The Art of Compassion: Caregivers of the Dying
By | Oct 28 2012
Written by Susan Akers
It is because you believe that you are born that you fear death.
Who is it that was born? Who is it that dies?
Look within. What was your face before you were born?
Who you are, in reality, was never born and never dies.
Let go of who you think you are and
Become who you have always been.
~ Stephen Levine 
Fear is a primal response to death. Fear of death often obstructs our longing to be who we are. Many people long to provide compassionate care at the bedside of the dying; each of these individuals has the capacity to cultivate this art of compassion. The pathway to an open heart is through mindfulness and presence: by coming face-to-face with our own suffering and fear of death and the suffering and death of others, we let go of our fear and open our hearts.
Since the natural lifespan for a majority of people includes both a time of wellness and a time of sickness that precede dying and death, each one of us will most likely face the dying of those we hold dear. Some may become caregivers for family or friends. Others, such as professional care providers, will offer care and service to the terminally ill in their work. In each of these situations, the dying process may be short or it may be extended over many years. However long or short the dying process may be it is common for all caregivers to long to serve others with a compassionate heart.
As a hospice nurse for many years, I have cared for countless patients and families at the end of life. I am not a special person because I am a hospice nurse. However, I do approach my work with a compassionate and open heart.
There can be much physical, emotional and spiritual pain at the bedside of the ill and the dying. I recall the time the young friend of one of my patients said to me “you must be tough as nails to do this work”. I paused and knew I was not tough. In the presence of this suffering and great loss, my own sadness had emerged. “No,” I responded, ”it breaks my heart.” Opening my heart to my vulnerability has softened and opened my heart to the suffering of all.
How do we begin to open our hearts? The heart of compassion calls for embracing the skillful means of mindfulness and presence -- attention, awareness, investigation and acceptance.
Compassion is our natural relationship with what is. We practice compassion by being present with whatever is arising in each moment. The Dalai Lama states: “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”  We each have the capacity to nurture our compassion through skillful means. Attention and awareness are discerning ways in recognition of the moment.
We can pause in any moment and pay attention to what is happening within us and what is happening around us. For instance, I cared for a young woman dying of cancer. Her fear and anxiety created distance from her family and friends. My own anxiety escalated in her presence. Each time I visited, I would pause and silently ask myself: “What’s happening?” My attention to the moment brought awareness to everything that was happening in that bedroom. In that open space I stayed. In staying with the raw feelings, my compassion arose. This perceptiveness to what’s happening in each moment strengthens our practice of compassion.
Through our conscious choice to practice skillful inquiry, we notice everything, investigate whatever arises without judgment, and allow things to be as they are. We notice our grasping for what is pleasant and our avoidance of what is painful and difficult. Our perception of our conditioned responses to suffering becomes more sensitive. In discovering this truth, we open our hearts with acceptance of the pain and suffering inherent in life and in death. Through my own conscious choice my open heart of compassion has been revealed. I have been a compassionate caregiver in the presence of the grief of a patient whose anger softens as she tells the story about the love of her life; a father who allows his dying teenage son to maintain his independence even as he calls him his baby; and a young husband and father who finds joy in the midst of great sorrow by the simple embrace of his wife.
We can overcome our fear of death and embrace the longing to be who we are through mindfulness and compassionate presence. Many people will be called to the bedside of the dying and each of these individuals has the potential to cultivate genuine compassion. This pathway to an open heart is through the skillful means of awareness, attention, investigation and acceptance.
As we embrace our own vulnerabilities our hearts soften and open in the face of the inherent suffering in life. This deep wisdom opens our hearts to the pain and suffering of all. Thus, we become who we have always been--- compassionate caregivers of the dying.
“Service rests on the premise that the nature of life is sacred, that life is a holy mystery which has an unknown purpose. When we serve, we know that we belong to life and to that purpose. From the perspective of service, we are all connected: All suffering is like my suffering and all joy is like my joy. The impulse to serve emerges naturally and inevitably from this way of seeing.” 
 Stephen Levine, Who Dies?: An Investigation of Conscious Living and Conscious Dying (Garden City, NY: Anchor Books, 1982), p. 179.
 Helping, Fixing or Serving?, Rachel Naomi Remen, Shambhala Sun, September 1999