Dr. Martha Jo Atkins researches and teaches about the language, movement, and visions most people experience at the end of life. She is the executive director of Abode Contemplative Care for the Dying in San Antonio, Texas.
We talk a lot on this podcast about what happens after you die, what’s going on on the other side of the veil. Martha Jo has dedicated her career to standing just on this side of the veil, making the transition better for others, observing the phenomena, and teaching us all how to better navigate the sign posts of dying for our loved ones.
WE TALK ABOUT:
- the mystical sign posts along the process of dying
- pre-death visions — do they happen for everyone?
- how the conversations we have in the room where someone is dying can help or hinder their transition
*Scroll down for a full text transcript.
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MENTIONED ON THE SHOW:
Signposts of Dying by Marth Jo Atkins, PhD
The Five Invitations: Discovering What Death Can Teach Us About Living Fully by Frank Ostaseski
When Breath Becomes Air by Paul Kalanithi & Abraham Verghese
Paula by Isabel Allende
The Nine Elements of Near-Death Experience by Dr. Raymond Moody
GUEST LINKS - Martha Jo Atkins
HOST LINKS - SLADE ROBERSON
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My name is Martha Jo Atkins. I am a death and dying educator, counselor, and presently, I am the executive director of Abode Contemplative Care for the Dying in San Antonio. We take care of people who are in the last three months of life, and help them transition from here to there, and it's a really pretty magical place.
So I do private practice and that stuff and teach about preparing for end of life questions to ask yourself, things to talk to your family about, that kind of stuff.
Well we'll get to how you manage the fun of all of that in a minute.
But I am curious to hear more about Abode Contemplative Care for the Dying. Would you talk a little bit more about that and maybe explain how is it different than other forms of hospice care?
Yeah, so Abode was started by a guy named Edwin Sasek, who studied at the Kubler-Ross Centre back in the 80s, which was in New Mexico, and Edwin learned about the monasteries in the 14th and 15th centuries, where dying people, travelling people who were dying, would go to the monasteries and the men in the monasteries would give them the best of what they had. So the best food, the best mat, the best whatever they had to help them travel on their next journey.
And Edwin had this dream of starting a place where there was a chair, and a mat, and a light bulb, and somebody could sit with somebody who was dying and help them go. He didn't have a model for that and some 20 years later, he met a classmate of his who had been at the Kubler-Ross Institute too, who was running a non-profit home in Michigan I believe, where he was caring for dying people.
And Edwin put together a group. He had a model, he has that kind of energy that has, invites people to follow, and a group of people put Abode together and it's built on contemplative practices. So mostly about presence.
So how do you bring your spiritual practices to bear in every day life, and he invites people to do that in context, in this place, in this community. Helping people with their dying process.
So we got three people who come at a time. They're in the last three months. We go and visit them and make sure that this is the right place for them. All the people who are coming to us recognize that they're dying. They don't necessarily like it, but they understand that that's what's happening. And then we accompany them. Walk alongside them as they're on their journey.
Right now, we're not charging a fee for that. I think that's going to be changing in the springtime, just because economics are the way they are and we need to be able to support ourselves. So we'll charge something, and also have financial aid for people. Edwin's dream was for this to be for people who couldn't pay and for us to be able to care for those people and we still will do that and we will care for other people who can pay and that will allow us to keep the cycle going of helping people who need it.
Mmm... that sounds wonderful.
Yeah, it's a pretty magical place.
And the question you ask was how it's different. It is not a hospice. Hospices in our country, it's a benefit of insurance, it's a benefit of medicare and medicaid, and there's a number of days that you can be on hospice, you get a doctor and a nurse and a social worker, a chaplain and an aid that will come to your home for short amounts of time, 30 minutes to a couple of hours and care for you, and the rest of the time, your family or friends are the ones who care for you.
And so we take care of those people who are in the gap. We don't get money from hospices or from medicare or from insurance. That money all goes to the hospices. The hospices refer someone to us and we are simply a home. We serve as extended family.
So you guys fill in the gaps for someoneo who maybe doesn't have those family members present.
Right. Somebody who's 90 and their spouse is 90 and they've been married for 70 years and he can't turn her. And he doesn't understand what's happening.
Or recently, we had a 26 year old who didn't want to die at home. Who had a 4-year old and an 8-month old, and was worried about her mother. So we had, at one point in the room, there were four generations in this room helping this woman say goodbye to this life, and we got to be a part of all that and facilitate some opportunities for the goodbye saying there.
So I'm sure tons of people must ask you about, you know, the sadness or the depression that goes along with this environment.
I'm sure you have to see that differently in order to manage all that.
So talk to me about the emotional part of doing this work.
So I, along with the people I work with, my colleagues and I feel called to this. And it is very much a soul calling and it very much is, it's a place we want to be and it's a place where we find the energy and yes, there are moments of sadness, and as we do the work, we learn how to carry the sadness differently, and carry the work differently.
So when I first started doing death and dying work, I was in my 20s and I took everything home and was sad about everything. And the way I saw death and dying in my 20s is very different than I see it now. It now it is a transition. Somebody is going to their next place.
There is a sweetness to it. There is a... Oh, there's an ineffability to it. There's... Words fail me sometimes to talk about how beautiful it is.
And it's, there's not a lot of bullshit. I think that's the other thing I really, really love. People who are dying don't have time to pretend, and so the conversations are real. And for those of us who love those kinds of conversations, this is just...
