Befriending Old Age and Death

Befriending Old Age

Why Aging Seems to Happen Overnight 

Buddhist philosophy states that activities of this life are like an endless series of ripples in water, one after the next, after the next, after the next. We get caught up in life's activities as they come . . . one after the next, after the next, after the next. Accordingly, we age, year by year, month by month, day by day, hour by hour, minute by minute, second by second. Yet, because we are so involved in life's activities, most of us remain unaware of just how fast we are continuously aging. 

Consequently, aging just seems to come upon us. We wake up one day with a gray hair, a wrinkle, or a new pain in our body. Suddenly, we are old. Older people often exclaim: “My whole life went just like that!” It seemed like yesterday that they were young, but now they are in their seventies or eighties. Because we get caught up in and absorbed by activities, we lose some awareness of how the time has passed. We also have a tendency to believe we will live forever, so we take much of our lifetime for granted. 

When studying old age, we do not want to fool ourselves by only being optimistic. There are certain changes that come with aging and death, and specific sufferings are associated with the changes. It is important to be quite frank about these changes, in the hope that we can gain some insight into the nature of the aging and dying process. 

All As Relative and Impermanent 

From the point of view of Buddhist philosophy, everything is born, everything grows, everything is destroyed, and everything ceases. That is why things are called “relative.” Things are relative in the sense that nothing is permanent, and everything changes. All things are relative because there are causes and conditions that form them. Likewise, there are causes and conditions which result in degeneration. For instance, we can notice change in the world around us. Everything that one sees, changes. The planets change, weather changes, and gross phenomena change. Change also occurs in a single thing, like a flower. It grows, blossoms, withers, and then decays. Human life follows a similar course. From the moment of birth we grow, little by little growing older until we face old age. All the people in the past have faced that. All the people in the present are facing that. All the people in the future will face that. 

In Western culture, people often have considerable resistance to the aging process. A resistant person might try to maintain life as permanent because of great attachment or disappointment. For instance, if somebody says to a child: “Oh, you really have grown up!” the child would feel complimented. However, if you say to a young adult: “Oh, you really look like an old person!”, it would most likely not be taken as a compliment. In Tibetan society, if someone says to young person: “You look old!” they would probably take it as a compliment. I remember, when I was a boy, wanting to be old and appreciating old age. Rather than resisting death and being disappointed with life, we should accept the aging process. There is something very beneficial about change and growth. Maintaining an appreciative outlook allows us to live full lives. 

Physical Aspects of Old Age 

According to Buddhist philosophy, the human body is composed of five elements: earth, water, fire, wind, and space. The specific combination of these elements is genetically inherited from our parents. The five elements deteriorate slowly and continuously from the time of our birth. However, most of us are unaware of any degeneration until we begin to age, when both the internal organs and the outer perceptual organs are affected in a more noticeable way. For instance, only when we cannot see as clearly as we used to do we notice that our eye organ is aging. 

As the sight deteriorates, so does the hearing, until there is just a general sense of sound echoing in the ears. This is because the ear organ is aging. Likewise, the ability to smell is not as precise as before, because the nose organ is aging. Even if you eat very flavorful foods, you cannot taste well, because the taste buds are aging. Then, when the food is swallowed, digestion is difficult. Digestion takes longer, due to the weakening of the fire element. 

Our body grows frail and unable to resist sickness when we reach old age because the elements have weakened. Due to the degeneration of the body organs, it becomes harder to retain warmth. You may put on blankets to stay warm, but there might be some difficulty moving when you are fully covered by blankets. It also takes more effort to stand up. An older person might have the mind to stand up fast, but the body follows more slowly. It becomes difficult to walk erect and stay balanced. Sitting down is no longer a simple thing. You have to let yourself “fall” down to sit down. These are descriptions about old age that we can verify in people around us. They are some of the facts of growing old. All of us who become elderly will face these situations. 

Emotional Aspects of Old Age 

From the Buddhist medical perspective, as we age, the wind element grows stronger. The wind is the destroyer of the other four elements. Since older persons have more wind in their body, they become sensitive, or not quite as patient as they used to be. Although most of us are impatient to begin with, impatience becomes more prevalent with age. 

