Caring for the Dying

If you are able to help these people go to the pure land, then that is the quickest way to free them from cyclic existence or rebirth. Otherwise, without actualizing the path, there is no way to experience this or to overcome the normal experience of death.

The great advantage to helping others be reborn in these pure lands is that it is possible for them to become enlightened there in that very life. However, one is not able to be enlightened in every pure land. To become enlightened in a pure land, there needs to be the opportunity to practice tantra in that pure land, but not every pure land gives that opportunity. In Shambhala, Heruka or Vajrayogini pure lands, one definitely has the opportunity to practice tantra, so one can become enlightened there.

However, for that, from their side they also have to have merit. So, in order to bring the most benefit to yourself and others, first of all, one very good thing to do is to recite ten malas of OM MANI PADME HUM first thing in the morning. By doing this, your body becomes blessed. It actually becomes holy, so anybody who touches you or anybody whom you touch—even to shake hands or give a massage to—they are all purified. Even insects that touch you have their negative karmas purified. That means you are giving them the opportunity to have a good rebirth. Therefore, every time you touch sick people, touching their hands or body purifies their negative karma. So, this is a very good thing to do.

It is said that reciting OM MANI PADME HUM has infinite benefits. The benefits of reciting OM MANI PADME HUM can never be finished, Buddha said. It is said that if you recite ten malas of OM MANI PADME HUM and then go into water, swimming or whatever, your body is so blessed that the water that touches your body becomes blessed too. It becomes holy water, so that water then purifies all the insects—there are uncountable numbers of insects in the water—and it purifies all the people who swim there, for example, in the ocean. Whoever the water touches, it purifies. The benefits are unbelievable.

It is mentioned in the text that if you recite ten malas every day, then your children’s children’s children’s grandchildren, up to seven generations, are not reborn in the lower realms. This is because they are a continuation of your egg, or, if one is a father, of your sperm, and because your body is blessed, even if they are not born yet, they have the continuation of your egg, blood, and sperm, which comes from your body and is blessed. As a result, they are able to die with virtuous thoughts and that means they won’t be reborn in the lower realms. For seven generations, it helps them to not be reborn in the lower realms.

Also, when a person who recites ten malas a day dies and their body is burnt, even the smoke has these qualities, so that anybody who smells the smoke or who it touches is not reborn in the lower realms. Even the smoke from the burning body purifies negative karma. So there is incredible benefit from this practice, especially when someone is working in a hospital. It is very good for this. If you do a lot of chanting, particularly if you chant at the hospital, but also if you do the practice at home, there is a great effect just from touching them. There is a lot of benefit in that.

The other practice to do is Medicine Buddha. Recite the name and mantra every day, and then pray to Medicine Buddha that, “Anybody who sees me, touches me, remembers me, thinks about me or talks about me, just by this, may all those beings never be reborn in the lower realms ever. May they immediately be liberated from all disease, spirit harm, negative karma, and defilements.”

Here, especially, think of people who are possessed by spirits and are so difficult to help. Usually we can’t help them until that person’s karma finishes. In some cases, sometimes we can help, but that person needs merit from their own side. Pray that people in those difficult situations —and people who are in a coma, who have AIDS, cancer and all those difficult diseases—may immediately be relieved of those heavy sicknesses, just by touching, hearing, seeing, thinking of, or remembering me. Then, in the same way, pray especially for those people who die, that just by seeing, touching, or remembering me, or hearing my voice, immediately they experience incredible bliss, happiness and joy, and have no fear at all. Then pray that immediately their consciousness is able to transfer to a pure land, where they can become enlightened quickly. Pray in that way.

We must pray to Medicine Buddha like this every day. This is a very good, favorable thing to do. Why? The Medicine Buddhas made a lot of prayers in their past lives before they were enlightened, and they dedicated those prayers to being able to actualize the prayers of anybody who recites their name and mantra. Because of that, if you recite Meditation Buddha’s name mantra, all those things happen. Especially for all those particular problems and difficulties they made prayers about, they are able actualize those benefits for us. Not only that, they also help us become enlightened.

