Hi reddit, my name is Frank Ostaseski. I’ve spent the past 30 years sitting bedside with a few thousand people as they took their final breaths. In 1987, I cofounded the Zen Hospice Project, the first Buddhist hospice in America. In 2005, I founded the Metta Institute to train healthcare clinicians and family caregivers in mindful and compassionate approaches to end of life care.

Some people that I companioned came to their deaths full of disappointment and turned toward the wall in hopelessness. Others blossomed and stepped through that door full of wonder. All of them were my teachers. These people invited me into their most vulnerable moments and made it possible for me to get up close and personal with death. In the process, they taught me how to live. I wrote about those lessons and more in my book The Five Invitations: Discovering What Death Can Teach Us About Living Fully. You can read more about it here if you’d like www.fiveinvitations.com

If you want the tl;dr of the book, the main points are:

  1. Don’t Wait
  2. Welcome Everything, Push Nothing Away
  3. Bring Your Whole Self To An Experience
  4. Find A Place To Rest in the middle of Things
  5. Cultivate a ‘Don’t Know’ Mind

Happy to explore those in more detail or anything else you’d like to talk about. AMA!

My Proof: http://imgur.com/a/kcxN9

UPDATE: Thanks everyone for the great questions. This has been a ton of fun, but I've got to sign off for now. Thanks again!

Comments: 213 • Responses: 45  • Date: 

nanoH2O234 karma

Was/is there a discernible difference between how atheists and religious people handled their approaching death?

FrankOstaseski562 karma

Great question. I think people who have been willing to live into the deeper dimensions of what it means to be human have an easier time with dying. For some that ease comes through religious or spiritual practices or training. I don't think those things are necessary for people to have a peaceful death. I worked with a man who was an atheist. He described what he thought would happen after he died. He said that his body was basically energy and that he would become molecules and mix with all the other molecules in the universe. He was quite comfortable with his dying. Idealized notions of a “good death” or a “dignified death” are troubling to me. They can blind us to what is actually happening, causing us to override the unpleasant and trample the sacred. Arbitrary standards about things “going according to plan” exert enormous pressure on dying people, adding guilt, shame, embarrassment, and a sense of failure to an already challenging process. Dignity is not an objective value. It is a subjective experience. Care with dignity promotes self-respect, honors individual differences, and supports people in the freedom to live their lives and their deaths according to their personal wishes. When we interfere, we may miss out on or even interrupt the subtle dimensions of the dying experience. No matter how noble our intentions, we need to resist the temptation to act on our own biases or impose our well-meaning advice or spiritual beliefs on people who are dying. Hannah was a Christian scientist with a deep and unwavering faith in God. At ninety-three, she had arrived at a place of acceptance of her death. She told me that her image of death was “to rest in the hands of Jesus.” Hannah’s well-meaning granddaughter, Skye, came to visit. Skye shared that she had been reading a number of books on near-death experiences. According to these books, at the time of death, people are often greeted by their deceased relatives. Skye said, “Grandma, you don’t have to worry, because when you die, everyone you know who died before you will be there to meet you.” When she heard this, Hannah became terrified of dying. The secret she had never shared with her family was that her husband, Edgar, had physically abused her for a good portion of their married life. He had died five years before. The idea of meeting Edgar again “on the other side” and spending eternity with him filled Hannah with desperation.

Our support of someone who is dying needs to include mindfulness, warmth, authenticity, stability, and generous listening. This allows us to enter the question of dying without so many answers. Being with dying calls for humility, acceptance, and a willingness to let go of control.

HotSauceHigh28 karma

Were they able to comfort Hannah?

FrankOstaseski54 karma

Yes, we were able to comfort her and her faith supported her as well.

quoi_de_neuf_Oeuf166 karma

What are your thoughts on physician-assisted suicide?

FrankOstaseski45 karma

Sorry, answered this question last night but it didn't get saved. Physician-assisted death differs from "suicide'. It's now legal in 5 states (California, Colorado, District of Columbia, Oregon, Vermont, and Washington). Death with Dignity can refer to an end-of-life option that allows certain eligible individuals to legally request and obtain medications from their physician to end their life in a peaceful, humane, manner. To qualify for a prescription of medication under existing physician-assisted dying laws, you must be 1. an adult resident of California, Colorado, District of Columbia, Oregon, Vermont, or Washington; 2. mentally competent, i.e. capable of making and communicating your healthcare decisions; 3. diagnosed with a terminal illness that will lead to death within six months. Oregon’s Death with Dignity Act (DWDA), enacted in late 1997. Thousands of people have actively and directly requested information. Thousands more indirectly. In the 20 years since the law was passed a total of 1,545 people have received prescriptions written under the DWDA, and 991 patients have died from ingesting the medications. That is an average of 49.5 people per year. Many people feel it gives more agency to individuals dealing with terminal illnesses. One side benefit is the laws is that pain management and symptom control seems to have improved in those states that allow physician-assisted death.

nightwing71826159 karma

How would you show someone that life is precious and worth living? Specifically someone going through tough times and negativity in their life.