As we grow older, the mind organ weakens, and it becomes difficult to remember things and communicate clearly. Older persons often recount memories as if they were sleeping and having a dream. If an older person is unable to maintain a train of thought during a conversation, they are not necessarily suffering or having a negative experience. These psychological changes are characteristics of aging, due, in part, to the physical changes. Someone aging should simply notice the changes taking place, and try to understand them. We should not take the aging process personally, since both the physical and emotional changes are universal characteristics of growing old. 

Societal Aspects of Old Age 

Society provides us with guidelines for how to treat our senior citizens. Unfortunately, these guidelines often are not kind. Being mistreated can be one of the most painful aspects of old age. For instance, a person naturally loses the power of the speech with age. An older person could have been influential in their younger years, and used to others taking their words seriously. With age, our elders' speech is not as highly respected. Similarly, older persons are often ignored because they are not as actively involved in the world. People may lose interest in what they have to say. Younger people may also make cutting comments to their elders. They may say: "You don't understand our generation.” “You don't know what you're talking about.” These comments contain an inherent lack of respect for the elder, and can be quite painful to hear, because our elders' advice usually springs from genuine concern for the well being of their children. 

Generally, nobody wants to cut someone off intentionally. Yet, when two people have difficulty communicating, irritation arises. Irritation leads to curt words and an exasperated tone of voice. This miscommunication is often related to unimportant topics. Children and their parents, or grandchildren and their grandparents, get into a conflict, and the children cut their elders off verbally. This type of aggressive speech is not helpful to the relationship. Older persons may have love, care, and concern for their younger relatives. They might also possess much wisdom that they have come to believe in, so they may give a lot of advice. Yet, at the same time, they may not expect you to do things exactly as they advise. They often want their children to be independent, out in the world, doing what they think is right. Your parents may not want to control you, yet this might still be your perception. 

When receiving a contrasting opinion, we should follow these three steps: listen, contemplate, and apply your own wisdom. Instead, we tend to challenge our elders by arguing our own view point. This arguing is not necessary. We can simply consider the elder's advice, and listen for the wisdom in their words. Our elders are appreciative when we can listen without arguing, debating, or cutting them off. They also appreciate that we can apply our own wisdom to the situation while respecting their advice. 

In our fast-paced world, older persons are often disregarded be cause they cannot function as efficiently as others. Independence not relying on the assistance of family and friends-is greatly valued today. When our elders feel badly about moving slowly and needing help, this only adds to their suffering. They may become removed from things, further isolated, and lonely. The difficult emotions and physical changes that arise in old age appear unnatural and unique in this context, even though they are common features of aging. 

Befriending Old Age 

We cannot alter the physical aspects of growing old, or prevent emotions from arising, but we can work with these changes. Befriending old age involves slowing down, settling in, and respecting the changes with a welcoming attitude. We can befriend emotional changes by seeing them as a part of old age, without taking them personally. Feeling badly about the physical and emotional changes only adds further pain to the situation. 

Although growing old is a natural process, some people struggle with it, and some people do not. In general, those of us who struggle with life's difficulties have a harder time aging. A person who resists aging might try to avoid the experience by not letting go of the things that they need to let go of in old age, or by becoming mentally absent. These people might complain, which only creates more suffering. Older people who do not struggle contain themselves, maintain an open attitude, and accept their situation. In this way, they do not impose their ideas or speak to others forcefully. They are settled and content with the aging process and, therefore, have no need to be outwardly aggressive. 

Befriending Another's Old Age 

When providing care to an older person, it is important to relate with them completely, and try to foresee their needs before they have to ask for your assistance. To provide care in this manner, you need to take time to do things correctly and precisely. It helps to have your mind fully present, so you can engage in the relationship and be available to understand their words. If what they are saying makes sense, it is a great gift to you. We should not only express love and care for older persons in words, but also show it with actions. We can do this by helping them get physical things done, or simply by being with them. The small, mindful things a caregiver does exemplify love and care in action. 

