1장
Confronting Our Final Journey: A Guide to Making Peace with Death
In a world that often avoids discussing mortality, Judith Lief's "Making Friends with Death" stands as a compassionate guide through life's ultimate transition. Drawing from Buddhist wisdom and practical experience working with the dying, Lief offers something increasingly rare in our death-phobic culture: a clear-eyed, warm-hearted approach to facing our mortality. The book has become a touchstone for healthcare professionals, spiritual seekers, and anyone confronting serious illness. Oprah Winfrey once highlighted it during a segment on mindful approaches to life's challenges, noting how it transformed her own relationship with impermanence. Rather than offering false comfort or spiritual bypass, Lief invites us to look directly at death-not as an enemy to be conquered, but as a teacher that can profoundly enrich how we live each moment.
2장
Life's One-Shot Deal: The Journey We Cannot Pause
Life moves continuously, changing in the blink of an eye. From the moment of birth, we're on a one-way journey with no pauses or do-overs. Most of us become caught in everyday hassles, losing track of life's bigger picture. We take our existence for granted, as if we had endless time. Yet by disconnecting from death's reality, we paradoxically diminish life's value and urgency.
We find ourselves suspended between birth and death, often unsure how we arrived here or where we're heading. Our existence traces back only so far before hitting mysterious boundaries we cannot penetrate. When we contemplate our beginning-that moment when we first appeared-we encounter profound mystery. Where were we before birth? Similarly, when we look toward our inevitable ending, we face questions without clear answers. What happens when we're no longer here?
This journey isn't something abstract or distant. It's the very fabric of our existence right now. By cultivating awareness of death, we don't become morbid or depressed-rather, we develop a deeper appreciation for our whole life journey. We reconnect with the experience of actually living.
The Buddhist tradition offers specific contemplative practices to help us explore these boundaries. When we sit quietly and reflect on these mysteries, we begin to recognize how precious and precarious our human existence truly is. We see that our life isn't guaranteed or owed to us-it's a remarkable opportunity that arrived without our asking and will depart without our permission.
What makes this journey so poignant is that we can never truly know its full dimensions. We're like travelers who joined a caravan midway, unable to see where it began or where it ultimately leads. Yet this very limitation can awaken us to the extraordinary gift of being alive right now, in this moment, on this remarkable journey.
3장
Surfing the Present Moment: Life at the Edge of Change
Our life isn't just bounded by birth and death as distant events-each moment within our journey faces these boundaries. Death and life are completely interwoven, constantly threatening our self-image and desire for control. We try maintaining a solid identity by distracting ourselves with past memories and future plans, blurring the lines between timeframes.
Yet our life isn't one solid thing-much is already gone, and the future may never happen. We live only in the present, that undefined territory where past and future meet. We're like surfers riding a wave's crest, with what's behind constantly disappearing and what's ahead uncertain. The Buddhist tradition recognizes this fluid nature of existence, describing it as "impermanence"-the understanding that nothing stays fixed or permanent.
"Most people are afraid of impermanence," writes Lief, "but actually impermanence is like a breath of fresh air, a breath of freedom, where we don't have to take ourselves so seriously." This perspective shifts our relationship with change from one of resistance to one of creative engagement.
Our breath demonstrates this pattern perfectly. Each inhalation begins anew, each exhalation completely dissolves. Between them lies a subtle turning point-a gap where one breath has ended but the next hasn't yet begun. This pattern of arising, appearing briefly, then dissolving characterizes all experience.
Meditation helps us become familiar with this territory where past and future touch. As we practice, we develop the ability to rest in the present moment without constantly grasping at what's gone or anxiously reaching for what's next. We discover that this present moment-this very experience happening right now-is our only point of contact with reality.
When we truly understand this, our approach to life transforms. We stop postponing our happiness for some future achievement. We recognize that waiting to live fully until we've accomplished certain goals means we might never live at all. Instead, we learn to ride each moment's wave with awareness and grace, knowing it will inevitably dissolve even as the next one forms.
4장
Navigating Life's Doorways: The Transformative Power of Transitions
Our entire life is a transition, not one solid thing. Even within our current life, each moment is a transition with its own birth and death. Transitions are like doorways-we think we know what's on the other side but can never be certain until we walk through. These moments make us uncomfortable and vulnerable, yet they open us to new possibilities.
