<![CDATA[Patient Choices Vermont

Maria was our dear friend, spiritual sister, and way-shower. The diagnosis of HER2+ Breast Cancer landed on top of decades of depression. For two years she diligently researched and tried a myriad of alternative and traditional treatments. After nearly a year, the tumor in her right breast was blocking the lymph nodes and nerves nearby, causing swelling and loss of the motor function of her right arm. She carefully held that arm up for months to ease the pain, while diligently trying different practices to disable diseased cells and stimulate the lymph (the body’s water) so it could return to the bloodstream and support the immune system. Eventually, however, Maria's breast cancer had metastasized into her liver and become a terminal illness. There would be no more treatments.

The story that unfolded over the following months is full of the love, care, and competence of our community, plus Maria's son, his wife and his father.

Getting the news that her end was inevitable, Maria preferred to use the option of Medical Aid in Dying, the medicine that ends life with dignity. Medical Aid in Dying is a modern name for an ancient idea that evokes the controversial question of who owns a life. Fortunately it's legal in Vermont, another reason to love our small but mighty state.

We met with Toni from Patient Choices Vermont, the organization that educates Vermonters about the option of Medical Aid in Dying brought forth by The End of Life Law, Act 39. Toni helped us understand how the medicine works and the most important requirements - that Maria be of sound mind in making the decision to use it, and that she physically drink the medicine herself, without anyone's help.

Able to meet those two requirements, Maria felt empowered by the option to choose the timing of her own death. Yet she also considered the feelings of her son, Cristian, and his father, Chris, about this choice and held open the option of dying by fasting. For weeks, either option was possible. Watching videos and reading books, we educated ourselves about what it takes to care for someone who chooses to die by fasting.

Maria’s personal, spiritual and professional work exposed her to suffering in many ways. Prior to her diagnosis, Maria was a caretaker of the dying; a death doula herself really, although too humble to claim that honorable title. Her work as a caretaker was an expression of the Bodhisattva vow she had taken when she was 20 years old. The vow, in Buddhism, is among many other meanings, a dedication to compassionately helping all sentient beings. Not surprisingly, the aspiration of living up to the vow was a personal and spiritual challenge for Maria, one that weighed heavy on her heart. She knew, first hand, the depths of suffering as a sentient being. Thanks to her profession, she also knew first hand, the inner work that could be done at the end of a life and she embraced it.

One night Maria told us "I've forgiven everybody, including myself. I have no regrets. I'm at peace and am ready to die." This statement affirmed what I'd been witnessing; she had been releasing the self-doubt, burdens and confusion she'd carried for so long.

As her body continued to weaken, finally Maria was ready to ask for more support. She called six women to gather for her final "Women's Council" - a women's group that was formed in April, 2017. We knew exactly what to do. Set intentions, luxuriate in plenty of silent meditation, share deeply, sing, play instruments, grieve, laugh, massage each other, snuggle, and share meals. It was the last one we had with Maria.

After that Women’s Council, we moved Maria, with only a few belongings into what is affectionately called "the church", a former Catholic church beautifully converted by artists into a sacred gathering space of our community. The church is filled with objects of art created by those in our community and countless memories, surely made by those who used the space well before our time, and most definitely by our community. Chris and Cristian moved into the church with Maria, carefully managing her increasing pain levels, supporting her needs, and spending precious, tender time together.

Maria invited a few people from her family of origin to visit from New Jersey so she could say her final goodbyes. Our community invited a gathering at the church for Maria’s friends in western Massachusetts - an hour away - where Maria had lived much of her adult life. These gatherings allowed many final goodbyes while she was lucid and even upbeat. We had our weekly Thursday night drum circle, enjoying her company singing, laughing, and tapping the rhythm with us. We continued to visit Maria at the church, as she gracefully still managed her own schedule of visitors while winding down and resting more. We paid special attention to keeping her space at the church quiet and sacred, yet we were next door mobilizing our resources, and tending to the many practical necessities.

Meanwhile, a beautiful mix of spiritual traditions was underway. We met with a close friend of Maria and Chris to learn about his lineage of Tibetan Buddhism and how we could incorporate best practices from the Tibetan Book of the Living and Dying. He informed us of the ancient medicines and traditions that provide Maria additional help with a smooth transition through death and the Bardo - the time, as the Tibetan Buddhists believe, between death and rebirth when reviews of life and karma happen.

