Yoga in Palliative Care

Supporting patients and carers with yoga and mindfulness

“People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within.”

- Dr. Elisabeth Kübler-Ross

As yoga teachers, we seek to coach and inspire people in their lives, and sometimes help them make challenging lifestyle changes, ultimately allowing them to also die at peace with themselves, their lives, longings and regrets. On our yoga paths, it becomes necessary to learn to manage abhiniveśa, the fear of death.

As yoga teachers, we can step in at the end of people’s lives. There are so many tools that we can use in these often painful, stressful and otherwise difficult situations for patients and for their carers. Our tools need to be well-selected and used with skill to give comfort and dignity to those who are suffering, and to those close to them. Our own daily practice and maturity in life are very important in providing support and guidance in these circumstances. It is not a time to be unclear or unsure. Our work is therefore to come with the right choice of practice: mantra, breathing techniques, guided visualization, yoga nidra, touch, movement, the concept of purusa, and whatever else our yoga knowledge can bring to those confronting their mortality.

The Importance of a Daily Practice

Every journey is different. Reasoning with “cause and effect” logic, people often get stuck in the “anger/blame” mode (cf. the five stages of grief, as developed by E. Kübler-Ross). On the yoga path, I have learned to focus on what nourishes me, tapping into a source of light and love, forging my own mantras and my own meditation practice. When I walk in nature, I find feathers to remind me of my connection with the universe and my ancestors. I find it really important to have a creative practice, anchored in the sensory world, connecting with that inner bliss, exactly that which we wish to share.

Self-Care

Working in palliative care, has many rewards. It can bring insights and gratitude. In life what looked like a stumbling block turns out to be a stepping stone. Embracing people at the end of their lives can be a reflection on how you live your own life and your own way forward. It can reset your own priorities. You may feel the need for self-care more acutely and that’s where working in palliative care feeds back into your daily meditation practice. Do allow the self-care to go off the mat, through e.g. contact with nature, journalling, friends, and expressions of gratitude. The experience of having been of assistance can then enrich our own lives (karma yoga).

What is fear of death?

As a volunteer in palliative care for Karuna*, I was trained on many levels to be prepared for death. You are with a client and what will you do if he or she dies on your shift? What is this fear that makes me a little nervous when I step into the house? How will I handle the avalanche of emotions of loss, grief, despair and unfinished business? I explore the fear… until the answer appears: love, acceptance and kindness.

The yogic approach

The first step for the yoga teacher is your (spoken or unspoken) greeting of namaskar: meeting the dying person and the carers on the level of equality and connection, with presence to their trauma and experience of loss. The quality of your presence can be soothing; your voice and movements are calm and soft.

Often as yoga teachers we communicate with verbal instructions and physical demonstrations. In the palliative environment I find it meaningful to add touch: shake hands, hold hands, give the gentlest hand or foot massage. Pick up the body language: let go of the hand at the smallest sign or hold your hand out as support.

From a bed, on a chair or on the floor, sit next to the person. This will enable you to look at the same point (drishti) and be less confrontational. Gentle movements and mudras may bring well-being. The shared practice of ujjayi-breathing can bring some clarity of mind and focus. You toolbox is your treasure cove.

One of the yoga therapy tools more widely used in India is pilgrimage. Liberating the soul from the confinements of space and time (the same four walls and the same 60 minute session), you can take your patient and/or their carer to their special place…

An integral yogic notion and practice

Yoga in Palliative Care is of course no different from yoga in general. It celebrates life because it is mindful of its impending end. Each yoga teacher will bring their own flavour, tradition and inspiration. Dying peacefully is the result of living peacefully.

*www.karuna.org.au “Gently underpinning our work, our spiritual foundation derives from Tibetan Buddhism, specifically the teachings and practices of Lama Thubten Yeshe (1935–1983) and Lama Zopa Rinpoche of the Foundation for the Preservation of the Mahayana Tradition (FPMT)”. Note from the author: Although I regret that Buddhist philosophy often takes over contemporary yoga language, I acknowledge the amazing life force and wisdom that is common to all inspired and enlightened beings. Karuna’s mission is universal in its kind and unique in Brisbane.

References:

- BKS Iyengar, Light on the Yoga Sūtras of Patañjali, Noida, India, 1993 (2010)

- Steven Jenkinson, Die Wise, Berkeley, CA, USA, 2015

- Atma Muni, On Love, Mechelen, Belgium, 2016 (talks)

• Matthew Remski, Threads of Yoga, Charleston, SC, USA, 2012

After 25 years in the corporate world, Ilse Broekaert found mindfulness to be the answer to stress and burn-out. She trained at Byron Yoga Centre, at Ayurveda Hospital Retreat (India) and in Belgium with Atma Muni and Suman. Ilse worked as a family support volunteer and biographer in palliative care. Her mission is to make yoga accessible to as many people by lowering financial and cultural thresholds. Upcoming workshop on “Yoga in Palliative Care”: 19 November 2017. More information: yogamadetomeasure.com