Reflections on a hospice job

For the last year I have been working in a hospice as a nurse, working with people with life-limiting, chronic, incurable and terminal illnesses all along the disease trajectory (or life journey, if you prefer). I’m now moving to work in a slightly different area, geographically and professionally, and it’s definitely made me reflect on spiritual practice.

Firstly: spiritual care of others is not just facilitating religious involvement, such as helping people access priests, monks, rabbis, imams and so on. That’s just being a gatekeeper: it’s helpful and thoughtful, but it’s not the actually care. More importantly, in this age of secularism, spiritual care is often described only in terms of psychological care- listening, empathising, helping. While these are all superb, these are not spiritual care. Spiritual care occurs when someone attempts to unconditionally provide this non-judgement, love, attention and help. It occurs when someone provides it on the level of the person receiving that care, making it all about them and not about the wishes of the practitioner to be wise or grand or impactful. It occurs when it combines the groundedness of genuine and open discussion about the experience of life, illness and dying with an ability to ask what this means to the person, significantly.

Secondly: there is nothing wrong with enjoying your life. At one level, there is nothing to do but help others, and all else is selfish. But at another level, everything is utterly, wonderfully fine. Life and death, seeming opposites, dissolve into each other conceptually when I reflect that all is changing, constantly. And what better way to live in this creative, unworried, ever-changing flux than to participate with curiosity, interest, joy? Any form of masochism I have had, has been a cruder push towards what I should really be doing: I’ve often said that at the beginning, we feel pushed away from suffering; but now I’m a little further on, I feel drawn towards mystery and wonder instead. Why is my own activity in the world any less a legitimate expression? It seems to be slapping God in the face if I should be on my death bed, and He asks: Did you enjoy the journey I made just for you? And I reply: No, I was scared you’d hate me for getting it wrong.

Thirdly: Death is absolutely one of the best topics for spiritual practice, ever. The ultimate taboo, utterly feared and hidden away by the way most of us live, the Great Change. It evokes so many emotions that are not fit for the Western dinner table: morbid fascination, primal fear, sublime awe. It drives us to do so much, wanting to make our mark on the world, but it can also drive us to misery and depression, feeling nothing matters. I feel that, as ostensibly a Buddhist, it is easy to say that death has no sting if you simply subscribe to the rebirth thing; as a Christian, to say you have an immortal soul; or as a more subtle avoider of these issues, that you never existed separately and that you are part of the perfect Universe. But for you to be taken by the shoulders and really shaken in the way that will make you practice spiritually in as pure a way as you can manage, really going for the Unconditional and not simply the benefits, something has to die. That thing is you. Maybe something remains, but that isn’t you. Call it your personality, your form; you will be disintegrated and scattered. It’s that the flying specks of debris that are you continue to impact on other flying specks is what makes you still existent, but not in the separate way you’d like to. Don’t tell me you’re 100% happy with that. Meditate on it, mull it over, face it in visceral, real ways. Visit your grandparents and make them happy before they’re gone. Refuse to dye your grey bits and look at them every day. Don’t avoid funerals, volunteer at a hospice, talk to your best friend about their cancer. Stop bloody hiding from reality, and see how happy and real it makes you.

Fourthly: Yes, I do want to be happy and real, but real comes before happy. This is why death avoidance is unhelpful. This is why bracket emotions are unhelpful. This is why a ‘tomorrow’ approach is unhelpful. Real does not mean impulsive, pessimistic, or blunt. It means dropping layers of avoidance. It means vulnerability. It means a huge level of authenticity which as a middle class male, I really sense is there, but I find hard to access. Some people radiate this authenticity even as they are afraid. They are not afraid to be afraid, angry about being angry, shamed about being shamed. They face criticism and praise looking the other person in the eye. They are not invulnerable, realising that all this is impersonal. They can laugh at themselves knowing it doesn’t diminish them. They are capable of having the toughest conversations without trying to avoid them, falling into clichéd replies. They let the world carry them a little. That’s who I’d like to be, knowing it’s all imperfect and impersonal, but that I have something to do.

Finally: You do have something to do. It isn’t set in stone. It isn’t likely the thing you want to do. But it is right now, it adds up to something greater than the sum of the parts, and your life definitely does not lack meaning. Finding out how to enjoy this as it comes, bringing a little unconditional love, staring the end in the eye, and trying to be as honest with myself and others as I can, is the point right now.

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