Tag Archives: spirituality

“Six Things That Matter Most” — A List for All Seasons

            There often comes a time when a family is told their loved one has just a few hours or days left before dying.  It can be an agonizing time of not knowing what to do other than wait.   The loved one may still be able to communicate or, more often, is sleeping much of time.  What do you do when “there’s nothing more to be done”?

            Ira Byock, a leading physician in contemporary hospice and palliative medicine, came up with a helpful resource for such times.  He would take his prescription notepad and write four phrases: “Please forgive me. I forgive you. I love you. Thank you.” He would give that to a family member and invite them to consider if any of those statements would be appropriate to say.  He wrote an influential book on the transformative and healing experiences he witnessed arising from people using these simple statements.  As the book became popular, two more were added: “Goodbye” and “I am proud of you.”

            The values represented in these statements — forgiveness, love, gratitude, and acknowledging the cycles of life — are universally present in the great spiritual traditions.

            When I was at Hospice of Santa Barbara, we took those six statements and had them printed on business cards.  Our staff and volunteers could then give them to families when appropriate.  I began to carry some in my wallet, a practice I’ve continued for more than a decade.

            I was grateful to have the card when my father was dying.

            He was in his last days at a nursing home. My two sisters and I used the list as a prompt for talking to him. He was no longer responsive, but it felt like the right thing to do. Maybe he heard us or maybe not.  Maybe he could sense what we meant through tone or feeling. Or maybe it was just for us.  

            “Dad, please forgive me for the sleepless nights I gave you as a teenager.”

            “There were times when I was growing up I was afraid of your anger.  I knew you were under a lot of pressure and loved us, but it was still scary. I forgive you.”

            “Thank you for providing for us, encouraging us and believing in us.”

            “For the way you worked so hard to honor mom and provide for us, for the integrity and honesty with which you lived your life, and for your service to our country during the war – we are proud of you.” 

            Dad wasn’t from a generation when many men would say “I love you.”  But we knew he loved us.  It was easy to say, “I love you, Dad.”

            The “Goodbye” statement can be tricky.  It can be tempting to say it to have some closure, but it may be too early.  (I remember one family had asked a harpist to play in the room; the patient woke up and said, “Get that music out of here…I’m not ready for the angels yet!”) But if, say, a family member is leaving town or death is clearly imminent, then “Goodbye” can be fitting.

            As I did presentations on hospice in the community, I would pass these cards out.  People would later tell me how helpful they were.

            But I also knew what everyone who works in hospice knows…the work is not just about the dying, but also about the living.  Whether dad was fully aware of what we were saying, it gave us closure. 

            The list can also be helpful after a death when we didn’t have an opportunity to speak the words in person. We can write a letter to the person using the list as possible prompts.  We can then save the letter just for ourselves. Or we can take it to a place we associate with the person, including a gravesite, and read it.  When it’s served its purpose, we can keep it or create a simple ritual and burn it.

            “Six Things” can also be valuable when death is not on the horizon. Roughly half of Americans die with some form of hospice care, which means there may be time for meaningful bedside moments.  It also means the other half of us will die without such an opportunity – heart attacks, strokes, accidents, etc.  If these are the six things that matter most, why wait for a moment that we may never have?  Why not use them when we are alive and well?

            Once, I was doing a daylong retreat on this theme. I gave the background and handed out the cards. Then I said, “But let’s not wait. I encourage us all to think if there is anyone we want to say any of these statements to now.”  I gave everyone 45 minutes. I’d brought stationery and envelopes if people wanted to write letters, and also encouraged people to make a phone call, send an email or text a message.  

            When we regathered, I asked for people to share experiences. One woman said she had called her daughter.  The call went to voicemail and mom left a message, “I just want to say I love you!” The daughter called back a few minutes later sounding frantic: “What’s wrong mom?! Are you OK??”  Mom laughed and reassured her she was fine, but was doing this as part of a retreat.  So, giving a little background can help when we are conveying such deep feelings.

            As time went on, I’ve found the “Six Things” a good way to take inventory from time to time in my own life on occasions like anniversaries and birthdays. Is there someone I want to say these words to now, since there’s no guarantee I’ll have a chance in the future?  Why not just do it? Once we do, there is a sense of freedom.

            Six simple statements, loaded with healing power. 

Your Purpose Is More Important Than Your Plan

 It seems some people follow a straight, well-planned path in life: they set goals and expectations day after day, year after year — and achieve them.  But for most of us, events can disrupt our plans.  It could be something affecting only me, or something like COVID that impacts everyone. We can be left with feelings of loss, discouragement and confusion. What can I expect in life?  Isn’t there some divine plan that is designed to make me happy?  Or was the plan to make me suffer?  Or is there no plan at all?

            Over the centuries, these are questions that have been pondered and debated by countless people in many spiritual traditions. Today I’m offering my personal perspective by focusing on a fascinating story from the Jesus tradition as exists in the Gospel of Mark, Chapter 5.

            As we pick up the story, Jesus has become increasingly popular due, in large part, to his healing power.  The day begins when a local leader, Jairus, comes to him and begs him to come to his house and heal his daughter, who is close to dying. Jesus agrees.

            On the way, a woman who has been suffering from hemorrhages for 12 years comes up behind him. Her condition makes her “unclean” in the culture of that time, so she can’t seek him out publicly like Jairus. But, she hopes, if she can just sneak up behind him and touch his cloak, she might be healed.  She carefully approaches, touches the cloak and immediately senses in her body that she is healed.

