Facing the possibility of death sooner than I expected

and how I plan to cope...

So, dear F(friends) and family,

My chronic leukemia has transformed into an aggressive lymphoma with a variable prognosis. Depending on how the chemotherapy I just started works and if I go through a stem cell transplant afterward I could have as little as 4 months to live or as much as several more years. Details on my condition are on my blog My CLLTrail.

So what does death mean to me, a Quaker with more recent tendencies to Buddhism?

For all humans when life is cut shirt there is to be expected a fear and dread of  loss of things we were planning to accomplish and  losing contact with still living loved ones. Another loss for me, less than 3 years from retirement, would be the chance to enjoy a few years of doing something other than my usual work (20 years pediatric practice, 10 years of online medical education), like travel, try writing a novel, etc.

Thinking about death leads me to ask myself what I really believe about God, the soul, and afterlife.

Do I believe in God ? Yes but not the Judeo-Christian Great White Father on his heavenly throne, nor the pagan Mother Earth. Rather an underlying Spirit, more like a life force. Here is where my biomedical training comes in; I really like the concept of biocentrism, more a scientific theory than a spiritual stance, which combines physics and biology and states that life created the universe, not the reverse. 

But other than a wonder at the complexity of life and the unlikelihood of it, and those moments in solitary meditation and prayer as well as in Friend's meetings for worship, when there is a real nonverbal experience of that Spirit, the Inner Light (read here and here if you are not familiar with Quaker "theology"), I often tend toward agnostic thinking. My science background and just going through life, forgetting about God/Spirit seem to be responsible for these frequent lapses, probably many humans do this. And of course, all the hypocrisy and violence of "religious people" - Jews,  Christians and Muslims in today's world. The Right to Life but wars OK crowd and the jihadists....

Do we have souls that live on after our biological death? Does the existence of God necessarily predispose to souls and immortality? Perhaps not. One of my coping mechanisms for dealing with death is to do this Yale open online course, PHIL 176: Death. 

Then there is the "science" of near-death experiences, the light at the end of the tunnel that people experience. I may do some more reading on this, but as a physician I am skeptical about these episodes confirming the presence of an after-life, could it not just be the effect of low oxygen on the brain?  A bit more intriguing and on my future reading list, is the story about the near after-life experiences of the neurosurgeon, Dr Eben Alexander, who after coming down with meningitis, experienced what sounds like heaven. I am still skeptical though because hallucinations are certainly symptoms that can be seen in meningitis!

But my increasing interest in Buddhism and mindfulness meditation may be the real key for me. If there is to come an afterlife I do think I prefer the idea of multiple reincarnations, landing where karma from the recent life may lead...

Mindfulness meditation based on Buddhism has been used quite successfully in many areas of medicine and also have helped terminal patients face death. From a pre-publication chapter on  Mindfulness for Cancer and Terminal Illness, comes some helpful direction.

In this chapter, mindfulness is defined as "the awareness that arises through intentionally attending in an open, caring, and nonjudgmental way. This definition was meant to take into account mindfulness as both a way of being in the world and as a process or practice."  Here are the ideas behind the apparent success of this program:

The question remains: Why would mindfulness ... as described above, be especially helpful to people coping with cancer?  As it turns out, many of the issues cancer patients face are best dealt with through approaches that emphasize acceptance and awareness, as well as non-attachment.  Non-attachment arises from an understanding of impermanence, the constantly changing nature of all things.  With an understanding of impermanence, patients are able to loosen their stranglehold on needing things to be or stay a certain way, or needing to know exactly the outcomes of their treatments and their prognosis for the future. With a more present-moment stance and through the practice of seeing things clearly as they are, simply allowing acceptance of circumstances, patients are able to stop struggling with questions of “why” And simply dwell in the “what” of each moment.  Worry often arises from questions around the future – these can be attenuated through focus on the present-moment and learning to allow events to unfold moment-by-moment.

Guided meditation holding thoughts of loving kindness has great appeal. From  Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death comes some examples of such phrases held in contemplation during meditation:

“May the power of loving kindness sustain me.”

“May I be peaceful in body and mind.”

“May I receive other’s love and compassion.”

“May all those I leave behind be safe and peaceful.”

“May I be free from suffering.”

“May I be free from fear.”

“May I accept my pain, knowing that I am not my pain, not my body, not my illness.”

“May I accept my suffering, knowing it does not make me bad or wrong.”

“May I accept my anger, fear and sadness, knowing that my heart is not limited by them.”

“May I remain in peace, and let go of expectations.”

“ I ask forgiveness from those whom I have harmed.”

“ I freely forgive all those who have harmed me.”

“ I forgive myself for mistakes made and things left undone.”

“May I remember my consciousness is much vaster than this body, as I let go of this body.”

“May I open to the unknown, as I leave behind the known.” 

“May I, and all beings, live and die peacefully.

Great stuff, methinks!

So I plan to read more on this approach, both the clinical mindfulness approach and some Buddhist texts, as I keep working on this form of meditation. I expect these to be very helpful no matter how much time I have left.....

Most importantly I have to be grateful for each day I have, no matter how I feel, no matter the weather, no matter whether at work or play....and keep up my prayer and meditation practice almost compulsively

Try to live each day in complete mindfulness, and expect the rest of my life to be a real adventure to savored.