 19 has affected everything in our lives, including the kind of spiritual life and spiritual care we are able to live at the end of life. I'm Larry Grimm, Dr. Larry Grimm, and I wear several hats here. First of all, I'm a Presbyterian minister. I like to say I'm one of the liberal, open-minded progressive Presbyterian ministers, and I am also a coach, a personal coach for life and faith which I am focusing on, elderhood, and folks who are in their elderhood who would like to benefit from care and from coaching. I want people to engage, not just age, but to engage in their lives. The third hat that I wear is for Bristol Hospice. I'm a spiritual counselor, also known as Chaplain, with Bristol Hospice Hawaii here, one of the several hospice services here on Oahu. And today I'm interviewing myself about spiritual care and how COVID-19 affects all of us in our spiritual life. First of all, I'd like to address what is spiritual care. There are many people who have various associations with the term chaplain, and I don't like to use the term chaplain really in the hospice setting because it carries with it so much baggage. So spiritual counselor is another term that we use, which I think is an effective one. But what is spiritual care, then, that I give? Spiritual care, for first of all, is not telling a person what to believe about the end of life. It is not proselytizing and securing somebody's conversion on their deathbed. It is not proposing and propounding a particular way of belief from my own presbyterian background. What spiritual care is begins with listening. I'm listening to my patients and family members makes sense of what they're going through in this end of life time. Most of us have never been at the end of life, as most of my patients are, when they come into hospice care. Some have been at the end of life before and recovered and have backed away from that precipice, so to speak. What I'm doing is listening for the resources, the spiritual resources, the spiritual emotional resources that every patient and family member brings to this end of life occasion. What helps them make sense of what they're experiencing. So one of the things that I listen for is how the people, how the persons are moving and the patient in particular is moving through the five stages of dying, which Dr. Elizabeth Kubler Ross first identified. Those five stages, as you know, and the very popular knowledge have been denial, anger, bargaining, depression or distancing, I like to call it, and acceptance. And so part of my hope and my plan and my goal for my patients that I work for, if they do, as they usually say, they have a goal of dying in peace. And family members want their loved one to die peacefully and not in pain. So, but one of the things that I use to listen for is how are they moving towards acceptance through these stages of dying to acceptance. Because acceptance is a wonderful experience. Acceptance is one of the, it's not just a matter of intellectual affirmation, I'm going to die, scheduling my death for the next certain time, and we'll get into that in a minute. But acceptance is an opening up to it and a relief actually about relief from fighting against it. One of the persons that I have been helped most in understanding and experiencing this actually has been Alan Watts. Alan Watts is a philosopher, died in the 1990s, I believe, maybe early 2000s, and he was so instrumental in bringing together thoughts from Eastern philosophies, Eastern traditions of Hinduism, Buddhism of its many sorts, and the Eastern philosophy and bringing it together was Western thought and integrating the two. So I'd like to play for you a video. It's a 10 minute video, but it's a beautiful video about accepting death. Back in 1958, I was in Zurich and there met a most extraordinary man by the name of Carl Fried von Dierkheim. He was a former German diplomat. Who had studied Zen in Japan. And when he came back after the war, he opened a meditation school and retreat in the Black Forest. He said, well, I tell you what, a lot of my work has to do with people who went through spiritual crises during the war. And he said, you know, we all know that when a person's in an absolutely extreme situation and they accept it, there is a possibility of a natural satori. And that's what I mean when I was explaining that when one gets to an extreme, that is to say, to the point where you realize that there is nothing you can do about life, nothing you could not do about life. Then you're the mosquito biting the iron bull. Well, so in the same way he said, look, you heard a bomb coming at you. You could hear it whistle and you knew it was right above you and headed straight at you and that you were finished. And you accepted it. And suddenly there was this strange feeling that everything is absolutely clear. You suddenly see that there isn't a grain of dust in the whole universe that's in the wrong place. Did you understand completely, absolutely, totally what it's all about? Because you can't say what it is. But he said in so many cases the bomb was a dud and they lived to tell the tale. Or he said you were in a concentration camp. You've been there so long that you gave up all hope whatsoever, ever getting out. You were just going through this miserable, boring, degrading grind week after week after week. Nobody paid the slightest attention to you as an individual. You knew you would never get out and you accepted it and suddenly something changed. Extraordinary feeling, freedom. Or he said you were a displaced refugee. You had lost your family. You didn't know whether they even existed. You were miles from your home. You didn't know whether it existed. You had lost your job, your very identity. You were absolutely nowhere and you accepted it. And suddenly you were as light as a feather and free as the air. Now he said so many people have had those experiences and they talk about them to their families and friends and they say oh well you were under terrific pressure and you probably had some hallucination, you know. Well he said I am showing those people that so far from having a hallucination those were the few, few occasions in which they woke up. So you see this is always the opportunity presented by death. That if one can go into death with eyes open and have somebody help you if necessary to give up before you die. This extraordinary thing can happen to you. So that from your standpoint in that position at that time you would say I wouldn't have missed that opportunity for the world. Now I understand why we die. The reason we die is to give us the opportunity to understand what life's all about by letting go because then we come to a situation