If the elder is sensitive, irritable, or complaining-simply notice, or take it humorously. Do not challenge them at all. It is not necessary for the caregiver to get irritated in response. We should not try to change the person, tell them right from wrong, or give them advice. Rather, the caregiver should try to maintain a sense of humor. Of course, we should not undermine our elders with sarcasm, but humor can loosen up the situation. If the elder catches themselves being disagreeable, their attitude might change. If the elder is complaining, grumbling, or being irritated, you might try agreeing with them, or simply nodding. When the elder experiences your full attention, the situation can become more eased and pleasant. In all societies, there are examples of children taking advantage of their parents. For instance, children often ask their parents for some of their material things, thinking that, because they are old, they no longer have attachment to certain objects. Even if their attachment has waned, older persons are still fond of things, and do not enjoy being taken advantage of. Children should be mindful of the financial support and material things taken from their elders. We should maintain an attitude of giving with older persons. Rather than being selfish, we can be generous. 

On Appreciating Older People 

We should learn to enjoy older people, and have a pleasant time with them; not just nice older people, but all older people. Our elders are very knowledgeable, and we can learn from them. Being with our elders can often feel more genuine than being with our peers. Since they have less worldly demands on them, they have more time to relate to us, and to tell us their life stories. Often, the painful accounts can be the most inspiring, because there was insight gained, and courage shown. These stories can encourage the listener to live fully, accepting life's challenges. 

Spending time with our elders also helps us gain some perspective. We can see that older persons are not different from ourselves. We can begin to imagine what our own experience of aging and death might be like. This exchange can help bring relaxation to the younger person's life, and clarity to their mind. 

Questions and Answers 

Q: Rinpoche, my mother is quite old, and is fearful of death. She denies what is coming. Could you address how we might help our parents with this kind of difficulty? 

VDKR: If your mother is a meditation practitioner, she should not ignore her death. She should acknowledge it, and practice in preparation to die.

Usually, for nonpractitioners, ignoring death is natural. Distraction, on a relative level, is helpful, but painful as well. Therefore, do not try to talk with someone in denial about death. Do not try to make them aware, or have them face what is coming. Sometimes that is not helpful. 

You want to see your mother face death. You want to change her viewpoint. Instead of trying to change your mother, you should appreciate her. This is not an everlasting relationship. These are not everlasting situations, and there is limited time. While you have the chance, you should appreciate your mother, and provide her with service. This would be very helpful. 

Q: Rinpoche, the flip side to ignoring old age is waiting for, or even wishing for death. How do we work with someone who has lost the “will to live and resists medical treatment? 

VDKR: When I spoke about taking the aging process naturally and without resistance, I was not saying that we should refuse medical care. We should try to view aging as an organic process; however, if we can do something to ease the process, to change things even a little bit, that would be helpful. For instance, exercising, taking vitamins, and taking care of your health is always a good thing. Just because you are old, if you have a headache, that does not mean you should not take an aspirin. However, all the things we do to prolong life or make life more comfortable should be taken within the context of aging and dying as a natural, inevitable process. 

You would want to speak to someone who has lost the “will to live” about finding inspiration. These are not black and white situations; life is precious, yet death is inevitable. If one can see both sides, the possibility arises for insight and progress. However, if the person believes death is “just sleeping" and life is a hassle, you might want to talk with them about death not being "just sleeping.” First you need to assess how open they are to discussing these subjects. 

Q: Rinpoche, could you address the difficulties involved in watching someone close to you age and die? 

VDKR: There is a saying in Buddhist philosophy: “As one ages, one becomes more like a child." Likewise, as a person ages, their needs increase. The attendant's care, love, and attention to detail must also increase in response. This childlike quality can be seen as a joyful thing, rather than a negative attribute. It can be an enjoyable state of mind to be present with. 

Q: Rinpoche, the way I have learned most in my life is through dialogue and discussion. I would not want to get to a certain age where people, out of respect, would not challenge me anymore. I understand why one should not be cutting and mean, but is there some middle ground? 

VDKR: It is possible to engage in dialogue without being challenging. If you ask earnest, compassionate questions, people will recognize your honesty and engage with you differently. Emotionally charged questions are, generally, not pleasant to older people. This does not mean you should not ask penetrating questions. If there is room for discussion, we can certainly have meaningful conversations with our elders. However, it does not help to have an attitude that implies: “I am right, and you are wrong", since this makes communication more difficult, rather than facilitating interaction. 

