By Alizah Salario

The old man sat motionless, his head slumped low and his face masked with a peaceful expression. The man, a master teacher of Tibetan Buddhism, had spent his last days in continuous meditation and prayer in preparation for death. He’d also given one of his students, Kunchok Gyaltsen, the responsibility of performing his funeral rites. At just 22, Kunchok had already been living at the Kumbum Monastery in Amdo, Tibet, for six years when he found his longtime teacher dead in his room, still seated in a meditative pose.

Kunchok began the funeral rites by plugging his teacher’s nostrils with butter. Blocking the body’s holes after death prevents any discharge. According to Tibetan Buddhist tradition, this is important so survivors can offer the entire body to the fire gods during cremation. Next, Kunchok lit butter lamps, traditionally made from clarified yak butter with a wick stuck in the middle, to alight his teacher’s path through the transitional stages between life and death. He made burnt offerings of tsampa, a traditional Tibetan food made from barley flour, in case his teacher grew hungry on his journey.

Using a type of Tibetan astrology called Shin Tsi, he then calculated the most auspicious date for the funeral and cremation. The Shin Tsi forecast determined that his teacher’s body should remain for five days, during which time his students — several hundred of them — came to his room to pay their respects, offering their prayers and lighting butter lamps as gestures of respect and goodwill. When the time came, Kunchok and a few other students carried their teacher’s body to the funeral pyre.

“During cremation, they didn’t think they were setting their master on fire. They think, ‘I can feed the fire gods,’” explains Kunchok. After the cremation, the students scattered the remains in the mountains. Shepherding their teacher on his journey to the afterlife wasn’t morbid or sad. Rather, it was an honor.

It was over a decade later and on the other side of the world when Kunchok first experienced a death he considered sad. He was living in Los Angeles and earning his doctorate at UCLA’s School of Public Health. This time, it was a stranger’s death. A dying Tibetan man had requested the presence of a Buddhist monk at his deathbed, but by the time Kunchok arrived, death had come for the old Tibetan. There were no butter lamps or tsampa offerings. It was a private home, not a monastery, so perhaps this was to be expected. But there was also no stillness. No sanctuary. No pause to buffer the transition from life to death. Kunchok watched in disbelief as the man’s body was quickly carried out on a stretcher and taken away in an ambulance.

“I was very sad,” says Kunchok. “I said: ‘Oh, this is how they treat the dead. The bed is warm. The room is still warm.’”

For Kunchok, the man’s death was akin to throwing random items in a bag and rushing out the door before a long overseas vacation. What would happen to the man’s spirit? It was then that he understood the crucial difference between the Tibetan medicine he’d studied for years and the western system he was only just beginning to learn.

The main ballroom of the 2015 Art of Dying Conference is packed. Wearing the burgundy and saffron robe traditionally donned by Tibetan Buddhist monks, Dr. Kunchok Gyaltsen is easy to spot. At 50, Kunchok’s shaved head and nearly unlined face give him a boyish, almost cherubic look. His only accessories are a plastic conference nametag, stylish Prada eyeglasses, and wood prayer beads wrapped around his wrist. During opening remarks, he slides his prayer beads up and down (later he explains this is how he keeps track of his prayers, shifting a bead for each repetition). Dr. Kunchok sits in the back of the room with Gyaltsen “Jensen” Druknya, his one-man entourage and friend since their youth together at the Kumbum monastery. Kunchok and Druknya, along with Bobbi Grant Llewellyn, a registered nurse and clinical social worker, are the co-founders of Arura Medicine of Tibet in Charlottesville, Virginia, a community clinic that provides education and access to Tibetan medicine, particularly to elders.

Held in Manhattan at the New Yorker Hotel, the fifth Art of Dying Conference brings together thought leaders in death and dying, and professionals who specialize in palliative and hospice care. Outside the main conference room, books on death, dying and grief are for sale, from modern classics like Joan Didion’s The Year of Magical Thinking to self-published narratives about near-death experiences. Also for sale: black obsidian and crystals for healing and protection, prayer beads and other amulets. A table is cluttered with flyers about death doula certification courses, and spiritual retreats.