"Whether minor or major," Lief observes, "transitions have transformative power. When one experience dies before another arises, we experience freedom." This gap between experiences offers a taste of liberation-a moment when we're not bound by our usual patterns and habits.
Major life transitions shake up old patterns and provoke new directions. Consider the woman who lost everything after a stroke yet found a new perspective with nothing to lose and nothing to prove. Her identity as a successful professional was stripped away, forcing her to discover who she was beyond her achievements. Similarly, a man who attempted suicide after an AIDS diagnosis experienced a dramatic shift in appreciating life despite difficulties. His brush with death awakened him to the preciousness of each moment.
Transitions have a unique quality of freshness, like traveling to a strange country, but this fades as familiarity returns. When we first enter a new situation-a new job, relationship, or living situation-everything appears vivid and immediate. We notice details we'll later overlook. This heightened awareness is valuable, showing us reality before our habitual filters reassert themselves.
We tend to avoid the pain of transition, preferring to define our world and secure our ground, even preferring bad news to uncertainty. Humans generally dislike ambiguity-we'd rather know something definite, even if it's negative, than remain in suspense. This preference for certainty over possibility often keeps us trapped in familiar but unsatisfying situations.
By noticing the pervasive transitions in everyday life-from eating food to walking through doorways-we can learn to accept death as our constant companion. These "little deaths" prepare us for the ultimate transition. Each time we willingly let go of one moment to embrace the next, we practice the art of dying while fully alive.
5장
The Final Transition: Understanding Death's Unfolding Process
In Tibetan tradition, death isn't an instant event but a gradual transition continuing beyond what Westerners consider the endpoint. While we typically consider someone dead when their heart stops and brain activity ceases, Tibetans continue working with the dying person, recognizing that the transition takes time-roughly three to four days.
Many people sense a lingering presence after someone dies before feeling their definite absence. Carol's cat, for instance, treated her dead dog normally for days before suddenly refusing to approach the body, as if finally recognizing the dog's consciousness had departed. This suggests that our awareness of death's completion may be more intuitive than clinical.
Without physical grounding, consciousness speeds up with nothing to limit it. Yet this disembodied state also removes perceptual obscurations, allowing even previously confused people to understand clearly. This explains why some individuals with dementia experience moments of remarkable clarity near death-the loosening bonds between consciousness and body can sometimes allow greater mental freedom.
Our state of mind at death profoundly affects our journey-whether we're angry and desperate or maintain awareness and concern for others. The Tibetan tradition places enormous emphasis on cultivating positive mental states for this reason. They believe that our final thoughts and emotions create a trajectory that influences what follows death.
"The best preparation," Lief writes, "isn't exotic practices but working with our minds now, applying whatever tradition we follow." This practical approach means that daily meditation and mindfulness become rehearsals for death. Each time we practice returning to present awareness despite distractions, we strengthen the mental muscles we'll need during our final transition.
Death presents a moment of complete uncertainty where we directly encounter the vivid yet unreal quality of experience. This moment, like meditation glimpses, offers opportunity when old patterns drop away before new ones form-a particularly significant "little death" among the many we experience throughout life.
Understanding death as process rather than event changes how we approach it. Instead of seeing death as a cliff edge-a sudden drop into nothingness-we might view it more as a gradual slope, a territory to be traversed with awareness. This perspective allows us to participate in our dying rather than merely have it happen to us.
6장
Confronting Our Death Theories: Five Patterns of Hope and Fear
Our theories about death often obstruct direct experience of it. We prefer comfortable speculation to confronting the raw experience of change and uncertainty. By examining our assumptions about death, we can uncover our preconceptions and bring them to light.
Lief identifies five basic patterns of how we conceptualize death, each reflecting both theories and habitual responses. Rather than seeking a "correct" view of death, we need to examine our own assumptions and recognize our genuine vulnerability.
The first pattern views death as complete cessation of consciousness-an assumption so common in our society we don't recognize it as just one possible perspective. For some, this permanent loss of consciousness terrifies as it threatens their identity. For others, particularly those exhausted by life's struggles, oblivion represents welcome release and rest. This view leads to death-avoidance behaviors pervasive in Western society: hiding aging, segregating the elderly and sick, whisking away the dead, and disconnecting from death's reality.
