The Wisdom Blog: Classic & Contemporary Buddhism

The Final Stretch - watching the breath at the end of life

by Gerry Stribling
December 11, 2015
Fri, 12/11/2015 - 15:04 -- Gerry Stribling

In meditation, we watch ourselves breathe.

In real life, sometimes we’re compelled to watch others breathe (sleeping lovers and sick children come to mind). I like to tell people about when I lived at an elephant bath in Sri Lanka—and found it mesmerizing to watch elephants lie utterly still on their sides in shallow rivers, looking dead, except that every twenty seconds or so, the tips of the animals trunks popped up from the water like periscopes, to blow out an old breath, suck in a new one, and drop back down under the water.

Now I watch people breathe their last.

Im the midnight-to-three guy when our local hospice has a request for “eleventh hour” volunteers, the handful of us who go and sit with people during he last twenty-four to forty-eight hours they are alive.

Usually our encounters happen in nursing homes. Theyre hospice patients, so that means that theyre not hooked up to monitors or tubes or IVs. No one is supposed to try to revive them if their breathing stops or their hearts stop beating. Eleventh hour volunteers receive additional training to understand the physiology of death. Often we have information from our training that we will ultimately need to share with family members, who may not be studied up on such things and dont understand, for example, why hydrating grandma would actually increase her discomfort at this stage of the game. The families can be eager for more detailed information about their loved ones imminent death that the doctors may not have time to provide.

But mostly, we sit in quiet rooms and watch and listen to our patients breathe.

They all breathe differently. Ive had patients who snore. I spent two nights with an eleventh hour patient earlier this month, an old black woman. On the first night she breathed strongly, deeply, and rhythmically.  She started out the same way on night two, but as the hours progressed, her breathing became rapid, and eventually she was breathing only through her mouth, almost panting like a dog. I left at three. She died at six.

This is Louisville, Kentucky, home of the Kentucky Derby, and the various wings of the nursing home where the black woman spent her last hours were named after horse-racing terms, like “The Starting Gate” and “The Far Turn.” My patients wing was named “The Final Stretch.” Dont know if the irony is intended.

The following weekend I sat with another very old woman in a different nursing home, and again I watched the rise and fall of the sheets that covered her torso, and listened as her staccato inhalations were followed by short sighs. Her breathing didnt vary the whole three hours of my shift. No moans, no movement, no signs of restlessness. I was reminded of the elephants as I sat in fascination to watch the woman who was about to relinquish her life, seem not to cling to life with every breath, but rather to celebrate it. “You go, girl,” I whispered in her ear. I dont know if I was encouraging her to breathe on, or to let go. Either way, I whispered it to her with enthusiasm. She died later that day.

Why do we sit in the dreary, dark confines of the rooms in which people die, a place where no one wants to be? Because were asked to. Some people do not want to pass away all by themselves. They may have no one else to sit with them, or a beleaguered family desperately needs a break to rest from their vigil. Not every patient requests eleventh hour services, but for some people, not being alone when they die is important.

It’s peaceful duty. I can think of no other situation or place, even tying flies in my man cave, that seems so peaceful, watching Grandma breathe.

The reality about death is that people generally have great aversion to it. That may be the dumbest, most obvious observation I have ever made. But like anything scary, like snakes or spiders, the more you confront the inspiration of your fears, the less scary it becomes.

This aversion comes from ignorance, and leads to fear and loathing, and suffering, and unwholesome attachment. Sometimes people want Grandma to stay “alive” as long as possible, artificially prolonging her suffering, with a respirator tube stuck down her throat. In our time we have sanitized death. People dont die at home anymore. In 19th Century America it was hardly unusual for Grandmas corpse to be laid out in the parlor so people can come by and pay their respects. Funeral homes perform that function now. Talk about sanitized. You could eat off the floor in a funeral home.

The courage it takes to sit in a quiet room and watch and listen to someone die comes from the abiding happiness enlightened people, Buddhist or not, experience when they perform compassionate deeds. I am hardly in click-my-heels ecstatic joy after a shift in a nursing home, but when I meditate on the good deeds Ive done, or Im planning to do, the joy is there, inside my head, such incredible joy that for a moment or two in time, I feel like I'm bathed in sunlight. There is no other feeling like it. I don't need a pat on the head. I can pat my own head.

And then after a shift I go to the Waffle House, to reward myself, since its the only restaurant open at three in the morning.


Gerry Stribling is the author of Buddhism for Dudes.

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