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Learning to live with your death

by Tomoko Otake

Staff Writer

It can be a big challenge, even a burden, to strategize your life and prioritize your goals — and then stick to them. It would be far easier if we just had to opt for one pleasure or another, but life being what it is, we must sometimes grapple with really agonizing choices — none moreso than if illness forces us to confront our own imminent death.

By way of preparation for such a life-changing circumstance, a recent workshop in Tokyo, titled “Shi no Taiken Ryokō” (“A Death-experiencing Journey”), offered participants a dummy run navigating their way through the maze of options that may arise at such a time — or rather, the imminent loss of them — after being diagnosed with terminal cancer.

Despite the workshop’s rather dark and depressing theme, the second-floor hall of Shotokuji Temple in Shinagawa Ward, Tokyo was full to capacity with 30 people — mostly in their 20s and 30s, and 80 percent of them female — who had signed up in advance for the 90-minute course.

Moderator Tetsuya Urakami, a 39-year-old Buddhist priest from Yokohama who has been running these workshops since January, said he started them to help fellow monks better understand the spiritual pain of those given not long to live. However, he soon found they were very popular with young people who saw them as a way to evaluate what’s most important in their lives.

“In Japan, clergymen are not welcome in hospitals, especially if they are Buddhists,” Urakami said by way of a preamble before starting the workshop. “Monks are only expected to appear after people die (to conduct the wake and funeral),” he continued. “And of course when I show up at a wake, I have no chance to learn what kind of spiritual agony or struggles the deceased had faced before they passed away — or how their family members had dealt with the situation.

“So, instead of just reading the sutras for those who have died, I wanted to find a way to soothe their pain in life.”

He happened on that way, he recounted, when he met Midori Hiruta, a nurse and director of a hospice in western Tokyo who was conducting a “dying workshop” to help staff there improve their care of people facing imminent death. That workshop was modeled on one first run in 1986 by Rev. Dick Lentz at the St. Vincent Hospice in Indianapolis, Indiana, from where others on similar lines have come to be held for healthcare professionals across the United States and in Japan, Urakami said.

Last summer the monk asked Hiruta to host a Lentz-style workshop for him and some fellow monks, and afterward he sought her guidance on how to conduct similar meetings himself.

To find out more, I signed up for one in the rather casual expectation it would be just a kind of simulation game lasting 90 minutes. But right from the start, Urakami’s solemn tone of voice, and meditative instrumental music in the background, put me into a sober and serious frame of mind.

“If you find the workshop unbearable, raise your hand and the attendants will lead you out,” Urakami said in his calm, baritone voice. “Or you can stop the work halfway through and just listen. Don’t force yourself to continue if you find it’s too agonizing.”

With that somewhat scary caveat, the black-robed monk handed each of us 20 blank pieces of paper the size of a business card — five each that were white, blue, pink and yellow.

First, on our white slips we were told to write down which five material things were most important to us. Then, after giving us barely enough time to think about that and plump for our choices, Urakami told us to write on the blue ones five things we loved in nature — whether mountains, rivers, birds, butterflies or whatever. Next he told us to write our five favorite activities on the pink slips. And finally, he broke the hushed silence in that dimly lit room to say that our last remaining blank slips, the yellow ones, were reserved for the names of the five people who were dearest to us.

Despite the scope of the questions and the considerable challenge of weighing how to answer them, Urakami seemed to be moving us on at such a pace that I barely kept up, and was actually scrambling to fill out the 20 cards in 15 or 20 minutes.

That done, our somber emcee asked us to each spread out all of our 20 cards in front of us. Then he told us to close our eyes and listen to him while breathing deeply from the stomach.

“This is a story about you, or someone who is exactly like you,” he began. “You’ve had a busy but fulfilling life. One summer night, you come home quite pleased with yourself and start preparing dinner. Then you suddenly feel a heaviness in your stomach. Is it exhaustion from the heat? Or is it because I’ve been quite busy lately? you wonder. You try to ignore it for a few days, but the heaviness is still there and you start having difficulty sleeping. One day, you reveal your condition to your family and get an appointment at the hospital. You feel you are beginning to lose something.