In the second pattern, death is viewed as an unfair insult or mistake. We feel angry at the injustice that everyone must die regardless of merit. Our response is attempting to outsmart death through scientific advancement, searching for immortality through genetic manipulation, cryogenics, or medical interventions. This leads to extraordinary measures to prolong life, with doctors refusing to "admit defeat" regardless of patient suffering.
The third pattern sees death as the ultimate dispossession, sweeping away everything we've accumulated-not just physical possessions but emotional, intellectual and spiritual ones too. Our insights, accomplishments, experiences, memories, even our bodies must be relinquished. In response, we gather possessions around us like a fortress, fearing the "lightweight" nothingness of having nothing.
The fourth pattern frames death as separation from loved ones-breaking ties with everyone we know. The prospect of departing alone on a one-way journey with no chance to see familiar faces again creates profound pain. Our fear of this separation leads to desperate clinging to relationships, throwing out "emotional tentacles" to pull back dying loved ones.
Finally, death is seen as the great interruption that sets limits and destroys plans. It doesn't wait for us to finish projects or even sentences. This pattern reveals our fear of unfinished business and running out of time. We try outrunning death by staying busy, working faster, accomplishing more-believing if we're occupied enough, death can't sneak in.
By recognizing which patterns dominate our thinking, we can begin to loosen their hold on us. We might notice how we fluctuate between patterns-fearing oblivion one moment, raging against death's injustice the next, then worrying about all we'll lose. This awareness itself begins to create space around our fixed ideas about death.
7장
The Inevitable and the Optional: Understanding Pain and Suffering
Buddhist tradition distinguishes between life's inevitable pain and the suffering we create through our responses. Though we fantasize about pain-free existence through wealth, health, or technology, suffering persists because of how we relate to our experiences.
The tradition identifies eight forms of suffering: four universal conditions (birth, old age, sickness, death) that affect all beings regardless of circumstances; three forms based on the gap between expectations and reality; and an underlying persistent uneasiness beneath all experience.
Birth involves intense, violent change-a life-death struggle as we're thrust from darkness into light, from continuous nourishment to dependency. Throughout life, we experience many forms of birth as we're repeatedly pushed into unknown worlds requiring adaptation.
Aging brings diminishing physical capabilities, stiffness, brittleness, and slow healing. Even before literal old age, we suffer its qualities: loss of freshness, jadedness, and the disappearance of first-time experiences. Our options narrow with each passing day.
Life is punctuated by illness and vulnerability to accidents-from minor hassles to major threats. Even small reminders of vulnerability like paper cuts can be upsetting. Sickness interrupts momentum, disrupts plans, and potentially isolates us from healthy society.
Death comes to everyone without discrimination-rich and poor, sane and crazy, good and evil. We can't buy our way out or exercise our way free. In daily life, we experience death as finality-lost opportunities and endings that cannot be reversed.
Beyond these universal conditions, we create additional suffering through our relationship with reality. We suffer from not getting what we want, trying desperately to hold onto what we have, and being stuck with what we don't want. We're perpetually unsatisfied, gaining little pleasure from what we have while feeling great pain about what we lack.
Beneath all these specific forms of suffering lies a persistent uneasiness. Even when things go well, we never truly relax. We're always restless, vaguely threatened. Ironically, we often notice this suffering only when we achieve our goals, feeling that hollow "So what? What now?"
The distinction between pain and suffering offers a profound opportunity. While we cannot eliminate pain from human existence, we can transform our relationship to it. Through meditation practice, we learn to experience pain directly without adding layers of resistance, resentment, and fear. We discover that much of our suffering comes not from the pain itself but from our desperate attempts to avoid it.
8장
The Settling Mind: How Meditation Transforms Our Relationship with Death
Throughout life we repeatedly encounter birth (being thrust into new situations), illness (life breaking down), old age (enthusiasm growing stale), and death (finality and endings). Amid this constant change, meditation offers a practical method of settling in the midst of change and dealing with our pain.
The practice combines mindfulness (calming and focusing the mind) with awareness (paying attention), creating a state of relaxed alertness that Suzuki Roshi called "readiness mind." Our mind constantly settles and expands, like viewing calligraphy on white paper-first focusing on the brush stroke, then expanding to see the white space, the wall, and beyond.
