Care for theterminally ill By Swamini Pramananda Spiritual Advisor Ganga Prem Hospice

Swamini Pramananda

The fear of death
Nothing has held humanity’s attention more than the experience of ‘death.’ So for terminal patients, spirituality primarily means to help them to be free from the fear of death, of the unknown and to give them hope for life after death. We can only do this if, within ourselves, we can come to a place of comfort with regard to our own death.

We find that most human beings resist the idea of death. Nobody wants to discuss death because the fear of becoming extinct is so great that no-one wants to disappear from the face of earth. It is important to eliminate from our mind the thinking that we die at all, in the sense that we bring an end to our lives. The scriptures reveal to us that at the moment of what we call ‘death,’ we merely change the form in which we have lived and continue our existence.

We cannot truly love life if we are afraid of death. If we are, we will always walk in fear throughout our life. In other words, only when the fear of death is removed from our lives, is our life itself lived fearlessly. We need to understand that each moment of life ends the instant it begins. Life and death are two sides of a coin and we cannot relate to one fully, whilst remaining ignorant of the other.

Comfort in dying and dignity in death
The dying also know that people are not ready to face death. Some of them recognize that there are many situations in which death is preferable to life. What a relief it would be for them if they only knew that even though the experience of death would soon occur, death is not real, since truly life does not end. They need to know that death would be the most joyous experience of their life, as they are at last, being taken Home. They would be reassuming their natural state and once again living totally as a soul, and hence it is okay to go!

But the dying are often sensitive to the level of resistance from their loved ones regarding their decision to leave. Have you noticed how many people wait until the room is empty before they die? Some even have to tell their loved ones, “Please go… You have not eaten today” or, “Go, get some sleep… I am fine” or, “Take some rest and let me sleep too.” Then, when the loyal guard leaves, so does the soul from the body.

If they told their assembled relatives and friends, “I just want to die,” they could hardly hear it. They would tell the dying, “Now, don’t talk that way” or, “Please don’t leave me.” In fact, the entire medical profession is trained to keep people alive, rather than keep people comfortable so that they can die with dignity. You see, to a doctor or a nurse, death is failure. To a friend or relative, death is disaster. Only to the soul is death a relief – a release.

The goal of a Hospice is to give the dying that comfort and dignity in death. To achieve this aim, an insight of what happens after death is essential, so that the dying can die comfortably without resistance. The greatest gift you can give to the dying is to let them die in peace – not thinking that they must ‘hang on’ or continue to suffer, or worry about you at this most crucial passage in their life.

Death is only a transition
In fact, death is only a transition from one state to another state. It is like going from one room to another, or one can say, going from one country to another. We need to know and understand this very well - that no one ever ceases to exist. There is no annihilation of the spirit. The statement, ‘He is no more,’ is wrong. In our language it is appropriate to say, ‘He has passed on,’ as it is only the physical body which is no more. In Hindi, there is an expression, ‘Uskaa shareer shanta hogayaa,’ which means, ‘his body has come to an end.’ This alone is appropriate and not, ‘Uskaa anta hogayaa’ which means, ‘his life has come to an end.’

The Katopanishad, belongs to Yajur Veda and begins with a young lad named Nachiketas who asks Lord Yama (the Lord of Death) the following question in mantra 1.1.20. He says,

Yeyam prete vichikitsa manusye, astityeke nayamastiti caike
Etad vidyam anushistas-tvayaham Varanam esah varastritiyah

“When someone dies a question arises regarding his death. Some say ‘the soul continues to exist.’ Others say, ‘the soul does not exist.’ I would like to learn the truth from you. Of all the boons, this is my third boon.”

Lord Yama replies in mantra 1.1.20,

Na jayate mryate va vipascit nayam kutaschin-na babhuva kascit
Ajo nitya shasvatoyam puranah na hanyate hanyamane sharire

“The Illumined Self is neither born nor does it die. It did not originate from anything, nor did anything originate from it. It is birthless, eternal, undecaying and ancient. It is not injured even when the body is killed.”

