Good evening. Thank you all for coming. Is there anyone here who is here for the first time tonight? Welcome. My name is Tova Green. I'm a resident here at City Center, and I'm also a hospice social worker. And my talk tonight is going to attempt to bring together those two parts of my life. First, I want to thank Jordan for inviting me to give this talk and also to teach a class this practice period. We're having a six-week practice period, and I'm teaching a class with Victoria Austin on beneficial action, and I'll be saying a little bit more about that as we go along. I also would like to thank my teacher, Linda Cutts, for her constant support and guidance.

[01:04]

So the class that Vicki and I are teaching is based on two things. One is a short essay by Ehe Dogen, who lived about 800 years ago. It's called The Bodhisattva's Four Methods of Guidance. And the theme of this practice period is bodhisattva activity. A bodhisattva is an awakening being, so that's really all of us, because we're all in the process of waking up. And The Bodhisattva's Four Methods of Guidance was written in 1243. And the other text we're studying is a book by... Reb Anderson on the precepts called being upright and working with the precepts, which are kind of our guideposts to leading an ethical life, you might say.

[02:10]

That's one way of looking at them, but they're not just actions, but ways of thinking that can help us to act in a caring, connected way with all beings. So the theme of my talk tonight is not killing, but cherishing life, which is one of the precepts. And I'm going to talk about the four methods of guidance through the experience of a hospice social worker. See how that works. So the four methods of guidance that Dogen describes are giving, kind speech, beneficial action, and identity action. And I'm going to talk about each of those in turn.

[03:14]

So Dogen describes giving as non-greed, and he says that whether it is of teaching or of material, each gift has its value and is worth giving. So there are many ways we can give. Material gifts, whether they be objects or money, are one. But there's also teaching, and there's also an understanding that we can give, especially if we're practicing, we can give the gift of fearlessness. We can give the gift of presence. We can give the gift of compassion. So many things that we give are not material things at all. We can give a smile. So Dogen also says that to give to yourself is a part of giving. So how does that apply to my work as a social worker?

[04:19]

One of the gifts that I see every day is the gift of caregiving. And I want to talk about a specific person, a specific, I'll call her, at hospice we use the word patient. So a patient and her sister, who I visited today. The patient is a woman in her 70s, and I'm going to call her Betty, who lives with her younger sister, who I'll call Lena. Both of them lived in their own homes until Betty began to have seizures about six months ago and was diagnosed with brain cancer. And she went from being independent and living alone to needing a lot of help. Before she retired, Betty told me she had been very carefree and had worked in Social Security.

[05:23]

in the social security office for about 30 years. And she has a son, David, who lives in San Jose with his wife and teenage children. So she had had a rich life, but suddenly she couldn't walk on her own and needed a lot of assistance. So her sister, Lena, invited Betty to live with her in her home in Daly City. And A couple of months after that happened, Betty was admitted to hospice, and I began visiting these two sisters as the social worker. So we work as a team, and I will say more about that later, but we usually work as a team, including a nurse, social worker, chaplain, and sometimes home health aides and volunteers. So the first time I visited Betty and Lena, and introduce myself to Betty, Lena immediately said she wanted me to step into another room because she wanted to ask me a question about Betty's medication.

[06:31]

And then what I realized was she really didn't have a question about the medication. She asked me not to use the word hospice in Betty's presence because Betty didn't know that she was dying. And... presented a dilemma, but I'll get to that later. I want to talk more about Lena and the gift of caregiving that she gave to her sister. Lena had been living alone, and she too was retired, but she was very active in her church. And suddenly with her sister there, she had to be there all the time. At least that's how she felt. And although she had some help from neighbors and from her other family members, she was cooking dinner for her sister, helping her bathe and dress, making sure she didn't fall.

[07:34]

When I first met Betty, she was sitting in her wheelchair with a bicycle helmet on to protect her head in case she fell. And over the weeks that I visited Lena as the caregiver, She was usually cheerful, but she was getting more and more tired. And she began to ask about ways hospice could help her take a break from caregiving. And I really saw this as an example of her seeing the importance of giving to herself. And she was feeling that she had no more to give. And sometimes we don't pay attention to those signals if we're taking care of other people, whether it's children or aging parents or friends who are ill. I mean, I imagine almost everyone here has had some experience of caregiving. So I was able to arrange a five-day respite stay for Betty in a nursing home in Pacifica.

