Saturday, October 23, 2010

a Journey of Spirit

This Blog reflects on my journey, caring for hospice patients living the later days of their lives. It compares aspects of my own spiritual upbringing to that which I experienced in my journey to Japan, and reflects in some ways on the connections between Pure Land Buddhism and the challenges we sometimes face caring for patients in hospice.



Visiting Usui Sensei's resting place in Tokyo, one finds oneself at a peaceful, meditative place which is a Pure Land (Jodo sect) Buddhist cemetary. In biographies about Mrs Takata, an "Archbishop of the Jodo sect" is mentioned, but one cannot know with certainty exactly what this realtionship represented. Many of Mrs Takata's stories were allegorical, and she was writing at a time of intense prejudice in America.

Respected sources record Usui Sensei as a Tendai monk, and suggest that he was originally laid to rest in a Tendai cemetary and then moved to his current site. Others have recorded Usui Sensei as Christian, which is doubtful, or Pure Land Buddhist. The truth in history is beyond my grasp, but the fact is that Usui Sensei lays to rest at a Pure Land cemetary and that fact led me to reflection on the serenity and connection of Pure Land thought. I am not a Buddhist, but, people in moments of need seek a connectivity that seems to me best represented by what the great religions have in common, not in the qualities that make sects distinct.


Recently I was caring for a patient with cancer. Randy was unsconscious, he had suffered through surgery and chemotherapy and radiation therapy. Every conventional modality had been tried. He had been rejected for stem cell treatment (though I have had patients who have been through even that in their struggle). We were able to control Randy's pain, but his family family were suffering. They looked to the hospice team for help and support. Time and again in hospice, we are faced with patients and their families who look to us for guidance and for caring, when we have no tools for curing. What do we do? It just doesn't feel right to button up the "white coat" and walk away in these moments.



In these moments, all members of the hospice team become equally important. When all we can do is connect and support at a human level, there is no hierarchy. Every member of my Team is valued.


Honen was a Buddhist monk who lived from 1133 to 1212 Common era in Japan. He studied at Mt Hiei and was ordained a Tendai sect Monk at age 15. He founded the Japanese Pure Land or Jodo sect. Usui Sensei is laid to rest in a Pure Land cemetary in Tokyo. It is likely that Usui Sensei was a well educated man, aware of the teachings of many sects of Buddhism, and of Christian, Jewish and Muslim teachings as well.


One of Honen's principal teachings occurred when followers of his Jodo Shu sect saw both Honen, and his student Awanosuke, studying the meaning of "Nembutsu." "Of course," one said, "Honen's Nembutsu practice is better than Awanosuke's." Honen answered, "there is not the slightest difference between the two, because both of us have the same intention of wanting to attain birth in the Buddha's Pure Land."

What was the nature of this practice "Nembutsu?" It is repeating the affirmation, "Namu Amida Butsu" often translated as "homage to Amida Buddha," - a simple statement of faith. I have also seen this described as "save us oh Amida Buddha"using the term of Buddha as a manifestation of God the creator who is still active with compassion in the world.

There is a comparable Jewish prayer in the mystical "Hallel." It is a most basic affirmation of faith. "Ana (and then a Hebrew name for God) ho-shi-a na." It translates "please God (creator and ongoing ruler of the universe) save us."

In hospice, at moments when science has failed, a simple reaffirmation of faith and acknowledgement of a higher power that connects us can mean so much to patients and their loved ones. So much often pours out, "we didn't think we could talk about this with you." At a time when people need connection the most, and when more surgery is not an option, science should not "sterilize" the discussion of a creator from the room.


Honen was known for another teaching, and that was his belief that attainment of enlightment was not limited to the rich or to fellow Monks. Honen believed that women and men, rich and pure, fisherman and Samurai, Monks and laypersons, could all attain enlightenment, and this was revolutionary in his time at Mt Hiei. Honen defended his position based on stories and teachings from the historic Buddha, Shakyamuni.


Honen taught that in seeking enlightenment it was not enough to seek just for oneself. The search for enlightenment required assisting others. It was a similar dilemma that led the great Jewish scholar Hillel to teach, "if I am not for myself, who will be for me? but if i am only for myself, who am I?"

For those who do not believe in the revelation that there is a God who created and still cares for the world, and that all human beings are connected through that spirit - it is not for me to convince or convert. But in those moments when transition seems near, it is reasonable to talk about those strengths and connections by which the patient and the family have lived. Those who make simple affirmations of faith seem to suffer less, if at all.



Whether Sensei Mikao Usui was a Christian or a Buddhist, and if a Buddhist a Tendai or Pure Land follower, he lived a secular life and passed to the world a very non sectarian message that without religion allowed for connection to a Universal spirit through simple method.

These 5 affirmations seem consistent with most of the major religions, and seem to help reduce suffering.


1. We will not worry just for today (since we Affirm faith in a Creator)


2. We will not be angry just for today (since we ask the merciful Creator to forgive us all our errors just as we forgive others)


3. We will work hard today (since human beings of all stations in life can reach enlightenment, we all need to do our own share)

4. We will be grateful just for today (for what the Creator does for us)

5. We will do kindness just for today (to enlighten and connect oneself one must attempt to help others - we send ripples of compassion into the world)


When we return to that which we all have in common, rather than focus on that which makes us distinct, we are more able help others through a difficult part of their journey.

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