Nina Thompson’s involvement in end-of-life care began fifteen years ago. A project manager living in Vermont, Nina became a hospice volunteer after her father’s death. A few years later, she picked up the Zen training she’d set aside years ago and began practicing again. “I got out my old cushion and some incense, and I started to sit for an hour every day on my own.”
Around that time, she got a call from a work friend who was dealing with a life-limiting illness. “You’re one of the best project managers I know, and I hear you’re a hospice volunteer,” he told her. “I wonder if you’d manage my death for me.”
“It was a remarkable moment. I accepted the challenge, and it changed my whole life,” Nina says. “I noticed that when Zen and death crossed, the whole universe opened up to me; it seemed like everything I wanted to know was at that intersection.”
After that experience, Nina signed up for the New York Zen Center’s Foundations in Contemplative Care, a training program in spiritual caregiving. In 2012, while participating in the program, she created a nonprofit called the Wake Up to Dying Project, a traveling exhibit set up in public spaces—outside of a library or city hall, for example—for four days. Participants were encouraged to explore dying through art, workshops, stories, conversations, and reading materials. “It was all about death and service to community, and living too. We were encouraging people to make different life choices based on accepting the truth of death,” Nina explains. By the time the project shut down some six years later, it had been experienced by thousands of people across the Northeast.
Nina then spent about a year and a half “doing a deep dive” into her practice with her teacher, Roshi Sunyana Graef, at the Vermont Zen Center. “The alignment of end-of-life care and Zen was powerful and transformative,” she says. “I knew I wanted to become a chaplain.”
By the time she completed her second unit of Clinical Pastoral Education, Nina had already begun working part-time as a hospice chaplain with the University of Vermont Health Network – Home Health & Hospice, serving patients in their homes, facilities, and an end-of-life respite house. That work continues today, and there’s nothing she’d rather be doing.
How do you present yourself to your patients? If they ask, I’ll say I’m an interfaith chaplain. If they press, I’ll say that my own faith is Buddhist and what’s important to me is holding them in their faith. Vermont is very secular, so sometimes I have to reassure people that I’m not a minister.
In hospice we take care of mind, body, and spirit, and I often introduce my role as being the spirit part. From devout Catholics to atheists and from nature to NASCAR, whatever you take refuge in, I’m here to support you in that. I’ve had ordained Christians embrace me as their chaplain even knowing that I’m Buddhist. Once, when I was reading scripture to a priest, he said to me, “How can you read so authentically?” I told him that it sincerely moved me to be in service to him in that sacred space.
I don’t do much self-disclosure in my work, but with one patient who was really struggling I took the opportunity to share that I’d been grappling with illness myself. I told him I felt as though my entire world had shifted overnight; the rug was pulled out from under my feet, and it felt like something new was being taken away from me every day. And he said, “Yes, that’s what it feels like.” His wife said that from that point on, everything changed. They were able to talk about the past and the future, to cry and reminisce, to be together and hold each other. He died soon afterwards.
What would you like to share about your health struggles? I have an autoimmune disease that pretty much happened overnight nearly a year ago. It felt like I was one person one day and someone else the next. It’s been humbling; it’s slowed me down and made me reflect deeply about who I am and what I want to do in the world with the limited energy that I have. It’s like I was hit upside the head with a two-by-four: Hey! Stop and think! What really is most important to you? And the answer was: I want to be a Zen practitioner and a hospice chaplain. And I’m so grateful that with the support of my teacher, my sangha, and my wife, who’s also a practitioner, I can do exactly that.
What does a typical workweek look like? My week starts at the inpatient respite house. Mondays are intense because there hasn’t been a chaplain over the weekend and there are always lots of transfers and new admissions. I’ll also plan how the rest of the week will go with clients in the field. I usually see them every other week, more often if there’s a spiritual crisis or the person is actively dying.
We have one full-time chaplain, two part-time, plus a per diem who covers vacations and sick days. I’m part-time. There are weekly interdisciplinary group meetings with the other members of our hospice team as well as a monthly chaplain meeting where we can dive deeper, talk about how we’re navigating certain client situations, and discuss organizational changes.
One of the specificities of Vermont is that it legalized medical aid in dying. Yes, Act 39 is the Patient Choice and Control at End of Life Act. I think this is an important title because it really is about patient choice. As a chaplain, I’m there to support them in whatever their spiritual needs may be.
Can you walk us through the process? There’s a legally prescribed process that the patient needs to go through. Their physician and our medical team help them through it. During the initial phases, our hospice team will ask the patient about their vision of what will happen: Where do you want to be? Sitting on the couch, on the bed? Who’s around you? What do you want to be seeing and hearing?
Once the medication has been received and the patient has decided that the time has come, the family can prepare it and present it to them. The patient will have to consume the medications themselves. They take the first pills, and then there’s about a half hour for life review, readings, prayer, guided meditation—whatever we’ve agreed to—before they consume the liquid medication. After that, unconsciousness happens pretty quickly, generally within ten minutes. It isn’t a slow letting go; it’s a faster death than you normally see, and it’s important for families to know what to expect.
There’s something amazing about it. When you know that someone’s going to die this afternoon at two o’clock, you show up, you say what needs to be said, you let them know how much you love them… It’s hard, and it’s beautiful. My job is to be there and hold the space, to support those present in the way they need to be supported.
It’s been very meaningful for me to create ritual around this process with people. One woman had a favorite walk in the woods, and I learned the walk so I could “accompany” her as she was taking the medication: we’re going now, and as we reach this point, we can see up to the next clearing, there’s a bench, and you’re going to sit on that bench and pause while those who have loved you from both sides of the veil are gathering around you… It was like a handoff.
I might engage the family with readings or hold silence; whatever is meaningful for the person is what we try to do. Loved ones are usually present—once there were twenty-some people in the room dancing and singing and circling around the person. She wanted to use a guided meditation, and I helped her craft what would be said during the time between the first set of medications and the last. It was like a memorial as she was dying, a celebration of her life.
For a Buddhist, the questions around choosing to end one’s own life would probably be similar to a theist’s, wouldn’t they? Instead of asking whether God will condone the decision, we may wonder if it will negatively affect our karma and rebirth. When you first thought about being involved in someone’s process, what was it like for you? So many thoughts. In our Buddhist practice there’s a precept about not killing. I had to really sit with and think about it. And it became clear to me that it wasn’t about me, it was about them. So I turned myself to the precept that says you don’t withhold spiritual aid when asked, you offer it freely. And that became my guiding principle.
I don’t know what I would do in that situation. I mean, I’ve been around death and dying for fifteen years, and it wasn’t until the current illness that I was like, whoa! I’m gonna die! My body will break down; it’s not going to do what I want it to do. If this is an option at the end of my life, I doubt I would choose it, but never say never.
What have you learned about yourself since you began working as a chaplain? I’ve discovered that I’m more “interfaith” than I’d realized. My roots, trunk, and form are Zen, but I am deeply moved by Jesus and scripture and God and pagans and contemplative animists and all of the faith traditions and spiritual beliefs I’ve encountered. I’ve also learned how critically important my Zen practice is to me, and how much better I am at being a chaplain when I’m practicing deeply.
I cannot believe my good fortune to be able to do the work in the world that I love and feel I should be doing. It feels like my bodhisattva vow in practice.