Meditation practice requires a protected setting and regular practice. It's simple yet subtle, using what we already have: our breath, thoughts, emotions, and body. The practice is like dripping water on stone-each session may seem insignificant, but over time transforms even the toughest rock.
The basic instructions involve three components: body, breath, and mind. For the body, take a comfortable upright posture that's neither too stiff nor too loose. Place hands on knees with arms hanging straight. Keep eyes open and directed downward. Let the senses relax without trying to close them off.
With the breath, breathe naturally without manipulation. Note the outbreath, gently placing attention on the breath going out and dissolving into space. Take a little break with the inbreath. If your mind wanders, gently bring it back to the outbreath.
For the mind component, work with your ongoing mental activity without judging or analyzing. Simply notice when you're thinking and return to the breath, labeling whatever arises as "thinking."
Though meditation is simple, it continuously deepens as you discover its many subtle layers. The posture balances dignity with vulnerability-a strong back paired with a soft, exposed belly. The breath reveals personality, reflecting our ongoing rhythm of taking in and letting go that marks our entire life, from first inhalation to final exhalation.
Mindfulness practice is nonmanipulative, based on acceptance rather than rejection. We're not trying to shape our thoughts or eliminate them-we simply note them and return to the breath. This can be frustrating as we discover how uncontrolled and crowded our minds truly are. But by practicing regularly, we gradually uncover who we really are without editing our experience.
Like a mountain lake settling when the wind dies down, our minds gradually become clear enough to see whatever lies beneath-whether treasures or discarded junk. This practice helps us communicate more directly with others and provides strength to stay present with difficult experiences, including pain and death.
9장
Opening to Compassion: The Path from Self-Concern to Connection
Compassion is inherent in our very nature as human beings-not something we need to create but rather uncover. Cultivating compassion means removing the obstacles that block this fundamental human quality. When we develop awareness, friendliness, and openness, compassion arises naturally as an appropriate response to needs we encounter.
The foundation of compassion is empathy-being touched by others' suffering. Most of us have learned to harden our hearts as a way of coping with life's intensity. Through meditation and tonglen practice ("sending and taking"), we can reverse this closing-down process and reconnect with our natural capacity for compassion.
Tonglen practice works directly with our self-absorption by reversing our usual patterns. Instead of taking in what we desire and rejecting what we don't, we take in what we've rejected and send out what we desire. This counterintuitive approach gradually dismantles our self-protective barriers.
When we try putting compassion into action, we often encounter obstacles that reveal the difference between genuine compassion and its distorted versions. We might employ "prepackaged compassion"-arming ourselves with simplistic advice and ready-made strategies to mask our own discomfort. Or we become "compassion bulldozers," so determined to help that we ignore the objections of those we're trying to help.
Some use the "compassion credential," treating others' misfortunes as opportunities to bolster their own identity as helpers. Others engage in "rush-job compassion"-giving assistance without making genuine human connection, maintaining protective barriers that keep suffering at a distance.
"Guilt-based compassion" arises when we try forcing ourselves to feel what we think we should feel around people in distress. When our actual feelings don't match these expectations, we feel guilty and resentful, creating a cycle that undermines genuine connection.
With "heavy-handed compassion," we create a solemn, hushed atmosphere around the dying that stifles spontaneity and humor. We become so attached to this atmosphere that any freshness or lightness feels threatening.
True compassion avoids these pitfalls by remaining grounded in present awareness. It doesn't require us to be perfect or free from discomfort-rather, it asks us to acknowledge our limitations while remaining open to others' experiences. This balanced approach allows us to be genuinely helpful without burning out or creating dependencies.
By recognizing the obstacles to compassion in our own behavior, we can gradually develop more authentic ways of connecting with those who suffer. This doesn't mean becoming saints overnight, but rather cultivating greater honesty about our motivations and limitations while continuing to extend ourselves toward others with increasing skill and awareness.
10장
Practical Wisdom: Six Slogans for Caring for the Dying
When facing death or working with dying people, our actions are most effective when grounded in awareness and kindness. Like learning any skill, this requires practice through meditation, contemplation, and tonglen. The six slogans serve as reminders to bridge the gap between our desire to express compassion and our ability to do so.
The first slogan, "Start with Knowledge," reminds us to develop four types of understanding: outer knowledge about diseases and systems; self-knowledge about our strengths and triggers; attentiveness to subtle environmental cues; and intuitive knowledge that emerges spontaneously from the space between people.