Buddhas have ten powers, and the last one is the power of prayer. Because they have achieved the power of prayer, for that reason it is very powerful to pray to them. Their prayers are able to be actualized for us. Pray to them, and whatever powers they have completed, you are able to receive. So, make prayers to Medicine Buddha in this way, reciting Medicine Buddha’s name and mantra.

For the patients, even though they have to deal with their sickness, they are still very lucky to be looked after by a Buddhist nurse like you, especially one who has met tantra. They are very lucky to be looked after, touched and prayed for by you. As a Buddhist, by knowing what is best, you will make the correct prayers. Some others may pray, but the prayer may not be correct. Therefore, recite Medicine Buddha’s prayer. This practice is very, very important.

Chanting Medicine Buddha’s name and mantra also helps whatever you are praying for in your daily life to become actualized. As for the patients, of course, what you are praying for is the best thing that could happen in their life. So that helps them very much. Medicine Buddha is not just effective for the patient; it helps with everything—for you and for other sentient beings.

While you are with the patients, the other thing to do is sing songs. The people might be Christian, Jewish or of other religions, not Buddhist, or have no religion, but you can sing the mantra OM MANI PADME HUM and the Medicine Buddha mantra as a song. They will just think you are singing a song to make them happy, but you can be singing OM MANI PADME HUM, Medicine Buddha mantras, and all the powerful, pure holy mantras. They will think you are singing songs to comfort them.

First, make sure you think about the person’s background, which religion they are from or whether they have no religion. Sometimes, if they are not Christian, they might hate to hear Christian chanting. In that case, if you chant a tune that sounds Christian, it might disturb them. So, recite the mantra in the form of a song, OK? That is very good because when they hear it, it plants the seed of enlightenment and liberation and leaves a positive imprint in their mind. Probably in some of these people’s lives this is the only positive thing they will hear. In their lives, nothing else is positive. There is nothing else which leaves a positive imprint. Time Magazine and movies are just another story of anger and attachment. But due to the imprint from hearing you chant, sooner or later they will meet the Dharma. They will actualize the right path and eliminate all the defilements, and that brings them to liberation and enlightenment. So that is a very good thing to do.

While the person is suffering and in so much pain, you may not be able to really stop that suffering right now. The chanting is able to plant positive imprints in their mind, to actualize the path that eliminates defilements and bring them to enlightenment. This is the most important thing. In some way, the longer they stay, the more you can benefit them. Even if they stay just one day longer, they will hear the chanting and think about things, so that too will help them. Psychologically, I think this is beneficial.

It will also help you psychologically. To see so much suffering is difficult, and then if you don’t know how to help, it is much worse. So it will help you psychologically: when you see so much suffering, you know what great benefit you are actually able to offer to them. Maybe you can’t stop their pain now, but you are helping them towards the long-lasting happiness after enlightenment. Then you can enjoy your work in the hospital, because you see the great benefit you can offer.

When a patient is experiencing great pain, you can do Medicine Buddha practice. Visualize Medicine Buddha on their head, take strong refuge, and then visualize that the nectar comes from Medicine Buddha’s heart and purifies them. The four things—spirit harm, sicknesses, negative karma and defilements—come out in the form of dirty liquid. Sicknesses, pus, blood, spirit harms, snakes, scorpions, things like that come out, and they are completely purified. Make a strong prayer that this actually happens, and recite the mantra.

When you know the person is dying, the best thing to do is visualize Medicine Buddha and pray very strongly, immediately, that they will never be reborn in a lower realm; that they will be born in a pure land where they can become enlightened. Pray for them to receive a good rebirth in their next life, a perfect human rebirth, in which they can practice a right path. When you do this practice with patients, whether or not you chant out loud depends on the patient, whether they are receptive or not. But the visualization doesn’t depend on verbal recitation, so you can do that just while sitting or standing there.