Q: Rinpoche, Stephen Levine talks about the difference between pain and suffering: pain caused by our physical condition, or our emotional state, and suffering caused by our relation to such a physical condition or emotional state. In old age, I think pain is inevitable, but I do not think suffering necessarily is. 

VDKR: That is a very good point. Physical pain is inevitable, and some of the uprising emotions may be unavoidable, but our attitude towards the situation could develop in either a negative or a positive way. We should remember that growing old is a normal and natural process, and have some capacity not to take aging personally. We should be able to “let go" and enjoy every moment of life as it comes, without dwelling in thoughts or wishes of either pain or bliss. In this way we can live more fully, because life is not a one sided experience. I agree that attitude is more of a mental construct, and it can be either positive or negative. 

Q: Rinpoche, I feel I should have the right to determine when and how I am going to die. I do not look forward to having either my children, my friends, or my doctor tell me I have to stay alive longer than I wish to stay alive. I believe one of the ways of living in a positive way is to be able to make your own choices about death. Could you address a person's right to choose? 

VDKR: Your attitude is very inspiring, to have precise resolutions about your aging and death. Unfortunately, modern society sometimes forces our elders to have a decisive attitude about their death, due to external pressures rather than conscious decisions. For instance, when children and grandchildren live far away, with demanding jobs and interests, families can become separated. The grandparents can feel helpless, ignored, and a burden to their family. From this isolated perspective, the older person might make choices about their death that are based more on lack of support than on conscious decision. To avoid these situations, we should be extremely mindful of our elder's needs. We should not make them feel they must be independent because we cannot spare the time to help them. If our own obligations come first, our elders might feel they are a burden. 

Certainly, it is wonderful if you are able to make conscious decisions about the details of your death. However, if a person's situation is not so fortunate, then children, grandchildren, community, and friends should step in and help, in any way they can. The supporting community should try to engage with the older person. This is very necessary to end the isolation, and help the person make more lucid decisions concerning their aging and death. 

Understanding Death

The Story of the Grieving Mother 

Once, when the Buddha was in the world, a woman's infant son died. She loved her son very much, and she could not accept his death. People thought she had gone mad, for she was holding her dead son in her arms going everywhere, asking everyone to help her bring her son back to life. 

She went to all the different teachers and all the people she had hope in, but nobody could help her. Finally, she brought her son to Sakyamuni Buddha. 

She pleaded, "Blessed One, please! Bring my son back to life. Help me!" And she cried. 

Buddha replied, “I will help you. But, before I help you, I want you to do one thing for me." 

“Yes," she answered. “What is it you want me to do?" 

Buddha said, "Find me a mustard seed from a home where death has never occurred.” 

So the woman went from home to home in search of the mustard seed, thinking this was an easy task. 

Everyone she met in her search was quite willing to give her a mustard seed, but when the woman asked, “Has death occurred in your home?" the answer was always the same. There was not one home she could find where a death had not taken place. 

During her search for the mustard seed, the woman engaged in many situations: somebody's father had died; somebody's mother had died; somebody's spouse had died; somebody's child had died. Death had occured in every home, and, in each situation, people were struggling with the pain. 

So the woman returned to see the Buddha, but this time she did not have her son in her arms. 

Buddha asked, "What happened? Where is your mustard seed? Where is your son?" 

The woman replied, “I tried and tried to find a mustard seed, but I could not find one from a home where death had not occurred. I have also seen how crazed I am, wanting my son to come back to life and not accepting his death. I have seen that death is common. It is natural for everyone to die. Therefore, this afternoon, I went and took my son's body to be cremated. You have taught me a great lesson.” 

"That is right,” Buddha answered. “You have learned a great lesson. Just as everyone is born, everyone dies." 

Death as a Natural Process 

Even though death is a normal part of life, people are often confused about what death is and how one dies. Death can occur to anyone at any time, whether they are young or old. The physical body is vulnerable, and there are numerous circumstances that could cause death. For instance, a flu could land even a strong, healthy person in bed. If a bird is hit by a stone, the bird is no longer able to fly. It just lies on the ground with an open mouth. Similarly, when we are hit with something as simple as the flu, we are knocked into bed and can hardly speak or move. 

