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A friend to the dying - Teacher offers insights from more than 25 years of hospice work

BY KARNA HUGHES, NEWS-PRESS STAFF WRITER

Santa Barbara News, September 18, 2007

"That people are still dying in this country in fear and distress despite their access sometimes to really good medical care is a tragedy for me."
Frank Ostaseski,
a founder of the Zen Hospice Project and the Metta Institute® in the Bay Area

Frank Ostaseski is the kind of person you might want by your side at the end of your life.

But as much as the dying have been helped by Mr. Ostaseski over his nearly three-decade-long career (which earned him a commendation from the Dalai Lama in 2004), the longtime Bay Area resident has learned precious lessons about living and dying from them. "When you sit at the precipice of death for a while, as patients do for months on end, sometimes you see things," he recently said by phone from his Sausalito office.

Mr. Ostaseski will share insights gained from a life of service during two upcoming appearances in Santa Barbara. He'll give a free workshop to caregivers on Saturday at Hospice of Santa Barbara, and on Monday he'll present a Mind and Supermind talk, "Surrendering to the Sacred: Opening to Life," at the Lobero Theatre, co-sponsored by Hospice and Santa Barbara City College's Continuing Education program.

Now a 56-year-old father of four, Mr. Ostaseski got involved with hospice work at the beginning of the AIDS epidemic in San Francisco in the '80s. Before that, he'd worked with groups serving disabled and at-risk children in New York, and for a stint lived in Mexico, helping people in refugee camps who were fleeing wars inGuatemala, Nicaragua and El Salvador.

"In those camps I saw a lot of dying, horrible dying and (I thought), you know, there's got to be another way to do this," said the native New Yorker. "When I came back to the States, while the suffering and face of suffering was different, people were still dying in horrible ways here, even though they had access to all kinds of care."

For example, he remembered calling family members of patients dying from AIDS, who would hang up once they found out that their sons were gay, never to call back.

"But those are the real horror stories. I think the more common experience is simply that people find themselves oftentimes in acute care settings or in nursing facilities where they are often quite isolated in their dying, where their dying isn't considered a kind of relational event. . . . That people are still dying in this country in fear and distress despite their access sometimes to really good medical care is a tragedy for me."

Medical developments, such as improvements in pain management and symptom control (which largely grew out of the hospice movement), are encouraging, yet "the medical model is simply not large enough to embrace what happens in the time of dying," Mr. Ostaseski said.

While working for secular hospice agencies years ago, he wondered what it would be like if care were given differently, incorporating more of a spiritual dimension. What if, instead of simply trying to make the best of a bad situation, caregivers saw the possibility for growth and even transformation in their patients' final days? What if they examined their own beliefs and fears about death so that the environment wasn't one of dread or denial? What if compassion and mindfulness were part of a caregiver's training?

Drawing on those basic Buddhist principles, he helped found the Zen Hospice Project 20 years ago in conjunction with the San Francisco Zen Center. Brought up Catholic, Mr. Ostaseski was an altar boy and had gone to a Catholic high school, but was drawn to Buddhism in his 20s. Several aspects of Buddhist practice initially attracted him: "One, it didn't ask me to believe anything. It asked me only to trust my direct experience," he said. "The other was that it wasn't afraid to talk about suffering and how it was possible to find a kind of freedom from suffering, not by the good graces of some other beings, but through one's own exploration and effort." He had known suffering intimately himself, having lost both of his parents in short succession as a teenager.

"This is a culture where we don't like to talk about suffering very much, and, as a result, it can leave us really short on compassion," he said. "It's not that Buddhism has a corner market on compassion, but it has a pretty deep understanding of it."

The Zen Hospice Project initially reached out to local homeless populations who weren't eligible to receive government services, especially those dying of AIDS, cancer and other illnesses. As founding director, Mr. Ostaseski wanted to be sure the program wasn't dogmatic and didn't push any religious beliefs.