that the ego can't deal with. When we are no longer hypnotized by that then our natural consciousness can see clearly what all this universe is for. So therefore we have missed this golden opportunity by institutionalizing death out of the way instead of having a socially understood acceptance of death and rejoicing in death. Now I could imagine that one person would want to rejoice in death in an entirely different way from another like say a wedding is a rite of passage. There are certainly some forms of celebrating a wedding which I would find a total bore and quite offensive. Other ways would be very good. I would enjoy it. So everybody in other words I'm not saying that you've got to get mixed up with a lot of people coming laughing around you and giving you presents and cards and everything because you're going to die. But I'm only indicating a general thing that the doctor the ministers the psychiatrists and above all us really owe it to our friends to work out an entirely new approach to death. Because what has happened you see from earliest childhood the child learned that great uncle was dying and saw the family put on long faces and say oh that's too bad. Even Christians who think they're going to go to heaven you know they get absolutely morbid more so than anybody else about death because heaven as they all know is a very boring place and so this frightful thing is dead you know. I want to understand that for the living to lose someone you love or even for a dying person to worry about what an earth my wife my children my whatever going to do without me. One can understand a certain worry in that but nobody is indispensable and there comes a point when you have to say I'm sorry but I am completely going to abandon responsibility for anything because there is no further way I can do it this is another way of that surrender. And then the curious thing that occurs is the moment all that has dropped suddenly it dawns on you that to be important existence does not have to go on any longer than a moment. Quantitative continuity is of no value. How long can you hold your breath? Who cares? So it follows from that you see that if any one of us without being shocked into it by being bombed or put in a concentration camp could at this moment be as one about to die genuinely and honestly we would understand the mystery of life because death is the in a certain sense the source of life just as we see in nature when the leaves fall from the trees they mold and rot and this supplies humus from which more plants can grow it's a cycle like that. But in every way symbolic and otherwise human beings try to stop that cycle. Unamuno said human beings are the only species that hoard their dead and therefore with the ghastly art of the mortician we try to make the body unpalatable to the worms and so to stop life as if to be eaten in due course were an indignity to the human being whereas we eat everything else and we give nothing back so that is a kind of a social symptom of our profound disorientation with respect to death. We think death is unnatural and furthermore in our culture we think birth is a disease and send a mama to the hospital for the most unnatural weird kind of parturition. In other words more and more one regards the healthy and inevitable and natural transformations of the body as pathological. I can imagine you know people having sexual intercourse on an operating table to be sure that the whole thing is hygienic. You know everything about us like that has become over interfered with by specialists and less and less the province of our own preferences. It's very very hard indeed to die in your own way without some blasted bunch of relatives come fussing around and insisting that you go to a hospital that you get fixed with the tortures of being fed through tubes and things to keep you alive indefinitely and waste the family savings. Now this is simply nonsense it's this perfect panic to survive at all costs. Hi I'm Larry Grimm and I'm partnering with Think Tech Hawaii in Elderhood and Aging Gracefully I recall it and there's so many wonderful resources on the island of Oahu for the kupuna for all of us who are elders and it's part of my mission to bring that to light and as a spiritual counselor for Bristol Hospice of Hawaii I am also involved in spiritual care and profoundly aware that COVID-19 has had a tremendous impact upon our spiritual lives and upon the spiritual care that we give. This particular video acceptance of death highlights the joy and the wonder of acceptance and the importance of acceptance. It's not as I mentioned before the video began it's not just a matter of saying oh I accept that I'm going to die now but there is a satori a tremendous enlightenment I like to think it's surprised by joy like C.S. Lewis used to say an awareness that all is well all will be well and all manner of things will be well and so moving into that acceptance is a tremendous benefit to growing and growth through the end of life cycle. That has been of course tremendously impacted by COVID-19. Usually when I am giving spiritual care what I'm listening for is the individual resources a person brings to make sense of their dying individual beliefs that maybe they have accepted through the religion that they have nurtured through their lives belief about life after life belief about God belief about and faith and trust in something greater themselves belief in the flow of life and the cycle of life of which death is a part sometimes it's those beliefs that enable a person to flow through that end of life cycle into a stage develop into those stages into acceptance also there is a community dimension to those resources because there are people who are come about who are supportive of those individual experiences and knowledge family and members of the really religious community there there's also a sense of the near death experience a person may bring that they've had in the past and so they come to this final dying and they say you know I'm not afraid because I've already been there and I've shared that with my community my family and my friends and they're all aware that I'm not afraid of this and so the community is able to support them in the community of faith we engage in ritual we ritualize our anticipatory grief the coming loss of my of the person I love when and we ritualize the grief at the time of death sacramental rights from certain denominations while the catholic church in particular may become important or the ministry of prayer by a community of prayer givers prayer warriors or a ministry of of presence which is often just a matter of sitting and thinking and meditating and being together all