[08:43]

And that happened last week. And when I visited today, her sister Lena was rested and really happy. She said she spent the first day sleeping, and then she saw her friends and spent time planning an event at her church. So this way she was feeling she was ready to continue taking care of her sister. In a recent article in the summer's issue of Buddha Dharma, there are several articles about loving and what it means to love and care for people. There's one by Sharon Salzberg about caregiving. And she says, any skillful relationship of caregiving relies on the balance between opening one's heart endlessly and accepting the limits of what one can do. And I think that's true of all giving, not just caregiving. Being able to open our hearts, be generous, and then also to know when we have to

[09:48]

stop, take care of ourselves, and find a balance that's right for each of us. So along with this bodhisattva method of guidance giving, there's a precept that I vow not to take what is not given, but to freely give, ask for, and accept what is needed. And that is a version by Kosho McCall, who used to practice and teach here, and now is in Austin. I vow not to take what is not given, but to freely give, ask for, and accept what is needed. So, I find that this is true not only for my... for the caregivers that I work with, but for myself as a hospice caregiver in a sense, to also pay attention to the balance between giving and finding what it is that replenishes me, that allows me to do this work day after day with a sense of joy and gratitude.

[11:14]

One of the things that really nourishes me deeply is living in this community, in this building, going to the Zendo every morning, sitting with everyone, and doing my Zendo jobs, and just feeling that there's this saying in our meal chant, there's no giver, receiver, or gift, because they're all connected. And I feel that very much in the morning when I'm sitting in the Zendo with everyone and going to service, that we are all supporting each other and giving each other gifts and receiving gifts at the same time. So the second method of guidance is kind speech. And Dogen says, when you see sentient beings, you arouse the mind of compassion and offer words of loving care. It is kind speech to speak to sentient beings as you would to a baby.

[12:17]

Although, in my experience, kind speech is not always necessarily, say, soft and gentle. Sometimes it's important to say things that are hard to say, but that are a way of speaking your truth. And the precept related to this is, I vow not to lie, but to communicate the truth. So there's some dilemmas for me in my role as a hospice social worker. So last week, when I visited Betty, the day she arrived at the nursing home, it was the first time I had spoken with her apart from her sister, Lena. When I visit them at home, Lena's always there. And I think that Betty somewhat censors what she says to me. So this time I visited her and found her in bed.

[13:19]

She had just arrived. She was eating ice cream. And she asked me, what's wrong with me? I can tell that I'm getting weaker and I'm losing weight. And although I... I knew that she had brain cancer. I also knew that her family didn't want to tell her that. And I remembered that Lena hadn't wanted me to use the H word, the hospice word. So a question came up for me. Well, what is kind speech in this situation? How could I respond to Betty's question while honoring her family's wishes? If I didn't tell her the truth, would I be lying? I wonder, what would you have done in that situation? And who do you identify with? Is it Betty or her family, the sister? So these dilemmas come up for me frequently in my work as a hospice social worker.

[14:24]

And I try to listen to the concerns of everyone involved, the patient, the family, other caregivers, the members of the hospice team. And in responding, I think about, actually the Buddha had some guidelines about right speech or kind speech. Is it true? Is it timely? Would saying this be beneficial? And, you know, in this situation, I felt that the most skillful response for me at that moment was, what I did was to just say to Betty that I could really appreciate how hard it was for her not to know what was wrong and to empathize with those feelings. But I didn't feel it was appropriate for me to tell her what was wrong. But I did, when I got back to the office, I called her sister and I said, you know, I think Betty really wants to know what her illness is.

[15:33]

And... So we had another conversation about that today. And so this brings me to the next method of guidance, which is beneficial action. Dogen says, beneficial action is to skillfully benefit all classes of sentient beings. That is to care about their distant and near future and to help them by using skillful means. Beneficial action is an act of oneness, benefiting self and others together. And this is where I think the precept of not killing but cherishing life comes in. And by not killing and cherishing life, we are able to feel our connection, or maybe the other way around, when we feel our connection with all of life, we're

[16:36]

acting to cherish life and not to kill, and not to kill ideas as well as not to kill beings. So today when I visited Lena, I asked her about her reluctance to tell Betty that Betty has cancer. And what Lena said was that if she told Betty, Betty would lose all hope, and would just sit in her wheelchair wondering when she was going to die. So her feeling about it was that it would be, in a sense, killing life to tell Betty that she was dying, that she would be taking Betty's hope away. But I said, I listened, and I also said, Sometimes when people know they're going to die, it makes the time they have left all the more precious. And it's an opportunity to cherish life.

[17:39]

And I don't know if you've had any friends or family members who've received a terminal diagnosis. It's a very hard thing to receive. And often what happens is people decide to do things they've been putting off. to say things they've been meaning to say but haven't gotten around to, to tell people that they love them, and to say things that are hard as well, you know, things that they want to be sure they clear up before they die. So it's not necessarily when somebody knows that they have a limited time to live. makes that time very precious and very meaningful. So when Lena talked a little more about her difficulty in telling Betty, she began to realize that she was also having a lot of difficulty in realizing that Betty was going to die.