Similarly, in reply to his disciple, Arjuna’s question on knowing the nature of the Self, Lord Krishna replies in the Bhagavad Gita Chapter 2, verse 21:

Vedavinashinam nityam ya enam ajam avyayam katham sa purusha partha kam ghatayatihantikam

“One who knows the self as Imperishable because it is eternal, unborn, and cannot decline, how can he kill anyone or cause anyone to be killed?”

Near death experience and past life regression
Like the ancient scriptures quoted above, today, the medical profession also understands that life continues. We hear of people coming back from death and telling of various experiences in the other world such as meeting their loved ones, communicating with Masters, or entering into the Infinite Light, etc. This is called NDE or near death experience. Here, too, we understand that the soul does not die and that life continues.

Not only that, we know that Hypnotic Past Life Regression, is used by some Psychiatrists to investigate and treat phobias, etc. The patient is guided to another life whilst in a hypnotic trance, in which the event of the current phobia was experienced. Re-living the event consciously brings a release of the trapped emotions that have caused the phobia in the patient. In the study of children’s past lives, memories are yet another proof of the continuity of life.

One unique phenomenon is the Out of Body Experience, OBE, or Astral Travel as known to us through the experiences of the yogis of India. The uniqueness of the OBE is that, when one is alive here itself, one recognizes that the soul exists apart from the body.

Thus, in modern society, there is enough proof that there is continuity of life. The Soul is eternal and hence there is enough assurance that I will live on, even without the body. It is we who need to pause in our lives in order to reflect and assimilate this understanding into our psyche. So whatever we do from now on, on our planet, will reflect our new beliefs and understanding.

Beliefs, behaviours and conditions
So far, our life in our present dominant societies, has been based on our belief that we have only one life to live and hence we have chosen to become competitors between ourselves. We have chosen to destroy other life forms in an urgency to acquire, hoard and live on forever. We live with the philosophy of ‘Survival of the fittest’ rather than ‘Live and let live.’

In order to change these conditions today, we have to change the ‘beliefs’ that have created those conditions. Our beliefs create behaviours and behaviours create conditions. It is not about trying to ‘change’ the conditions of life on our planet. It is the beliefs that have created those conditions and it is the beliefs that need to be addressed. It is important that firstly we work on changing our beliefs and then assist others in changing theirs.

An opportunity such as serving in a Hospice is a rare blessing to enjoy while we are alive. Sharing our days with the terminally ill gives us a chance to deepen our understanding of the nature of life and death, and heal ourselves of the fear of mortality as we work to heal others.

Working with the terminally ill
As we work with the terminally ill, we must understand that a patient may accept that the Soul is eternal, but that does not address his basic question as to, “Where will I go, and will I be alone?”

In the Bhagavad Gita, Lord Krishna says in Chapter 8.5:

Antakale ca mameva smaran muktva kalevaram. Yah prayati sa madbhavam yati nastyatra samshayah.

“There is no doubt, that whoever leaves his body remembering Me, the Lord, at the time of death, attains Me.”

Further we understand that the thought life, convictions and core values one holds during life are carried on after death. For the terminally ill person, it is a relief to know that, not only will he continue to exist, but if he can change his thought life, he can soon be one with the Infinite Light. In this manner, given proper insights about his eternal self, he will be ready to move on gracefully and become one with the Infinite Light. He alone can die gracefully who has lived gracefully, who has been in touch with truths higher and greater than those which meet the eye.

I consider it a great blessing for the living, to be part of the life of one who is terminally ill and yet courageous enough to die gracefully. I remember my mother’s death and the prelude to it. While she lived, she worked as a Social Worker and while she was on her death bed, saying good-bye to people, she solved many fights within the large family. She told her relatives that it was her death-bed wish that they make up with each other, love each other, as life is too short to waste away in petty matters. She made the living understand that it does not matter anymore, as to who was right and who was wrong, as right and wrong are our own perceptions about people and situations.

She wanted me to chant daily the Nirvanasatkam and the Katopanishad, as these sacred works reminded her of the fact that the Self is eternal, free from the limitations of the body and is of the nature of Infinite Light. As she remained awakened to the truth of her Self in the last days of her life, she gave me the greatest blessing of learning how to close my accounts with the world, whether the others close theirs or not.