Even if you are going to do powa, transferring the consciousness into a pure land, when the patient is about to die, still the first thing to do is Medicine Buddha practice. Do that immediately. Purify them and make a strong prayer, as I mentioned before, that their consciousness will go to a pure land where they can become enlightened. After that, then do Amitabha powa, which is a special practice for transferring consciousness to the pure lands. If you are working as a nurse, especially in a hospice, it is very good to receive these teachings. Then you have to do this practice until you get a sign indicating that if you do it at the time of death you can be born in a pure land. The sign can be pus and blood coming out of one’s crown or hair falling out. In one Nyingma tradition, after students have done the retreat, the lama puts kusha grass on their crown and if the grass goes inside immediately, then we say this person has succeeded in powa. If it doesn’t work, it means the person has to do more practice. After you have done the practice for yourself and you have the sign, that means you can then use the practice for others. This is a very good service for others, to bring them to a pure land. Especially if one is looking after dying people, this is a very good education to have.

You asked about using your job to help develop renunciation. Hospitals are incredible places for renunciation. You see the person dying and suddenly they have a heart attack. Then, suddenly, death is happening. Especially in places where people have heart problems, they have to watch the machines all the time, and at any time the doctors and nurses can all come running. I know from when Lama Yeshe was in hospital in California with heart problems. I know how this machine starts making sounds, then everybody runs into this small room. I watched through the window, but I didn’t go inside. The hospital is a very intensive teaching—it shows that death can happen at any moment. What happened to the dying person can happen to you anytime. You have to think this way; it can happen in a moment.

When we look at animals, we feel no connection at all. We think, “Oh, I’m a human; they’re an animal.” We never think, “I’ll become one of them too,” or “I myself have been one numberless times in the past,” or “I’ll be like this if I don’t purify my negative karma.” Normally, we don’t think of that. Animals seem to us to be only very slightly similar to us. The reality is that we ourselves have been reborn as animals countless times, and if we don’t purify the negative karma we create, it will happen in the future again.

In the hospital, the meditation should be like that. We shouldn’t think, “This is the patient and I’m a healthy person.” We shouldn’t think there is no connection. We should think, “I am the same as them. I’ve also collected so many negative karmas in the past of various types, so this can happen to me as well. If I have created similar negative karma, then I will also experience sickness in the future. As long as I am not liberated from samsara—which means liberated from the delusions and karma, and that happens only by practicing Dharma—as long as this doesn’t happen, I will experience these things without end. There will be no end to these sufferings.” Thinking like this, Dharma practice becomes unbelievable. It becomes the most important thing in life.

The foundation of Dharma practice is renunciation. Among Dharma practices, the practice of bodhicitta is the best, bringing the most benefit. Working in the hospital, everything can become an inspiration for you, by thinking this way, “I’ve experienced this sort of sickness and death numberless times in the past because of karma, and if I don’t purify, then in the future I will experience this without end. Therefore, I’m going to practice Dharma.” So, not just renunciation is important, but also bodhicitta. Especially bodhicitta, OK? It is very good.

So, this is what you can do for them. While you are present, recite the mantra, verbally or silently, then make your prayers stronger and stronger and stronger. Maybe recite one mala of the mantra, about that duration, but you can also do it for longer. When they have a lot of pain or some emergency, you know what to visualize, and also you can even benefit them by touching them.

You have received Chenrezig initiation, so you can visualize yourself as Thousand-arm Chenrezig and then visualize AH on the body, where there is a lot of pain. One way you can think is that the AH is in all sentient beings, and then you draw all the sicknesses and spirit harm out. All the defilements, negative karma, everything is sucked out and absorbed into your ego. Everything goes up into your heart and completely destroys your ego. This way you are using all their suffering to generate bodhicitta in your mind and to destroy delusions. You are using that as medicine to heal the ego, the chronic disease of ego, a condition which has no beginning, which has harmed you from beginningless rebirths. We need to have bodhicitta, so that we can become enlightened and liberate all other living beings from samsara and enlighten them.

Send beams from the OM on your crown into the person’s heart, totally eliminating these four things: sickness, spirit harm, negative karma, and defilements. They are completely gone and the patient’s whole body becomes in the nature of light.

1. Thirty-five Buddhas tsa tsas: seven times. Long-life tsa tsas: three times.

2. Ask Geshe-la if he has the text Zungdu [a collection of dharanis found in the Kangyur]. Take the section of the Namgyalma mantra and put that on her body, touching the skin. Leave it on her when she is dying, even after the death, for some time.

