Sacred Passage: How to Provide Fearless, Compassionate Care for the Dying Margaret Coberly, PhD, RN Shambhala Publications, Inc. Horticultural Hall 300 Massachusetts Ave. Boston, MA 02115 Tele: 617-424-6277 Price: $22.95 (Hardcover)
Sacred Passage is a sensitive, unsentimental exploration of death, an inevitability that most human beings dread. Death is a painfully uncomfortable topic for most of us, yet the author addresses the denial of death at the very outset. With candor, she examines our fear, discomfort, and squeamishness toward death, and questions many of the assumptions that underlie them, for example, the importance of wholeness, permanence, and beauty. She also unmasks the deceptive strategies we devise to avoid confronting the reality of death. Because these strategies often backfire, "the sadness and sense of loss that occurs is intensified beyond measure when we are unprepared." This realization naturally leads to the question: "How can loved ones and caregivers become genuinely present and compassionate in the face of human mortality and suffering?" The book offers some novel responses to this dilemma.
Sacred Passage is an important book for both caregivers and patients. Coberly compellingly demonstrates how terminally ill people can experience emotional and spiritual healing, even when they cannot be cured. The book is especially valuable for hospice nurses and caregivers because it examines some of the avoidance issues they encounter in working with both patients and patients' families. Several poignant stories reveal the ironies and tragedies of delayed admissions to hospice facilities due to denial of the inevitable.
Many suggestions are presented throughout the book for helping to meet the changing and challenging physical and emotional needs of a dying person. For example, a Tibetan Buddhist death meditation is offered as a way to analyze one's own understanding of death and thereby enhance one's ability to talk openly with patients and their families about the process of dying. Nurses with hospice experience will find the Tibetan Buddhist descriptions of dying of particular interest, because they explain in detail the stages of the dying trajectory according to the Tibetan Buddhist texts. Familiarity with these stages, which unfold psychologically as well as physiologically, gives caregivers a way to better understand the patient's physical and spiritual needs. As understanding of death's physical and psychological processes deepens, so does the caregiver's self-confidence, comfort level, and capacity for compassion.
Buddhist approaches to dying are rooted in an understanding of the fleeting nature of all living beings without exception. Insight into the momentary nature of ourselves and all living things results in a sense of immediacy-a relaxed appreciation of the present moment, including our last. Understanding the law of cause and effect is another key to psychological transformation, acting as an antidote for guilt and fear. Generating loving kindness and compassion for all living beings without exception helps mend emotional scars and unresolved relationship issues. Learning to replace meaningless, destructive habits with fresh, constructive responses results in greater peace and happiness for ourselves and others, even in times of duress.
Margaret Coberly is uniquely qualified to guide this down-to-earth exploration about how to care for the dying. After many years of professional emergency room and hospice nursing experience, she completed a doctorate in psychology in which she explored Tibetan Buddhist perspectives on death and the application of these perspectives in caring for the dying. Her understanding was profoundly enriched by many experiences of caring for family members and close friends as they negotiated the final stages of life. Her emotionally charged stories of these experiences vividly convey death's finality and simultaneously illustrate the transformative impact an open, compassionate presence can have.
Dr. Coberly's personal experiences also demonstrate how facing death honestly and courageously can open up new opportunities for personal growth and insight, both for the dying and for the living. While working as an emergency room nurse in a trauma center in Los Angeles, she happened upon some books about Buddhism. These books explained that contemplating death is not morbid; on the contrary, an awareness of the imminence of death can result in a much richer, more expansive understanding of life. From a Buddhist perspective, it is human beings' unrealistic expectations of permanence that are the source of much suffering and disappointment. Recognizing this connection, we begin to realize that the fear and discomfort that attend a terminal diagnosis result primarily from our own shattered illusions of permanence.
Tibetan Buddhism preserves many treasured teachings to help guide the path of inner transformation. Texts such as The Tibetan Book of the Dead speak of the bardo, the intermediate state between death and the next life, as an opportunity for awakening. These texts describe the attractive and frightening visions that may appear to consciousness during the journey to the next life and how to recognize the imminent dawning of the clear, light nature of one's own mind. Awareness of the details of the dying process can illuminate the "sacred passage" from this life to the next or, with practice, from ignorance to enlightened awareness.
Sacred Passage offers essential insights of benefit to everyone who cares for terminally ill patients, insights that can transform sad events into opportunities for spiritual awareness. In today's ethnically diverse society, this book sheds valuable light on alternative views of the human condition that can be of great practical value in a clinical setting. The gems of wisdom and the cornucopia of practical techniques for dealing with the universal experience of dying will enhance the interpersonal skills of both healthcare professionals and family members. By keeping an open mind toward death, we may come to understand the death is not simply a terminus, but potentially the most vibrant and potent of human experiences.