I understood that all the experiences of life are meant for our own evolution and that is why they happen the way they do. Our evolution is marked by our own capacity to forgive and let go.

One of the noblest contributions we can make in society is to take this understanding of the truth of life, and guide the terminally ill into relaxing and freeing themselves from the pain of psychological bondage with people, things and situations, whilst managing their physical pain in separating from the body. It is a contribution which also helps us to evolve spiritually as human beings.

Nani Ma at her ashram near Uttarkashi

Life after death By Nani Ma Trustee Shradha Cancer Care Trust Spiritual Advisor Ganga Prem Hospice

When we look at what we call a dead body, it doesn’t look as if there is something called, ‘life after death’. The body doesn’t move. It doesn’t speak, it doesn’t laugh or cry. It doesn’t even breathe. We have to dispose of it just like any other machine which doesn’t work anymore. If we don’t dispose of it right away, it will start to decompose, to disintegrate because the material of which it is made deteriorates quickly.

Facing death with the help of understanding
The body that seemed alive just minutes ago is dead now and we have started to weep, because our loved one will not be with us anymore. Bhagavan Sri Ramji spoke to Tara when her husband lay dead on the ground and she was beside herself with grief. (Adhyatma Ramayana: Kishkinda Kanda, ch. 3) He asked her to think carefully and tell him whether she was grieving for the body that lay in front of her or for the Atma, the Soul that had inhabited it. He said that if she was grieving for the body, which was made up of the 5 elements in the shape of flesh, bones and blood and that had taken form according to time, action and the modes of nature, then that body still lay before her and so there was no need to grieve. If on the other hand she was grieving for the Atma, which had lived in the body then also she should not grieve as that Atma is all-pervading and changeless. It is neither born nor dies, is neither man nor woman. It is one-without-a-second and cannot be affected by anything. It is eternal, pure knowledge and infinite.

Bhagavan Sri Ramji was referring to the Hindu belief that in an individual, the eternal Atma or Soul is enveloped within 3 bodies; a gross or physical body which is made up of the 5 gross elements and has a form with arms, legs, a trunk and many internal fleshy organs; a subtle body which is made up of subtle elements and consists of the sense organs, the 5 pranas or life breath and the mind or thinking faculty along with the emotions; and a causal body which is made up of ignorance. The causal body covers the Atma and hides it from our vision and understanding while the subtle and gross bodies project a personality into a universe which is similarly projected by the mysterious power known as Prakriti or nature of the original Being.

When we say someone is dying, what we actually mean is that the gross body has, for some reason, become unfit for habitation by the soul. Perhaps some of the body’s essential parts have been irreparably damaged by an accident. Perhaps it has developed an incurable, progressive disease or perhaps it had just become old and worn out. When this happens the Atma leaves the physical body taking with it the subtle and causal bodies. In the Srimad Bhagavad Gita (ch.15, v.7-11), Bhagavan Sri Krishnaji describes this subtle process as being akin to the wind taking the sweet smell from a flower and carrying it away. He describes how the ignorant person cannot see the Atma which presides over the body and uses the sense organs and mind to enjoy gross and subtle sense objects. The ignorant person sees the body functioning and not the power within, much as we may see a machine working and forget the electricity which is responsible for its functioning.

This ignorance leads to great distress when the living consciousness that is the Soul suddenly leaves, taking with it the subtle personality and leaving behind only a corpse. It is confusing and distressing for all of us but not for the wise who, as Lord Krishna says, perceive the Atma as it lives within and later leaves the body.

Tara replied, “Then if the body is only an inert substance and the Atma is eternal consciousness, who is it who suffers or enjoys?”

Bhagavan Sri Ramji replied,
“As long as there is the feeling of ‘I’ and ‘mine’ towards the body and sense organs, as long as the jiva atma or individual soul lacks discrimination between Spirit/ Atma and matter/ bodies, so it will be connected to this material universe full of the sorrows and enjoyments involved in sensory experience… Because the jiva atma identifies itself with the mind it becomes affected by the sorrows and joys which actually belong to the insentient mind… When one comes to know, from one’s own experience, one’s true Self as the non dual Existence, Knowledge and Bliss and that the Atma is separate from the body, sense organs, mind and ego then one will be free… The sorrows of the world will not be able to touch one.”