[18:49]

And she asked me how long I thought Betty had to live. which, of course, it's an impossible question to answer most of the time. When someone's very close to the end of their life, there are changes that you see, and then it's easier to say, well, I think this person might live for a day or a week. But with Betty, I really couldn't say, but Lena realized that she... she doesn't want to lose her sister, and she began to get very teary and to get in touch with her grief, which I think she had been denying. I think that's why she didn't want me to use the hospice word, because she was having trouble acknowledging that her sister was dying. So, cherishing life in the face of death is You know, it's something we all do.

[19:51]

We all know we're going to die. We just don't know when or how. And some of us may think we're closer to it than others of us, but we really never know. So I think it really does that awareness. And I think one of the things that hospice work makes me aware of is how precious my own life is. Every day I feel grateful to be alive and healthy and able to do the things that I do every day, including going to work. And I'm at an age, I'm going to be 70 this year, so I'm older than many of my hospice patients, which is also kind of a wake-up call for me. Okay, well, I'm very fortunate, actually, to be approaching my 70th birthday and to be healthy and full of energy and able to appreciate life, my life.

[21:02]

So I want to move on to the last of the four methods of guidance, identity action. And this was the topic of Vicki Austin's talk on Saturday. And she describes it as cooperation. where our action stems from knowing that we're all connected. And Dogen describes it as an act of oneness, benefiting self and other together. So identity action is based on the understanding that we're not separate from one another. And that's actually the basic understanding from which all of the precepts arise. So in hospice, we work as a team. I mentioned that before. And each member of the team brings their gift or area of expertise. And with Betty and Lena, the team consists of a nurse whose name is Jeff, a chaplain, Marshall, myself, and home health aides, as well as Betty and Lena.

[22:16]

and their family and friends. There's a lot of people involved. And I think we each contribute in different ways. Jeff, as the nurse, checks Betty's medications. He communicates with the doctor. He orders medical supplies. And he talks with Betty and Lena. about how things are going. And if he notices a problem that he thinks I can help with, he'll let me know. And we're actually, after my visit today, Lena thought it would be very helpful for us to have a family meeting with Jeff and me together, the nurse and social worker together. with some of the other family members as well to help them understand what's happening because they are all having trouble accepting that Betty is dying.

[23:19]

So, you know, it's interesting after they've been on hospice for four months, and I think this isn't so unusual that people still have a lot of difficulty accepting that their loved one is dying. The chaplain marshal, when he visits Betty... He reads to her from the Bible, and he sings with her. This is an African-American family, and they love to sing. I'm not saying that all African-Americans love to sing, but they go to a church where there's a lot of singing, and they do love to sing. So Marshall will sing with Betty and pray with her, and she loves his visits. They're always, for her, very uplifting. And then I talk about some of the practical issues around the respite care, what other ways Lena might get some support as the primary caregiver.

[24:27]

And kind of sometimes feel like I sometimes maybe am the glue that holds the different members of this team together. And then I can also talk with family members about their grief and do some... One phrase we have for this is anticipatory grief. It's the grief that happens before you lose someone through death, but you're losing them all the time in other ways, little ways that they're changing. And then the home health aides have been coming to help because... Betty has been getting weaker, and Lena can't really get her out of bed in the morning by herself. So the home health aide comes in the morning and helps Lena bathe Betty and get her dressed. So we're really able, as Betty and Lena need more help, to provide more support. And now we're talking, Lena and I, about whether she can take care of Betty.

[25:34]

at home when Betty's no longer able to get out of bed, and she may not be able to, and then we'll find a place where Betty can go, where she can get the kind of care she needs. So that's a little view of how identity action works for a hospice team, where there's a tremendous amount of communication and cooperation, and each person bringing... their special area of knowledge and experience, but we all need each other. None of us could do it alone. And so again, I just want to, in terms of identity action, I think that any community really is an a community that functions well is an example of identity action.

[26:35]

And I really appreciate that about our sangha, not just the residential community, but all of you who come and lend your energy and enthusiasm and support to Zen Center. So those are the four Bodhisattva, Methods of Guidance. And this week in our class, we talked about identity action and we divided into small groups. And one small group wrote a poem together. Each group was demonstrating a way that we can cooperate with each other. So the group that wrote a poem decided that one person would write a line passed the poem to the next person who wrote another line and then folded over the first line and then the next person wrote a line and so on.

[27:38]

And the poem remarkably turned out to have some coherence and I think relevance to the theme tonight. So I thought I would end my talk with a poem and then have some time for questions and discussion. So this is the poem. The Heart of the Buddha as the tumbling of the waterfall drops heaviness in heaps and flies on the wind's wings. Where would I fly in all this, in unending cloud and sky? I'll read it again. I think every poem needs to be heard more than once. The heart of the Buddha, as the tumbling of the waterfall, drops heaviness in heaps and flies on the wind's wings. Where would I fly in all this? In unending cloud and sky.

