September-October 1997

Vicki Mackenzie talked to Ven. Pende Hawter about his work at Karuna Hospice Service, which he started in Brisbane, Australia in 1992.

What motivated you to start working with the dying?

Probably the most significant experience was when my father was dying of cancer. I spent the last two weeks of his life with him in the hospital. I found it an incredibly uplifting and inspiring experience. Two years before that my brother had been killed in a light plane crash and I’d been involved in the search party. Although I was around 19 years old, I discovered that around death I was calm. That was a big turning point in my life. So when my father died a couple of years later (which I’m sure was related to his grief at the loss of his son) it was more or less expected that I’d come back and be in charge. So from then on I knew that I was very comfortable around death.

Why was that do you think? Most people would think that being around death was depressing or frightening.

That’s an interesting question because over the years I have seen many people be depressed by the death of a parent or friend. I think the reason is because of the depth of the relationship you develop with someone who is dying – the very deep level of connection and communication. It’s extremely intimate. The person is dying and is aware that they have very little time left. Each day is very important, and there’s no time for superficiality. You talk about and share very deep things – what happens after, the meaning of life. That’s what I have always found extremely special.

When I look back I’ve never had the concept that people disappear when they die. Even before I knew about the Buddhist beliefs I always felt that death was like a transition. When my father died I felt in a very strong sense he was still around at some level, even though the body had died.

Did you come from a Christian background?

I came from a nominal Anglican background. My own inner faith was always there quite strongly as I was growing up.

When did the idea of the Karuna Hospice Service start?

I went to Kopan Monastery in Nepal in 1983 to do the November Course with Lama Zopa Rinpoche and was with Lama Yeshe the night after he’d given his last discourse. I was called up to Lama’s room because I’d trained as a physiotherapist and had actually run a clinic at the Atisha Centre in Bendigo, at Lama’s suggestion. He was very sick. I went on to Bodhgaya and did many practices and prostrations and dedicated them to his recovery, but he passed away at Tibetan New Year, March the year later.

At the end of ’84 Lama Zopa Rinpoche suggested I go back to Queensland and start another physiotherapy clinic. Then two years later Rinpoche asked me to start a hospice.

So it was Rinpoche’s idea?

Yes and no. What had happened was that Rinpoche had just been to the Atisha Centre, had looked at the original plans of Lama Yeshe and seen a place allocated to be a hospice. I don’t know if that original idea had come from Lama Yeshe, me or both. But Rinpoche liked it. So we set up a committee and had meetings and a year later I sold my physiotherapy clinic and worked full-time for Karuna.

How many people did you start off with?

Basically three – Hilary Clarke, the volunteer coordinator, and Margaret Gulley, the nursing coordinator, and me.

What was your brief?

The instruction from Rinpoche was to work with the dying, because at the time of death when people are losing everything there’s a lot of fear. To help people at that time, to help put positive imprints into their mindstreams in order to help them in future lives.

Was it specifically to work with the dying at home?

Not necessarily, but that was the easiest way to start, and the cheapest. Our aim was to start there with the intention of setting up our own hospice. We still have that in mind.

How much of the Buddhist approach towards death did you adopt in your work?

It wasn’t that overt. In our voluntary training courses there was a segment on the Buddhist view of death and dying, complemented by a segment on Christian and Jewish views. The nurses certainly did not have any formal training in the Buddhist approach.

How did you go about implanting positive imprints?

That’s something that I’ve talked a lot about over the years. What is a Buddhist hospice? What should you be doing for the dying? I guess in our society very few of our patients are Buddhist to start with. The basic thing we’re trying to do is to help them die peacefully with positive thoughts – to induce a gentle and calm situation. All the people at Karuna are helping to do that. The nurses by offering compassionate care and pain control, the volunteers by providing reassurance and companionship, the counselors by helping to resolve conflicts. We also have a monk or nun going out to selected families when it’s been relevant.

It’s been more of a subtle Buddhist influence rather than an overt one because we’ve never felt it appropriate to go and chant Buddhist mantras into the ears of dying Christian patients.

How big is Karuna now?

We employ 16 to 17 people. We have a staff of seven. And we’re about 65 to 70 percent government-funded. We have an annual budget of A$550,000 ($440,000).

Apart from the government, where do you get the rest of the budget from?