Facing death, losing our loved ones and fear of our own death, is the greatest sorrow that we can experience on this Earth. Death follows us like a dark shadow throughout life and to escape it many people resort to the very immature method of ignoring its existence. However this method doesn’t work for long because death is present with us daily and each and everyone us has at some time to face the loss of our loved ones and finally to face our own inevitable death. Hinduism offers 2 main ways of overcoming the sorrow involved in the death experience:

One is the acquirement of knowledge such as Bhagavan Sri Ramji taught Tara in the Ramayana or as Bhagavan Sri Krishnaji taught Arjuna in the Bhagavad Gita. It is the knowledge that the Atma or Soul is always separate from the body, knowledge that there is life after death because ‘life’, the Atma, is present before, during and after its transitory habitation of this ephemeral body. “Beings are not manifest at the beginning. They are manifest in the middle, O descendent of Bharat, and (again) they are not manifest at the end, what is there to wail about?” (Bhagavad Gita ch.2, v.28). The death transition is in fact just like changing one’s clothes when they wear out. “Just as a person discards old clothes and takes new ones so the embodied soul discards worn out bodies and goes to other new ones.” (Bhagavad Gita ch.2 v.22) This knowledge of the Atma is at first an intellectual understanding based on logical reasoning but when perfected through spiritual practice it becomes experiential knowledge capable of liberating one from all sorrow.

Life after death could mean return to one’s own true form. However, if at the time of death, there is continued desire for more physical and emotional enjoyment, the jiva atma will take the subtle and causal bodies and move into another body which is suitable to the personality and desires of the individual and to the activities which he previously performed in order to satiate those desires.

Facing death with the help of devotion
In Hinduism, otherwise known as Sanatana Dharma (the eternal religion), the other principal method to overcome the sorrow connected to both life and death is devotion, or surrender to the Higher Power. Belief in a Supreme Being that knows better than we do is an integral part of the Hindu faith. Belief that Bhagavan or God knows best and does the best for us brings great solace to those devotees who choose this path. For those who worship God with form, there is the reassurance that devotion and surrender to that form leads, after death, to an Eternal Abode where the Deity resides. Sri Krishna Bhagavan says, “Fix your mind in Me, be devoted to Me, worship Me and bow to Me. You will come to Me, I truly promise you. You are dear to Me.” (Bhagavad Gita ch.18, v.65)

The acme of this devotional path is when the devotee can completely submerge his mind and intellect in the Deity to the extent that he has no separate will of his own but is satisfied with whatever his Lord gives him. If the devotee is able to fully surrender and worship Bhagavan constantly it is believed that he will attain Bhagavan. Sanatana Dharma teaches that whatever a person thinks of at the time of death, that is what he will become. These last thoughts are believed to be formed by the habits of a person’s lifetime. “Whatever one remembers at the time of leaving the body, O Kaunteya, one will reach that, as one has always been influenced by that. Therefore, remember Me at all times and fight (do your duty). Having your mind and intellect surrendered to Me, you will come to Me without a doubt.” (Bhagavad Gita ch.8, v.6-7)

This belief also means that if one has not been able to keep one’s mind and intellect on the Higher Power throughout one’s life and therefore is not able to remember Him at the last time one will take birth again in other forms according to one’s desires, tendencies and actions. “Some souls enter the womb for acquiring new bodies and others enter immovable life (trees etc) in accordance with their actions and their knowledge. (Katha Upanishad, 2.2.7.) This does not mean to say that if we have not been able to achieve the goal of our practice in this life that all practice was in vain as Sri Krishna promises, “(One who has striven for realisation of the Truth) will not be lost either in this life or the next. O dear friend, one who has done virtuous deeds will not go to a bad state of existence…There (in another life), O Scion of the Kurus, he will regain the understanding of his last life and he will work again for perfection.” (Bhagavad Gita ch.6, v.40-43) The different possibilities of reincarnations are described in all the Hindu scriptures and range from births in heaven, through births in both movable and immovable forms, to births in the nether worlds and the various hells.

