Sunday, November 20, 2005

A Call, A Death, A Final Goodbye

The call just came at 5pm. Mary answered my cell-phone and received the news: "A" stopped breathing just moments ago. The hospice nurse is on her way to pronounce her dead ,and the family is gathered around her diminutive body which has ceased its earthly rhythms.

A votive candle is now lit in the lap of the Buddha statue on our dining room altar. In some cultures, candles are lit for the newly dead to light their way through the confusion of the first hours of death. It is said in the Tibetan Book of the Dead that the "Bardo" stage---the stage of transition following death---can be shocking and confusing for the unprepared soul, and there are specific meditations that can be practiced to usher a soul through the Bardo towards enlightenment.

"The Tibetan Book of the Dead (also called The Bardo Thotrol) from Tibetan Buddhism was traditionally read aloud to the dying to help them attain liberation. It guides a person to use the moment of death to recognize the nature of mind and attain liberation.

"It teaches that awareness, once freed from the body, creates its own reality like that of a dream. This dream projection unfolds in predictable ways both frightening and beautiful. Peaceful and wrathful visions appear, and these visions can be overwhelming. Since the awareness is still in shock of no longer being attached to and shielded by a body, it needs guidance and forewarning so that key decisions that lead to enlightenment are made. The Tibetan Book of the Dead teaches how one can attain heavenly realms by recognizing the enlightened realms as opposed to being drawn into the realms of seduction that pull incorporeal awareness into cyclic suffering."

I loved “A” more than any patient that I can remember. I can’t quite put my finger on why that is. Maybe it was all of the cigarette-smoke-laden plantains that she gifted to me over the years in her inimitable way. Maybe it was the way she would react with genuine surprised delight when I would arrive at her home, even if we had just hours earlier agreed upon a time for my visit. Maybe it was how, even in her most sickly state, she would inquire after my son and wife and dogs, sending her blessings to them and all of my extended family. I realize that this past Friday was the only time she had not asked that ubiquitous question, her mind being too disengaged from her body to make such an effort, although I’m sure that the intention existed in her mind, even if the words were unsaid.

It's funny how I never tired of her questions, her inability to grasp some of the things I tried to teach her, her reluctance to make changes that we felt were necessary for her health. She was apparently knowingly infected with HIV by a man whom she had met during her fifth decade of life, but she embraced and rallied around that diagnosis with determination, and her steadfast adherence to the medications kept her virus completely at bay for many years, even at the time of her death. Was the cancer that grew in her chest related to HIV even though she had no detectable virus in her blood? Perhaps, but the data is still not there for us to draw any firm conclusions. Whatever the case may be, she smoked like a chimney and only stopped when 24-hour oxygen was absolutely required to sustain her.

Over the last five years, I would often use "A" as an example of the complicated nature of my patients: HIV, diabetes, hypthyroidism, anxiety disorder, major depression, psychosis, history of suicide attempts. But I would also use her as an example of the closeness and personal satisfaction that I gleaned from my work, emotional depth created in such bonds of professional therapeutic relationship and, yes, friendship. Granted, the friendship in its active form was somewhat conditional based upon a one-way relationship of my visits and attentions to her health, but the true spiritual friendship and bond was one born of a kinship that neither of us ever defined and only recently verbalized. Just a few weeks ago, while visiting her in the nursing home, A and I agreed that perhaps we had known one another in a past life, and that there was no way to fully understand why we felt so closely connected. She was quite lucid at the time of that visit, somewhat sad and thoughtful, but readily agreed that our kinship was special to her.

A was a gem, and I will miss her dearly. There was something magical about her that touched me deeply. I am blessed to have known her, and I send her my love and blessings as she leaves this earth, leaves her body, and leaves her family to carry on in her memory. Goodbye, dear friend.
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