hospice you didn’t feel piety. The practice there had been energized by the dross of suffering—not
consumed by it.
Some years after the founding of the hospice, Issan was diagnosed with AIDS. We hoped he
would live a long time, but as it turned out, he had only a few short years left inside him. As Issan’s
health was declining, I came up from Southern California to visit him in the hospital. Although I
have been at the bedside of many dying people, watching Issan die was not easy for me. He had
been there for so many. He was a good friend and a role model. His life taught us all what it meant
to be a true human being, present for another in such a way that any sense of “other” disappeared.
Sometimes that disappearing was in laughter; sometimes it was in silence. Sometimes he looked
with his eyes right into the heart of the matter.
Like so many others, I wanted my friend to continue to live. Thin and fragile, wrapped in a hospital
gown, Issan was sitting up in bed in the late afternoon when I went to visit him, maybe a month
before he died. I sat on the side of his bed, and suddenly my face was wet with tears. Issan
reached over to touch my hand. He looked at me and said, “It is not necessary.” Here the patient
was not judging himself or me, nor in the end, did I judge him. I had profound appreciation for
Issan’s courage and humor, wisdom and love. The feeling between us was not characterized by
judgment but by respect and love, and by a deep sense of the reality of impermanence.
Emotional Awareness of Self and Patient:
• Responsiveness to patient’s needs and emotions
• Greater accuracy in responsibility attributions
• Less dismissing of patient’s or other caregivers’ emotions
• Less withdrawal/abandonment resulting from negative emotions (e.g., anger, disappointment,
shame, grief)
Story: The following is a letter from his physician, who was a participant in our professional training
program for clinicians: “As with everything he did in his life, Steven went out fighting. By the last
day, he required continuous oxygen. When his breathing became terribly labored (and long after
he had become unresponsive), we turned off the oxygen. I fully expected him to pass in minutes.
No, not Steven. Never the easy way out. He still labored, minutes turning into hours. Family and
friends started reading poetry—Blake, Wordsworth—preparing for a night that seemed to have no
end. At one point, I thought of co-meditation, but couldn’t imagine how I could do that. Too late
now, I thought. Then, without any idea what I was doing, and with still no end in his agony in
immediate sight, I began speaking into his ear, my forehead almost resting on his, my hand slowly
rubbing his chest in soft circles, as I whispered to him to relax, to slow the breath down, to be easy.
Within minutes his breathing pattern slowed, the labored quality going. A few minutes later, when it
had slowed even more, the end clearly near, I called someone else over to take my place by his
side, and with her now whispering in his ear, he died quietly, peacefully. A long, hard labor over.
The night complete. A man reborn into another world.”
This good doctor had such resonance with his patient, and such devotion. I know him well. His life
was changed as a result of what he gave to his patient and what he learned from him.
Self-Regulation in the Caregiving Relationship:
• Emotion regulation in the caregiving context
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