Zen Hospice Project... Being of Service
Frank Ostaseski is the Founding Director of the Zen Hospice
Project, a nationally recognized programme of conscious care
for the dying in San Francisco. Inspired by the 2,500-year-old
Buddhist tradition of contemplating sickness, old age and
death, the Zen Hospice Project encourages and supports a mutually
beneficial relationship between volunteer caregivers and individuals
facing death. This innovative model of conscious care provides
a spectrum of collaborative volunteer programmes, residential
care, and training which aim at cultivating wisdom and compassion
through service. Founded in 1987, the Zen Hospice Project
is the oldest and largest Buddhist hospice in America.
Buddhist practitioner, Frank uses his knowledge of both Buddhism
and Western psychotherapy in his work of de-mystifying the care-giving
article is based on a talk given by Frank Ostaseski at the Munich
conference on Death, Dying and Living in November 1996.
we are going to explore our intention in service, and I think
it's helpful to start with the basic, but true premise that
real service does not happen unless both people are being served.
At an installation ceremony at the Zen Centre, a student asked
the abbot, 'What can the Dharma teach me about serving others?"
The abbot answered, "What others? Serve yourself!"
The student persisted, "How do I serve myself?" To
which the abbot responded, "Take care of others."
I work with people who are dying, and some of these people are
very tough. They may have been living on the streets for some
time, or be angry about their loss of control. Often they have
lost their trust in humanity; turning their heads to the wall,
they withdraw. Most of them don't care beans about Buddhism.
These people don't trust easily and if I am going to be of any
use to them at all, I have to be particularly clear and honest
about my intention; if I'm not, they will quickly sniff out
my insincerity and sentimentality.
the individuals I work with blossom, and the way in which they
die will be a great gift; they make reconciliations with their
long-lost families, and they find the kindness and acceptance
they have been looking for their whole lives. It can be quite
wonderful to be around these people. But I don't do this work
because it can turn out so well. Chasing such rewards brings
exhaustion and ultimately leads to manipulation because we're
so busy trying to create the conditions that lead to a reward.
In so doing we miss the current situation. I do this work because
I love it and because it serves me. I try to see myself in each
person that I serve, and I try to see them in me. Those I work
with know and trust that, in fact they come to rely on it. They
understand we are in it together.
at the very heart of service we understand that the act of caring
is always mutually beneficial. We understand that in nurturing
others we are always caring for ourselves, and this understanding
fundamentally shifts the way we provide care. I'm not the good
guy coming to the rescue; I have no white horses. Instead we
become what I call 'compassionate companions'. 'Compassion',
when literally translated means ' suffering with others' and
'with' is the most important word, because it implies belonging.
'Companion' is 'one who travels with another'. So in this relationship
there is no guide, there is no healer and no one healed; we
simply accompany one another. And as my friend Reb Anderson
says, "We are simply walking through birth and death holding
If we are
paying attention as we walk into the room of someone dying,
we immediately understand, in a visceral way, just how precarious
this life is. As we understand that, we also come to see how
precious it is. When we keep death close at hand, we become
less compulsive about our desires, we take ourselves and our
ideas a little less seriously, and we let go more easily. We
become more open to generosity and to love. Paradoxically, working
with the dying will make us kinder to one another. In the face
of death everything we normally identify with ourselves will
either be stripped away by illness or given up gracefully-but
it all goes. 'I'm a father', 'I'm a mother', 'I'm a hospice
worker', 'I'm a sexual deviant'-whatever our notion about our
identity, it will go.
surface, the lives of the people I work with seem to be very
different from mine: they're black, I'm white; they shoot heroin
and have AIDS, I don't; they're homeless and alone, I pay a
ridiculous amount of rent and I have four teenagers. It would
be easy to convince myself that we are separate, after all a
few months ago we might have just walked past each other on
the streets. But the wonderful thing is that now, in the hospice,
we are thrown together in the most intimate of circumstances.
And suddenly in the midst of all the activity, in the details
of service, we find a meeting place. We find that we belong
any action of the body, thought, or speech, there is a moment
of intention that we need to be aware of because clarity about
our intention gives us choice about how we can proceed. A moment
of contact with our intention can break our habitual patterns
and keep us from operating on automatic pilot.
Zen tradition there is a practice called dokusan. It is an interview
with the teacher. The student is instructed to wait outside
the teacher's door, where they must gather themselves completely
into the moment. They have no idea what is waiting for them
on the other side of the door, they have no idea what their
teacher will ask them, so they have to be ready, flexible and
open. Going into a dying patient's room is like going for dokusan.
