How to Be a Friend Until the End

According to Frank Ostaseski, offering care to someone who’s dying is like meditation: there’s no one right way, but practice helps, and so do basic guidelines.

Frank Ostaseski
3 July 2024
A woman holding a man's hand in a hospital bed.
Photo © Victor Torres / Stocksy United.

A friend or family member shares the news of a life-threatening diagnosis or we see them stumble on a curb or over their words, and in that moment we realize that we’re about to become a companion to someone facing death. Perhaps it’s a conscious choice. Maybe we feel we have no choice.

It’s important in the beginning to remember that we already know how to care. We’ve extended a helping hand hundreds of times in a thousand meaningful and loving ways. Caring is a natural expression of our humanity. We can trust our good hearts to be reliable guides.

Offering care is like meditation, there’s no one right way, but some basic guidelines and practice can help.

Embrace Impermanence

Recognition of the transience of life is a central tenet of Buddhism. Impermanence is an essential truth woven into the very fabric of existence. It’s inescapable and perfectly natural. How we meet that truth makes a world of difference.

One of the most exquisite of Japanese terms, mono no aware, expresses an aesthetic sensibility that’s challenging to translate. It speaks to a gentle sadness—to being deeply moved by the transient, finite nature of things. It doesn’t deny loss or bypass grief but reminds us that the beauty of things and our appreciation of those dear to us is heightened by our awareness of their ephemeral nature.

Isn’t it the fragility and brevity of the cherry blossom, or morning light, or cresting wave that captivates us and invites us into wonder and gratitude?

Enter Mindfully

In the Zen tradition, we have the practice of dokusan, a face-to-face meeting with the teacher. The student is instructed to wait outside the teacher’s door and gather herself. She has no idea what’s waiting for her on the other side of the door. She has no idea what the teacher will ask, or perhaps even what she most needs. She does her best to be ready, flexible, and open.

Going into the room of someone who’s ill or dying is like going for dokusan. Empty your mind, open your heart, and enter with fresh eyes. Once in the room, sit down, talk less, and listen more. Touch when appropriate.

Be a Calm Presence

When we’re caring for someone who’s sick, we lend them our body. We use the strength of our backs and arms to move them from the bed to the commode. In the same way, we can also lend them the strength of our mind. We can help to create a calm and accepting environment. We can be a reminder of stability and concentration. We can expand our heart in such a way that it can inspire the individual who’s dying to expand theirs. One calm person in the room can ease the entire experience for everybody.

You Are Enough

We’re always messing with ourselves—telling ourselves what we should be experiencing, trying hard to be someone special, hoping we’re doing it all in the right way. Often in spiritual practice and in caregiving, we set some goal of where we think we ought to be and then use that to not be where we are.

I’m guided by the counsel of Carl Rogers, the great humanistic psychologist:

“Before every session, I take a moment to remember my humanity. There is no experience that this man, this woman has that I cannot share with him, no fear that I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep his wound, he does not need to be ashamed in front of me. I too am vulnerable. And because of this, I am enough. Whatever his story, he no longer needs to be alone with it. This is what will allow his healing to begin.”

No Advice

Some of us reach too quickly for our version of a prescription pad, doling out unsolicited advice. While our intentions may be genuine, we can be blissfully insensitive to the way we impact others. The attachment to the role of helper runs deep for most of us. If we’re not careful, it will imprison us and those we serve. Let’s face it: if I am going to be a helper, then somebody has to be helpless.  

Is what you want to say true? Is it helpful? Is it the right time?

Wise speech is a mindfulness practice. Words can heal or harm. Before speaking, pause. Silence has the benefit of slowing things down. Ask yourself, is what you want to say true? Is it helpful? Is it the right time? And, maybe most important, is it wanted? If the other person doesn’t want to hear it, you may not need to say it. But at times we do need to speak whether the other person likes it or not. In such situations it’s more likely to go well if you follow the other guidelines covered in this article.

Turn Toward Suffering

An integral part of healing is letting go. But there’s no letting go until there’s letting in. As James Baldwin once wrote, “Not everything that can be faced can be changed. But nothing can be changed that is not faced.”

Suffering is exacerbated by avoidance. Our attempts at self-protection cause us to live in a cramped corner of our lives. We accept a limited perspective of the situation and a restricted view of ourselves. We cling to what’s familiar in order to reassert control, thinking we can fend off what we fear will be intolerable. When we push back, hoping to get rid of a difficult experience, we’re actually encapsulating it. In short, what we resist persists.

Suffering will only be removed by wisdom cultivated through inquiry, not by drenching it in sunshine or attempting to bury it in a dark basement. Compassion manifests through the medium of fearless receptivity.

Love Heals

The boundlessness of love is made evident when the veils between this world and the invisible world are thinnest. At birth and death, love can melt division, allowing us to move beyond what we thought possible.

When someone is sick, when their body is ravaged by illness, when they can no longer function in their familiar roles, when their identity is shifting daily, many people feel un-loveable. When someone believes they’re beyond love, you cannot convince them to love themselves. But you can show them that they’re loved.

When someone is sick or suffering, love them. Just love them. Love them until they can remember to love themselves again.

Frank Ostaseski

Frank Ostaseski is the founder of the Metta institute, cofounder of the Zen Hospice Project, and a coordinating teacher for a new multiyear training program at spirit rock Meditation Center called Heavenly Messengers: awakening through illness, aging, and Death.