Are you seeing that circle widen?
Yeah. I mean, I get to talk to you across the world. That’s amazing. Even a couple of years ago when I’d tell people what I do for a living, you watch the blood drain from their faces. They would get uncomfortable and sometimes just walk away.
[Laughs]. Leave you hanging!
Yeah! Now I tell people what I do and they’ll say: “Oh that’s so cool! Tell me more! What’s it like?” So we’re in a different time, that’s for sure.
Why do you think that is?
I think a lot of people have been looking for new ways of thinking for some time. And therefore respecting it when we see it, not ignoring it, waiting or other people to see the potential also. I think also there’s an ageing population to contend with and most everyone you or I know has either taken care of someone who’s nearing the end or has died. So they see firsthand the flaws in the system. I also wonder if climate change has something to do with it.
Well, I think as human beings for the last couple of hundred years the thinking has been man versus nature. In high school English that’s the theme of so many novels we were taught, that we were sort of at battle with nature. I think we’re realising that, A) we are part of nature so we’re at battle with ourselves, which is kind of silly, and B) we have an impact on the world—it’s not an endless sink. So there’s a reckoning happening where we see we belong to a single planet. Australians, Americans, Chinese, whatever. We’re part of one planet and we’re affecting that planet. And that reckoning, that we could actually be evincing the end of our species? Shit!
That’s like a megadeath. So I think that is part of the backdrop. And all of us trying to bend our heads around that is also inviting a different attitude to these other aspects of our lives.
What have you learnt about attention in your work?
I think Buddhism is so interesting because of its relationship to the present moment. How it frames the undeniable: the past is in the past, the future hasn’t happened yet, and really we only have the moment. That’s a little oversimplified because we have this talent, this penchant to remember things, and this penchant to forecast futures. So I want to take that capacity very seriously. Saying: “I’ll just live in the moment!” That’s very hard to do for a number of reasons. But I do think there’s something to it when your moments are running out, all the more reason to soak up what you have while you have it. That’s the discipline. Delight in it while you have it. I watch myself and my patients forecast grief about a loss that hasn’t even happened yet. So you’re consumed not by enjoying the final waiting moments you have, but by the fact that those moments are about to be gone.
That’s so true.
And that’s fine and normal, but I also think it’s something to push against. And this gets back to the notion of “playing it all the way out” or “living to your last breath.” I see that in the dogs I’ve lived with: how they’re just alive, alive, alive and they’ll accommodate whatever happens to them, and then they’re dead. There’s alive and then there’s dead. There’s not a lot in-between. You know, there’s illness and there’s a body falling apart, but you’re still there. I think the mindblower—especially among healthcare professionals—is when I simply point out that dying people are still alive. Cause we talk about “the dying” as though it’s some other species. And then we come across all the problems that happen when you separate yourself from others. But the fact is we’re going through this same damn thing.
It’s this story we’ve told ourselves about dying. I think of people I’ve lost in my life—my grandfather, I remember this look he gave me when I visited him just before he was to die, this desperate look that said, “I can’t believe this! This wasn’t meant to happen to me! Can’t you do something?” You know, this story that says there is a wrestle between life and death. Right up until the end it has to be this kind of tension.
Yeah. Well, you know what? There are some important subtleties. Like I want to be creating these pathways so that dying with some joy left in your heart or peacefulness is possible. But one of the tricks in this work is that while you want to have this expansive sense of the possible, you don’t want to alienate people who don’t get there. Because in fact dying is still pretty scary. And dying can be filled with pain. And you may not be able to train your brain to live in the moment right up ‘til the last breath. So as we articulate these things together out in the world, the trick is helping this transformational joyful thing, setting the conditions for it, but not mandating it. I see my job as setting a stage, providing the environment for certain things to happen. But I can’t mandate what those things are. In fact, I have a lot of patients who aren’t really interested in a peaceful death. They see themselves going down swinging. I don’t see it that way. But I don’t want to alienate that guy. He’s the one who’s dying after all. And my job is to help him be what he wants to be through to the end. So yes joy, peace, yes. And we don’t want to alienate the harder negative stuff.
And what about the role and the place of loved ones in this? It’s a different experience for them altogether because they’re losing the loved one. They’re saying goodbye to them.
Yeah. It’s a related role but an importantly different role. I’ve spent a fair amount of time with families in clinic and at Zen and they suffer in all sorts of ways. As problematic as hospitals are, at least there’s an enormous expensive building designed for your problem as a patient. But the family are often in the way, there’s not a lot of space for them, their suffering is short shrift to the patient’s suffering. You’re right, the loved one must live on past the person’s death, and make peace with that and love other people again, remembering that person. But letting them go is really tricky. So it’s a huge piece of the job and especially if we’re interested in crafting this different society it’s all the more critical the loved ones go back into the world and are still around to help affect change. If they have a very negative experience and there’s no space for their grief, and their grief gets horns and teeth and they turn gnarled and shut down, that’s not going to help this cause by any stretch.