Ideally, our bodies and minds should enter the room at the same
time. Sometimes that's not the case, is it? We leave our minds
way behind sometimes we even leave our bodies behind! Or we
enter the room days before we ever got there.
a volunteer I know who did this. He went to a patient's bed
and the patient got very excited saying, "Oh I'm so glad
you're here. I finally have someone to talk with about my dying."
The volunteer got very excited and said, "Yes, yes, yes.
I'm going to get books by Elisabeth Kübler-Ross and Steven
Levine and I will be back next week and we will talk all about
it." Of course the next week he came back with piles of
books and the patient said, "Yes. We're watching the football
game on TV, please come in. Watch the football game with us."
in care-giving, we're not so much looking to see what serves
but to confirm some idea we have about ourselves. We want to
be somebody. We say, 'I work with the dying/ with the emphasis
on 'I', and invest in the role, not the function. I sometimes
call this 'helper's disease', and it is a much more rampant
epidemic than AIDS or cancer. We try to set ourselves apart
from other people's suffering. We set ourselves apart through
our pity, our fear, our professional warmth and even our charitable
acts. This work has nothing to do with charity.
A few years
ago a woman at our hospice was just a few days from her death,
and she was quite sad and depressed. This seemed natural to
me; she was dying. But a nurse suggested that we start her on
Elavil, which is a medication used to enhance people's moods
and usually takes about three weeks to start working. I asked
the nurse, 'Why do you want to prescribe this medication?"
She replied, 'Well, she's suffering, and it's so hard to watch
her suffer." So I said, "Maybe you should take the
to the role of helper is old in most of us; helping others provides
a needed sense of power or respectability that we collect at
the end of the week like a pay cheque. But if we're not careful,
this identity will imprison us as well as those we serve. After
all, if I'm going to be a helper, somebody has to be helpless!
Rachel Remen, who runs the Commonweal Cancer Centre in California,
speaks very beautifully about this. She says:
is not the same as helping. Helping is based on inequality,
it's not a relationship between equals. When you help, you use
your own strength to help someone with less strength. It's a
one up, one down relationship, and people feel this inequality.
When we help, we may inadvertently take away more than we give,
diminishing the person's sense of self-worth and self-esteem.
Now, when I help I am very aware of my own strength, but we
don't serve with our strength, we serve with ourselves. We draw
from all our experiences: our wounds serve, our limitations
serve, even our darkness serves. The wholeness in us serves
the wholeness in the other, and the wholeness in life. Helping
incurs debt: when you help someone, they owe you. But service
is mutual. When I help I have a feeling of satisfaction, but
when I serve I have a feeling of gratitude. Serving is also
different to fixing. We fix broken pipes, we don't fix people.
When I set about fixing another person, it's because I see them
as broken. Fixing is a form of judgment that separates us from
one another; it creates a distance.
fundamentally, helping, fixing and serving are ways of seeing
life. When you help, you see life as weak; when you fix, you
see life as broken; and when you serve, you see life as whole.
When we serve in this way, we understand that this person's
suffering is also my suffering, that their joy is also my joy
and then the impulse to serve arises naturally - our natural
wisdom and compassion presents itself quite simply. A server
knows that they're being used and has the willingness to be
used in the service of something greater. We may help or fix
many things in our lives, but when we serve, we are always in
the service of wholeness."
for those who are suffering, whether or not they are dying,
wakes us up. It opens up our hearts and our minds. It opens
us up to the experience of this wholeness that I speak of. More
often than not, though, we are caught in the habitual roles
and ideas that keep us separate from each other. Lost in some
reactive mind state, busy trying to protect our selfimage, we
cut ourselves off and isolate ourselves from that which would
really serve and inform our work. To be people who heal we have
to be willing to bring our passion to the bedside; our own wounds,
our fear, our full selves. Yes, it is the exploration of our
own suffering that forms a bridge to the person, we're serving.
how it works. A few years ago a very, very dear friend of mine,
someone I loved very much, was quite sick with AIDS. I had known
him for many years. In just one afternoon he lost his ability
to speak, hold a fork, stand and to formulate a coherent sentence,
and it happened during the afternoon that I was taking care
of him. It scared the hell out of me. Me! 'Mr. Hospice'!
I did everything
I could to take care of him. He had enormous fistulas and anal
tumours, and constant diarrhoea. We moved incessantly from the
toilet to the bathtub and back to the toilet again. It went
on all night. I was exhausted and all I wanted to do was get
him to bed so I could sleep. I tried every trick I knew. I was
cajoling, I was manipulative, I was paternalistic. I changed
wardrobe more often than Madonna.
middle of one of these moves from the bathtub to the toilet,
he spoke. From his garbled mind he said, "You're trying
too hard." And indeed I was. I stopped right there, sat
down beside the toilet and started to cry. It was the most exquisite
meeting of our whole relationship. We were completely helpless
together. No separation. No professional warmth.
not willing to explore our own suffering, then we will only
be guessing as we try to understand our patients. It is the
exploration of our own suffering that allows us to serve others.
