How do we “know” something? How do we know anything? Our primary sources usually involve written documents or the spoken word, with information ranging from ludicrously false to probably true. Yet, most of the time, even the most “objective” information has a slight personal twist to it, placing a layer between it and us. What we know in these instances is what another source has said about it.

Knowing

Our “knowing” gains more credibility if we personally have witnessed or participated in something. It’s one thing to say “I read it,” and quite another to say “I saw it.” Most of my end-of-life articles for the past eight years falls into the “I saw it,” category on issues directly relating to death and grief. What I have witnessed in the deaths of my patients and the grief of their families often bears little resemblance to what some books and academics say I should be experiencing.

And then, there’s the type of information derived from experiences so personal that what you know reaches the level of “knowledge.” I’m often asked what people think as they approach death. Not weeks or days before, but very close to it. Until last night, I could only explain what I saw.

I woke at midnight with an incredible pain in my abdomen. A little Pepto Bismol, I thought, and I’d be fine. But I wasn’t fine. As the intensity of the pain increased and spread, I began having difficulty breathing and almost passed out.

“Should we go to the emergency room?” My wife, Wendy, asked. Based on my past reluctance to seek medical attention, I’m sure she expected me to say, “Let’s wait 15 minutes.”

“No, call 911,” I said in a whisper.

Revelations for Before Your Death

After dressing and stumbling down the stairs, I laid on the couch and for the first time ever, thought I was dying. Did I have any of the amazing revelations some teachers and authors say the dying have? No. Did I think about my life: those things I regretted doing and what I wouldn’t achieve? No. What I thought about was the pain, nothing else.

Paramedics and firemen were in the house less than four minutes after Wendy called. Their reactions to my breathless words, gray pallor, and pained facial expression confirmed my belief that, indeed, I was dying. By the time I was in the ambulance, the pain was cyclical—a few minutes of ascending pain, a few minutes of descending pain. When the pain diminished, allowing me a window of rationality, I looked back at my life and realized my hospice patients had taught me well.

“If I die now,” I said to myself as the paramedics attached leads to my chest, inserted an IV, and spoke to the hospital emergency staff by radio, “I haven’t left much unsaid or undone.” For eight years I have been a midwife to death and witnessed what made some deaths easier than others. I learned the importance of forgiving those who did unskillful acts against me, asking for forgiveness from those I wronged, letting go of what no longer worked, communicating heart-felt feelings, and I trying to live my life with compassion and love. If I was to die, I had cleaned my plate of those things I observed made dying difficult. I realized my hospice patients had given me more than experiences. They had conveyed a knowledge about dying that had practical consequences.

“Is there anything I can do to make you more comfortable?” the paramedic said as the ambulance sped to the hospital.

“Yes. Either get better shocks for the truck or have San Francisco fill it’s potholes.”

As we laughed and bounced along the streets, my belief that I was dying diminished. After six hours and many tests, the diagnosis was uncertain: probably an ulcer created by continuously taking ibuprofen.

Reality About Your Death

We often fret and wonder how we will act in certain situations. Some have comparatively minor consequences, such as what we’ll say when something embarrassing we did is uncovered. Others are pervasive, such as how we will approach our deaths.

I was given a dress rehearsal—one that was frightening, but also enlightening. What I experienced when I thought I was dying was a confirmation of those things I witnessed that eased my patients’ deaths:

1. Forgiving the unskillful acts of others
2. Letting go of what no longer works
3. Giving unconditionally
4. Communicating from the heart
5. Being compassionate (if not, at least understanding)
6. Not afraid to love
7. Asking for forgiveness for your own unskillful words and acts.

Every death is unique. But these seven lessons are a good starting point. Above all else, don’t wait, that pain you experience might be more serious than an ulcer.

5 Responses

  1. Marty Tousley, CNS-BC, FT, DCC

    Beautifully stated, as always, Stan. I’m so relieved to know that you’re all right. Clearly this world isn’t done with you yet. We need you here to share more of your hard-earned wisdom with us. ♥

    Reply
    • Stan Goldberg

      Hi Marty,
      Thanks for your kind words. I’ve always found the the worse something initially appears, the more likely a great lesson is hidden in it. Although I would have preferred a less painful one.

      Reply
  2. Henry Shen

    Stan: You have always been my hero since I read your book “Lessons for the Living”. I’m SOOOOO glad that you finally got your own life experience touching the edge of death (at least mentally). And the even more valuable thing is you “tested” all the points you learned from your hospice patients! When are you going to have the next edition so that you can add this wonderful piece into it?

    And of course, congratulations on you being well! People need you here. BTW, can you just not use ibuprofen any more, and try Acetaminophen? I prefer the latter. Does Acetaminophen have a similar side effect?