"Give and Receive," the second slogan, explores generosity as the foundation for working with the dying. True generosity creates connection rather than control. Sometimes receiving is more generous than giving-for the dying who feel they have nothing to offer, acknowledging what we receive from them is a profound gift.
The third slogan, "Pay Attention to Details," emphasizes how small gestures make enormous differences in the lives of the dying. Creating healing environments through personal touches transforms sterile settings into human spaces. Our behavior communicates volumes through seemingly insignificant details-the doctor who acknowledges the patient directly, the visitor who notices they're standing on an oxygen tube.
"Slow Down," the fourth slogan, cuts through our mental speed and reminds us to be patient. Impatience creates a vicious cycle of forcing ourselves beyond limitations, growing angry at failures, and becoming increasingly exasperated. By slowing down even slightly, we open ourselves to new possibilities. To truly connect with dying people, we must match our pace to theirs rather than pushing them to face death's realities faster than they're able.
The fifth slogan, "Don't Give Up," balances "Slow Down" by emphasizing effort and commitment. Between trying too hard and holding back lies a sustainable middle path. Choicelessness-giving up the option of escape-allows us to act with complete conviction. Like an elephant's steady gait, exertion means continually moving forward regardless of how we feel.
"Be Present," the final slogan, teaches us when to relax our effort. In our action-oriented society, it's frustrating to be in situations where there's little to do, as with the dying. Yet it's our being that matters most-who we are and how that manifests in whatever we do. Our presence is the most powerful gift we can offer, providing stability like an anchor amid chaos.
These slogans work together as a balanced system, each complementing and tempering the others. They remind us to approach death with both knowledge and openness, effort and patience, attention to details and presence of mind. Through their guidance, we can develop greater confidence in our capacity to be truly helpful during life's most challenging transitions.
11장
The Art of Accompanying: Being Fully Present with the Dying
Each time we enter a dying person's room, we have an opportunity to reconnect with awareness and compassion. Entering properly means dropping our baggage, theories, and prepackaged approaches at the door to take an unstructured look at what's happening. This vulnerable, groundless moment makes us receptive to new insight.
The challenge is entering the dying person's world rather than imposing our own, accepting their confusion, pain, or fear. This takes courage because we must overcome the temptation to distance ourselves from death. Instead of pretending benevolence, we must acknowledge our own fears and limitations, which actually lightens our approach and removes barriers.
After entering a dying person's space, we can improve the environment through simple, non-judgmental connection. Trungpa Rinpoche used the phrase "one death" to describe how we connect with dying people through our shared experience of loss. Throughout life, we experience many "little deaths"-disruptions and losses both large and small. By acknowledging these gaps in our own experience, we can connect with those facing the ultimate discontinuity.
Even without medical expertise or spiritual authority, we can help through our presence of mind. A good starting point is accepting people as they are rather than trying to change them. Sick and dying people often become magnets for unsolicited advice from friends who suddenly transform into self-appointed experts.
In our culture, death is often viewed as a mistake or failure rather than a natural part of life. We can help by respecting death as both a powerful, challenging experience and something quite ordinary and expected. Expressing friendship is perhaps the most powerful way we can help, though it takes incredible gallantry to express love knowing the relationship won't last.
Honest communication becomes rare in an environment of fear. Dying people are routinely lied to, often with good intentions like preserving hope. The result is a suffocating atmosphere where everyone dances around the "Big Unspoken Fact." It's important to tell dying people the truth about their condition with sensitivity and timing.
Our behavior creates an environment that deeply affects the dying person. A gentle, open, accepting atmosphere supports them, while chaos and emotional outbursts become hindrances. We must resist the temptation to micromanage death, making it neat and clean. An atmosphere that includes rawness alongside beauty and tenderness may be more disturbing but is ultimately more honest.
Though death is typically treated solemnly, humor can be liberating. Without humor, we adopt strange, artificial behaviors around dying people-changing our tone, movements, and expressions. Humor maintains ordinary human connection and acknowledges that sick and dying people exist on the same plane as the rest of us.
Through these approaches, we learn that accompanying the dying isn't about having perfect answers or techniques. It's about showing up with our full humanity, meeting them where they are, and walking alongside them as far as we can on their journey. In doing so, we discover that death teaches us how to be completely alive.