The body is quite vulnerable, whether we are young or old. It only appears that as we age we face death more closely; however, this is simply a conventional viewpoint. According to the Buddhist medical system, death occurs when there is an imbalance of the five elements. This imbalance brings forth a sickness that becomes the cause for our death. When this sickness comes, we fall into bed and do not get up. The body's five elements rapidly degenerate. The Buddhist system speaks of two deaths, the outer death and the inner death. What follows is a discussion of the outer death, or how to confirm the stages of death and dying. 

Deterioration of the Sense Organs 

Near the time of death, as the wind element becomes stronger and the other elements become more fragile, the internal organs, as well as the sense organs, weaken. As the disease progresses, the eye organ ceases to function. At this point, the dying person cannot see images clearly. All that appears is a vague white light, and things akin to hallucinations. The ear organ decays in a similar fashion. There is still a general sense of sound near the time of death, but an inability to differentiate words or meaning. These are signs that the ear organ is ceasing to function. 

This deterioration occurs to the organs for smell and taste, and also to the body. If the dying person is a meditation practitioner, this is the time to sit up straight and engage in practice. Death is a process that takes time, up to a few days following the deterioration of the sense organs. 

Dissolution of the Five Elements 

The body, flesh, and bone are part of the earth element. Therefore, the physical body dissolves into the outer earth element. When this disintegration begins, the feeling is like falling down, or like something heavy pressing down. Often, at this time, the dying per son will ask: “Please, pull me up!", or they will ask you to make their pillows higher. Yet, as high as you raise their head, they still feel unsupported. This is a sign that the body is dissolving into the outer earth element. 

The blood and all the liquid contained in the body are part of the water element. When the dissolution into the water element begins, much liquid runs from the dying person's nose and mouth. Any heat contained in the body is part of the fire element. When this heat dissolves into the fire element, the dying person’s nostrils become dry. White droplets appear at the edges of the mouth and nose. If you pay close attention to the signs, you can witness the body heat dissolving from the lower part of the body up towards the head. You can even notice a faint trace of mist appearing from the dying person's head. This is the sign that the heat contained in the body (the inner fire element) is dissolving into the outer fire element. 

Destruction of the Essential Life-Force Wind 

Our breath, our internal wind system, is part of the wind element. According to Buddhist medical theory, there are five winds: the uprising wind, which enables us to breathe; the downward wind, which enables us to eliminate wastes; the heat wind, which allows us to retain warmth and digest food; the distributing wind, which carries the energy from digested foods to all the parts of the body; and the life-force wind, the essential life-giving wind of the body. When the life-force wind gets stirred, pain ensues. Strong emotions are generated when other bodily winds enter into this wind. When this wind is disturbed, our life is threatened. When the life-force wind disintegrates, we begin to die. Our life ceases when this wind exits the body. 

All the different types of wind contained in the body dissolve into the life-force wind at the time of death. At this point, the dying * person cannot move, and begins to have difficulty breathing. There is a particular raspy, echoing sound of a person's breath right before the end of life, because it becomes difficult to take in air. Next, all the blood contained in the body rushes into the heart, and the dying person takes three long breaths. At the end of these three breaths the whole nervous system stops, the whole wind channel system dissolves, and consciousness is ejected from the body. This is the final sign: outer death has occurred. 

The signs of death, then, are quite observable. When the five senses become weakened, death is beginning. When the dying person asks to be lifted or held up, that is another sign. A further sign is when the nostrils begin dripping, and then dry out. Echoing, raspy breath is also a sign. When three long out breaths preceed no further breathing, this is the sign of outer death. These are signs we can see when witnessing a death. These are also signs we can be aware of at the time of our own death. 

The Importance of Knowing the Signs of Death 

Many people are confused and fearful about death. They are unaware of the signs, and bewildered about what is transpiring during the dying process. This ignorance produces tremendous anxiety about our own death, and the death of people around us. Studying this material can provide some insights into the dying process. When we are more aware of what is happening and how it is happening, we can better arrange for coping with another's death, and preparing for our own. 