3. Recite the Medicine Buddha puja aloud for her, especially reciting the mantras out loud. Recite a mala of the mantra in her ear, then talk positively to her; then recite another mala and then talk. Alternate like this. If it looks difficult for her to die, you can say, “You’re not the only one who has to die, everyone has to die soon. You have lived a good life, sincere, and you have done many good things. So, without clinging to anything, go to Dewachen, Amithabha’s pure realm. This a million times better than here, you can meet Buddha and receive teachings, there is no suffering, sickness and old age, so it is much better than here.” Ask her to think, “I’m experiencing death to bring all beings into ultimate happiness by taking on all their suffering and death etc on myself. How wonderful this is.”

Keep doing this until death, when the breath stops. If it’s possible, after she dies bring the body to the center, then do the Medicine Buddha puja and recite the King of Prayers many times. Take strong refuge when doing the Medicine Buddha practice and visualise the Eight Medicine Buddhas above her head, while praying that she goes to the pure realm. Then from the nyung nä sadhana chant the requesting prayer to Chenrezig that comes after the prostrations, and repeat. [Find links to these practices in the FPMT  Catalogue.]

4. Now request Kopan to do 50,000 Zang chö mön lam (King of Prayers), with dedication to the pure realm.

I think that is all for now. Rinpoche wants to ring the dying person, so arrange to be with her when he calls. Rinpoche feels that helping old students to die is a very important service for us to offer. We will all be in this situation sometime. 

Dear Ralph,
You can still play golf and while playing golf, generate yourself as Yamantaka, with your mind living in the three principles of the path. Two years is still a long way away, and death can happen any time to any of us; it is a good way to think anyway.

With much love and prayers...

During the Illness
The main thing is to take care of the dying person's mind. Many others can take care of the body, but we can take care of the mind. The most worthwhile thing to do is to inspire the person to think of others with loving kindness and compassion, to wish others to be happy and free from suffering. If a person dies with the thought of benefiting others, the mind is naturally happy and this makes the person’s death meaningful.

Teach the person taking-and-giving meditation (tonglen: taking upon oneself others' suffering and giving others one's happiness) or loving kindness meditation (metta), according to the capacity of the person’s mind. If the person has a stronger nature of compassion, a "brave mind," they will be able to do tonglen, to take others’ suffering and give happiness. If the person can do tonglen, it's the best way to die, as it means dying with bodhicitta. His Holiness the Dalai Lama calls this a "self-supporting death." For those who don't think others are more important than themselves, wishing others happiness and to be free of suffering is easier.

It's very important to know the person's mind. Teach according to the person’s capacity: check at the time, use your own wisdom, and judge how profound a method to present. It would be best if you could give the dying person some idea of the death process according to tantra: the evolution of the dissolution of the elements, the senses, the consciousness, all the way to the subtle consciousness.

For the person who has lost the capacity to understand because of coma, dementia, and so on, there is not much possibility for him or her to understand. We should aim to help the person at least have a precious human rebirth. This should be our aim, not necessarily that the person believes in karma, for example, but that the person dies with a positive, happy mind, loving kindness, and compassion; this is our precious gift. Our main aim is to take care of the physical body so that we can take care of the mind, to transform the mind to the positive, so that at least the person can die without anger, desire, etc.

Learn various methods to benefit the mind, calm down the mind, to be of benefit now and in the future. Get an idea of what level of method to offer. If one visualizes Buddha, in the mind or outside, for example, or watches the conventional nature of mind, its clarity, other thoughts such as anger and attachment do not arise. If one can do this at the time of death, according to the person's mind, you can talk about the "fully enlightened being" rather than the Sanskrit "Buddha." Talk about God if that's more skillful: compassionate God or loving God, or Omniscient One. Explain to the person that the nature of the mind, the heart, is completely pure, and that the fully enlightened one, God, is compassionate to everyone, including him or her. Get the person to think that his or her loving heart is oneness with God, that the kingdom of God is within. This frees people from guilt, anger and their negative thoughts.

Initiations and vows don't necessarily protect you from the lower realms; if you take them and don’t fulfill your commitments you just create more negative karma and more causes for a lower rebirth.

