Dharma in Hospice and Chaplaincy: A Conversation

September 9, 2025

Editor's Note: I'm grateful to our four panelists, who share a work history of chaplaincy, counseling and hospice work. I had asked them if they'd be willing to speak with each other and be recorded, so that their dialogue could be turned into an article. Terry, Marshall, Nancy, and Jennifer are respected elders in both our sangha and in their professional worlds. As chaplains, counselors, and hospice workers, their work is a breathing example on how the dharma addresses the great work of life and death. I was honored to be able to be present for their conversation and trust that you, our readers, will find much value in it.

Ken: How do you find the dharma in your work?

Jennifer: Just going through my day with patients yesterday, I was thinking about how dharma is woven through the language I use with people, even though it's not dharma-specific language. I often encounter people in physical distress asking Who am I? Because people can no longer do physical or even mental activity, they don't feel like they contribute anymore. Their loss of meaning and purpose is acute. And that's so much of the don't-know mind—even though I would never use that phrase with anybody.

Somebody yesterday was talking about how difficult it was to retire. But then he found all these hobbies and other things to make his life meaningful. But now it's like he's at a different form of retirement, because now he's got to retire from retirement. He can't even do the puttering and the community activities and the things that he enjoyed. So now what do we do? We explore the inner world, which reminds me of the Buddha sitting under the Bodhi Tree: Now it's time to look inward and find the meaning. So I try to find opportunity in this forced, sedentary time for people to try to help them see it as an opportunity, depending on their cognitive abilities, for some kind of spiritual awakening. What do you guys think?

Terry: Yeah, I like the idea that it's an opportunity to go deeper and to help people see these moments actually as opportunities to deepen life and explore questions of “Who am I?” And I do use don't-know mind all the time. People seem to be able to understand that when it's presented in context. What is this moment really presenting people with when they start asking questions? Why isn't the world that I grew up in working for me now? Who am I? And unlike the medical model of finding problems and fixing them, I get to just sit with people in these questions. Part of the dharma for me is just sitting with those questions and not having any agenda. Just sitting with them in that curiosity. And following them. And when something comes up, being able to point it out, maybe magnify it a little bit, and say, “Wow, you just made this. When I asked you how you were doing, you made this hand gesture. What does that mean?” I just sit in that curiosity, without any real intention or feeling like I need to fix anything. I love that feeling that we can sit in this place of opportunity with people. It’s almost like standing at a doorway and asking, “Would you like to step through here?” Sometimes they do and sometimes they don't. Either way is completely OK. It’s a wonderful privilege to be able to be in that space.

Nancy: It starts with me. I just sat an hour ago with a client on Zoom. This client carrys a tremendous amount of trauma and pain. I sit in awareness with no intention; being open to seeing what's being presented. A big piece of my work is being open to pain, discomfort, dukkha, whatever we want to call it. The people I work with find a huge sense of safety with someone who's willing to sit with them in their pain.

My first introduction to Buddhism was in the Himalayas in a Tibetan Buddhist monastery. Tibetan Buddhism, general mindfulness, and the Kwan Um school all emphasize being open to both the pleasant and the unpleasant. Sitting in both. Not pushing away, not craving either.

In tonglen practice, we connect directly with bodily sensations, going to the space before pain; being present in this moment. We make friends with and get to know our thinking, our judgment, our opinions. We see them as guests that come and go. With awareness we choose when we want them and when we don't. We hold space for the client's pain. The work is to sit upright and steady in the midst of it—to be with dukkha, pain, and to be equally present with the pleasant as well.

I also work with couples using communication skills, which I really enjoy. My intention is to guide them beyond blame, looking at their experiences and feelings, finding out what they actually need. I rely on nonviolent communication, which I find to be a great Zen dharma language in terms of being nondualistic and not knowing. This communication style is about being present and open—like a tiger sitting ready for whatever happens.

Terry: Three and a half years ago I retired from working as a chaplain for twenty-eight years. The work I did was within hospice. One of the major dharma issues there is using the language of death and life, all the time, working within a medical model. Just because we can use these words, life and death, we deceive ourselves into thinking we know what we're talking about. In than setting I would constantly have before me that big question: What is it we call life? What is it we call death? What is this? What is this? I loved that aspect of it.