FrankOstaseski650 karma

I once worked man who wanted to take his life because of his terminal lung cancer. Right before he died he said I am happier now than I have ever been. He told me his joy didn't come from things or the activities of life but from his attention. He said, "now my pleasure comes from the softness of the sheets in the coolness of the breeze." Bringing our attention to the details of life we often discover a gratitude for simply being alive.

IAmShinobI80 karma

  1. What was the most common disappointment that everyone shared?

  2. Have you ever felt overwhelmed by all the deaths you have witnessed?

FrankOstaseski230 karma

  1. Not having loved fully is the most common disappointment.
  2. sure at times I feel overwhelmed. When I'm working with some of his dying I'm always looking at my own fear my own grief. But I've learned that when I'm aware fear it means there is a part of me who can relate to the fear. That means fear is not the only thing in the room. We can relate from fear or from our capacity to witness our fear. Death is the elephant in the room. A truth we all know but agree not to talk about. We try to keep it at arm’s length. We project our worst fears onto it, joke about it, attempt to manage it with euphemisms, sidestep it when possible, or avoid the conversation altogether. We can run, but we cannot hide. We can run, but we cannot hide. There is an old Babylonian myth, “Appointment in Samarra,” which W. Somerset Maugham retells in his play Sheppey. A merchant in Baghdad sends his servant to the marketplace for supplies. But the man returns a short while later empty-handed, pale, and shuddering with fear. He tells his boss that a woman in the crowd bumped into him. When he looked at her more closely, he recognized her as Death. “She looked at me and made a threatening gesture,” the servant says. “Now, lend me your horse, and I will ride away from this city and avoid my fate. I will go to Samarra and there, Death will not find me.” So the merchant lends his servant his horse. The man rides off in a wild fury. Later, the merchant goes to the marketplace to buy his own supplies. There, he sees Death and asks why she threatened his servant earlier that day. “That was not a threatening gesture,” Death replies. “It was only a start of surprise. I was astonished to see him in Baghdad, for I had an appointment with him tonight in Samarra.”

skyscraperdream49 karma

How often do you think of your own death? How do you keep this in mind when small things piss you off?

FrankOstaseski174 karma

Yes I think about my death often. When I'm in contact with the precariousness of life it causes me to appreciate its preciousness. Then I don't want to waste a moment. I want to step in fully and use my life in responsible way. Without a reminder of death, we tend to take life for granted, often becoming lost in endless pursuits of self-gratification. When we keep death at our fingertips, it reminds us not to hold on to life too tightly. Maybe we take ourselves and our ideas a little less seriously. We let go a little more easily. When we recognize that death comes to everyone, we appreciate that we are all in the same boat, together. This helps us to become a bit kinder and gentler with one another.

truck_de_monster45 karma

I died in an accident a couple years ago. The experience got me completely over my fear of death. I'd like to get into helping people that are scared of their own impending death. How do you help those that are scared of what's happening?

Bonus question: has your interactions brought you to the understanding of death you had hoped?

FrankOstaseski52 karma

Consider volunteering in a local hospice. But understand that what happened for you your experience. It may not be how another person meets their dying. Advice doesn't help when you are dying. My slogan is “Meet ’em where they’re at.” I encourage our caregiver to support patients in discovering what they need. Bonus question answer. Dying is a Mystery...an endless, unfolding mystery. It is the land of unanswerable questions. The inexhaustible mystery of being.

murraybiscuit6 karma

Not to disparage your experience or willingness to help, but isn't the anguish of death (by terminal illness / senescence) less in the uncertainty of the afterlife, and more in the immediate physical pain, and anguish of grief over the loss of loved ones? Neither of these are really a factor in accidental / sudden death. I'm just trying to understand how your experience would translate beyond simple compassion? I'll admit ignorance on both camps, so please educate me.

FrankOstaseski22 karma

I don't think we need to believe in an afterlife. Many people experience deep transformation during the dying process and have no such belief. And it is important to say that dying is not always physically painful. That is a myth. Sudden death, of course, differs from death after a long term illness. Most of the folks I have worked with were ordinary people. Individuals coming face-to-face with what they imagined was impossible or unbearable, walking toward their own deaths or caring for someone they loved who was now dying. Yet most found within themselves and the experience of dying, the resources, insight, strength, courage, and compassion to meet the impossible in extraordinary ways

jimthesoundman41 karma

Did any of them confess horrible crimes or tell you where their massive quantity of treasure was buried?

FrankOstaseski60 karma

No buried treasures....but yes confessions of all types

whatsthehappenstance75 karma

In these confessions, anything about government secrets in regards to working with anything of extraterrestrial origin?

FrankOstaseski54 karma

nope

jimthesoundman10 karma

Can you give us some examples of the worst of these confessions?

Did you ever report any of these confessions to the police or appropriate authorities after the person was gone, so they could close the case file?