Want to know how psilocybin, more commonly known as the active ingredient in magic mushrooms, is used to lessen end-of-life depression and hopelessness among terminal cancer patients? There’s a session on that. Curious about STEs (spiritually transformative experiences) and the liminal state between life and death? There’s a session on that, too. Part science, part spirituality, the Art of Dying conference is an answer to what the program describes as a “clear call to understand and work with death and dying in new and more open ways.” 

Dr. Kunchock (Photo by Robert Llewellyn, courtesy the UVA Tibet Center)

Enter Dr. Kunchok. As the only practicing Tibetan monk to complete a doctorate in Public Health from an American university, this year he’s been tapped to lead two workshops and share his mastery of Tibetan medicine, a complex 4,000-year old medical tradition that emphasizes the importance of finding the imbalances that underlie illness. In Tibetan it’s called Sowa Rigpa, literally, “the knowledge and science of healing.” In Sowa Rigpa, correcting imbalances is the first step toward treatment and healing, and the diagnosis process requires a holistic assessment of body and mind.

One of the tradition’s main tenets is that death is inevitable, and each day of life brings us closer to it. This approach to death is vastly different than that of a western biomedical system, which gives both doctor and patient the job of “fighting death,” says Dr. Leslie Blackhall, a specialist in palliative care and a professor at the University of Virginia School of Medicine who has also studied Tibetan medicine. (Dr. Kunchok is a visiting professor at UVA, where he teaches Tibetan medicine for part of the year, and spends the rest of the year teaching at Qinghai University Tibetan Medical College in China.)

“[Fighting death] is an attitude that is helpful sometimes, but in its entirety, it is very disconnected from reality because that’s not what reality is like,” says Dr. Blackhall.

Later, in one of his lectures, Kunchok notes that the denial of death is often so reflexive that “it’s okay” or “I’ll be okay” are common responses to the news of a terminal illness. Says Kunchok: “You can say you’ll be okay, but you’re not okay. You’re dying.”

“Our profession is not set up to accept death,” continues Dr. Blackhall. “In certain ways it’s good. Look at HIV. Everybody died of it in 18 months; now people can live a long time. But can we learn to balance the preciousness of life and trying to prolong life, and our human mortality? That’s what interests me about Tibetan medicine, because I think they do balance those things in their culture a lot better than we do.”

Dr. Kunchok is there to explain this balance, physically and spiritually, and discuss the importance of preparing for a good death. But in a medical system that isn’t set up to accept dying, and in a culture where mortality often applies to someone else but rarely to ourselves, a “good death” may be a challenge.

“I don’t think many people take seriously death and dying,” says Dr. Kunchok.

The Kumbum Buddhist Monastery in Amdo, Tibet rests in a narrow valley surrounded by mountains. During his childhood, Kunchok, who was raised by his grandparents, found inspiration in his grandmother’s stories of old monks and their vast storehouses of wisdom. After a period of study with a Buddhist teacher at home, Kunchok entered the Kumbum monastery and was ordained as a monk in 1981, at the age of sixteen.

Monastic life required a rigorous schedule for Kunchok and the other young monks: 3:30 a.m. wake up, followed by a study period before the young monks cleaned house and gathered for their first prayers in the big temple. After tea and tsampa for breakfast, he was off to a clinic to learn to make herbal medicines, then debate, which is considered a form of philosophical inquiry in Tibetan Buddhism because it allows monks to deepen their understanding and knowledge — all before returning to the clinic for a couple more hours. Kumbum was only 140 kilometers from his home, but rough roads and limited transportation made it feel a world away.

“There was no time for thinking,” says Kunchok. “There’s so much work to do, so many studies. I was energized.”

At the monastery, he was known not only for his work ethic, but also for his cooking. He made traditional Tibetan noodles and momos (a type of dumpling) and taught the other boys, including Jensen, who came to the monastery as a young boy, how to cook.

“He [was] always focusing on his own studies,” says Jensen of Dr. Kunchok. “He’s really a person that never wastes his time. We’re young, we always play outside, and he’s telling us we waste our time.”

At the monastery, Jensen and Kunchok became like brothers. Today, Jensen’s wife and kids are a kind of surrogate family for Kunchok. He lives with them when he’s in Virginia, and Jensen’s children adore having him around.