Maria's pain continued and she slept for most of the time, yet she was aware that we were all very close by, poised and ready. Enduring intense pain, Maria decided she would use the Medical Aid in Dying and set the date of the upcoming Tuesday morning, just a few days away. Hearing this, a couple people acquired practical materials like ice packs while a couple people built an arbor of bendable saplings, adorned with cedar branches, dried grasses, flowers and herbs - a DIY beauty. We set up her deathbed center stage of the church with the adorned arbor, and a statue of Shiva, one of the principal deities of Hinduism, just behind her.

On Maria's final night, we gathered in the church, welcoming in the four directions, a tradition of Native American tribes. We lit an outdoor fire that would remain lit through her death, the wake, until she was cremated. From a deeply weakened state, Maria received our love in the form of prayers, expressions of thanks, music and song.

Tuesday morning when we arrived at the church she had already walked herself from her bedroom to her death bed, beautifully adorned and awaiting her. Her son, his wife and his father, and the six women whom she invited to witness her death were there. We each had some final 1:1 time with her, and then sat in a circle around her holding sacred silence only enhanced by calming music of our own making. Many others were gathered outside the church around the fire holding sacred space for what was about to transpire.

Maria, feeling ready, asked for the anti-nausea medicine (a precursor to the final medicine) and drank it down. With her functioning hand, as if her son were a newborn, she gently stroked his head that rested on her chest. Sacred silence, tears and love filled the space. Finally she asked for her final medicine. Without hesitation, she drank that down, chased the bitter taste with a clementine and laid back peacefully. As we awaited, soon, one graceful cough gave way to her death.

The church bell was rung, signaling to those at the fire outside that the end had come. That end was also a beginning. It marked the start of the next four hours in which we followed the tradition of the Tibetan Buddhists to place two items on Maria’s chest, and then not touch her body nor begin the grieving process. A "Bhavachakra" was placed on her chest, representing the endless cycle of birth, death and rebirth, along with a gold leaf, commonly believed to keep the soul and body clean and pure as it passes on.

Rather than grief, scents and sounds filled the space. Sweetgrass, palo santo, frankincense, myrrh and sage were lit, as they are believed to evoke protection, elevate spiritual connection and be useful for transitioning. The Native American flute, said to communicate love, filled the space, followed by the hang drum, an instrument based on the Caribbean steelpan, which offered a quiet, peaceful resonance. Then the charango, a South American string instrument, paid homage to Maria's native country of Chile. We also offered our own voices as the instruments, chanting "Lokah Samastah Sukhino Bhavantu" meaning “May All Beings Be Happy and Free” in Sanskrit and “Assalamu Alaikum” meaning “May Peace Be With You” in Arabic.

At the four hour mark, the women tended to Maria's request of undressing her, cleaning her with rose water and painting her body with ginkgo leaves, a symbol of strength, hope and peace. Although her requests ended there, we further adorned her beautifully and peacefully laid body with a white and gold silk sari from India, wings of hawks, bundles of sage, dried flowers and dustings of cannabis and tobacco.

We created a prayer card and invitation for a viewing and ceremony to honor Maria's life that would begin the following day. We sent it wide and far to friends from when she lived in Massachusetts, friends of her son and his father, friends and colleagues from her days as a caretaker, friends from the local dance community, former lovers and life partners.
Many of her loved ones came by the church throughout the day, while we served tea and baked goods, holding sacred space and tending to their comforts and emotions. Some sat next to Maria, some held her hand and caressed her face, some admired her from afar. Sniffles, tears and silence mixed with the calming hang drum, and burning of frankincense resin.

As the sun set and candles were lit on every windowsill, altar and available surface, the crowds that had been touched by Maria arrived for an evening ceremony. The church was filled with concentric circles of people sitting on cushions with an assortment of drums and rattles in the middle. As is our community's custom, there wasn't a prepared schedule or defined plan for the ceremony, but rather loving intentions held by people practiced at collaborating and allowing Spirit to guide us.

One person opened the ceremony with a deeply heartfelt, beautifully crafted acknowledgement of the truth of who and what was there in that moment... some had experienced Maria's long struggle, some had fallen out of touch with her. Some had been intimately involved in Maria's dying process, and some had been unaware it was happening. Some had resolve and closure with Maria and some did not. Some were comfortable with how Maria had ended her life and some were not. Yet, despite our differences, love was in the air.