Mantras, for example, help the person eventually to attain a higher rebirth after the negative karma is used up. Even if the person doesn't want to hear mantras, they leave a positive imprint on the mind, so that sooner or later the person will meet the path and have the ability to practice teachings, to clear obscurations, and attain enlightenment. Even if the person gets angry hearing mantras and dies with an angry mind, it's still better than not hearing mantras and staying peaceful. In this way, step-by-step, a person's karma brings him or her to the Mahayana path and to enlightenment. Arhats get stuck, while the Mahayanist gets enlightened, even if the arhat starts off with the higher rebirth. 

When the Person Is Dying 
If you have studied the death process, you will be able to recognize the stages a person's consciousness is going through, what elements are absorbing, and so forth, when the person is actually dying. It is better if the family don't cry, as this creates clinging in the mind of the dying person. There are sounds to help the consciousness at the time of death, sounds that benefit, mantras and so forth.

Other than this, keep quiet and don't make any sound. Teach the family how to create this atmosphere.

It is OK to medicate pain in order to help the person to be able to think, but medicating for mental anguish is not OK. Sedation before death prevents working out bad karma. Anguish becomes fruitful if the person can experience it. It is hard to tell the difference. Often families want the patient medicated, but it is more for their own comfort than the patient's. 
At death, invite the Sangha to chant mantras nicely, in an uplifting way, as the Chinese do. When they chant like this, the person feels that nothing is more important than Amitabha Buddha. They feel protected, supported, and guided.

Chanting the Thirty-Five Buddhas' names is extremely powerful. People can come and chant together. Also, chant the five very powerful deities' mantras, normally used in Jangwa to liberate those dying and the dead, and to purify living ones and liberate those in the lower realms. Giving Breath to the Wretched has powerful mantras, and is the text to use to help.

Place a stupa on the person's chest or let the person hold it. It purifies negative karma each time the stupa touches the person. Even if the consciousness has already left the body, it can still be beneficial to touch the body with the stupa. This is also good to do with babies or with people who don't understand. Even to a non-Buddhist you can say that the stupa is for peace, healing or purification. The person can visualize light rays coming from the stupa.

It is also good to have a few stupas on hand for healing or to dispel spirit harms. Also, a sheet of paper with the Ten Great Mantras written on it can be put on the dying person's body while reciting the Dedication Prayer at the end. 

When the Breath Has Stopped 
The very first thing you could do after the breath has stopped is Medicine Buddha practice as a group or individually (for animals as well). Chant the names and the mantra. Medicine Buddha made a promise that whoever chants his name and mantra will have all his or her prayers and wishes succeed. The power of the prayer has been achieved by Medicine Buddha, so it's very powerful for the prayers to succeed. Of the Ten Powers, one is prayer, so pray as if you are Medicine Buddha's agent, on behalf of the being who has died. Then do Amitabha po-wa (transference of consciousness to a pure land) and other practices.

Recite Sang Chö, The Prayer of Good Deeds  [commonly known as the King of Prayers.] At funerals, it is also good for everyone attending to read it together.

Recite the Namgyalma [Ushnisha Vijaya] mantra 21 times, then blow on water, sesame seeds, or perfume or talcum powder, blessing it with the mantra, and then sprinkle that over the dead body. The Namgyalma mantra is very powerful for purifying; it is best to recite the long mantra if possible, but the short mantra can also be recited. If it is written on a cloth or paper and placed on a mountain top or roof, or where the wind can blow it, whoever is touched by the wind receives blessings and their karma is purified.

Circumambulating a stupa that contains the mantra purifies all the karma to be reborn in the hot hells.

In Tibet, when the breath stops, you would not touch the body until a lama in the village did po-wa; this is important. Look for signs that the consciousness has left the body (after po-wa), for example: the white drop, like pus or water from the nostril or, for a woman, blood and water from the lower part of the body. First pull the hair in the center of the crown toward the back, so that the consciousness comes out through there. Also, a sign is if hair falls out from the back of the head.

His Holiness the Dalai Lama says that is it difficult at the time of death to really meditate as you did in life. If, during your life, you couldn't meditate well, then you can't keep your concentration at death. The essence is to have accumulated merit and practiced purification in everyday life in your relationships with sentient beings, to have served others with a sincere heart, loving kindness, and compassion, to have done hard work to benefit them, and to have made offerings to the Guru Triple Gem.