While still a young monk, Kunchok was drawn to medicine and demonstrated an aptitude for it, both as a scholar and practitioner. After completing the first National Tibetan Medical Training since the Cultural Revolution, Dr. Kunchok became the Deputy Director of the Red Cross Branch Hospital at Kumbum Monastery, where he treated Tibetans, Chinese, Mongolians and anyone who walked through the door. His reputation as an outstanding medical practitioner began to grow.

“One thing I thought was a little bit unethical is every time we evaluate our work, we count the number of patients,” he recalls. “At the individual level we said, ‘Ah, I had more patients than you today,’ and then I feel better. Also, in the hospital they say, ‘Oh, your hospital is less important because you don’t have more patients. Then I feel like, ‘why the doctors need to be happy when they have more patients?’ It’s against your ethic. Usually, you need to be happy there is less patients, right?”

“The only problem with being a doctor is, I’m a Buddhist monk,” says Kunchok. “I need to think compassionately, and not be thinking of my fame.”

Over a decade later in 1997, his studies led him to UCLA, and eventually, to a level of fame. He has authored numerous articles and books, and his work across cultures has earned comparisons to Dr. Robert Thurman, named one of TIME magazine’s 25 most influential Americans in 1997 for his early advocacy of Buddhist ideas.

According to Tibetan Buddhism, there are four sufferings in life: birth, death, sickness and old age. Kunchok specializes in health and wellness related to the first two. These life-cycle events are considered crucial transitions in Tibetan Buddhism, and in addition to his work with the dying, Dr. Kunchok is known for his work in maternal and child health. He was instrumental in opening the Tibetan Natural Birth and Health Training Center in Repkong, China in 2009, which caters to women in rural Tibet and has helped to reduce maternal mortality rates.

“The only problem with being a doctor is, I’m a Buddhist monk,” says Kunchok. “I need to think compassionately, and not be thinking of my fame.”

When Kunchok approaches the podium for his first workshop on death and dying in Tibetan medicine and Buddhism, he doesn’t mention any of his accolades.

“I thought there’d be an intro, but there is no intro. So I guess it’s like when you die,” he says.

The crowd laughs. His opening line sets the tone for a workshop that’s more storytelling than academic discourse. He moves effortlessly between stand-up comedian and contemplative monk, weaving medicine and philosophy with humorous anecdotes about cultural gaffes: “Last time I was in Seattle, I saw a liquor place. It says ‘spirits.’ I said, are there ghosts there?”

(Illustration: Dale Crosby Close)
More laughs, but his self-effacing punch line is a lead-in to a big idea. He goes on to explain his confusion over the dual meaning of “spirits.” In Tibetan, the word for spirit defines a distinct concept, and would never do double-duty as a synonym for booze, or anything else. He goes on to discuss a friend’s mother who had lots of plastic surgery. “Why is she looking like that?” he asks. He’s not questioning the surgery, but rather the pervasive denial of aging in the U.S., and what it suggests about Americans’ acceptance of decay and mortality (or lack thereof).

Underlying these cultural chasms are two vastly different ways of looking at medicine, healing and mortality that Kunchok negotiates on a daily basis.

In a western system, “every human dies — every single one — but weirdly enough, no single medical school teaches students about death,” explains Dr. Blackhall. “That is, how do people with heart disease die? What happens when their illness becomes no longer amenable to treatment? Even though a quarter to a third of Medicare dollars are spent on that phase of people’s illness, nothing is taught on it, because the model is one of medical progress, of medical miracles. It’s sort of like Lazarus, right?”

In the Tibetan system, learning about death is integral to the practice. Dr. Kunchok flips through his PowerPoint and shares some of the many ways practitioners of Tibetan medicine are trained to recognize signs of death: The color and consistency of a patients’ urine is one indicator, the way the wrist creases when you put your palm to the top of your forehead is another — if you can easily see a line in your wrist, death is imminent. With this last one, everyone in the room presses palm to forehead to check their wrist crease. The audience laughs, craning awkwardly as they look for a new sign of death. It’s a small gesture, but telling of Dr. Kunchok’s larger message: We can develop greater comfort with death, in our own bodies and in the bodies of those we care for.
“If you travel, you need to pick up your ticket, pack your bag. If you prepare, you are going more peacefully, you will not forget anything. Death is like that also. And then, on the airplane, you can relax.”
He describes the dying process using the four elements (fire, earth, air, water) and how each is connected to both external and internal signs of death. For example, an external sign might be that a person becomes weaker and loses their sight, while internally they’re experiencing the appearance of mirages or smoke.

