Atul Gawande has a beautiful piece in last week's New Yorker on hospice care and end of life issues. Having had end of life experiences in recent years with my son, my mother and my aunt, it really hit home for me. But I found myself pressing back when I read these sentences:
Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer...
It is probably a small thing, I know: Zen is Likely a combination of Buddhist and Taoist ideas and practices, so Gawande is not far off the mark. But there are some great Taoist references for the idea his is offering here. Take, for instance, passage 50 of the Tao Te Ching:
People born into life enter death.
Constant companion in life and in death, this body is the kill-site animating their lives. And isn't that because they think life is the fullness of life?
I've heard those who encompass the whole of life could walk on and on without meeting rhinoceros or tiger, could charge into armies without feeling shield or sword. A rhinoceros would find nowhere to gore them, a tiger nowhere to claw them, a sword nowhere to slice them.
And isn't that because for them there's no kill-site?
This is Hinton's translation, and I know there will be those who take issue with it (where is the reference to "three in ten"? - see Chinese text and alternate translation here). But he gets at the basic idea here, which is a bit complicated.
There is a bit of ambiguity here. At first the "kill-site" (i.e. the thing that we worry about and which can ultimately bring about our death) of our body is our constant companion because we "think life is the fullness of life." That is, we worry about the distinction between life and death, the boundary between animation and non-being. But toward the end of the passage we learn that if we simply focus on living in the present, "encompass the whole of life," we can get away from the anxieties of death, in effect have no "kill site." The ambiguity arises in the contrast of "think life is the fullness of life" and "encompass the whole of life." They seem rather similar. The Legge translation, and others, draw a clearer line between "excessive endeavors to perpetuate life" and "he who is skillful in managing the life entrusted to him." The classical Chinese is difficult, but Legge lets us see the main point, which is essentially Gawande's.
And that is: if we fight to hold on to life, we will lose it; but if we just give ourselves over to the natural unfolding of life then there is no "kill-site;" we will live serenely to the end of our days and melt back into Way without injury from rhinoceros or tiger or sword.
Perhaps that is what hospice allows us to accomplish.