A meditation practitioner should become familiar with all the stages mentioned above, and engage in awareness practice to maintain a clear mind during the entire dying process. The next stage after outer death is the bardo, or transition state between death and the next life. It is necessary to keep in mind that everyone in the human realm goes through the experience of dying-everyone in the past, everyone in the present, and everyone in the future. It is a very natural, common process. Hopefully, by meeting the challenge of old age and death with awareness, our next life will be a favorable situation.

Questions and Answers 

Q: Rinpoche, is death always a painful experience? 

VDKR: People who have resistance to death, who hold on to life and relationships, have a harder time going through the process. On the contrary, people whose attachment to “self” and others is not as strong have an easier time. In the same way that birth is painful, death, by nature, is also painful. Yet the degree of the pain depends on our realization of mind, and the way we have learned to work with attachment and other mental states. 

Q: Rinpoche, when you die, is it frightening to lose your body as a reference point? 

VDKR: The Buddhist teachings explain that when death approaches, the whole structure of conceptual mind falls apart. There still is conceptual mind, but the structure in which mind functions begins to deteriorate. A person might become "unconventional.” For instance, older people sometimes say things uncharacteristic of their normal speech. Conceptual mind is still functioning, but the structures, the reference points, are not. This can be confusing and frightening, both to the aging person and to the friends and relatives. 

Most people dread dying. Yet, by knowing exactly what is occurring, we can face death fearlessly. We can go beyond the painful situation, beyond the apprehension, and maintain awareness through meditation practice. 

Q: Rinpoche, what kind of awareness practice does one do at the time of death? 

VDKR: All the Buddhist practices are guided towards working with the nature of mind. Whether we are a good meditation practitioner or not is only known when our skull falls to the ground. 

Q: Rinpoche, how can we benefit a dying person? 

VDKR: As much as you remain centered, focused, and maintain good intentions, that comforts the dying person, and helps guide them in whatever they are going through. Try to remain lovingly kind and compassionate, and, if you wish, engage in meditation practice.

Q: Rinpoche, is it helpful to let a dying person know the stages of death, or would this arouse more confusion? 

VDKR: It depends on the individual. Generally, knowing the signs of death would make things less confusing, and allow for more possibility to accept the process as it occurs. 

Q: Rinpoche, I work with people dying of AIDS, and try to pay close attention to their needs. I also try to maintain a safe, uplifted environment. What is the best way to care for dying people and their environment, according to their wishes? 

VDKR: When someone is dying, we must keep in mind that we are powerless to stop the process. However, we can provide a sane environment by keeping ourselves centered and paying attention. Rather than bringing confusion, fear, and chaos into the room, we can practice loving kindness and compassion. We are not different from the dying person, because we all have the potential to die. Maybe they are time-limited, and we are not. Even that is a relative concept, for, within 100 years, we are all going to be dead. A person dying of AIDS knows they have a cause for their death. We have yet to learn what our cause will be. In this way, we should all be relating to our death as a dying person does, but we do not. This is naive of us. Meditation practice trains us to work with the mind, to work with uprising emotions and confusion, and to cultivate wisdom. We all need to receive this training, because we will all face death. 

What joins us to the dying person-what allows us to have a strong sense of loving kindness and compassion-is the knowledge that, eventually, we are also going to be on our deathbed. Death is not something that is happening to them only, and will never happen to us. If we keep this in mind when we are with a dying person, we will be able to attend them in a much more compassionate way. When we cannot put ourselves in the position of people who are suffering, then we feel séparated from them, and numbed to the pain. However, when we are able to put ourselves in the position of others who are suffering, then naturally, without any effort, we become a lovingly kind and compassionate person. 

Q: Rinpoche, could you say something about inner death? 

VDKR: Inner death is explained in detail in the Tibetan Book of the Dead

Q: Rinpoche, can you be cognizant of the dissolution of the five elements when you are dying? 

VDKR: Yes. You can see the signs, but the level of that sight depends on your mind. You can be cloudy or you can be clear. Due to meditation practice, the ability of your mind to be strong is unlimited under all physical conditions.