General fundraising, appeals, service clubs. People like Rotary contribute. But most of the non-government funding comes from the general public.

We started a second hospice, the Cittamani Hospice, two years ago on the Sunshine Coast in Queensland. It’s situated near Chenrezig Institute in a little town called Palmwoods. That now employs four part-time nurses, a full-time administrator and 30 to 40 volunteers. It’s part of the organization of Karuna Hospice.

How many people have you helped to die over the years?

Nearly 500 in five years. We saw our first patient in January 1992. It’s a lot of people.

Have your views on death changed during that time? Has your experience substantiated what you’ve been taught about death and dying in the Tibetan Buddhist tradition?

My experience is that the way people die co-relates very, very closely to the teachings – as does the whole death process. We see repeatedly the importance of the state of mind at the time of death, and that state of mind is in direct relationship to the way people have lived.

As I say over and over again in my lectures, basically people die as they have lived. We see very angry people who fight and struggle and die angrily and unhappily. And we have seen very kind, gentle people die extremely peacefully. It’s undoubtedly completely true that our whole life is a preparation for death. We all will die as we have lived.

For instance, there was one Zen student who was dying of AIDS. He was drifting in and out of consciousness and three of his sisters were looking after him very lovingly. One of them had sat with him through the night and in the morning someone brought some food to him. In his half-conscious state he said, “Please give some to my sister sitting in the corner.” Even close to death he was still thinking of others, because that was his habitual state of mind.

In these years of working with the dying have you changed?

I don’t think there’s been much change. As I said, I’ve always been comfortable around death. I think that as the years have gone by I find it less necessary to say anything when I’m with a dying person. A quiet calm presence I find is often better than words. When someone is dying and the family is gathered I often just sit there quietly, not saying anything. I’m often told how helpful that is.

I’ve never walked away from a death feeling I hadn’t been useful. Most of the staff at Karuna are also very comfortable around death and it’s that which gives such reassurance to the family.

People die as they have lived. We see very angry people who

fight and struggle and die angrily and unhappily. And we have seen

very kind, gentle people die extremely peacefully. It’s undoubtedly

and completely true that our whole life is a preparation

for death. We all will die as we have lived.

 

Is the medical profession equipped to deal with the emotional and spiritual needs of the dying person and their families?

It’s much better than it used to be in the hospice and palliative care movement. People now understand that you can’t get rid of somebody’s pain unless you deal with their emotional, social and spiritual needs. And there’s now a greater effort to offer reassurance and comfort to the family.

You work has been well received all over the world. Can you tell me about any feedback you’ve received?

It’s been an interesting exercise. By setting ourselves up in the mainstream of palliative care services we’ve been very widely accepted in the community. Karuna has been a unique, highly respected service in Brisbane, the capital of Queensland. One woman even wrote her Ph.D. on Karuna. And of course the government has supported us.

In my mind there’s been a struggle to find the right balance between being an upfront Buddhist organization but at the same time not pushing the Buddhist aspect. Some people feel we’re not Buddhist enough – and some feel we’re too Buddhist. The challenge has been to find the middle way, to manifest our Buddhism through compassionate service rather than saying mantras over people.

You’ve been invited overseas as well, haven’t you?

Last year I went on a four-month teaching tour to Europe and Taiwan. They were FPMT centers mostly, but also some hospitals. In Taiwan I gave lectures at three hospitals. Generally the courses were well received, not because of my knowledge, which is very little, but because I had some practical experience and was able to relate the teachings to what I’ve observed.

The other aspect is that Lama Zopa Rinpoche is encouraging many of our centers to look after the elderly and the dying and asks them to get information from me. Rinpoche has requested me to put together a short booklet about the various aspects of death and dying – basic information to help people.

Why have you left Karuna, and what is happening to Karuna now?

During the Kalachakra initiation of His Holiness the Dalai Lama in Sydney last year Ven. Roger Kunsang, Rinpoche’s attendant, asked me if I would be able to help take care of Rinpoche. I accepted and went to Nepal to take on the job, but then Rinpoche asked me to work as the administrator for the Maitreya Project, which I am now doing.

The new director of Karuna is Ven. Yeshe Khadro, the manager of the Chenrezig Nuns’ Community, who has had many responsibilities in the FPMT over the years; and Hilary Clark is the director of Cittamani Hospice. So they’re in good hands.