FrankOstaseski42 karma

I want to protect the confidentiality of the people I served. No...there wasn't anything that people told me that required me to report to the police or appropriate authorities

tadallagash39 karma

What in your opinion would be the ideal way to die?

FrankOstaseski170 karma

Ideally awake....with pain and symptoms skillfully addressed...content with my life....companioned by people I love who don't interfere with the process...or try to hold me back. Resting in a more open awareness. However, I think that grasping at a certain outcome may be a formula for suffering. My hope is that i can work with whatever cards I am dealt. In Buddhism, the old Pali word for suffering is dukkha, which is sometimes translated as “anguish” or more simply as “unsatisfactoriness” or even “stress.” Dukkha arises from ignorance, from not understanding that everything is impermanent, unreliable, and ungraspable—and wanting it to be otherwise. We wish to claim our possessions, our relationships, and even our identities as unchanging, but we can’t. All are constantly transforming and slipping right through our fingers. We think we need the conditions of our lives to reliably give us what we want. We want to construct an ideal future or nostalgically relive a perfect past. We mistakenly believe this will make us happy. But we all can see that even those people who realize extraordinary conditions in life still suffer. Even if we are rich, beautiful, smart, in perfect health, and blessed with wonderful families and friendships, in time these will break down, be destroyed, and change . . . or we will simply lose interest. On some level, we know this is the case, yet we can’t seem to stop grasping for those “perfect” conditions.

biolox27 karma

Any patterns in how their surviving family members coped?

FrankOstaseski143 karma

Survivors cope best when they realize that grief has many faces. Sadness is just one of the many faces of grief. I find it useful to think of grief as a constellation of responses, an ever-changing process. The author C. S. Lewis, after the death of his wife, wrote, “No one told me grief felt so much like fear.” Our grief manifests as anger, self-judgment, regret, and guilt. We experience loneliness and relief, blame and shame, and periods of numbness when we feel like we are walking through molasses. Rarely are we prepared for the intense feelings that engulf us when someone we love dies. Grief cracks our defensive shell of invulnerability. It exposes the ways we hide from the truth and asks us to acknowledge what has always been here but was previously unrecognized: our human frailty. Grief can be so powerful that instead of surrendering to its force, we reach for information and models that outline predictable stages of grief in the hopes that they will take us through our grief more easily. In so doing, we run the risk of confusing the map with the territory. Journeying through grief, it can indeed help to get familiar with the terrain, to know something of its patterns. But there is no “right” way to grieve, no timetable, no one path. And there certainly are no shortcuts through grief. The only way is straight through the middle. We don’t get past our pain. We go through it and are transformed by it.

FrankOstaseski108 karma

When I am sitting at a person’s deathbed, I feel my own fear. I’m in touch with my grief. In the service of healing, I draw on my helplessness as well as my strength, my wounds as well as my passion. This is how we discover an authentic meeting place with other people: through the vulnerable and courageous exploration of our own experience. When we repress an experience, it does not go away. It still lurks below the surface, encapsulated in its original form with all its associated energy. When we bury feelings or bypass them, the material is not available to us. We can’t understand it. We can’t use it in a constructive way. Repressed anger easily turns to depression, resentment, or fear.

BeckyDaTechie18 karma

What are the best things a family member or loved one can do at a bedside?

How do you suggest helping a carer on whom rage, fear, or hatred has been vented by the decedent?

FrankOstaseski88 karma

When we are caring for someone who is sick, we lend them our body. We use the strength of our arms to move them from the bed to the commode, and we can also lend them the strength of our mind. We can help to create a calm and accepting environment. We can be a reminder of stability and concentration. We can expand our heart in such a way that it can inspire the individual who is dying to do likewise. When people are really sick, in the last 24 hours, slow down, move less. Get quiet. Watch your own breath. Help to create an environment in the room which is characterized by fearless receptivity, willingness to meet whatever arises. Do simple things with great attention. Watch the state of your own mind. Its hard sometimes impossible to stay present when the person who is sick is venting on the carer. Sometimes we need to set boundaries. We tend to loose ourselves when others are angry with us. Telling the emotional truth can help, expressing disinterest in the unsolicited advice or criticism, using humor, staying connected to your physical center, harnessing your strength—all these strategies can help us stay connected to ourselves. Sometimes we need to speak up on our own behalf. “Don’t speak to me that way,” she said, her voice strong and confident. “It hurts me when you talk to me like that. And it doesn’t help me do any better.” It takes practice.

flagshipcomplex13 karma

As a student nurse, thankyou for this wisdom. Sadhu!

FrankOstaseski13 karma

Happy to help. Thanks for your work.

wineheda18 karma

What are your thoughts on people using psychedelics towards the end of life to ease anxiety/fear?

FrankOstaseski35 karma

There is a lot of good research demonstrating that the appropriate use of certain psychedelics like MDMA and Psilocybin can be very effective in reducing existential anxiety. Suggest you check out http://www.maps.org/

HiloFox18 karma

in the deaths you have witnessed, have you heard complaints or talk about hearing or seeing things that werent there?

