraordinary practice of compassion which enables us to become fearless and confident, because we start to trust in our true nature rather than our ordinary fearful conditioned mind that is always trying to keep suffering at bay.

When we first begin doing the Tonglen practice, we may not have this confidence yet, so it might be helpful to train in the Self-Tonglen first, to practice taking in our own suffering, our negativity, judgments or aversion of pain and give out all of our love, happiness, understanding, and forgiveness.

The best thing we can do is to realize that we are facing death right now. We have to engage in our spiritual practice very meaningfully, as though it were our very last day. In this way, we are training ourselves, allowing our spiritual practice to fully enter our being and become part of our flesh and bones, so it becomes our whole way of perceiving and being in the world. And if we were to die unexpectedly or to find out that we have an incurable illness, our practice would really be there for us as a support. But what if a person is very close to death and doesn't have the chance to develop such a dedicated spiritual practice - what can they do?

It is very good to just call out for help, to invoke the sacred presence of whomever you believe in: God, Buddha or Christ. Then, pray to this Presence that you might be supported in your illness and your suffering, pray that he or she may guide and protect you fearlessly through the process of dying and help you let go of your attachment to this life and turn towards the truth.

Even if a person has no spiritual path, the bottom line in helping them to die well is to die not feeling empty-handed but knowing that their life has had meaning, that they have contributed to us in their life, or in their process of dying. So, as we relate to a dying person and give our love and invite them to tell us the story of their life, what they suffered and what they learned, we are actually helping them to not die empty-handed.

Q: How can we help someone who have difficulty communicating with his family or loved one? How can we express them our love and deep feelings when they are near death and sometimes unconscious?

A: Well, there are two things. First, people sometimes have a hard time communicating their very deep feelings as they approach this coming loss. They might find it easier to open up this communication first with a counselor or social worker. That may help them understand what is most important about their connection, and how to express this to the dying person.

I encourage caregivers and family members to remember that if they keep procrastinating and putting off saying what they need to, the person that they love might become unconscious and unable to communicate. Then they will lose this precious opportunity they have now; they will feel doubly bereft, from losing their loved one and the possibility they had had to enjoy the relationship and communicate fully. So, I encourage them to make this genuine connection early on and not be afraid of the natural sadness that will come because that's part of their love, it's all right for it to be there.

There are other people who, as you said, have lost the ability to communicate verbally, though we must remember that on many levels, communication is happening all the time. Through touch, being together even in silence, the communication is really what we are feeling in our heart. If we have a hard time using words to express our feeling, we should slow down, be more peaceful and with awareness try and see what is really true and then express this to the person - even if he or she has dementia.

We must try to also listen with our heart and feel what the other person may be expressing in a non-verbal way.

Some family members told me that they really had to push their loved one, before he or she died, to simply say "I love you". But what an extraordinary gift it is! For the dying person's children or partner, hearing "I love you," "I am sorry," or, "thank you for all you've done" one more time is a memory they can carry with them for the rest of their life.

Q: How can people deal with the death of a child?

A: I myself don't have direct experience with dying children but I've learned a lot about it from others who do. Children pick up the feeling and the view point about death from their parents.

If they have a very negative or frightening view of death, this is what the child will feel. If the parents have a more positive, life-affirming, or spiritual view of death, then a dying child will feel more secure. Thus it is vital to support the parents, because when they can come to terms with the loss of their child, then the child will have an easier time as well.

It is important to acknowledge all of the layers of the parent's pain, to allow it to be expressed and released. Of course, there are no words to describe how difficult it is; there's nothing, in this life, like seeing a child in pain without being able to do something. But we can also help parents to see that their own attachment and fear may make the child's pain worse.

So it is vital for parents to find sources of support and release -- perhaps through a parent's support group, with a counselor, or by writing out and releasing their fears and attachment. We are naturally afraid to let go, afraid that by accepting the death, it means we do not love our child. But beyond our attachment, there is still a pure love there. As Elizabeth Kübler-Ross says, "Your child may die, but real love doesn't die."

Q: It seems easier for children to die because they don't have a lifelong habit of attachment and grasping as we do.

A: That's true. If children are given good support in their process of being ill and dying, if they have really caring caregivers and a good communicative family, for them dying is not so difficult. They have often a natural trust or confidence in life and a very natural spirituality. It makes sense for them to pray or to call out for help.

So, letting go, as you said, is not so hard for them. The pain they often suffer is worrying about their siblings or parents. Of course, we have to be kind to ourselves. It's natural to have an attachment for children. It's equally important to realize that when it's time to really let somebody that you love go, we need to think about what is best for them in that moment, and not make them suffer more on our account.

Q: You personally experienced two aspects of death: first, facing it with the death of your husband and then doing hospice work and giving workshops and lectures. What did you learn from death?

A: I've learned that our failures are wonderful fuel for us to change and become better human beings. The more I keep my own death in mind, the more I'm forced to change and grow and pay attention to what it is I'm taking refuge in, what my real values are. Because of not knowing how to fully support my husband at the time of his death, I entered a spiritual path.

I'm very grateful now to the suffering that my husband and I went though because it brought something far richer and more meaningful in my life. Because of the spiritual path I found after his death, I now feel a deeper confidence - not just intellectual but a confidence born from my meditation practice - that death can be something wonderful.

And the gift for me now is that as I travel and teach and give seminars and present my book, I can assure other people that there is a spiritual dimension to death and to life. Knowing this is extremely helpful. In whatever spiritual tradition we follow, if we deepen our connection to the truth and make it part of our being, we can really give strength to other people when they suffer. And the joy this brings is beyond words.

©2006 Gilles Bédard