After Kunchok’s lecture, questions abound: What if you die suddenly? Is the spirit forced out? How do you know, exactly, that the mind is still alive when the body is dead? There are a few questions about
bardo — the transitional states that the spirit cycles through between this life and the next. Kunchok answers patiently, often referencing familiar concepts such as travel to explain a philosophy that’s foreign to many.

“If you travel, you need to pick up your ticket, pack your bag. If you prepare, you are going more peacefully, you will not forget anything. Death is like that also. And then, on the airplane, you can relax.”

In the west, bedside manner is considered just one part of practicing medicine. But for Kunchok, having a connection with a patient — what he calls “compassionate care” — underscores every aspect of his practice.

“Some people teach very high teachings, but they never think of sutra practice, or how we take care of each other,” says Kunchok.

In part, that’s why both the internal and external signs of death are so important in Tibetan medicine — they help to determine exactly how a doctor should interact with a patient. Many western doctors are also familiar with external end-of-life signs, says Dr. Blackhall, but Tibetan medicine is much more detailed in terms of what they believe are the internal processes that correspond with these signs. But whether or not a person understands the philosophy behind Tibetan medicine is not a prerequisite to grasping Dr. Kunchok’s message.

“What he teaches is a worldview that helps you put death as part of that, and make meaning of it in a way that enriches your life, rather than makes you feel more depressed,” says Blackhall. “Tibetan physicians, part of what they do is mental training. Part of it is mindfulness. Part of it is the cultivation of compassion, as a practice, not just, ‘Gee, I should be more compassionate,’ but actually doing practices that help you cultivate.”

Compassion is considered one antidote to the three poisons in Buddhism, which Kunchok defines as ignorance, attachment, and anger. Death is more likely to be accompanied by “unnecessary suffering” when these poisons are imposed upon the dying process, suggests Kunchok.

Dr. Blackhall puts it bluntly: “When your loved one or patient is dying, there’s suffering because you love that person, or because you’re a doctor and you become close to your patient. But there’s unnecessary suffering because you feel guilty or that it’s your fault.”

Dr. Kunchok’s combination of storytelling, Tibetan philosophy and medical expertise is a way of demonstrating the importance of compassion. His goal is not to change anyone’s beliefs — in fact, he says numerous times that “belief is dangerous” and cautions against blind dogma — but rather to illustrate how life and death, mind and body, are interconnected.

“In the science field, they understand each thing at a very deep level,” says Dr. Kunchok. “But there’s a big problem with integration. A liver specialist and a kidney specialist are two totally different doctors. The liver is the hot nature, the kidney the cold nature. So then [the doctors] each give medication to the person.” He explains that in the Tibetan medical tradition, this is like putting fire in water, and then putting water on fire. One will cancel the other out, and it will be a problem for healing.

Integration has served Dr. Kunchok well, not only in Tibetan medicine. Many of his projects incorporate a deft understanding of both western public health infrastructure and management systems with Tibetan medicine, such as the center for maternal health. His most ambitious project is just getting off the ground, and it’s a paragon of integration; Through Arura, he’s in the early stages of opening a wellness center in Virginia that caters to poor, uninsured or impaired senior citizens who might otherwise be forgotten. The goal is to use Tibetan medicine and spiritual practice to guide them through their last years of life.

Kunchok says his ability to do the kind of work he does stems from his understanding of
umma, or the Middle Path, the Buddhist concept of reconciling or transcending opposing views.

“We created medicine for infectious diseases, AIDS and everything, all those things we fight. That’s one kind of culture. It’s a concrete concept,” Dr. Kunchok says. “But you can also listen to alternative people and integrate their thinking. In public health, the field is very big. I can’t use all of it. Some of it makes sense to me, and I integrate it with the Buddhist practice and then I work in the field. I think this is my
umma path.”

Alizah Salario is a freelance journalist and writer living in Brooklyn. Her work has appeared in The New York Times, Slate, Al Jazeera, The Los Angeles Review of Books, Fusion, The Daily Beast, at The Poetry Foundation, and elsewhere.

This essay was originally published on Narratively.