of that is part of the process of moving towards acceptance and those are the resources people draw upon music has played a vital role in my ministry of spiritual caregiving I sing songs sing hymns I bring my laptop and play songs in Tonga or Ilocano or Japanese or Chinese in order to again real touch that those places in the heart and soul where music has been meaningful in the past there are also efforts to provide music at the time of death itself which are not so much oriented towards words and phrases and images as towards enabling the person to let go threshold choirs have been established and music fanatology has become an entire discipline in itself of bringing heart music into the dying process again this is a matter of enabling the person to accept the final let go that they do one of the other things that we have as a resource here and in colorado is our care our choice legislation that permits us to choose to die as we wish and I'd like to share a brief video of how that was generated here in color and did I say colorado in Hawaii how that was generated here in Hawaii and over the year became effective in January of 2019 let's listen to some of the preparations for that by show of hands how many of you here today are going to die a series of meetings is being held on Hawaii Island about death with dignity as the our care our choice act goes into effect in just a few months it's it's why it's so important to talk to your doctor and make sure your doctor and your your whole care staff that they know what what you want the conference room was full at the Hilo aging and disability resource center on October 24th for a presentation by compassion and choices Hawaii we call it the access campaign compassion and choices we work to help states pass these laws and then we stick around to make sure people have access to it they are the local affiliate for the nonprofit organization committed to improving care and expanding choice at the end of life we want to make sure that everyone who's qualified has the option the free presentation also delivered in Kona and Waimea talk to a pharmacist who's prescribed before intended to help everyone understand and prepare for implementation of the our care our choice act prescription the new law that authorizes medical aid in dying to self administer to bring about a peaceful death by law medical aid in dying is not considered suicide assisted suicide homicide or euthanasia access campaign director Samantha trad explained the details medical aid in dying eligibility criteria so as I said you have to be an adult at least 18 years or older you need to be terminally ill and you need to have a prognosis of six months or less to live and you need to be mentally capable of making informed medical decisions a patient must make two verbal requests separated by 20 days and one written request which can be submitted at any time so there is a waiting period the fastest a person could receive a prescription for medical aid in dying is 20 days and that is if you have all your ducks lined up in a row trad also played an emotional video documenting an end of life experience for one terminally ill patient a beautiful video after the presentation audience members had questions being on the outer islands I think we do suffer the issue of isolation many express concerns about implementation on the big island I know there's a shortage of physicians as well in hawaii too I've read in the newspaper and that's why being educated is so important east hawaii palliative care providers were also on hand kakumau is here lori miller and we have been talking to them and they're very aware of the law do you want to say anything to the executive director of kawaii hospice but I also serve as the president of kakumau which is the state hospice and palliative care organization and we have been very involved in understanding how this law has how this legislation has become law and working with our members to understand what position we would take as a member organization because our member organizations are quite diverse and representative of places like catholic hospitals and health insurance carriers and hawaii care choices which is the east hawaii hospice and palliative care organization would always support whatever our patients they have options multiple options lauren kim with the hawaii department of health was also in attendance the bill we have is something it wasn't there before and the form it was passed was enough to get passed that's what we have to recognize and i have the constitutional authority to implement the law as it's written the presentation was coordinated by the hawaii county office of aging state senators lorraine and noe and russell ruderman and state representatives cindy evans and joey sanjuana ventura in 2000 when senator noe was in it died in the senate by two votes this time around it died in the house the year before because and we killed the senate bill because we didn't believe they had enough safeguards so like senator noe said i know it is going to be more difficult for the patient itself but we ask for your patience we want to make sure it works the our care our choice act goes into effect on january first 2019 most people of course want a peaceful death so you can see that there are many commitments on the islands and in hawaii to enabling aging gracefully to continue right into the end of lifetime and our care our choice provides that opportunity i've had three patients in my care that have opted for that we don't at bristol hospice don't provide medications we don't encourage it we don't try to promote it we just are there part of the team as with any death our care our choice though gives us a chance to look forward to planning and all of this is to say that i'm trying to say that spiritual care is so effective when it's over a long period of time long period two months three months six months because it gives a chance for us to accommodate men and come alongside our patients and families as they seek to make sense of what's going on in their lives COVID-19 comes in and sudden death appears in so many ways you can get COVID-19 today have manifestations of symptoms and die within 24 hours it robs us of the opportunity to plan plan it robs us of a chance to grow through that end of life experience so what can you do i want to really encourage you to to fill out your advanced directives talk with family members talk with your community talk with everybody about the importance of death and dying and explore what it means for you to come into a time of acceptance and to live as Ellen once said honestly and committed as though you may die tomorrow a wonderful peaceful death