    I know, “experts” may speak like bookworms sometimes, but hey, I don’t think they would be like you if having been put beside the deathbed of hospice patients. Why? Because they are scholars, and you are the explorer. They learn, and you feel. You have a highly sensitive mind that can discover all details of physical, mental and spiritual objects with great delicacy. And as a master of language, you can write them down! When “experts”, if any, write in professional way, you do that with “fidelity”, like a camera. I’m not saying we don’t need experts, but when we think of death, we may prefer listening to something live and real, instead of a cold maze of mumbo jumbo. Their works, as great as yours, are for doctors, not for patients.

    Congratulations, again! And I envy of you also, cuz you are prepared and I’m not yet.

    Henry

    Reply
  3. Steven Evans

    Stan,
    Indeed you are well! I have been working 16 hours a day the past 12 days on a protocol for you … so don’t disappoint me by dying just as I get it finished this weekend. No, make no mistake — I won’t forgive you if you die before reading it :>))

    Although I don’t do hospice care, I “do” many clients with stage IV terminal cancer and have web-sat by some of them literally until their final hours. For some, their efforts to survive toward the end of their disease are often irrational since I can assure and document for them that what is being done for them [or to them] by their oncologist has never ever in the annals of known medical outcomes ever helped any patient with a status such as theirs. The only certainty is greater suffering. Water from Lourdes has a better probability of a cure [since I work in alternative medicine, let’s not dismiss the water out of hand, by the way].

    As I think about it, these are the non-hospice folks — striving to their last hour for a desperate Hail Mary savings pass. But other clients have also reached a point of equilibrium and we have discussed the matter for untold hours via email. Until the very end. Others — not so. But as your article aided me in reflecting about it, toward the very VERY end, they all fell into a form of acceptance. I had to think long and hard … but I believe “all” is correct. Just my happenstance mix of clients of course. But the odds are against this curious outcome by chance alone.

    I have read that as a lion has a gnu or gazelle by the neck, and there is no further alternative outcome, the animal will just stop struggling — go limp in a way. Reconciled. Do we have a programmed response in our reptilian brain that is activated similarly? Do we have a Buddha nature that can arise at that point? Are these two necessarily different?

    In the end, it is actually me — I’m the one that must rise to meet their end since I do end-stage resuscitation [under select situations but certainly not others]. I must come to meet them where they are. Some clients are far more Buddha-like than I sometimes. But over the years, I have begun to “awaken” to their needs more quickly than originally — their needs, not mine.

    But mine is quite a different experience in one way, I do think. I have many many clients who entered hospice care, only to be extricated with some simple alternatives [OK — not always simple but not complicated either]. But it is hard to communicate my angst when I see what I think is another one of these situations that can be reversed … been there, done that.. and they are already “accepting” and calm and centered. “Stop,” I want to yell. “The oncologist’s tool kit is a barren wasteland. There is much more than the Big Pharma chemo pimps can implement. I’m talking bone fide peer-reviewed published medicine, not some herb to be found under the giant pyramids.”

    So maybe I need your hospice care. Maybe I need your help from getting my own ulcer over this situation. In summary, sometimes I want them to take your 7 steps — to embrace your wisdom …….. some times, maybe not.

    I am delighted you are still here to give us a banquet of food for thought, my friend.
    Steven

    Reply
    • Stan Goldberg

      Words of wisdom as always. I completely agree about oncologists. When, as in my case, a highly respected oncologist said to me, “six of one, half a dozen of another,” in offering guidance on selecting intervention protocols, I thought back to my youth when Mr. Atomic was selling his magical soap at a traveling carnival (a great story I’ll write about some day).

      I have known a few clients over the past eight years who were “de-admitted” from hospice. Not because they were cured, but rather stabilized. I believe in their cases it had much to do with the compassion they received. Although I’m still waiting to be convinced about the efficacy of some alternative medical approaches (even those I’m using), I’m certain about the interaction between mind and body–the mind does have the capacity to modify body functions. Convince me twirling a dead chicken over my head at midnight on Market Street in San Francisco will get rid of cancer and I’ll buy two at my local Safeway. So, for eight years, I think I’ve been doing something right. I’m sure it’s the mixture of traditional medicine, Tibetan practices (I’m big on Tonglen), dietary changes, and being of service to my patients, being more concerned about living my life meaningfully on a daily basis rather fretting how long that will be. I’ll leave the fretting to my family.

      Your almost right about acceptance at the very end of life. For a very few people, they struggled even to their last breath. I don’t know if that was related to acceptance psychologically of what they were about to experience or a physical reaction of their the body shutting down. The more I witness, the less I judge. But acceptance prior to active dying was important for psychological comfort, physical comfort, and preparing their loved ones for the loss. As this episode with the ulcer has shown me, there is much that is hidden we can only guess about.

      Don’t worry, I have no intention of dying before I get to read and use your handiwork, so work less on it, enjoy your life, and plan to visit us in San Francisco.

      Reply

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