[28:42]

So as we come together in community, as we cherish life, I think we may drop heaviness in heaps and fly on the wind's wings. Thank you. Are there any questions or comments? I was wondering how your training and education is going to work in terms of your practices in your work. Because I've heard about how your practice here guides your work at work. I was interested in the flip side and not that it's necessarily any different.

[29:50]

How my social work training bears on my life here or bears on my work at work. Actually, at work, most people don't know that I'm a priest. My patients don't know. But my social work training has been helpful in many ways. One is that as a social worker, you learn that it's not so different from identity action. You learn that a person, even though you study a person's, what do you call it? personality, that's not exactly it. We look at a person in a context of their family, their community, and society. So social work really sees the whole picture.

[30:51]

And there's an understanding that a person does not exist alone. And I think that's very compatible with identity action. But so really understanding that learning about family systems, how families work, learning about community resources, and then learning also about individuals' psychodynamic makeup and how to assess a person's strengths, how to help a person who has some emotional difficulties, how to deal with someone who might be suicidal. or depressed, or some of my patients have a dual diagnosis that means they may have an emotional or psychiatric diagnosis. It would be a psychiatric diagnosis which manifests in some emotional difficulties, but they may also be having difficulties with alcohol or drugs.

[31:52]

And then they have a terminal illness. So all of that, is a lot for someone to deal with. So I feel my social work training really has helped me understand what's going on with the person and their situation and their family and to be able to communicate clearly and compassionately. So I was very fortunate. The School of Social Work that I went to recently developed a program in contemplative social work practice. which I was able to attend a couple of years ago. It was for me very affirming because I hadn't been doing social work for a while. I had been working as a hospice volunteer coordinator that year. And when I did the program in contemplative social work, I really knew that I wanted to return to social work and that it was... find to do that as a priest.

[32:54]

And there was no separation or contradiction between those two parts of my life, which is really how I feel now. Does that answer your question? It did. I mean, thank you. I guess I didn't ask my question very well. I was thinking more along the lines of I was thinking it would be less like, I don't know if I It's hard to say what the right thing to do is in a situation where your patient doesn't know that she's going to die, and then the family has asked you not to help the patient. And I was thinking about when I studied social work in grad school, and if I was in that position, I feel like immediately it was really easy for my brain to kick in the social work training and have that override my practice in terms of it's to speak the truth from what you said with .

[34:08]

And I thought that what was primary to me in my head would be that there was a confidentiality issue. So it was easier for me to sort of like black and white like that and not necessarily wonder if I was telling the truth or part of it. I think that certainly came up for me, confidentiality of what, you know, confidentiality, but I think Part of confidentiality is about respect, respecting people's boundaries and respecting what people tell you one-on-one. And in this situation, trying to respect everybody in the family, the patient, and not to take sides in a sense, but just, you know, on the other hand, trying to see what was keeping the family from telling her.

[35:17]

the truth. So, and I think that we're getting there. And I think the best outcome would be for her sister or her son to tell her, not for me to tell her. Thank you. Any other questions? Comments? Patricia? Hi. In the market, you find that with caregivers that there's at the one place, they're participating in compassionate care, supporting the patient in their last moments of life, or supporting a patient who's trying to let go of it. I'm wondering about the or, you know, supporting a patient in their last moments of life or... Supporting a patient who's letting go of life, or who needs to let go of life.

[36:33]

I don't see them as separate. I think if, you know, caregiver understands that the person is dying and needs to let go of life, then supporting them at that moment would be helping them to do that. I mean, sometimes a family member can't see that, and it's very difficult. And sometimes... That's sometimes where a hospice social worker can be of some support. But, you know, often caregivers really can see that the person is ready to go. And... with a little, you know, they don't want their loved one to suffer, usually. Sometimes people have a lot of difficulty letting go, and sometimes the patient herself or himself has difficulty.

[37:33]

I recently worked with a woman who had a 15-year-old daughter, and she was a single mom, and it was very, very difficult for both of them to let go. So it's not always a conflict, though. Does that make sense? Is there more that you want to ask about that? Not right now. For some reason, in my head, it's a great discussion. I don't think it's easy. Sometimes it's a big discussion and sometimes it's just kind of coming together. I'm looking for some words here. An acceptance that develops in the room.

[38:38]

And it's also sometimes... Not all caregivers are on the same page. Like the different family members may have different senses of what's going on, and some may find it easier to let go than others. So sometimes it's more complicated, but I don't necessarily think that it's always difficult to let go for the caregiver. But we could talk more about this. Anyone else? Thank you very much.

[39:16]

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