Dying of old age has changed drastically since we Baby Boomers were young. Our parents helped our grandparents over the threshold, and now, for the younger of us, it’s our turn to be the helpers, but the advances in medicine have made the journey immensely more complex. And it’s hard to talk to our parents about the daunting prospects they face.
“There’s no one telling us how to navigate the issues,” said Zen chaplain Trudi Hirsch. “People need education to help their parents die better.” To provide that education, while supporting elders and their caregivers, Hirsch and Wendy Drolma, her former student at the New York Zen Center of Contemplative Care, have opened the Black Plum Center in Chichester. A series of intensive workshops, entitled Caring for the Caregiver, will begin in the spring. Meanwhile, they are offering twice-monthly free meditation sessions, as well as fee-based classes in contemplative approaches to the arts.
Hirsch spent 11 years as a monastic at the Zen Mountain Monastery in Mount Tremper, followed by 20 years as a chaplain, including 15 years in a supervisory role. She has worked at nearly every hospital in New York City and is currently chaplain supervisor at Vassar Brothers Medical Center in Poughkeepsie. Drolma’s 100 hours of clinical training involved visiting patients at Benedictine Hospital in Kingston. The two women say their role is not to provide religion but to bring presence and understanding to whatever patients are experiencing as they face sickness or death.
Both have observed many families visiting declining relatives in the hospital, and Hirsch pointed out how tricky the relationship can be. “The family will come in and say, ‘You’ve got to eat!’ They’re trying to say, ‘You’re not dying. If you eat, you’re okay.’ And then the patient will go along with the family, to please them, but it doesn’t give the dying person a chance to talk about who they are, to review their life story, to make their good-byes.”
Her Buddhist training has helped her let go of the tendency to see a patient as an object of pity or as someone who needs fixing. At the monastery, her Zen practice involved meditation on koans, paradoxical statements that cannot be understood through logical thinking. She discovered her patients were living koans. “The more patients I see, I expand my own humanity,” said Hirsch. “When I felt blocked with my patients, seeing a separation between us, those separations became my koans. I have to work on myself, let go of all the things I think are ‘me,’ so I can join their world.”
A chaplain is trained to accept the patient as she is and listen to what she’s going through, “which is not pretty,” said Hirsch. “I’ll visit a patient in her 90s in the morning. She’ll be upset, saying, ‘Oh, I woke up. I wanted to die in my sleep.’ As a chaplain you learn not to say, ‘How great you’re still alive!’ Instead, you say, ‘That must be difficult.’ I’m with them wherever they want to go.”
She wants to convey these skills to caregivers, so they can respond in an authentic way, allowing the dying to say what they really need to say. This openness requires an acceptance of death as inevitable for all of us and has profound implications for decision-making as our elders approach the end. Now that medicine can keep patients from succumbing to innumerable formerly fatal ailments, the end of life for many people has become a long, expensive, and agonizing journey. As one faculty after another is lost — sight, hearing, mobility, swallowing, speech — both patients and their loved ones go through years of torment waiting for the end.
Offspring face difficult ethical decisions in deciding whether to extend the life — and often the suffering — of their parents. Even with a living will that specifies a patient does not want to be resuscitated under traumatic circumstances, relatives may panic when an elder has a health crisis near the end of life — a bout of pneumonia, for instance — and decide on a trip to the emergency room.
“Eighty percent of people die in the hospital,” said Hirsch. “Most people want to die at home. As soon as someone gets a terminal diagnosis, the family should call hospice. If you want to take care of your parent at home, you need to be educated in what to expect: ‘This is what death is going to look like, so don’t freak out.’ When you are deciding whether to call 911, even though you’re anxious and scared, hospice is great at taking care of the situation. They can switch to palliative care,” addressing symptoms to make the dying person comfortable instead of initiating an invasive intervention that prolongs life for someone already prepared to die.
Palliative care is a given for hospice workers, but obtaining it for a relative in the hospital can be tricky without the help of hospice. “At many hospitals, there are only three doctors who can sign off on palliative care,” said Hirsch. “The attending physician’s role is to save the patient no matter what. They’re not going to hand the patient off to someone who will ask, ‘Do you want to be conscious with a little pain or unconscious with no pain?’ and let the patient decide. Some doctors still have a problem working with palliative care. It means they’ve failed. A whole bunch of things have to change in our health care system.”
Especially with so many Baby Boomers needing our own Medicare services, we have to learn how to humanistically manage our parents, ourselves, and our physicians. A cohort of informed caregivers can put pressure on doctors, and indeed the whole system, to shift the focus from saving life at all costs to improving the quality of death. For caregivers whose elders are not yet close to death, now is the time to learn how to communicate with their parents and to prepare for the decisions to come.
Caring for the Caregiver will address such topics as how to deeply listen to and join with the “other” in their suffering, without clinging to the emotions that arise; understanding how to care for yourself while caring for others; end-of-life issues such as heath-care proxy, living wills, organ donations, and funeral options; coping with grief; and much more. The program begins with three full-day sessions held on the first Saturdays of May, June, and July, focusing on “Being the Caregiver.” The series of three days is $300, but people can sign up for a single Saturday. The next series, on first Saturdays in September, October, and November, addresses “Death & Dying…Ours and Others,” followed by “Recreating Oneself After a Loss,” in January through March of 2019.
The free ongoing meditation practice meets the second and fourth Thursday of each month from 5 p.m. to 6:30 p.m. The practice begins with a guided relaxation, moving into simple breathing, visualization, and beginning meditation techniques that are designed to alleviate the demands and stress of modern life. The first and third Thursdays, artist Tor Gudmundsen offers a drawing class, with a fee of $25. The third Friday of each month, Hirsch leads a spiritual dance class, involving gentle, contemplative movements, for $15.
Other offerings include “Life Casting and the Death Mask — Hanging in the Space Between,” an opportunity to sit for a mask casting with Drolma, a professional mask-maker, at her studio in Woodstock. Leah Rubinstein, a potter and former operating room nurse, will offer a monthly “Clay and Healing” class, also in Woodstock, where participants will make clay pots as a healing gesture for self or others. Other classes may be added throughout the year.
For details of classes, to register, and to check for new events, see https://blackplumcenter.com. Most classes take place at the Black Plum Center’s newly renovated space in Chichester, close to Phoenicia.