Like Jen, I seldom would use dharma language. Most of the programs I worked in were lucky to have a chaplain. They don't have the luxury of having the Buddhist chaplain, the Catholic chaplain, the Protestant chaplain. So one has to be something for everyone, without being hypocritical. It was wonderful how that would call on us to be respectful of a diversity of beliefs and values and sources of meaning. So much of it just depends on our presence. Are we really, truly listening? Are we really present in each moment? In that aspect, everything we hear, see, smell, taste, touch is the truth—is the dharma. It’s being awake and alive, moment by moment, in the work. I'm grateful and I want to listen more.

Ken: With each of you having shared your experience and your views so richly, what does that evoke for everyone else?

Nancy: I actually mention Kwan Seum Bosal with some clients as being that place in us that is nourishing or loving, listening to the sounds of the world. I turn to my own experience of using Kwan Seum Bosal. For example, in the dharma room chanting while filled with anger toward someone, I watch that anger turn to compassion. Just today, I mentioned Kwan Seum Bosal to a couple of clients. I explained how in Asia, it’s simply love energy, which artists have personified into Kwan Seum Bosal in Korea, Guanyin in China, Kannon in Japan, Quan Am in Vietnam, and Chenrezig in Tibet. I talk about the energy of it, which comes from my own practice. 

Terry: I have often found it necessary to develop a concise way of explaining my role to colleagues, friends, patients, and families. When people hear the word chaplain, they tend to project a lot of preconceived notions onto it that aren't necessarily accurate. Frequently I have to explain that my role is to try to tune into what gives people a sense of meaning and purpose and value. And what language do you use to talk about that? In relation to dharma, it’s about letting go—not being attached to my language, my beliefs, my values, so that I can quickly tune in to the language games the other person is playing, allowing me to skillfully support and assist them.

Marshall: I think that's really important. And I find it sort of fun to translate.

Jennifer: While I don't use dharma language, it’s true that dharma is simply things as they really are. That idea is repeated over and over in the sutras. Things as they really are. So when I say I don't use dharma language, I mean I don't refer directly to the language of the Buddhadharma unless somebody's specifically open to that. That said, dharma language is just things as they really are.

One thing I was thinking about also is the use of humor, which to me is such an important mark of spiritual health. Because the punchline is we die: all the things you stressed about and worried about, all the hard work—and poof, it's gone. And humor requires skill. It has to be used with care, because not everybody's ready for it. But the people that are ready benefit a lot. That’s also dharma: nonattachment. There's got to be humor. Otherwise, if we take everything so seriously, it's just so heavy. Humor is also a great way to connect with people. People love it when you can make them laugh or smile. And that builds trust.

Marshall: Nancy was talking about Kwan Seum Bosal, and I just realized that whenever I want to talk about Kwan Seum Bosal with non-Buddhists, I replace it with "your guardian angel" instead. Because your guardian angel is intimate with you. Your guardian angel has been watching you your whole life, witnessing your life and loving you your whole life. Your guardian angel is always going to be with you. And that idea of a guardian angel watching over someone is also inspiration when I’m sitting with patients who are not awake. Our practice gives us the perfect tools for sitting with people who are not awake, because we sit silently for hours. And we don't think that that's in any way strange. We know that there's a lot going on when we're not using our words, in this this before-thinking mind.

One of my practices will be sitting as their guardian angel, looking at them as if I have watched them their whole life, completely intimate with them. So maybe that's a version of sitting here as Kwan Seum Bosal.

I'm always fascinated by this practice of listening, as Nancy was saying—I'm willing to listen to your pain and to your joy. And how to be this clear mirror. The practice that we do in the Kwan Um School that I think is perfect for this is listening to the bell. Listening to the bell after the morning bell chant and after the evening bell chant. At Empty Gate Zen Center in Berkeley, we have a really big, resonant bell. You can feel the vibrations going through your body. And just like that, letting emotions go through my body, feeling them completely, being completely intimate with them. And yet they're not mine. They don't belong to me, so I just let them [go] right on through. They come in, I feel them completely, and I let them go. So those are two of my practices.