            At that moment, Jesus also has a visceral, somatic experience – “power had gone forth from him.” Taken by surprise, he turns and asks who touched him.  The disciples reply: with so many people close by, how can they know? The woman reluctantly steps forth “in fear and trembling” and confesses.  He does not condemn her. Instead, he says “Daughter, your faith has made you well; go in peace…”  He then resumes his walk to Jairus’ house, where he takes the little girl by the hand and brings her out of her coma.

            The story is rich in implications.  As the philosopher Paul Ricœur put it, great spiritual texts (like lasting works of art) have a “surplus of meaning” – more than just one point. For today’s question, I will focus on consciousness and decision making.

            Imagine if we can “get inside” Jesus’ consciousness as he started that day.  What did he know, and when did he know it? When he woke up, did he know Jairus would come to him?  Did he anticipate the act of the woman?

            Jesus has been described as a “Spirit Man,” one of those people who has a much deeper level of awareness than most. People in the Gospels find it uncanny the way he can “read them” and know what they are thinking. I’ve known a few people in my life who have had that ability, so I believe it exists.  And I’m guessing he had it in spades.

            However, I think if we take the story at face value, his encounter with the bleeding woman is written in a way to suggest Jesus did not anticipate it — he’s surprised and taken off guard.  If he had a “plan” for his day, this encounter was not part of it. Or, to put it another way, if he started out with a plan for the day, he had to adapt the plan to fit real events.  Some years ago, it struck me: he had to change his plans, but he did not have to change his purpose.  His purpose was to exhibit divine justice, grace and compassion. The woman unexpectedly touching his cloak became not a cause of frustration, but a new opportunity to express his purpose.  He could fulfill his purpose regardless of unanticipated events that came his way, presented to him by the choices other people make.

            This has been a liberating insight. My day may go “all according to plan.” Or it may be interrupted by all kinds of events — some positive, some not. Living a spiritual life does not mean we have to assume we are to follow a preordained script.  Rather, it means we try to keep clarity about what is most important to us and others in moments of unexpected events and decisions; we assume we need to be creative in adapting to the ups and downs that come our way.      

            The divine presence never leaves us and is always ready to help us improvise in a way that stays true to those deeper purposes.  Remember that when events – big or small – interrupt our plans. 

When Compassion Isn’t Enough

As part of my work at Hospice of Santa Barbara, a group of us attended a week-long retreat at the Metta Institute in Marin County. The theme was “Cultivating Presence” and led by Frank Ostateski, an accomplished teacher of both Zen meditation and hospice care.

            In one of his talks, Frank focused on the traditional greeting in parts of Asia – “Namaste.”  You clasp your hands palm-to-palm in front of your chin and sometimes follow with a slight bow.  It had become well-known in the West through its frequent use as a way to close a yoga class and was often said to symbolize “I bow to the sacred in you.”  Frank had closed his classes with the familiar gesture, and as students we returned the blessing.

At one session, Frank focused on a deeper meaning “Namaste” can have. One hand can represent the virtue of compassion and the other hand wisdom. He went on to describe the importance of the two virtues always being combined. We may feel great compassion for someone and feel the impulse to take an action. However, actions arising from a genuine motive may have unintended consequences. Therefore, it is critical to evaluate the compassionate urge with patient and practical wisdom if we want to make the best choices.

            I thought this was very helpful and began to share this concept when I was doing the initial training session for hospice volunteers.  Many are led into hospice service out of a compassion for those who are dying, but it is critical we always seek to place that emotion in the presence of wisdom from trained staff and veteran volunteers.  I often used the following story as an illustration. 

            Once we had a very caring volunteer assigned to a low-income family where the father had died.  The volunteer had spent time with the young son in the afternoon and when he dropped the boy off back at home, realized the family had very little food. Moved by compassion and wanting to make a difference, he and a friend went to Costco and bought several hundred dollars’ worth of food for the family and dropped it off at the house.  Soon after, one of the family members called our staff member responsible for the case. They noted how appreciative they were but said they did not have sufficient refrigerated storage to keep so much food and were embarrassed it would be going to waste.  If the volunteer had run his idea by our trained staff member, he would have been affirmed for the impulse, but guided into an action that would better fit the situation.  The compassionate value needed to be matched by wisdom.

            I was reminded of the charge Jesus gives his disciples when he sends them out in pairs for the first time: “… so be wise as serpents and innocent as doves.” (Matthew 10:16).   The serpent was seen a very subtle and clever creature (it was not always identified as evil as it became in later tradition.)  Doves were seen as pure and often symbols for the divine spirit.  Jesus is saying: be open and trusting, but also be smart and strategic.

            I have thought of this many times in my life and career, which I have spent in religious and nonprofit communities.  It was always natural for me to approach any challenging situation with compassion and tact.  Many times, those values led to outcomes I felt good about.  But as time went on and my responsibilities grew, I encountered more complex situations where compassion and “innocence” alone were not enough. I benefited from practical wisdom from others who understood the complexity of organizational challenges and the need to make unpopular decisions that could be perceived as uncaring. When I was able to incorporate that wisdom, outcomes improved.  

            Anyone who has been involved in 12-step programs knows this well.  If someone you care about is struggling with addiction and they beg you for money or help, it is a natural reaction to meet their requests. But that can often make the situation worse.  You need the accumulated wisdom of the support group and the program to make the best choices.

            Caring, empathy, love and compassion are prized virtues.  But the best outcomes arise when they are blended with voices of experience and wisdom. Namaste!