This is what allows us to touch another person's pain with compassion
instead of fear and pity. And we have to be willing to listen,
not only to the patient but to ourselves.
pay careful attention to what's immediately in front of us.
A year or so ago a very tough, eighty-year-old Russian Jewish
lady was in the process of dying. As I walked into her room
I saw that she was gasping for air. The attendant sitting by
her bed said to her, "You don't have to be frightened,
I'm right here with you." The woman replied, "Believe
me, if this was happening to you, you would be frightened."
I just watched. Then the attendant said, "You look a little
cold, would you like a blanket?" The woman replied, "Of
course I'm cold! I'm almost dead." If I was going to be
able to help her, I knew that I would really have to listen.
I really had to pay attention to what she was telling us.
struggling with her breath, but she wanted to be dealt with
honestly-she didn't want any bullshit. I said, "Adèle,
would you like to suffer a little less? Would you like to struggle
a little less?"
there, right in between the in-breath and the out-breath there's
a little place in which I've seen you resting. Can you Put your
attention there for just a moment?"
this was one rough, tough Russian Jew with absolutely no interest
in Buddhism or meditation. But she did want to struggle less.
So for a few moments she tried this and, as she did so, I saw
the fear in her face begin to wash away. She took a few more
breaths, and then died quite calmly.
If we are
going to be of service we have to pay attention to what's immediately
in front of us, act with minimal intervention, and bring to
the experience the same attention and equanimity that we cultivate
on our meditation cushion. The degree we are willing and able
to live in this ever-fresh moment is the measure of our ability
to be of real service. When the heart is open and the mind is
still, when our attention is fully in this moment, then the
world becomes undivided for us and we know what to do. Each
of us here can do that, we .don't need twenty years of Buddhist
practice. Each of us has the capacity to embrace another person's
suffering as our own. We have been doing it for hundreds of
years-we've just forgotten how, and so we have to remind each
hospice first opened, one of our volunteers, Tom, was helping
a patient with AIDS to move from the bed to the commode. As
they began to move the patient fell, causing chaos: his pants
fell down around his ankles and the commode tipped over-it was
like a small Hiroshima. This is what care-giving is really like.
Anyway, Tom fumbled through it all and got the patient back
into bed. Then he called me. "Frank, I want you to review
with me the techniques we learned in the training about positioning
people in bed." I said, "OK, let's just do this: the
next time you go to move J.D., before you start just check your
belly. See if your belly is soft. If your belly is not soft,
don't do anything."
give me that Buddhist stuff. I want to know what do I do with
his knees?" "Just check your belly and call me back
a bit like saying, 'Take two aspirins and call me in the morning',
but he did call back a bit later.
it was the most amazing thing. I went to move J.D. and my belly
was hard as a rock, so I stopped. I took a few breaths, my belly
softened and the next thing I knew, J.D. was in my arms like
a lover or a small child. It was no trouble at all."
know how to do this.
practice includes this notion that we have all been born many
times before and that we have all been each other's mothers
and fathers and children. Therefore, we should treat each person
we encounter as if they are our beloved. As we inquire into
the heart of service, we see a pattern: common to all habits
that hinder us in our work is a sense of separateness; and common
to all those moments and actions that truly seem to serve is
the experience of unity. Einstein wrote about this, and Sogyal
Rinpoche quotes it on page 98 of The Tibetan Book of Living
human being is part of a whole, called by us the 'Universe'
a part limited in time and space. He experiences himself, his
thoughts and feelings, as something separated from the rest
- a kind of optical delusion of his consciousness. This delusion
is a kind of prison for us, restricting us to our personal desires
and to affection for a few persons nearest us. Our task must
be to free ourselves from this prison by widening our circle
of compassion to embrace all living creatures and the whole
of nature in its beauty."
heart is undivided, everything we encounter becomes our practice.
Service becomes a sacred exchange, like breathing in and breathing
out. We receive a physical and spiritual sustenance in the world,
and this is like breathing in. Then, because each of us has
certain gifts to offer, part of -our happiness in this world
is to give something back, and this is like breathing out. One
friend calls this 'simple human kindness'. Our work, I think,
is to get out of the way of our own innate wisdom and compassion-that
simple human kindness-and allow our inborn ability to see what
another needs, to serve the dying and the living.