Ive heard voices and scratches on the walls minutes before an elderly lady passed. She said she saw people crowding the room when it was only a handful of us in there. This has been haunting me for quite sometime and i wanted to know if it(or something similar) has ever happened to you.

Edit: typo

FrankOstaseski56 karma

It's quite common for people to have vivid dreams about relatives or friends who have died. Sometimes people see or hear things that as companions we cannot see or hear. There are many thoughts on the causes....some say medications, others say confusion due to illness, others speak of near death type experiences. The question I ask is are these "visions" disturbing or comforting to the person. Then I try to support them through their reactions.

The_Bravinator11 karma

Are they usually a positive experience, or is it a mix?

FrankOstaseski3 karma

In my experience mostly positive. But it is important to remember that each person's death is completely unique ...like each person's birth. What is helpful of nonjudgmental listening coupled with a genuine curiosity that encourages further inquiry.

SuperHarrison10115 karma

When you were little, did any of your family members or anyone you know die? For me when I was little, and still, death is something for me that is less morbid but in a way confusing and/or puzzling. The idea that someone or something just stopped. Have you ever felt this way or have seen family members of the patients in hospice that have this same feeling?

FrankOstaseski112 karma

Death and I have been longtime companions. My mother died when I was a teenager and my father just a few years later. But I had lost them years before the events of their deaths. They were both alcoholics, and so my childhood was characterized by years of chaos, neglect, violence, misguided loyalty, guilt, and shame. I became adept at walking on eggshells, being my mother’s confidant, finding hidden liquor bottles, clashing with my father, keeping secrets, and growing up too quickly. So in a way, their deaths came as a relief. My suffering was a sword that cut two ways. I grew up feeling ashamed, frightened, lonely, and unlovable. Yet that same suffering helped me to empathetically connect with others’ pain, and that became part of my calling to move toward situations that many others tend to avoid. Exploring our own hurt, in addition to contributing to our healing, helps us feel empathy for others who have suffered similar injuries.

N8Pee34 karma

I thank you for your service and very much appreciate your viewpoint. I truly believe hospice workers are angels amongst men. I've seen this from my own eyes and hope one day I can be a fraction of a measure of support that hospice workers provide regularly.

FrankOstaseski30 karma

I don't see myself as special. We are just ordinary folks. Caring for the dying is not more important than caring for our children. It is just what we have been called to do.

krebstarpatron23 karma

Beautifully written. This is a great AMA.

FrankOstaseski19 karma

thanks please check out my new book The Five Invitations: Discovering What Death Can Teach Us About Living Fully by Frank Ostaseski

HotSauceHigh5 karma

I am also a child of alcoholics and share your experiences. Have you ever heard of the ACA 12step group?

FrankOstaseski3 karma

Yes...of course, and I have participated in the past. Thanks for the good suggestion. I really think that ACA 12step groups are helpful for many people. Perhaps some reading this AMA?

StElizardbeth3 karma

Thank you for this.

FrankOstaseski2 karma

You are welcome. Completely welcomed!

ArizonaCaliDude14 karma

What are the common regrets that people have before they pass?

Thanks for dong this AMA, it’s very insightful!

FrankOstaseski33 karma

You are welcome happy to share what I have learned.. It's my way of honoring the lessons people taught me as they died. Bonnie Ware wrote a good book on this subject. http://www.bronnieware.com/regrets-of-the-dying/ Personally I'm more interested in how people transform as they die. How the dying process can be conducive to expansion. Dying is inevitable and intimate. I have seen ordinary people at the end of their lives develop profound insights and engage in a powerful process of transformation that helped them to emerge as someone larger, more expansive, and much more real than the small, separate selves they had previously taken themselves to be. This is not a fairy-tale happy ending that contradicts the suffering that came before, but rather a transcendence of tragedy. The discovery of this capacity regularly occurs for many people in the final months, days, or sometimes even minutes of life. “Too late,” you might say. And I might agree. However, the value is not in how long they enjoyed the experience, but the possibility that such transformation exists. Lessons from death are available to all those who choose to move toward it. I have witnessed a heart-opening occurring in not only people near death, but also their caregivers. They found a depth of love within themselves that they didn’t know they had access to. They discovered a profound trust in the universe and the reliable goodness of humanity that never abandoned them, regardless of the suffering they encountered. If that possibility exists at the time of dying, it exists here and now.

rosegold858 karma

How does it affect you, doing a job where all day, everyday, you're constantly around people who are dying?