"It's appalling to me all the ideas we have about how we should die," he said. "You know, we have these notions of a good death and bad death. I mean, who sits in judgment of these things? For me, I feel what's most important in this work is you can be a guide and it's really important sometimes to point to possibilities for people, but if they want to watch the 'Wheel of Fortune' on TV and eat H0x8aagen-Dazs and pig out . . . that's fine with me, 'cause I really have confidence what's most useful is the relationship."

Treating the dying with non-judgment, compassion and moment-to-moment mindfulness yielded "extraordinary" results at the Zen Hospice Project, he said. And he's heard similar reports from hospice caregivers across the country trained through the Metta Institute, which he left the Zen Hospice Project to found in 2004.

Mr. Ostaseski directs the nonprofit institute and co-directs its nine-month End-of-Life Practitioner Program, which offers residential weekend sessions and eight-day intensive sessions for commuting students. Several former and current Hospice of Santa Barbara staff members have taken the training. Metta faculty members, including luminaries Ram Dass and Dr. Rachel Naomi Remen (author of the best-seller "Kitchen Table Wisdom"), volunteer their time.

People don't always find self-realization before they die.

"I don't have a lot of romantic notions about it. I think it's the hardest work that we will do," said Mr. Ostaseski. But "there's a very simple opportunity, first of all, for people to exchange love, appreciation and gratitude; conceivably to repair relationships that may have been in need of repair, to express forgiveness, for example, if that's called for." They may come to accept and forgive themselves in a way they've never done before.

When people die, they also tend to look back over their lives to try to find what has had meaning and value. And that can lead to an awareness of what's really important in the present moment.

"That's not just a reminiscing," Mr. Ostaseski said. "I think that's a spiritual practice, even though we might not think of it that way in our culture. . . . We connect with what has been most important. We might also connect with what was difficult."

A more complicated part of the dying process is the way it strips away all the ways we've defined ourselves, said Mr. Ostaseski. "We have to ask ourselves a fundamental question: Who am I besides all of these identities and definitions, which I have been propping up all of my life? I think this can tend to lead people to experience a great deal of connection to something larger than themselves that also includes themselves."

Sometimes that's a religious experience, but other times it's simply feeling deeply connected -- maybe for the first time -- with other people and the moments left to live. "When I'm working with somebody who's dying, I'm making them soup and I'm changing their soiled bed linens and I'm holding the hand of a patient who's frightened. Life has been lived and is now coming to an end," Mr. Ostaseski said.

"These are very, very simple activities and yet, in the midst of those very ordinary activities, there's an opportunity for both me as the caregiver and for the person who's dying to wake up, to see life in an uncensored way and to find a common ground with each other despite all the superficial differences in our lives."

IF YOU GO

Frank Ostaseski will present "Surrendering to the Sacred: Opening to Life" in the Mind and Supermind series at 7:30 p.m. Monday at the Lobero Theatre, 33 E. Canon Perdido St. Tickets are free with registration at the door or in advance at the Schott or Wake centers. His appearance is co-sponsored by Hospice of Santa Barbara and SBCC Continuing Education. For more information, call 964-6853.

Mr. Ostaseski plans to talk about connecting to the sacred in life and how reflecting on impermanence can be a life-affirming practice. He said he hopes to have "an interesting exchange, not just about the issues around death and dying, pain management or assisted death, or these things that are the normal conversations, but to (ask) what do we think about dying? How do we actually feel about it?"

The dying have lessons for the living, he said, and can teach us to see what has meaning and value in life. "It's not that people get suddenly wise in their dying, but they have a different view that could have enormous importance for us as a culture."

Mr. Ostaseski will also present "Listening: The Healing Power of Human Presence," a free workshop for professional and family caregivers, from 9:30 a.m. to 4:30 p.m. Saturday at Hospice of Santa Barbara, 2050 Alameda Padre Serra, Suite 100.

The workshop will focus on "deep listening, or learning to listen in a full way," using the head, heart and body, said Mr. Ostaseski. "Most of us are familiar with listening from one or another of those centers but not with all three." To register, call 563-8820.

"In our hospice pipeline, he's known as the teacher of teachers," said Gail Rink, Hospice of Santa Barbara's executive director. "A lot of people who do end-of-life care in Santa Barbara have been trained by him."

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