A Zen counselor helps patients face death

Mission of compassion

By Kate Pastor

Rev. Issan Koyama’s most intimate experience with death occurred at his father’s bedside.

The two were not very close, but his father requested the 15-year-old come to his hospital room to shave his face just days before he died.

“I didn’t know how to give care,” said Rev. Koyama, now a Buddhist monk. “I never even touched his hand before. Looking right into my eyes, he took last three breaths and he died.”

He continued to hold his father’s hand for 45 minutes until a thought finally jarred him: Would the doctors blame him for not calling them sooner?

To his surprise, “There was nothing scary,” about watching his father die, he said.

Now he holds the hands of the dying as part of his life’s work.

A Riverdale resident and pastoral counselor for Continuum Hospice Care, he counsels those close to death both in the Bronx (including Riverdale) and Manhattan.

Rev. Koyama grew up a Zen Buddhist in a large, traditional family in Kamakura, Japan. Long after his father died, he worked as a journalist for an American fashion magazine in Japan, and later as a correspondent in Europe and America.

His career brought him to downtown Manhattan in the mid 1980s, where death once again confronted him as the AIDS scourge spread.

Each year, he sorted through his day planner, erasing contact information for people who had died. On one day, in 1988, he found himself crossing out information for almost 20 percent of his contacts who died that year.

Immersed in a world of youth, fashion and beauty, he watched as many of the glittering people were “quickly deteriorating in front me and dying,” he said. “This is the 1980s, about the height of the misinformation, paranoia, anger [about HIV].”

Death was everywhere.

In 1991, as HIV and AIDS became increasingly more visible, Rev. Koyama began working with the Gay Men’s Health Crisis (GMHC) in New York, one of the first HIV/AIDS organizations.

Meditation was quickly incorporated into the care.

“So with this strange buzzing sound in the room we started to give meditation practice,” said Rev. Koyama.

In those years, working with HIV and AIDS patients was synonymous with hospice care.

“Everyone was dying. There was absolutely no therapy at that point,” he said.

One patient asked Rev. Koyama if it was okay to bring a plastic bucket with him to meditation, in case he got sick. He walked in and vomited on the floor. Another patient couldn’t sit up to meditate, but lay down on the floor as Rev. Koyama placed his hands on the patient’s belly to help him feel his breath.

A regular group began to develop. When somebody didn’t show up, it was often because they had died between sessions.

“It was really rapid,” said Rev. Koyama, adding, “It expanded my sense of what meditation practice does.”

The affects, he said, were not purely spiritual and esoteric. They were “Powerful. Immediate. Pragmatic. Part of the medical practice.”

He traveled to San Francisco the same year and continued to connect death and Buddhist practice.

Issan Dorsey, author of Street Zen, who Rev. Koyama called a “hippy,” a “druggy” and a “drag queen,” before he had discovered the Buddhist teacher Suzuki Roshi, became a monk and established the Hartford Street Zen Center.

Located about a block from the Castro Street — a part of the city known for its large gay population — Rev. Dorsey would pick up men who were literally dying on the streets of AIDS and bring them back to the temple. Rev. Koyama said it became the first AIDS hospital and hospice in the nation.

One day Rev. Koyama found himself rapping on the door. A man with a shaved head and Buddhist robe opened it and Rev. Koyama froze.

“I broke down immediately and I just couldn’t explain why I came,” he said.

Rev. Dorsey, it turned out, had died of AIDS and Philip Whalen, a Buddhist and famous beat poet, offered Rev. Koyama the empty room of a deceased resident. Rev. Koyama undertook volunteer training while practicing at the San Francisco Zen Center and worked at the Zen Hospice Project under teacher and Executive Director Frank Ostaseski, until he decided to return to New York for chaplaincy work.

He left New York in 2004, returning to Japan for two years to establish a private medical facility. Staff continues to care for eight patients there.

But the diversity and energy of New York, called him back.

Today he lives on Johnson Avenue, and spends his days at the bedsides of the city’s dying. He carries with him the four-noble truths of the Buddha.

He explains the Buddha’s teachings this way: suffering exists, causes of suffering exist and ways to alleviate suffering exist through practice.

“In a way, it’s very clinical,” he said of how the Buddha’s teachings relate to hospice work.

While some Buddhists focus on death counseling as a way to experience “being present” or “bearing witness” to suffering, Rev. Koyama sees his role as one part of a holistic healthcare regimen that takes a patient’s physical, psychological and spiritual well-being into account.

“I feel like a prayer delivery boy,” he said.

As with mediation, he says, “We develop this fearless sense of presence. We watch whatever comes out,” but he is also compelled to intervene.

“You cannot go there and come back and say, I offered presence,” he said.

Instead, he says sees his job as providing “calming, peaceful, stabilizing, safe energy to the people here who are imminently dying.”

Sometimes, though, even a Zen monk can fall into the grind of quotidian life. He finds himself forgetting about the importance of what’s in front of him. In that way, he says, his work is the same as mediation practice.

Thoughts come up, you get lost in them and then you bring yourself back to what’s in front of you.