Marshall: I don't know if this is your experience, Terry, but a lot of times, I would remind staff to remember, however you're holding your energy, whatever you're carrying, you're bringing that into this person's space. There’s a threshold, and when you cross over that and you walk through that door, that's a holy space. I tell them to try to remember to let go of whatever ideas they’re bringing into this sacred space where this person is doing their dying work—which really is every space, because we're all doing that work. I try to help staff remember how important it is to maintain their own spiritual practice to stay grounded as a means of respecting our clients and their space.

Terry: Our practice of walking meditation was such a vital part of my work each day, something I’d try to keep conscious of as I walked from one patient room to another. I did a lot of my work in an inpatient hospice unit. And so, walking from one patient room to the next patient room, how can I let go of everything that I was just engaged in with that patient and family, and not be carrying the leftovers of that with me as I then step into the next space. How can I be there 100 percent? Being in each moment and letting go of everything that came prior to it, with enough awareness, we can skillfully draw on whatever previous experiences might be appropriate in the new moment. Walking meditation helps with that. It’s hard to do sitting meditation when we’re so busy, but we can still do a lot of walking—and try to do it mindfully.

Jennifer: Another way that I use dharma is the relationship to the body, to sickness, old age and death. Sometimes, depending on a person's cognitive abilities and willingness, you can talk about how so much of our mental energy is devoted to maintaining this bag of guts that we walk around with. We have to keep it warm enough, cool enough; we have to keep it clean and dressed. We have to get it to the bathroom. We want to get it sheltered. We have to transport it from one place to another. We have to get it insured, educated, and so on. How much of our mental energy is devoted to maintaining this? And then when we think we're going to shed this body, what is left? What does our mind do so much with our time but cultivate this shell that eventually we shed? And we stress about it so much. So that's another practice that I incorporate, again, without using any terminology from Buddhadharma, but it's still clearly related to the practice.

Ken: How do you see that come to life when you're engaged? Because you're kind of suggesting that you don't lay it out that way with a plan ahead of time. So what happens with you as you see these things emerging with people kind of spontaneously? Because you've seen it with the people you've worked with, and you've seen it in practice, and you've condensed it in a very wise way. And then I'm wondering, when it's not condensed, but flowing in the presence of somebody: How is that? For any of you? To watch people inquire about their relationship with their body and who you are as that's happening. That's kind of what I'm asking.

Jennifer: It just depends so much on the person. A lot of times there's stuff that gets in the way. Some people can't even go there.

Ken: Zen Master Seung Sahn would talk about practices that were, in his words, “high class.” Just adjusting to who you're talking to. When somebody wants to go there, and you see the opportunity, there's a way of walking with them. In that specific kind of thing, how do you walk along with somebody who's considering what their body is? Maybe specific instances come to mind.

Terry: It’s about creating a safe space for someone to just be able to be whatever they are at that moment. So often, people are surrounded by others who are afraid to talk about death, and change the subject when it comes up. “You'll be just fine,” they might say. So our ability to just be real with people and to create a space where it's safe to feel whatever they're feeling, to talk about whatever they need or want to talk about, to respect what they don't want to talk about. And they don't feel like they have to feel or do something or that they aren't ready or wanting to do. Marshall referenced that earlier, creating a safe space for people, and modeling being comfortable using words like death or dying. That goes a long way to help people begin to get more comfortable doing that themselves—that it's it's OK to speak that language.

Jennifer: Another perspective I bring to this work is a concept I learned at Naropa University, which is rooted in the Tibetan tradition: the idea that every emotion has both a shadow and a light aspect, containing its own inherent wisdom. People often think, “I'm angry and that's so bad.” But it can be helpful to see there's sometimes wisdom in anger. Sometimes things actually are bad, like when you get treated poorly by someone, and anger is the natural response. There’s also wisdom in fear, because it arises from humans' deepest instinct, to want to live and to persevere and to protect our loved ones. So fear is not necessarily poison. People feel some relief in learning that their negative emotions actually have some wisdom also. I found that to be helpful in relating to difficult emotions.

Nancy: There is a common misunderstanding that emotions are bad. One evening at the Cambridge Zen Center, someone asked Zen Master Wu Kwang, “Do you have emotions?” “Of course I have emotions. I am a human being.” When I teach Mindfulness-Based Stress Reduction to teachers, I hear how relieved they are hearing that emotions are OK.