Practicing the good heart during your life, that is, bodhicitta, purifies so much negative karma, even very heavy karma, and it stops the creation of more negative karma. It is this negative karma that makes the mind experience fear of death. Especially, bodhicitta stops the immeasurable suffering, the suffering rebirths, that arise later from these negative actions. You should live in morality, the precepts, taking the precepts from a spiritual master or in the front of holy objects.

It is very important to integrate into your life the Five Powers and to learn the Five Powers to be practiced at death. These are very special practices to achieve enlightenment quickly. They involve po-wa: transference of consciousness at the time of death into a pure land. In the pure land one receives teachings on the Vajrayana, which enables one to achieve enlightenment in one lifetime. How effective the po-wa is depends on how well one practices the Five Powers at death. And this depends on how well one performs the general practices in life.

The lamrim explains the four ways to accumulate powerful, extensive merit. One should attempt this in everyday life, while performing all the normal activities – eating, sleeping, and walking, etc. – rather than the actions being done out of worldly desire and samsaric attachment. 

Creating a Conducive Environment for the Dying: Advice for Tara Home Hospice 
Make the place as beautiful as possible: a calm, peaceful, serene, holy environment is so important. There should be beautiful views, beautiful art, flowers, and images of Tara. Flowers give a very special spiritual feeling. The point is to create a positive imprint on the person's mind. By being there, the person is not afraid of dying, and the mind is elevated. When families come, they see it's a nice place and want to come. It makes them feel that there's no need to be afraid of death.

Because of His Holiness the Dalai Lama's wisdom and compassion, more and more people are feeling comfortable with Buddhism these days. We need to help people have an open mind to different methods. You can make it clear to people that Tara Home is Buddhist, then if they're OK with that, they can come.

The religious tradition of the residents depends on their prior practice in daily life. Advice you give them depends on what you have been doing yourself – lamrim, thought transformation – how one has been practicing in daily life, not just sitting meditation. In general, the Mahayana has much to offer to the dying, or to anyone with problems. Highest Yoga Tantra is the only system that offers a real explanation of death. The precise instructions only exist in the Highest Tantra, not in other traditions. Only general instructions are given in other traditions, not explanations in terms of the subtle consciousness, winds, and chakras, etc. 
The robed Sangha can live in Tara Home for several months at a time, to distinguish the level of practice that each patient can relate to, and to create a holding environment.

The new people just joining, who haven't done this service before, need to learn from the people who have been offering service for a long time. Those who are experienced in how peoples' minds are should study different books, different teachings from different sources, and from their experience come to know what states of mind people die with.

Meet together once or twice a month; everyone should read what has been compiled. People with more skill and wisdom can then edit this and it can become a book. There is no need to rush. This book will become a guide for the long run, for the organization, and to benefit other organizations.

You should practice po-wa. Each year, take po-wa teachings and do retreat on po-wa so that you can practice. It is very important to do po-wa retreat every year. If one becomes accomplished at po-wa and receives the signs of accomplishment, then this can be the best public service–liberating others and helping them at the time of death.

It is OK to ask other lamas to do po-wa–any Tibetan lama who is a good practitioner. Bring in high lamas to do po-wa and Jangwa purification. If it is difficult to invite the lama to the hospice, then the lama can do po-wa wherever they are, from a distance. You need to inform the lama which direction the head of the person is facing.

In general, it would be good to perform the elaborate Medicine Buddha practice once a week; this is very good for a successful death. Also, you can recite the Medicine Buddha Sutra once a month. The special text, with 100,000 Buddhas’ names, by Pabongka Rinpoche, can be recited at the time of death. Ribur Rinpoche got the text recently from Lhasa; it is at Tushita Meditation Centre in Delhi and Tibetan monks can read it. This text is rare.

I think it's good to listen to his story and to help him to look at all situations as positive. This is the best thing for him from the side of thought transformation. That is one point.