“Now open your eyes. Look at all the cards and pick one you can lose. Then crumple it up and toss it away on the floor.”

Straightaway tension spiked in my mind, though the first sacrifice was relatively easy: I took the card on which I’d written “kimono” — as wearing the traditional garment has lately been an obsession of mine. Then I rolled it into a ball and threw it away.

But the choices started to get more exacting as Urakami went on with his story of that “someone exactly like me” facing an unspecified cancer diagnosis followed by surgery, radiotherapy and chemotherapy.

There was mounting suddenness, too, because at every worsening turn of events that Urakami described — along with the patient’s state of mind — we were told to discard not just one but two or three cards each time.

Interestingly enough, with the act of tossing those little balls of paper my feelings began to synchronize with those of the patient — running the gamut of anxiety, fear, extreme loneliness, anger and depression.

Then, as the illness grows worse, the patient (by now I really felt that was me) begins to lose mobility, spending more time in bed as the dose of painkillers keeps on rising. Distant relatives and friends visit. You wake up in the middle of the night, wondering if you are dead or alive — or indeed if it’s morning or night. You hear birds chirping somewhere far away. You hear family members call your name. You can feel them squeezing your hands, but all you can do is try to squeeze them back.

By now, as Urakami’s story went on, the room was deathly silent each time we had to choose what to lose next, screw up the paper and throw it away.

Then, as the end neared and I sat there with my eyes shut, feeling torn between what to let go — is “money” more important than “sky”? Would I forsake “light” to be with “dad”? — I couldn’t help but notice some participants were quietly sobbing.

Urakami finally brought each of us to the last day of our life, and we were down to the last piece of paper. Our sleep is deep, our breathing is unstable, and we can hardly feel anything — not even much pain — anymore. Urakami asked us to breathe deeply three times with our eyes shut — then open them, take the last slip of paper, screw it up — and throw it away.

“Breathe deeply one last time — that will be it. … You have ended your life,” he intoned.

After a long pause, he declared that our “journey” was over.

The last slip — and the fact that I’d lost that, too — played heavily on my mind.

After the workshop, Urakami asked each of us what had been written on their final piece of paper. Most people cited their partner or a close family member; one woman said her cat; another had saved “singing” to the last.

I asked two people sitting next to me what they thought of the event. “My choices ended up being quite different from what I would have expected,” the woman said — confiding that her last slip had “thoughts” written on it. “I felt that, in the end, we crave relationships most,” said the man who accompanied her — adding that his last loss was “mother.”

Though I, like many others, had kept my family members till the very end, I had been surprised at many of my own decisions. While hobbies were easy to let go, I had a hard time giving up “money” and “food.” I also vacillated throughout the process, wondering if I was making the right decisions or not.

“I think older people would find it too tough to go through this, because it’s too close to their real life,” Urakami told me after the workshop. “But young people generally don’t think it’s such a taboo to talk about death. I find these events helpful to make people understand the Buddhist concept of mujō (the transience and emptiness of all things).

Personally, having been on that journey to dying, I’m not sure if I was left any more strategic or purposeful about my life (unless you count my singleminded craving for sweets afterward). Certainly, though, it did make a few elements in my life sparkle in ways that they never had before, making them feel more precious and dear to me.

Tetsuya Urakami’s website, with contact details, is at 753an.blog.so-net.ne.jp. Both it and the workshops are in Japanese.

  • nosnurbd

    Dying is much like going to sleep at night, but not waking up in the morning. We are sorry to go because we won’t get to see what happens tomorrow and tomorrow and tomorrow. It is the living, the loved ones left behind, that suffer. Enjoy what there is and love the ones you love.

  • nobuo takamura

    Quite an interesting article I’ve read! Something in me will lead me to another world beyond my imagination. I have given a lot of thought of death to my living spirit up untill now. I’ve never had so specific an experience as this process of crumpling something up and tossing it away, just like spending one day after another while being confined to bed, for just one situation among others.