We drummed, we sang sacred songs, we prayed, we shared memories and gratitude. Someone asked "what were her final words?" and a few people shared those touching moments, including "see you on the other side", that Maria had said to the eldest in our community. We passed around handmade ceramic cups of warm cacao, made from Maria's supply, as she always drank cacao in the mornings. Chris recited the Heart Sutra from memory, which he and Maria recited to their son, Cristian, to calm him down and put him to sleep as a young child. The Heart Sutra is among the classic Buddhist scriptures and conveys the instructions to experience reality permeated by wisdom and compassion. Finally, clementines were passed around, and we enjoyed them as an honoring of Maria's final taste. Clementines and avocados were always within Maria's reach.

The next morning, Chris and Cristian spent their final hours with Maria's body while listening to favorite songs that filled their home decades before. Once they felt complete, we, the women, prepared Maria's body for cremation. We covered her body in more cedar, sage, cannabis and tobacco, the clementine peels from the night before and a few sacred objects that people had placed on her body. We wrapped her up in the sage green flannel sheet she left us specifically for this purpose and tied some twine around her like a gift. She really was a gift to the other realms. Once the two people arrived to transport her body, we all carried Maria out of the church chanting "We love you so much. We love you so much. We love you so much", placed her on the stretcher, zipped up the body bag, and watched her be driven away.

Meanwhile, the outdoor fire was going on day three. We huddled around it, sending our prayers up to the universe, catching a ride on the smoke of the cedar branches. We laughed about how the signature on her email for many years said "If you want to change culture, throw a better party." Indeed, we had thrown her a party of a lifetime. She had changed the experience of death and dying for many, if not all of us. This is why we call Maria a "wayshower", bold enough to live out her values and serve as an example for the rest of us.
Someone stayed the night outside with the fire to keep it lit until the next morning when we'd do another ceremony at the hour of Maria's cremation. The crematorium notified us of the exact hour when Maria would be cremated and we were ready, around the fire, watching the sparks and flames dance with the cold wind until eventually it faded out, a symbol of the end - in the ashes.

Yet that's not the end of the ceremonies. Chris, in his beautifully humble and knowledgeable shamanic ways, held Native American pipe ceremonies every day for the 49 days that Maria passed through the Bardo. Maria's ashes were placed in front of him, along with sacred objects he's accumulated over the decades. These ceremonies included praying with a special tobacco pipe given to Chris by the Native American elders that taught him their rituals, such as pipe ceremonies. Tobacco is known by Native Americans as the unifying thread of communication between humans and spiritual powers. Our community gathered around Chris for these pipe ceremonies which allowed many of us to grieve and celebrate the life and death of Maria together, in community.

In the following months, as we cleared out Maria's very small, yet light-filled apartment, I admired how she lived out her value of leaving only a very small footprint on Mother Earth. Going through her humble belongings, I smiled at well-worn dishware from the 70's, and free furniture that she'd collected from neighbors' giveaways. Maria experienced environmental grief, suffering deep sadness about the loss of our natural world and its creatures. The books about the plight of Mother Earth were soiled by her tears. Her concern for her physical and mental well-being was evident in the shelves lined with obscure vitamins, supplements, tinctures, and medicinal herbs. Again, Maria was the "wayshower", bold enough to live out her values and serve as an example for the rest of us.

Remembering Maria, in all her glorious parts; the ghoster, the trickster, the Gemini, and the sparkle in her green eyes, there is so much to be thankful for. I give thanks to the medical professionals who cared for Maria during her battle with cancer, and to the pioneers and advocates who made medical aid in dying possible in Vermont. It is with sincere thanks to the medicine that our community benefited from such a healing and unforgettable experience of death, possibly a transformation in our relationship to death.

This journey showed me the power we have as a community to hold steadily strong and subtly soft energies simultaneously. It helped us to recognize our abilities to create immense beauty and cultivate immense compassion. We set aside our own needs, and renewed our patience with each other. We faced our own fears and stepped up to serve. We shared our love with those closest to us and also wide and far. Some of us prayed that someday, when our turn comes, we may be so blessed. I felt that, if given a terminal diagnosis, I wished to be surrounded by my friends and family and end my life with dignity in the moment of my choosing, just as Maria did. Gracias, querida Maria, for showing the way.