The role of the mind in relationship with life after death
What is clear from all the scriptures is the importance given to the role of the mind in relationship to life after death. It is the mind that governs our happiness and sorrow in this life and also it is the mind, with its latent desires, that can take us to liberation from worldly existence or throws us back into the whirlpool of samsara (the endless coming and going into different bodies). Life after death is very much an integral part of the Hindu faith and so also is the belief that the life we will have in the future is up to us. By controlling our desires and actions we can in fact control our future lives. If we wish for cessation of the pain of repeated worldly life and death, then we have to follow one of the paths outlined in the scriptures. All of these paths basically consist in attuning our minds to concepts which take us beyond the limited confines of our body-mind complex and the obsessive desires generated by it. “When all the desires contained in his heart cease to exist then a mortal becomes immortal and he attains Brahman (Atma) here.” (Katha Upanishad 2.3.14.) Like the visible tip of an iceberg, our physical and mental bodies are only the outward indication of something much bigger, something described in the scriptures as an infinite and eternal Being which is our own true form.

The spiritual practices of the Hindu faith, particularly meditation, are designed so that we ourselves can experience an existence beyond the body and mind. First hand experience of our own unlimited reality will remove all doubts as to the actual nature of our Being. “The knot of the heart is undone, all doubts are destroyed, all action is finished when that Totality (Brahman) is seen.” (Mundaka Upanishad 2.2.8) With experience of ourselves as other than the body and mind, it will not be difficult to understand that the death of the body is only a superficial transition which does not affect the deeper parts of our existence. Until such time as we are able to experience the Divine ourselves, the scriptures advise faith in the words of those who have had that experience. “Other people, although not knowing in this way (the difference between Spirit and matter), worship on hearing from others. They also cross over death, being engaged in listening.” (Bhagavad Gita ch.13, v.25) Direct knowledge of, or faith in the Higher Truth brings the Hindu peace and acceptance in the face of life’s greatest problem, the problem of facing death and what lies beyond.

Excerpts from the Kathopanishad
(the conversation between Naciketa and Death)

Kathopanishad is an ancient scripture in which a young boy goes to the land of Death. Death grants the boy three boons and as the third boon the young boy, Naciketa, asks Death to explain to him the secrets of death and immortality.

Naciketa said,
This doubt that arises on the death of a man, some saying ‘It exists’, and others saying ‘It does not exist’. Instructed by you I would know this. (1.1.21)

Death said,
No mortal lives by prana or apana (ingoing and outgoing breath) but all live by something else on which both of these depend. (2.2.5)
O Naciketa, I shall tell you of this secret, eternal Brahman and also how the Self fares after death. (2.2.6)

Some souls enter the womb for acquiring a body and others assume plant form, in accordance with their work and in conformity with their knowledge. (2.2.7.)

The Self is this which keeps awake and goes on creating desirable things even when the senses fall asleep. That is pure; that is Brahman, that is, indeed, called immortal. All the worlds are fixed on that; none can transcend it. This indeed is that. (2.2.8)

Just as air, though one, having entered into this world, assumes separate forms in respect of different shapes, similarly, the one Self inside all beings assumes various forms in respect of each shape; and (yet) it is outside. (2.2.10)

Just as the sun, which is the eye of the whole world, is not tainted by the ocular and external defects, similarly, the Self, that is one in all beings, is not tainted by the sorrows of the world. It is transcendental. (2.2.11)

There the sun does not shine, neither do the moon and the stars; nor do these flashes of lightning shine there. How can this fire shine? Everything shines after that self effulgent one. By its light all this shines. (2.2.15)

Its form does not exist within the range of vision; nobody sees it with the eye. When this Self is revealed through deliberation, it is realised by the intellect, the ruler of the mind, that resides in the heart. Those who know this become immortal. (2.3.10)

When all desires clinging to one’s heart fall off, then a mortal becomes immortal (and he) attains Brahman here. (2.3.14)

When all the knots of the heart are destroyed, even while a man is alive, then a mortal becomes immortal. This much alone is the instruction. (2.3.15)

The Purusha, the indwelling Self, of the size of a thumb, is ever seated in the hearts of men. One should unerringly separate it from one’s body like a stalk from the muñja grass. That one should know as pure and immortal. That one should know as pure and immortal. (2.3.17)

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