FrankOstaseski44 karma

I have done this work for more than 30 years. I have never burned out. The work is "real" and the conversations are often very touching, honest and inspiring. Of course, maintain skillful boundaries and engage in life affirming activities like being with family and friends and swimming in the bay. At the height of my hospice work many people died in the course of a week. At times when the grief was overwhelming, I did three things: I made a point of getting regular bodywork, often spending the better part of a session crying on the massage table; I regularly returned to my meditation cushion and the practices that stabilized my attention, regulated my emotional states, and cultivated pro-social qualities like lovingkindness; and, I would visit my nurse friends who worked on the unit at the General Hospital caring for babies who have been born to addicted mothers. I’d sit in a rocking chair, hold these babies, and rock them to sleep. There was something about the innocence of the babies and the satisfaction of being able to soothe them that enabled me to reconnect with my compassion and meet the daily suffering that was part of the hospice experience.

When_Ducks_Attack6 karma

I was a hospice volunteer for nearly 20 years (my mother helped found one), and I wound up at the bedside of more than a few people at the end of their lives.

There were nights where I had problems dealing with the experience I had just had, and some where I left the residence actually happy for the person.

Experiencing the different ways each of them dealt with their own death made coping with my mother's death a few years ago easier... not easy, but easier. I'll always be grateful to them for that.

I don't think I could do it now, though.

FrankOstaseski4 karma

I think it's a useful practice to accompany other people for their dying, before we find ourself on her own deathbed. It's great that you did that work for a while. It does not have to be your life work. It's not more important than other types of service. Wonderful though that you opened your heart to the people you served. This world needs our wholehearted service. We each find what is right for us.

There is a famous quote by the writer and Nobel laureate Rabindranath Tagore

I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy.

WaitWhat43557 karma

Well... have you ever been remotely glad when you saw a certain person die?

FrankOstaseski22 karma

In my experience, we can feel relief when someone dies. We may have the sense that they are relieved from a certain kind of physical pain or emotional suffering. This may be particularly true when there has been a long term illness or one that is devastating to the sense of self as in severe Alzheimer's disease. Or simply that the person was ready and accepting of their dying and wanted to go.

ItsSkixel6 karma

What was the most saddening death you've ever witnessed? My mom just started working in hospice and I was curious.

FrankOstaseski7 karma

When people die feeling like their life has been unlived. Don't wait to tell the people you love that you love them!

RitzyVagabond6 karma

Can you elaborate on your tl;dr of the book? Perhaps an example of how I could incorporate each one of those points into my life.

FrankOstaseski40 karma

Sure here some thoughts on my the invitations. The full title of the book is The Five Invitations: Discovering What Death Can Teach Us About Living Fully

Don’t Wait

We can harness the awareness of death to appreciate the fact that we are alive, to encourage self-exploration, to clarify our values, to find meaning, and to generate positive action. It is the impermanence of life that gives us perspective.

As we come in contact with life’s precarious nature, we also come to appreciate its preciousness. Then we don’t want to waste a minute. We want to enter our lives fully and use them in a responsible way. Death is a good companion on the road to living well and dying without regret. Waiting is Full of Expectation: Waiting, we miss what this moment has to offer. Worrying or strategizing about what the future holds for us, we miss the opportunities that are right in front of us

Welcome Everything Push Away Nothing In welcoming everything, we don’t have to like what is arising. It’s actually not our job to approve or disapprove. The word welcome confronts us; it asks us to temporarily suspend our usual rush to judgment and to simply be open to what is happening. Our task is to give our careful attention to what is showing up at our front door. Like James Baldwin wrote...."There are many things we must face in life that we cannot change....but nothing can be changed that we are unwilling to face."

Bring Your Whole Self to the Experience

To be whole, we need to include, accept, and connect all parts of ourselves. We need acceptance of our conflicting qualities and the seeming incongruity of our inner and outer worlds.

We all like to look good. We long to be seen as capable, strong, intelligent, sensitive, spiritual, or at least well adjusted. We project a positive self-image. Few of us want to be known for our helplessness, fear, anger, or ignorance, or that sometimes we are more of a mess than we’d like to admit.

Yet more than once I have found an “undesirable” aspect of myself, one about which I previously had felt ashamed and kept tucked away, to be the very quality that allowed me to meet another person’s suffering with compassion instead of fear or pity.

Wholeness does not mean perfection. It means no part left out.

Find a Place of Rest in the Middle of Things here is a Zen story about a monk who is vigorously sweeping the temple grounds. Another monk walks by and snips, “Too busy.” The first monk replies, “You should know there is one who is not too busy.” The moral of the story is that while the sweeping monk may have outwardly appeared to the casual observer as “too busy,” actively performing his daily monastic duties, inwardly he was not busy. He could recognize the quietness of his state of mind, the part of himself that was at rest in the middle of things.

Finding a place of rest isn’t about adding another task to your already too-long to-do list. Nor does it mean napping more during your workday (though this may prove helpful). It is a choice—a choice to be alert, to bring your attention to this moment.

