At this point I’d like to make a little detour away from Chih-I and look at Vimalakirti. I mentioned earlier that the illness we are talking about do not cover those taken on by Buddhas or Bodhisattvas for the purpose of instruction, such as the illness of Vimalakirti. Yet in the Vimalakirti Sutra we can learn important lesson, such as found in the exchange between Manjusuri and Vimalakirti on how to encourage a bodhisattva who has illness.
Working the hospital I had many opportunities to witness not only illness but hopelessness, and not only the hopelessness of the sick patient but the hopelessness of those who wished to encourage or support the patient. Many people simply did not know how to be a support, and worried about how to support without making things worse for the patient.
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It is a challenge to be supportive and yet remain honest, to offer encouragement without offering false hope, to be honest about an illness and its effects without either making them worse or discounting them.
One classic example is the compulsion to get a family member to eat when they are dying. There is the almost universal belief that if a person just eats that somehow that will be the key to beginning recovery. While that can certainly be the case in some situations it is not always so for every one.
Take dying for example. When a person is actively dying the body of its own accord knows it doesn’t need food. Since the organs are beginning the process of shutting down they don’t need food which interferes with that process. This is difficult on two levels, one being uncertain that that is what is actually going on, and while doctors can be reasonably certain about this there is still the possibility that there remains some uncertainty. This is where I think the family and those close to the individual can offer the medical staff some insight but it is hard to do.
It requires those supporting the patient to set aside fears and consider what may be happening and what are certain normal behaviors of the patient. All to often the dread of the death of the patient by those supporting clouds the ability to see things realistically. This is where listening to what the medical personal are saying and then looking at the patient from a perspective of the possibility that the medical diagnosis is correct while not completely abandoning hope for a different outcome is critical. Remaining overly optimistic for a wrong diagnosis can cloud vision and views. It isn’t impossible to remain encouraging while being honest, to remain hopeful without dismissing the real possibility.
In many ways it is very beneficial for the patient because then the person knows they can express their fears openly if they exist and they will be heard and honored. It’s tough for a patient who inwardly knows they are dying and they are trying to work through that process and all it involves while everyone around them is saying no, or don’t talk like that, or other such dismissive attitudes.
It is a complicate process, an intricate dance if you will between those supporting the patient and the patient being supported, between honesty and grief and hope and reality. In my experience the closer people come to being honest both about their fears and their grief as well as their hope the deeper the final conversations can be. There are many excellent books written by Buddhist and non-Buddhists that I feel are worth reading before the need arises. They offer insight, ideas, examples and wisdom. It really isn’t possible for one book or one person to have all the answers so my offering here is merely one person’s view based on my experiences.
When the body is in the dying process it is actively engaging in eliminating all unnecessary body functions. Digesting food takes a lot of energy, and the food being consumed isn’t really offering it’s full nutritional value because the body isn’t fully processing it in the way it would if it were healthy. The body tries to get rid of it and so it is an energy drain without the benefit of gain. Also as the body is shutting down it naturally produces pain relieving ‘medications’. Consuming food interferes with this process.
The body can go a long time without food, a week or more. It can’t go quite as long without water and the care facility will be adequately monitoring this or if at home small sips of water might be advisable, but consult with a qualified provider and don’t rely on my advice alone. I am merely offering an overview of the mechanics of the body dying so as to help those supporting understand what’s going on.
The body has the ability to produce powerful pain relieving compounds and will do so even in the dying process. What hospice or hospitals can do is monitor the situation and supplement the natural process to administer smaller doses of more potent pain meds if necessary to keep the patient comfortable.
Here’s something I found most people don’t realize about pain medications unless they have had them administered to themselves. Morpheme, the common pain medication given in hospitals causes constipation. You probably know this is very uncomfortable. Now if the patient is being forced or cajoled into eating when the body is shutting down more pain meds are needed to be given because the bodies natural process has been interrupted. More pain meds means more constipation. Now laxatives need to be given to counteract the constipation which can and usually cause some diarrhea which as you also know is uncomfortable and increases the need for anal maintenance which can hurt tender skin.
A whole cascade of measures and counter measures need to be taken all to keep feeding a body that is trying not to consume food so it can do its thing naturally. What was intended to be supportive, encouraging the patient to eat, now becomes a hinderance and harmful.
This is one of many things about the dying process and about illness that we as a society are ill prepared for.
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