When working with pre-release prisoners in a jail, I did a small, kind gesture for them: I brought them tangerines.They quickly pegged me as a "nice lady." A week later when talking about anger, I put my hand in a fist. They looked at me in shock. “I thought you were a nice lady.” “Anger is part of being human. What is important is how we relate to anger,” I replied. The prisoners, just like the educators and the Kwan Um school members, are relieved to learn that emotions are part of being human and the practice is not to shove them down but to learn how to relate to them in a healthy way.

Marshall: Right. Or grief, which I think is the primary emotion in hospice. If you didn't love, you wouldn't have grief. So, you know, there's the flip side of that, this grief is an expression of love.

Ken: Does anybody have any other stories? You've told a few. This is just such a wise conversation. There’s wisdom in stories. I wonder if this is evoking any stories for you. 

Marshall: I had a wonderful experience with a patient using tonglen. He was expecting his son to visit, and he always felt like his son didn't really respect him or pay enough attention to him. He was feeling needy around this relationship. So I suggested doing tonglen for his son before the visit because he was so anxious about it. As I talked him through the practice, the patient started to weep. He said, “I've never thought, what does my son need from me? I've always been thinking, what can I get from my son?” And he had the visit with his son, and later he said it was the first time that it wasn't negative. It wasn't beautiful and perfect and miraculous. But it was not bad for the first time. That was such a relief for this patient, and he was so deeply grateful. He died like three days later, after telling his daughter, with whom he was very close, that this helped him feel complete. So just this different perspective: “I never thought about what my son would need from me.” He wasn't a mean guy; he was just kind of needy and never thought about what he should be giving to his son rather than what he could get. So that was good. It was powerful medicine.

Nancy: I had a client who is a psychologist, who came to me during his divorce. He had a nine-year-old daughter. While going through this divorce, he came to see me a number of times. One day he said, “I'm having such a hard time with my daughter. She wants to come in for an appointment.”

She came to my office. I served her tea. She sat beside her father on the couch, drinking Bengal spice tea. She said, very adult-like, “This is very delicious tea.” Meanwhile, in her life, this nine-year-old has a psychiatrist, a school therapist, a biofeedback therapist, a family therapist—many caregivers. While she’s sitting on the couch, she looks over at her father. Her father is very relaxed. She asks, “Can we have pizza tonight?” Her father says, “No, not tonight.” She is down on the floor, wailing and screaming. Her spirit leaves her body. I kneel beside her. I ask her father to kneel on the other side of her. I say to the dad, “I'm present; everything's fine. Everything's OK. I'm supporting you. Let's go into your posture. Let's breathe.” We sit and give attention while the daughter has this experience. She falls asleep, and wakes up. This all happens within an hour.

A few weeks later Dad calls and says, “My daughter would like to come in again.” She walks into the office, and what do you think she says? Can I have tea? Can I have a pizza? None of that. Instead, “Can I have a nervous breakdown?” “Sure, of course. Come right down here on the floor. Dad, please come down also.” She has her nervous breakdown. The many people that she is working with seem to be trying to distract her, change her, make her feel better. I have the sense that these caregivers have been medicating her, trying to get rid of this energy. I am with her, mentally holding her, being present with her “nervous breakdown,” not afraid. She comes back for more.

Ken: Wow. Yeah. Deep gratitude for all your stories. Wordless gratitude to you all. Thank you all so much.

Terry Cronin, JDPSN since 2014, is the guiding teacher for Northern Light Zen Center, Cape Cod Zen Center, and Plymouth Zen Group. Retired in 2022, he worked in hospice care for twenty-eight years, mostly as a hospice chaplain.

Nancy Hathaway, M.Ed., is a clinical pastoral counselor licensed in the state of Maine. She is also a psychotherapist, senior dharma teacher, and college instructor. She specializes in individual and couples therapy and workshops with the approach of communication and mindfulness skills.

Jennifer Mancini has been involved with the Kwan Um School since 1999 and has worked as a hospice chaplain during that time. She has been a dharma teacher since 2013.

Marshall White is a Ji Do Poep Sa Nim in the Kwan Um School of Zen, and practices at the Empty Gate Zen Center in Berkeley, California. He is a board certified chaplain with APC, has worked in hospice for more than twenty years, and currently serves as a bereavement manager in the San Francisco Bay Area.