Cultivate Don’t Know Mind Not an encouragement to be ignorant. Ignorance is usually thought of as the absence of information, being unaware. Sadly, it is more than just “not knowing.” It means that we know something, but it is the wrong thing. Ignorance is misperception. Don’t know mind represents something else entirely. It is beyond knowing and not knowing. It is off the charts of our conventional ideas about knowledge and ignorance. Don’t know mind is not limited by agendas, roles, and expectations. It is free to discover. When we are filled with knowing, when our minds are made up, it narrows our vision, obscures our ability to see the whole picture, and limits our capacity to act. We only see what our knowing allows us to see. Don’t know mind is an invitation to enter life with fresh eyes, to empty our minds and open our hearts.

Rheastar4 karma

What is the most beautiful experience you have had with someone passing on to what is next?

FrankOstaseski16 karma

Blaze was one of the the first people who lived and died with us at Zen Hospice Project. She was living alone in a dingy SRO hotel room when she was diagnosed with terminal cancer.

Blaze didn’t have any friends, as far as we could tell. But shortly after she arrived, she asked us to track down her brother, Travis, saying that she hadn’t seen him in more than twenty-five years. It wasn’t easy. This was before the Internet, and Travis was a wrangler who rode the rodeo circuit. He never stayed in one place for too long. We contacted the Professional Rodeo Cowboys Association, and eventually we found him.

“Your sister is dying, and she wants to see you,” I told him over the phone. I really didn’t expect anything to come of it.

Then late one night, Travis showed up at the Zen Center front door. He cut an imposing figure dressed in full cowboy regalia: a ten-gallon Stetson, a king-size silver belt buckle, and snakeskin boots.

“So what kinda place is this where you got my sis?” he demanded, looking around the modest interior.

Travis, who was a year older than Blaze, had hurt his sister badly a few times. He had done some really awful things to her, he said. He had been abusive to her in many ways. That was why they hadn’t seen each other in so many years.

One day after we had a counseling session I suggested that we go talk to Blaze.

When we got to her room, Travis pulled up a chair next to Blaze’s bed and said, “You know, Sis, there’s something I’ve been meaning to tell you all these years, but, you know, I never could find the right words . . . I just wanted to say . . . about all those things I did . . .”

Blaze raised her hand like a traffic cop to stop him and said calmly, “In this place, Travis, I have somebody who feeds me. I have somebody who bathes me. I’m surrounded by love. There is no blame.”

I was awestruck by what I had just witnessed. A whole lifetime of pain forgiven in a single moment. A powerful act of mercy, the slate wiped clean. We all cried together, then a liberating silence followed.

artificiallyselected3 karma

Is the suffering you witness more often physical pain or emotional pain? How much physical pain is there at the end of life?

FrankOstaseski9 karma

It is important to understand that not all conditions that lead to death are physically painful. In hospice, when there is pain, we often speak about "total pain". It is a clinical idea and approach developed by Cicely Saunders, the founder of the modern hospice movement. Total pain recognizes pain as being physical, psychological, social and spiritual. It is important to remember that total pain was always meant as a teaching model. In other words, it is necessarily an 'over-simplification'. Point being that there are many things that contribute to our experience of pain. For example, fear of pain can exacerbate our experience of pain. Some people have a spiritual view that they are being punished and this can impact their experience of pain. Mental confusion can make it difficult to cope with pain. A sense of social abandonment can affect our experience of pain. So we need to care for the experience of the whole human being.

ashkei3 karma

Hi! Thanks for answering our questions. How'd you get into what you do ans come to open the first Buddhist hospice?

FrankOstaseski18 karma

The Zen Hospice Project was the first Buddhist hospice in America, a fusion of spiritual insight and practical social action. We believed there was a natural match between the Zen practitioners who were cultivating a “listening heart” through meditation practice, and those who needed to be heard—people who were dying. We had no agenda and few plans, but ultimately we did train a thousand volunteers. ''While we wanted to draw on the wisdom of the 2,500-year-old Zen tradition, we had no interest in pushing any dogma or promoting a strictly Buddhist way of dying.

My slogan was “Meet ’em where they’re at.” I encouraged our caregivers to support the patients in discovering what they needed. We rarely taught people to meditate. Nor did we impose our ideas about death or dying. We figured the individuals we served would show us how they needed to die. We created a beautiful and receptive environment in which the residents felt loved and supported, and where they were free to explore who they were and what they believed.

I learned that the activities of caregiving are themselves quite ordinary. You make soup, give a back rub, change soiled sheets, help with medications, listen to a lifetime of stories lived and now ending, show up as a calm and loving presence. Nothing special. Just simple human kindness, really.

Yet I soon discovered that these everyday activities, when taken as a practice of awareness, can help awaken us from our fixed views and habits of avoidance. Whether we are the ones making the beds or the ones confined to it, we have to confront the uncertain nature of this life. We become aware of the fundamental truth that everything comes and goes: every thought, every lovemaking, every life. We see that dying is in the life of everything. Resisting this truth leads to pain.

Techjeffe3 karma

Was it common for the dying to "see" people in the room? Two days before my wife passed, she suddenly opened her eyes and asked me, "Who are those men in the corner?" We were the only people in the room...