Another most valuable thing is to support him in reciting mantras and not just go there to talk to him. You can help him to recite whatever mantras he is familiar with from the past: Vajrasattva, Medicine Buddha, Compassion Buddha, or Guru Shakyamuni Buddha. Even if he can't recite the mantras himself, the person caring for him can recite them to purify and leave imprints. If the mantras are recited nicely, it can inspire the sick person and elevate his or her spirits. It can make the person feel that Buddha is the only refuge, that there is nothing else left in the world that is meaningful, and help to free the mind from problems from attachment, anger, and confusion.

Also, he should listen to tapes of teachings by His Holiness the Dalai Lama or Lama Yeshe. If the person is a Buddhist student, he can listen to tapes of any teacher he has met or with whom he feels a connection. If the person is not particularly Buddhist, he or she can still listen to the teachings of His Holiness the Dalai Lama and Lama Yeshe, especially something inspiring on the subject of bodhicitta. This is a very good thing to do.

This can also be done if someone is to have an operation. Before the operation, if possible, the person should listen to His Holiness the Dalai Lama's tapes or chanted mantras. The person will then become unconscious with positive thoughts of devotion to Buddha, Dharma, and Sangha. The main point is to try to help the person to have a last thought that is positive or virtuous, then even if the operation doesn't succeed, the person has had the most important protection that saves him or her from the lower realms. If a delusion arises at the end, the person will have to experience the heaviest suffering for inconceivable eons. You can help to save the person from all these unbearable sufferings for an incredible length of time. In this way, there is no regret, and the most important help and guidance for the person is given.

Or, depending on the person, you can sometimes read to him or her or play tapes on guru devotion or the lamrim. The person can either read the books or someone else can read them aloud, on certain subjects from Dharma texts. Dying with a virtuous thought is more important than being able to help someone's mind to be equanimous, protecting them from attachment and anger.

It is also good to read teachings on the qualities of pure lands, such as Amitabha's pure land. The person will then admire the qualities of pure lands, where there is no suffering and every enjoyment. This is one psychological method that becomes a cause for the person to reincarnate in a pure land rather than having him or her cling to this life and this world. It switches the object of the mind so that the person looks for a pure land and reincarnates there. The person becomes detached from this life and this world. I'm not sure whether the text on pure lands has been translated into English from the Tibetan. There are also sutra texts. You could request the geshe to give teachings on the pure lands. The descriptions of the benefits and qualities of pure lands are very inspiring.

When a patient doesn't like some of the people who are caring for him, it may not be a good idea for them to keep coming to see the person, because the patient will create more negative karma and imprints of anger again and again. Of course, the patient's mind or the mind of the person offering service could change. You have to be aware of the situation. If it is not possible for either side to change, it is better in terms of the process of dying that the patient be cared for by people that the patient is happy to meet. Of course, all this depends on the individual person's karma and it might not be easy, but you should try to do the best thing possible. The main thing is to help the patient to have a peaceful mind. Even if the patient's mind is not virtuous, it should at least be peaceful, particularly without anger, which is more violent and heavy.

Also, one thing that you can explain to the patient is to look in a positive way at the people who are caring for him. He can be encouraged to appreciate them and to think in different ways of their kindness. What to do and what not to do depends on the situation of the patient. There are a variety of methods in dependence upon the different individual person's character or karma.

My Dear Mike,
According to my divinations, it would be very good for you to perform Medicine Buddha practice for your grandmother. Visualize the seven Medicine Buddhas above her crown and follow the Medicine Buddha sadhana. Make very strong requests for her quick recovery, for her to immediately receive all the blessings, and for all her negative karma to be purified.

Then, as soon as death happens, pray for her to be reborn in a pure land where she can be enlightened, so that she may meet the Dharma and a perfectly qualified guru, and become enlightened.

You can also make this prayer after you recite each of the Medicine Buddhas’ mantra.

When you chant the last Medicine Buddha’s mantra, then do a strong visualization that nectar beams are emitted and completely purify all her disease, sickness, negative karma, and negative imprints. You can do this visualization again and again.

In one day do this practice five times. If you can’t do it this many times then do it as many times as you can.

Each time you recite the mantra do five malas with a good, strong visualization, especially visualizing the purification. If you can, visualize the seven Medicine Buddhas on the crown of her head, beams of nectar being emitted, purifying her, and you can also think that they purify you and all other sentient beings. You can think like this.

With much love and prayers...