So the Darkness Shall Be the Light

Contemplative care comes of age at a symposium in Garrison, New YorkJoe Loizzo

The thing that most made my internship at a preeminent Harvard community hospital seem like a descent into what Buddhists call the hungry ghost realm was coming face to face with the limits in our modern medical approach to the natural process of aging and dying. A disturbing experience with a dying patient one night when I was on call left an indelible impression that will forever remind me of those limits.

Admitted from a nursing home earlier that day for pneumonia, the woman—whom I’ll call Mary—was quickly given antibiotics, but her blood oxygen had to be monitored to be sure she didn’t need to be put on a respirator. As the night intern, I had to draw blood from an artery in her wrist, run it on ice to the lab, and act on the result if necessary. Emaciated and hovering between sleep and coma, Mary showed few signs of recognition as I went through the prescribed steps: introducing myself, explaining the procedure, and asking for her consent and cooperation. She barely responded as I tried to soothe and prepare her by stroking her hand. I can still hear her labored breathing and feel her body squirm in safety restraints as the needle punctured her wrist. Tapping the radial artery is usually the most painful of blood tests.

When I learned that Mary had died the next day, despite her healthy blood oxygen level and her initial response to treatment, I was haunted by the image of her squinting eyes and grimacing face, as she lay in a dark and drab hospital room with a young intern who could have simply comforted her like a son but had to stick her with a needle instead.

It’s been 30 years since that night, but I found Mary on my mind one recent Saturday morning as my train left Manhattan and tracked up the Hudson River, through a rolling landscape of mist-veiled cliffs, gorges, and vistas that looked for all the world like a Zen scroll painting. From the Garrison station, a trailhead led through the woods to the Garrison Institute, a former Catholic monastery where the Manhattan-based New York Zen Center for Contemplative Care (NYZCCC) was holding its first Buddhist Contemplative Care Symposium on palliative and end-of-life care, in partnership with the Garrison Institute. By the time I’d made it up the Institute’s granite steps, I’d already been serendipitously welcomed and embraced by the dynamic duo who founded NYZCCC and were now convening the historic symposium.

A naturally warm and outgoing pair, Robert Chodo Campbell and Koshin Paley Ellison look otherworldly in their black Zen monks’ robes and shaved heads, but they are engaged in a very down-to-earth mission: to help heal and transform our modern world’s conflicted relationship with the suffering of illness, aging, and dying. As the perfect complement to modern medicine’s all-out war on illness and death, Chodo and Koshin bring a meditative approach to the hard choices we face as we near the end of life. Their contemplative direction works to heighten our capacity for mindful presence, acceptance, and attunement, insuring the quality of our all-important last journey in life rather than focusing on fighting the inevitable until we lack the strength of mind to say goodbye and let go with courage and gratitude.

Once the gong of the opening meditation had sounded in the stained glass-illuminated hall, the day unfolded like a cross between a spiritual retreat and an information-packed clinical conference. Most of the participants were professionals—doctors, nurses, social workers, and chaplains—working in the emerging fields of palliative care and hospice care. Their faces seemed to drink in the air of mindfulness and compassion. The questions they asked after the meditations, presentations, and panels helped explain why. Although the last decades have spawned the new fields in which these brave pioneers work, our popular consciousness and professional approach to death haven’t changed much overall. How do we bring the qualities of mindful presence to terminal illness and end-of-life care when our hospitals are still anesthetic and impersonal and our medical system still attacks illness and death with a violence that treats quality of life as an acceptable casualty of medically necessary life-or-death treatment?

In place of quick fixes or high-tech solutions, the conference speakers—including Chodo and Koshin, physician Diane Meier, the founder of the Center for the Advancement of Palliative Care, and other thought-leaders in the field—offered complementary healing arts and an intimate spirit of unconditional presence, as well as their long-term vision of a cultural shift toward an enlightened acceptance of death and dying. Oncologist Anthony Back led a group exercise aimed at an awareness and transformation of the deep emotions stirred up in the presence of death. Palliative care physician B. J. Miller took participants on a thought-provoking journey through the medical humanities of philosophy, poetry, art, and architecture to a vision of healing approaches, environments, and communities that would help individuals and families transform their last moments together into uplifting experiences of beauty, belonging, and meaning.

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