FrankOstaseski4 karma

Yes, it can be quite common. Hard to know what the causes are exactly. For some, it is like a waking dream. For others, it can be caused by medications or brain disease. For others, it is a kind of spiritual experience. It may also be the deep unconscious coming to the surface. I usually ask some questions to find out if these images are disturbing or supportive. I try to help the person feel a sense of agency, that they can affect their experience. If The images are disturbing we talk about telling them to go away. If they're supportive, I suggest they asked them how they have come to help? Of course, it's really important to assess the medications that are being used and the ways they interact with each other. No need to argue about their experience or even deny it if it is not disturbing.

Air_Hellair3 karma

I'm going to be involved with a production of Marsha Norman's "'night, Mother" soon. Are you familiar with the play? What's your take on Jesse's decision to die?

FrankOstaseski3 karma

Sorry answered this last night but it did not get saved? I will try to remember what I wrote. I do not know the play well. I believe the central character, Jesse, is an epileptic and suffers from severe chronic depression that has never been treated. If this were real life and not a play I would want to get Jesse appropriate support for her conditions. Physician-assisted death is for people with a life threatening disease who have a 6-month prognosis. Jesse wants to commit suicide. That is a much more complex issue that needs a different kind of support.

smokeout30002 karma

What are the most common causes of death you have seen?

FrankOstaseski8 karma

Of the top 10 leading causes of death in the U.S. I worked with people dying of Heart disease (leading cause of death for both men and women in the U.S. and also the leading cause of death worldwide) Cancer mostly lung and breast cancer. Chronic respiratory disease like COPD and emphysema. Strokes due to Cerebrovascular diseases that develop as a result of problems with the blood vessels that supply the brain with blood. Alzheimer's disease is one type of dementia, that causes the death of neurons that eventually impair the ability to carry out basic bodily functions such as walking and swallowing. Diabetes is a disease in which the body is no longer able to carefully control blood glucose. When a person has diabetes, the body either does not make enough insulin or cannot use insulin as well as it should. This causes sugar to build up in the blood. Kidney disease is a condition in which the kidneys are damaged and cannot filter blood as well as healthy kidneys. Because of this, waste from the blood remains in the body and may cause other health problems.

I also accompanied many hundreds of people who died of AIDS. While AIDS is no longer in the top 10 causes of death. However, since the beginning of the AIDS epidemic, more than 70 million people have been infected with the HIV virus and about 35 million people have died of HIV.so there are approximately 36.7 million people worldwide living with HIV/AIDS. In the SF Bay Area about 30,000 people died of AIDS.

GrinningLion2 karma

I fear dying because I fear missing out. After all that you have seen, do you honestly believe there is something afterwards, or is it just 'non-existance'? Do you hope for absolute peace or a continuation in death? And do you think of humans were able to achieve immortality, should we? Would the elimination of death cause more issues to a person's soul/mind? Is death necessary?

FrankOstaseski1 karma

I can't say if there is life after death. This is one of life's great mysteries. I guess we will find out?

Personally, I am more interested in life before death. How can we use the precariousness of this life to help us appreciate the preciousness of this life? How can we become fearless which does not mean that we don't have fear. It means that fear is not the only thing in the room. That we can bear witness to our fear without becoming lost in it.

How can we use the truth of impermanence to help us understand what matters most. Each of us will have different notions of what matters most. It's not my job to determine that for others. There is no one size fits all prescription.

I do believe that when we live a life illuminated by the fact of our death, it informs our choices. You know what amazes me about life? Not that we can expand our consciousness to include all manner of experiences. What amazes me is that we can take all that we are as human beings and shrink it down into such a small story of self. Transformation, whether initiated in dying process, or giving birth, or through contemplative practices or falling deeply in love, is a deep internal shift through which our basic identities are reconstituted. It is a metamorphosis, as radical as the caterpillar’s movement from chrysalis to butterfly. In the process of transformation, the scales fall from our eyes, and we see and experience everything in a new way. We realize that we are more than our stories and the separate self we have taken ourselves to be. But each of us have to find our own way.

GUNPLAY3R2 karma

I work in a hospital dealing with all sorts of people with different sets of life experiences. It is concerning where I work at because the local older patients and people around the area where I work are mostly bitter and angry. I try my hardest not to generalize them into the same category but I view them as being entitled and full of themselves, because more often than not unfortunately this prediction proves to be true. It's heartbreaking because I've seen in some cases the older patients drive themselves here while being disabled and are unable to walk, how they able to push the pedals in a car eludes me. Is there any effective way to combat this ?

FrankOstaseski7 karma

It is true. For some, dying was a great gift. They made reconciliations with their long-lost families, they freely expressed their love and forgiveness, or they found the kindness and acceptance they had been looking for their whole lives. Still others turned toward the wall in withdrawal and hopelessness and never came back again. I think it is important to remember that people are not born angry, hopeless or violent. They are learned responses to the conditions they encounter in life. We can help people learn new ways, we can reflect the best in them their good hearts. Taking the time to really listen to people's stories can be very helpful.

