So the Darkness Shall Be the Light

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

The historic gathering was an auspicious sign, marking the beginning of a new hybrid field in which health care and the contemplative arts work together to make death an ultimate good. From the standpoint of contemplative care, a good death is one that respects the dying person’s need for dignity and intimacy, fostering a sense of the dying process as a culminating illumination of the meaning of life for both the person dying and those bearing witness. As many of us know from our own experience with dying friends or loved ones, the end of life often offers rare opportunities to affirm and deepen our highest human values—reconciling conflicts, sharing forgiveness and gratitude, deepening a sense of loving intimacy, and rising above our myopic experience of ourselves, our lives, and the world. So it is no surprise that most spiritual traditions see contemplative care as a rich vocation, offering practitioners an ideal vehicle for putting their spiritual aspirations to relieve suffering and promote human flourishing into real-world practice every day.

If taking a mindful approach to the end of life can be so beneficial, why is there still such confusion surrounding contemplative care? From a Buddhist perspective, the root of this lack of awareness lies in our modern materialist view of death. In reducing life to mindless matter—and mind to the physical brain—modern science, medicine, and popular culture have come to see death as a mere off switch, a full stop followed by nothingness. From this radical materialist view, we literally have no experience of death; therefore, the quality of our experience at the end of life just doesn’t matter. So the only human value modern materialist science can subscribe to is to prolong life at all costs, as long as possible: hence the medical emphasis on maintaining quantity over improving quality at the end of life. This bias persists despite the challenge presented by studies of people in coma states and a growing body of solid research on near-death experience indicating that many of us do indeed have vivid experiences when our bodies and brains meet the criteria to be pronounced dead. Many who come back to life after resuscitation can recall in detail events that took place in the room after they were supposedly dead, and some describe their near-death experiences as unimaginably heart- and mind-opening and permanently life-altering. While these findings are only a small part of the argument for a paradigm shift toward emphasizing the quality of the end of life, they do raise questions about the accepted science of death. In addition, growing concern about the mounting human and economic costs of our medical system’s de facto denial of death and dying seems to be moving us toward increased support for contemplative care.

Founded in 2007 and inspired by the work of the late Issan Dorsey, a Zen Buddhist monk who established the Maitri Hospice in San Francisco, the New York Zen Center for Contemplative Care has already had a rich history of successful partnerships and initiatives. It provides New York’s Beth Israel Medical Center with contemplative chaplaincy interns and has partnered with New York–Presbyterian Hospital. NYZCCC works closely with key hospice services, including the Visiting Nurse Service of New York Hospice and Hospice & Palliative Care of Westchester. It is also a national leader in education and training, offering a yearlong Foundations in Buddhist Contemplative Care, a fully accredited two- to four-year clinical chaplaincy program in Clinical Pastoral Education, and the recently launched Buddhist-track master’s program in Pastoral Care and Counseling at New York Theological Seminary. The center is even at the forefront of bringing contemplative approaches to palliative and hospice care into medical training, thanks to an ongoing collaboration with the Arizona Center for Integrative Medicine at the University of Arizona College of Medicine.

Over lunch, NYZCCC’s cofounders Chodo and Koshin and their Zen teacher, Roshi Pat Enkyo O’Hara, underscored the practical nature of the training programs, which prepare graduates to find jobs in a fast-growing field. I had the good fortune to sit in on a meeting to plan the publication of a volume on the clinical practice of contemplative care that would distill the rich offerings of the conference for practitioners around the world who couldn’t make it. The book will be the first to bring the healing wisdom of many spiritual traditions and all clinical disciplines to the complex challenges of facing aging, illness, death, and dying with compassionate openness and artful presence.

Lest you wonder if our hardworking pioneers are as severe as their black monks' robes might suggest, in true Zen style they surprised and delighted conference participants by inviting New York State poet laureate Marie Howe as a special guest, to recite her own poetry and an array of requests. Her presence brought to mind some lines from T. S. Eliot’s Four Quartets that I wish I’d had the courage to read to my patient Mary that night 30 years ago:

I said to my soul, be still, and let the dark come upon you
Which shall be the darkness of God. As, in a theatre,
The lights are extinguished, for the scene to be changed
With a hollow rumble of wings, with a movement of darkness on darkness,
And we know that the hills and the trees, the distant panorama
And the bold imposing facade are all being rolled away—
Or as, when an underground train, in the tube, stops too long between stations
And the conversation rises and slowly fades into silence
And you see behind every face the mental emptiness deepen
Leaving only the growing terror of nothing to think about;
Or when, under ether, the mind is conscious but conscious of nothing—
I said to my soul, be still, and wait without hope
For hope would be hope for the wrong thing; wait without love,
For love would be love of the wrong thing; there is yet faith
But the faith and the love and the hope are all in the waiting.
Wait without thought, for you are not ready for thought:
So the darkness shall be the light, and the stillness the dancing.

Now I can not only wait but also begin to hope that today’s trainees in medicine, oncology, palliative care, and hospice care may meet teachers like Chodo and Koshin, who can give them the courage to face death and dying not just as professionals, but as fully present, caring fellow travelers on the great journey of life we all share.

Joe loizzo, M.D., Ph.D., is the author of Sustainable Happiness and the founder of Nalanda Institute for Contemplative Science.

Image 1: From left: Robert Chodo Campbell, Koshin Paley Ellison, Enkyo O'Hara, Judy Lief, and Dr. B .J. Miller
Image 2: From left: Dr. B. J. Miller, Robert Chodo Campell, and Koshin Paley Ellison


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