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"Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight, helping us to discover what matters most." So wrote Frank Ostaseski, an internationally respected Buddhist teacher and pioneer in end-of-life care.
Frank is the founder of the Zen Hospice Project in San Francisco, the first Buddhist hospice in America. Over the course of his career, Frank has accompanied over 1,000 people through the dying process; these experiences have taught him lessons on how maintaining an ever-present consciousness of death can bring us closer to our most authentic selves. He describes these lessons in his bestselling 2017 book, The Five Invitations.
In this episode, Frank joins Henry Bair and Tyler Johnson, MD, to share hard-earned wisdom from his unique life journey. Over the course of our deeply reflective and even meditative conversation, we discuss matters ranging from Japanese death poems, to Buddhist mindfulness practices, to what courage looks like in the face of death.
In this episode, you will hear about:
- 2:16 How the AIDS crisis led to the founding of the Zen Hospice Project
- 3:52 What Frank's work looks like on a daily basis
- 5:57 Frank's role as an "interpreter" between patients and doctors
- 9:09 How clinicians can develop their own rituals in the process of healing patients
- 13:40 How Frank makes sense of the grief and suffering he witnesses, and despite it all, keeps his spirit balanced
- 25:58 How the tenets of Buddhism influenced care at the Zen Hospice Project
- 33:56 How progress in modern medicine sometimes hinders us in our acceptance of the impermanence and inevitability of death
- 38:20 Lessons on love, mindfulness, and finding meaning from Frank's stories of patients at the end of life
- 45:20 The Five Invitations and what they look like in practice
Following is a partial transcript (note errors are possible):
Bair: Frank, welcome to the show and thanks for being here.
Ostaseski: Happy to be with you. I hope we can be of some small service to the listeners.
Bair: Unlike many of our guests, you are not a clinician by training, but you have been at the forefront of leading a change in the way that we think about end-of-life care. And you have personally accompanied many patients who are nearing death. That's a really fascinating career to find yourself in, and we would love it if you could set the stage for our audience and tell us what first drew you to this career, this work.
Ostaseski: Well, that's always a tricky question, right? Because what gets us started and any one thing, you know, I think a lot of us who are working in healthcare had a calling way back when we were very young, actually. But to keep the story shorter, I'll just say that San Francisco was kind of ground zero for the AIDS epidemic. And I would say I cut my teeth on the AIDS epidemic. Prior to that, I worked in refugee camps in southern Mexico and Central America, where I saw a lot of horrible dying.
And when I came back, I wanted to put what I had learned in those places to work. And just then, the AIDS epidemic was beginning. So we jumped in and tried to do the best we could. The Zen Hospice, which was the first organization I started, was a kind of fusion of spiritual insight and very practical social action. We work mostly with people living on the streets of San Francisco who had little or no financial or family support. And so we became their home and their family and collaborated with the local hospice providers to get them the care that they needed.
Johnson: And, Frank, many of our listeners are either physicians or aspiring physicians, nurse practitioners, nurses, other healthcare practitioners, and so they have a sense when we have a physician on the show for sort of the day to day what that person does. Can you just talk a little bit through, what is your day job like? What is it that you actually do?
Ostaseski: Well, my day job has changed. When I was at Zen Hospice for almost 20 years, I was the director of that program, and I also functioned as the primary counselor, if you will, to the patients that were served through our residence program and our volunteers through our in-home support programs as well. So I was both the support to our staff and volunteers, but also to the patients and their family.
Bair: And what did that support look like?
Ostaseski: On any given day, it could look quite different, actually. You know, over the years, I've developed a lot of tools. I've got a whole big yellow toolbox full of tools that I carry with me and have been beneficial. But I don't set that toolbox down between me and a patient if I do. One of us is sure to trip over it. So I don't lead with my tools. I lead with my humanity. And when I need a tool, it's there. I can pull it out of my back pocket and use it as best as needed. But I lead with my humanity.
And what I've found over the years is that most of my work was human-to-human contact. We might even call it heart-to-heart or soul-to-soul contact with patients. And then often I was an interpreter for them between clinicians. ... That was often a big part of my job, being a middleman, if you will, an interpreter, agnostic, intermediary. These days I spend most of my time teaching around the world, teaching both clinicians and caregivers, and people are simply interested in, what can I learn from death that might help us to live more fully?
For the full transcript, visit The Doctor's Art.
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