There was this very sweet old Italian woman named Grace who lived with us at the hospice. She came to us with a six-week prognosis and seven months later she was still with us. Volunteers kept describing the same conversation when they would go into the room to be with Grace. "How you doing today, Grace?" "Oh, I just wanna die." Every day the same answer. It became kind of a gag at the hospice. And then one night in a volunteer meeting, I said to the group, "You know, maybe we're not taking Grace seriously enough."

So the next morning I went into her room, and I said, "Grace, how you doing today?" And she said, "Oh, I just wanna die." And I said, "Grace, what do you think is so much better about dying?" And she looked at me as if you say, what kind of a question is that to ask an 80-year-old Italian woman? And sensing we were on to something, I said, "You know, Grace, I have no guarantees that it's going to be any better on the other side." And she said, "Well, at least I'd get out." And I asked, "Out of what?" And then she began to tell me the story of her family.

As she told her story it became clear that for 50 years of her marriage she had always taken care of her husband: cooked his meals, balanced his checkbook, accommodated his moods. Now there was no real resentment about this; she always believed that it was her role as a wife. But now that she was sick, she couldn't imagine how he could possibly take care of her. She didn't want to be a burden and so dying was her ticket out. That's why she came to the hospice. After we spent some time talking, I suggested that she speak to her husband. I wasn't there for that conversation. They had been married for 50 years and I figured they could work it out amongst themselves. All I know is, three days later Grace moved out of the hospice and back home. She lived for another seven months in the care of her husband and daughter. Her dying wasn't a burden, it was a gift she shared with them.

Telling our story to someone else allows us to pull back and see more of the picture. We become more aware of the details, the ones that we might not have noticed before, and this can lead us to accept and open more fully to the situation we find ourselves in. In facilitating this sort of reflection, it's important to let the dying person set the pace and boundaries. It's best to focus on the positive, to remind the person of their accomplishments in this life and of their innate kindness. But don't withdraw from other truths that may need to be spoken. Stories may give rise to gratitude that wants to be expressed, but also to painful memories that open the door to a need for forgiveness or reconciliation.

offContent1 karma

Your thoughts on euthanasia? Like someone has a terminal illness that causes extreme physical and mental agony that cannot be relieved by medication but death is drawn out, shouldn't they be allowed to just end it?

FrankOstaseski3 karma

I do not approve of "euthanasia. Euthanasia is when someone else takes your life. Physician-assisted death differs from "suicide' and "euthanasia". It's now legal in 5 states (California, Colorado, District of Columbia, Oregon, Vermont, and Washington). Physician-assisted death requires that ten individual make the choice to hasten death and is able to ingest the medications themselves. See thread above.

LosingWeekends0 karma

A person shows up for hospice care. Develops a condition in hospice which is not treated. Patient dies.

You chose not to address that statement? Doesn't seem hateful. Seems curious. How do you justify that?

FrankOstaseski1 karma

I'm sorry I cannot comment on a situation involving someone being treated or not treated.... about which I have no details. Maybe better to talk you a physician you trust.

[deleted]-4 karma

[deleted]

FrankOstaseski5 karma

This is harmful and insensitive speech. I do not care to respond.

LosingWeekends-7 karma

Nope. I've watch hospice kill people. The general assumption that what you are doing is somehow honorable and kind is harmful, at best. Let's say someone develops pneumonia while under hospice care, but it was not preexisting when they showed up. You don't treat it, and they die.

How is that respectable? It's murder.

FrankOstaseski2 karma

This is harmful and insensitive speech. I do not care to respond.

MikeTorelloMCU-11 karma

do you think you may be unlucky to be around?

FrankOstaseski13 karma

This is harmful speech and I do not care to respond.

arcalumis-45 karma

What I don't get is; what's with this morbid celebration of death?

You're not going anywhere, no heaven, no hell and no post life enlightenment. You die and everything is over, there's nothing after this.

And even if there is, why imbue that to the dying, prepare them for nothing and if there's something beyond it will be a welcome surprise.

FrankOstaseski56 karma

Not sure we are celebrating death. However, we can use the fact of death to help us understand life and perhaps live a bit more fully. Death reminds us that everything comes and goes: every thought, every lovemaking, every life. We see that dying is in the life of everything. Resisting this truth leads to pain. When we live a life illuminated by the fact of your death, it informs our choices.... right in the middle of life. Each moment is born and dies. And in a very real way, we are born and die with it. There is a beauty to all this impermanence. In Japan, people celebrate the brief but abundant blooming of the cherry blossoms each spring. In Idaho, outside the cabin where I teach, blue flax flowers live for a single day. Why do such flowers appear so much more magnificent than plastic ones? The fragility, the brevity, and the uncertainty of their lives captivates us, invites us into beauty, wonder, and gratitude.