Walking with People at the End of Their Lives


The Rev. Hajime Issan Koyama, a Buddhist chaplain based at the Zicklin Residence of the Metropolitan Jewish Hospice, in Riverdale, works with people at the end of their lives—many of whom are isolated and have been abandoned by friends and family.

The four stages of interaction for the caregiver at the end of life are said to be: to show up; listen; care for the other; and watch—not unlike the process of Zen meditation. Issan’s job is to listen to his patients and walk with them as they are dying, to the place where they will be going. …to help ease his patients’ fear of their final passage.

Armed with the understanding that comes from years of study of Zen meditation and psychological methods, Issan says he is a “doula”—midwife. He can go everywhere his patients need him to go—to the point of death. At that point of death there is a door. He and the patient pass to the door hand in hand. The patient goes through. But Issan does not. He stays on the other side.

Issan says that on occasion he has found this process to be very frightening. He decided that he needed to create a better relationship with his fears. Further, he wanted to learn why he felt this powerful urge to compassion, to work with those at the end of life. He sought the aid of a psychologist skilled in dream analysis.

After analysis, Issan found that this urge to compassion stemmed from his understanding of his own childhood isolation and abandonment. An orphan, he was born into a wealthy family but cared for by a paid caretaker. As a child he lived in an ivory tower; there was an abundance of wealth but a total lack of love. Issan now uses this hard-won compassion, to help others who are dying in isolation and abandonment. Issan, like many in this business, is what Jung called a “wounded healer.”

Issan has stories of his interactions with patients at the end of life.

An African American lady, about 60 years old, diagnosed with inoperative cancer, was a patient of Issan’s at a time when Issan had first started his chaplaincy. He was eager to talk with her, but she was reserved and silent.  They sat together for long periods of silence.

Issan noticed that there were two huge vases of flowers situated behind the patient as she lay in bed, so that she could not see them. Issan began to describe the flowers to her—one bouquet was a vivid red, the other was yellow. They were beautiful, with striking foliage.  In time, the patient asked to see the flowers.

Finally, she began to talk.

She told him that she was inoperable. She needed to find a place to go to stay until she died but she had no relatives she felt she could call on. Her daughter, however, a lesbian, of whom she strongly disapproved, had said that she and her partner would be happy to give her a home. But she did not feel she could accept.

Issan said nothing. He listened.

The next morning when he came back to visit, she said, smiling, that she had accepted her daughter’s offer.


At one time he visited an on-call patient dying of HIV. The patient, raised by a single mother who was Catholic and homophobic, was in intense anxiety and pain. He was taking huge dosages of anti-anxiety drugs but was afraid to sleep, fearing he would wake up in the hell his mother had predicted for him.

Wearing the protective gown mandated by the hospital, Issan knocked on the door. He found not one but five people—four very agitated and angry young men—sitting with their friend, the patient. Issan took off the gown and sat down. They raged about the hospital, about their friend’s mother, about HIV/AIDS. Issan listened.

Gradually, the four friends stopped ranting and started to talk. They loved their friend. He was a wonderful guy and he was in extremis. He feared he was going to hell.

“What is hell?”  Issan responded. “A place where people hate us.

“What is heaven?  A place of compassion.  Your friend has already been creating heaven on earth for you, and all his friends. He is not going to hell. “

Issan sat in meditation with the four friends. They were finally were able to speak with their friend about funeral arrangements.

The young man smiled. He went to sleep. He slept.

Issan is about to enter upon an extraordinary professional program – the “End of Life” certification offered by the Metta Institute in San Francisco, run by Frank Ostaseki. Ostaseki’s deep understanding of the issues of death and dying are rooted firmly in the Zen Hospice Project program he established to deal with patients at the end of life.

The Metta program is more than training—it is a life-shifting experience, a powerful awareness practice. By participating, one may scrutinize oneself, and use those insights to help others. One’s own needs must be served well in order for one to serve others, well. The two are interconnected.

The program is timely for Issan in more ways than one. The hospice where he worked, which has been taken over by Metropolitan Jewish Hospice, has formally acknowledged Issan’s affiliation and achievements with the Metta Program and has welcomed him into the new organization as a full-time “spiritual counselor.” Issan, too, is preparing to embark on a new phase of his life.

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