Alleviating Suffering

 It’s three a.m. when the on-call pager goes off, rousing me out of a fitful sleep. By the time I arrive on the geriatric wing to answer the “obstreperous patient” page, the floor is quiet. “We’re fine,” a nurse tells me. “She’s calmed down. We just have to watch for the flying tray.”

One busy week later, I still haven’t visited this patient. Often, when I pass her room, I hear her calling out, “Help, help!” Her charts speak of dementia and pain; she’s triggered other “obstreperous patient” calls, and she’s been giving some of the nurses a really hard time. Now one of the palliative-geriatric physicians has asked me to check on her, so I cautiously step into her room, wary of the tray.

No tray in sight. I introduce myself as Chaplain Pamela; she tells me that she is Grace O’Mara, but she prefers her maiden name, Longsilver. Her cornflower-blue eyes are lovely and alert. Clearly grateful for company, she invites me to take a seat and says I remind her of—who was it? Kitty. Or Louisa, the chaplain’s daughter. And could I please move her arm out from under the covers.

Our lengthy conversation involves a good deal of time travel. I know from her doctor that Grace is alone: her sisters and daughter have died. She has few visitors. The palliative care team is working hard to help manage her pain; as a result, her disinhibited aggression has mostly subsided and she is a pleasure to be with. My heart is soft and grateful as I leave her room, yet I wonder about the lasting benefit of such a visit. These are my leitmotifs nowadays: Can we measure the value of salving suffering? What can chaplains do that a cheerful, red-vested volunteer couldn’t? Is simple presence enough?

Moreover, in certain Buddhist circles—including my own—debate about the ultimate usefulness of assuaging temporal suffering is making the rounds. The topic is timely, given the commercialization of spirituality and the spread of the mindfulness movement. Most of us agree that the Buddha meant his paths to be curative rather than palliative. Shouldn’t we be shooting for the big E rather than, say, “stress reduction”?

Ultimately, the rejection of unease, the search for comfort, and the clinging to it when we have it are counterproductive. We all know it. But does that mean we shouldn’t try to relieve suffering—our own and that of others—when and where we can? Palliative care, one of my units as an interfaith chaplain-in-training, is a fertile ground for such reflections.

I’m wowed by the team of doctors, nurses, and social workers whose job it is to alleviate pain, to make incurable illness bearable. You’d think they’d be a glum bunch compared to the labor and delivery folk, say, or the staff of any of the units where people actually improve and leave the hospital walking. But they’re not a glum bunch at all—they’re passionate and human and driven. Some are very funny. Some are deeply devout.

Jon, one of the nurses, says, “In Palliative we fix symptoms, not the disease. When pain fills your brain you can’t laugh, enjoy life, or be engaged. I knew a woman whose head was always under the covers, she was in such pain. We recommended a change of treatment, and when I went back in she was playing her banjo! It was amazing!”

Some years ago my teacher Sherab Gyaltsen Rinpoche gave a series of teachings on the history and practice of Chenrezig, Avalokiteshvara in Sanskrit. Chenrezig is the tireless and delightfully inventive bodhisattva of compassion. Some of his most recognizable manifestations are white with four arms or a thousand; his mantra, Om mani padme hung, resounds from Tibet to Mongolia to the Himalayas and beyond. Further east, he’s a she: Kuan Yin, the goddess of mercy and love. I tend to think of him as a quality or principle—Great Compassion—rather than as a deity or being.

Rinpoche told tales gleaned from the Mani Kabum, a classic, very old and very thick text covering just about every aspect of this bodhisattva’s life histories, practices, and activities. In one section, Chenrezig manifests in different spheres to alleviate ambient suffering so that beings of all walks of life have the space to discover their innate potential for goodness and wisdom. Some of these tales come back to me as I walk the hospital halls.

For example, in one story he appears as a beautiful Brahman youth on the island of Sri Lanka, then populated by lusty female man-eaters called rakshasis. He is able to satisfy their desires to such a degree that they stop preying on unfortunate merchant sailors (who are usually bedded, then devoured) and ask for teachings. Eventually they renounce their ways, which clearly have led to suffering for all involved, embrace the dharma instead of hapless seamen, and are finally liberated.

In another tale, he is a bee that visits the latrines of Khormojik and buzzes the mani mantra to help unstick the minds of the maggots, bugs, and worms that are habitually trampled there. Elsewhere, he’s a noble dwarf who shows up to help motivate a fellow in the god realm who’s stuck in a poverty mentality. He tempers the heat of the infernos with a cooling rain, overpowers the belligerence of the jealous gods as an über-Titan, and so on. From the heavens to the hells, Chenrezig appeases, satiates, soothes, and finally sets beings on the path to liberation.

It’s so perfectly palliative. Although it can’t magically wake us all up, Great Compassion can intervene by making our various situations just livable enough that we can shift our focus from pain, emotional overload, and warped coping strategies to the self-evident truths of the dharma: goodness, selflessness, and understanding lead to happiness; aggression, selfishness, and ignorance lead to suffering.

Anyone who’s ever been in acute physical pain or mental anguish knows how hard it is to function, practice, be mindful, or even just to be nice. Under the right conditions and with appropriate guidance, we may find the space and motivation to put down our trays, pick up our banjos, and pluck, strum, and roll all the way to the big E.