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The Final Crossing: Learning to Die in Order to Live
Dr. Scott Eberle
All cultures, indigenous and modern, have their own stories about how a dying person progresses through different psychospiritual stages. In some ancient examples, such as the "Ars Moriendi" from medieval Europe or the "Tibetan Book of Dying" from Asia, these spiritual teachings about dying and death also inform people about how to live well.
One example of "the art of dying" that is not so well known comes from a Northern Cheyenne teaching that originated centuries ago in the ballcourt ceremonies of the ancient Mayans. In the Mayan version, the teaching was seen as a way of helping a ballplayer to prepare for a highly ritualized game that, on rare festival days, would culminate in a sacrificial death. It was later adapted to guide anyone who was approaching a more natural death: the old, the mortally wounded, or the seriously ill. This teaching about how to die eventually spread farther than the ballgame itself, including to the Midwestern Plains and the Northern Cheyenne people.
In the Northern Cheyenne version of this teaching, consciously preparing for death involves four psychospiritual stages. The first is stepping onto Decision Road, which involves both recognizing that death is approaching and accepting this fact. People who remain in fierce denial, or those who die suddenly, will likely miss this critical first step and never reach the other three stages. But for people who do consciously acknowledge that death is coming, Decision Road will lead them next to the Death Lodge.
The Death Lodge is the place where a dying person receives final visitors. If old wounds still exist within any of these relationships, there will be a final chance to forgive and be forgiven. If the dying person and visitor have already done this in the past, or if they do it well during this last meeting, then they will be better able to express love and gratitude and say their final goodbyes.
From the Death Lodge, Decision Road leads next to the Purpose Circle, a place beyond the world of people. Here a dying person is called upon to do a life review, remembering with honesty both past successes and failures. For religious people, this summing up is typically done before a God. For agnostics or atheists, it is usually done alone.
Decision Road ends at the Great Ballcourt where each person "plays ball" with the Lords of Death. A place of transition—between the world of the living and the world of the dying—is common to many religious traditions, two examples being Christianity’s purgatory and the bardos of Buddhism. A real-world version of this transition place is also seen in the hospice world, where a person on the verge of death may move back and forth between interacting with the living and internally preparing for death. In this way, the physical body can be considered "the ballcourt" where a person does a final dance with death.
This four-part teaching can be easily mapped out alongside a 10-stage model that was presented in a classic article in the modern hospice literature written by Dr. Ira Byock.
Developmental Landmarks and Tasks for the End of Life
DECISION ROAD
- Acceptance of the finality of life
- Sense of a new self (personhood) beyond personal loss
DEATH LODGE
- Sense of completion in relationships with community
- Sense of completion in relationships with family and friends
- Experience love of others
PURPOSE CIRCLE
- Sense of completion with worldly affairs
- Sense of meaning about one’s individual life
- Experience love of self
IN BETWEEN WORLDS
- Sense of meaning about life in general
- Surrender to the Transcendent, to the unknown—“letting go”
That both these “road maps” describe much the same journey suggests that, in fact, there is a universal process that all people go through when they are dying if they choose to approach it consciously. No matter whether it comes from a more primitive culture from centuries ago or from the modern hospice world, and no matter if the stages of conscious dying are divided into four stages or ten, “the art of dying” is fundamentally the same for all.
The Psychospiritual Stages of Dying
The four-part allegorical teaching drawn from the Northern Cheyenne uses descriptive language to evoke the universal psychospiritual challenges faced by all people who are dying, regardless of culture or historical era. Each stage also contains major lessons that can be applied to the daily lives of people who work with life-threatened patients.
Decision Road
Here dying people are called to consciously take on the truth of their own mortality. The challenge of this stage is to have the difficult conversations about what lies ahead—with physicians, with family and friends, and most importantly, with one’s self.
For people who are alive and healthy, lessons at the deathbed teach us the importance of taking on these same difficult conversations now, well before we are dying. Will I choose to die consciously? begs the question: Will I live consciously?
Death Lodge
When a dying person enters “the death lodge,” friends and family are invited to come and say their goodbyes. According to an old hospice teaching, to complete a relationship you must be able to say five things. “Please forgive me.” “I forgive you.” “Thank you.” “I love you.” “Goodbye.” This is the essential work of the death lodge.
Here the challenge for people who are healthy is to do this death lodge work now, rather than waiting for the last days of life. This asks us to learn how to give and receive forgiveness, gratitude and love, so that our relationships may stay healthy and connected. Ask yourself: Rather than waiting to complete relationships at life’s end, how can I do the ongoing work of keeping my relationships “current”?
Purpose Circle
If blessed with enough time, any person will find purpose and discover meaning in many different ways. As death approaches, the time will then come to sum this up through life review and final closure. This may include writing a will, preparing a funeral service, creating an ethical will, finishing an important creative endeavor, or making peace with one’s own personal God.
This phase of dying challenges all of us—while we are living and well—to consider how we create our final legacy each and every day of our lives. Ask yourself: If I died tomorrow, what would I leave behind right now?
In Between Worlds
A dying person finally reaches the last days, which will test their own beliefs about what this final crossing represents. When a person dies, is that all there is—physical disintegration and nothing more? Or is there an afterlife? If so, do we go to some kind of otherworld, or are we reincarnated back into this world? Regardless of what a person believes, these ideas will likely influence the preparations necessary to make this final crossing.
Each of us makes our own deathbed every day of our lives. We, who are generally healthy, might consider how our own beliefs about this final crossing—including what lies beyond this life—may influence choices we make now. If ultimately we die the same way we have lived, how might I better prepare for this eventuality?
Resources:
10 Step Model: from “The Nature of Suffering and the Nature of Opportunity at the End of Life,” by Ira R. Byock, Clinics in Geriatric Medicine (May 1996;12 (2): 237-252.)
4 Step Model: adapted from teaching from the Northern Cheyenne people.
Dr. Scott Eberle is medical director, Hospice of Petaluma and author of “The Final Crossing.”
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