It's a beautiful, beautiful place to be and the sadness is, it's almost secondary. In fact, it is secondary. It's the opportunity to be with somebody in a very real presence and the veil is thin and we get to experience magic sometimes, and sometimes it's just life is hard, but we get to do it together, and it's good.
How did this specific calling find you? Was there a turning point that led you down this path? Was there a loved one that passed, that brought you into this experience?
My brother Jim died when I was 23. He was 37 and it was one of those phone calls in the middle of the night and I heard my mother make a sound that I had not ever heard her make before and I knew something was terribly wrong. And we as a family began navigating and negotiating grief and what it looked like and what it felt like and what it sounded like and, it was hard. It was really hard.
He was the oldest and much loved and we had to find our way. And one of the things I did was go back to school. I wrote a paper about starting a children's... The task was to write a paper about starting a children's service in San Antonio that didn't exist. So I wrote about starting a children's bereavement centre, and my professor encouraged me to follow up on that.
So I did.
I started this non-profit and ran it for about seven years called the Children's Bereavement Centre of South Texas. And in that process, I brought my family in and we were able to continue to have conversations about Jim and about our own grief and what we needed. And then we got to hear stories from other people and how they were managing and it became this back and forth of healing and helping, which is the best way to live life, I think. We give and we get and it's not all altruism. And I think for people who think that that is it, I think they're missing the goodness there. Because we get to receive too.
So we as a family did that. And became closer as families can in those situations sometimes and ours did. And then my mother was diagnosed with breast cancer and she had death bed visions. She saw my brother, she saw her parents and her grandparents as she was dying, and I had talked to her about, that that could happen and we had some really meaningful conversations around that.
That parlayed into more conversations and as my dad got sick more and more, and I ended up doing my dissertation work for my PhD on deathbed phenomenon, and it's been pretty great.
Well you know the reason why I wanted to have you on the show is because there is a magical component to all this. And that's how you and I know each other and that's the thing that we connected around.
And so, I mean, of course the most important thing I want to get to kind of some of the magical stories and the mysticisicm around all this.
So, I mean, what happens when we die?
There is a, from my vantage point, there is a trajectory of experiences, and the way I envision it now is like a cylinder, and we get on the outside of the cylinder and then we're pulled in and in and in until you get to the centre of it, and you go up and out.
Somebody saw my drawing and said, Oh, it's kind of like birth.
And I think it is. I think it's very much like birth.
As, when people come to us, they know they're dying. We know they're dying. And so, what I watch for, what I see are patterns and what I, the way I work is, when people come into our place, they're doing the work of dying. So sleep changes. One of the first thing we see, people's nights and days will get mixed up.
I heard a beautiful story this week about a little girl who, probably 6, 5 or 6 years old, got sent home, immediately didn't go to sleep. And they were talking about giving her more pain medicine and they were going to give her sleep medicine and finally somebody said, Why don't we just ask her why she's not sleeping?
And she said, she was afraid she was going to die when she went to sleep and she wasn't sure how she was going to get to heaven.
So some really smart person said, Get her some angel wings.
So they got her angel wings, put them on her, and said, If you happen to die in your sleep, you'll just fly to heaven. You'll know exactly what to do.
She slept from that night on.
I know. Isn't that a great story?
Oh gosh, that's wonderful.
Adults do that too. And we get so caught up in, you know, they're not sleeping, they need to be sleeping. It's very much a part of the process. And yes, sometimes you can give people medicine and get them resorted, sometimes not. That's just part of what they need to do.
We see people not want to be in their bed. They want to be in another place. They need to be on the couch or they need to sleep in the chair. And it's these little shifts that we watch for.
And then there is the visions that begin to happen. And you'll see people look outside, like out the window, out into the yard, and I'm often asked if it's medication related or disease related and I will tell you, the visions happen with all kinds of diseases, medicated or not, and they're different for people but they happen. And I let people make, encourage people to make whatever meaning they need to make out of those.
But as part of this trajectory of dying, the person will see people who I call "Friendlies" outside, so they're not people they know. They may see a baseball game. They may hear people on the porch. They may see somebody walking by. Sometimes they're people that are darker skinned than them, which I always find fascinating. White people see black people all the time, which I love.
And it's not a, there's not a fear there. It's just, Oh, there's somebody out there.
And then the dying person kind of comes back a little bit and they'll go, Okay, but reality is, there isn't really anybody out there, am I going crazy?
So part of what we do at Abode is normalize all of this. That these are things that happen and you may see people and you may dream about people and they're here to help you and this is part of the process.
The visions eventually come inside, and eventually the Friendlies become people they know. And eventually, the... If you're in a bed and looking at the end of it and you see somebody standing down there, that's one kind of vision people have.
And as they get farther into the process, and as they move into the cylinder, or closer into the cylinder, they'll begin to see people up midway around the room and then at the top of the room.
And you'll see people reaching. There's a back in time experience, where people are in, oh, the guy who did... Moody. Raymond Moody. Talks about your life review. And dying people have that. You'll see them go back, try to lasso a horse or, in my dad's case, he would put his stole on. He was a minister and he would open his Bible. And I knew exactly what he was doing. And other people would look at him and thought, What is Noble doing? He's back in Sunday school.
And further and further and further back people go. And then there's this reaching up as those are reaching towards something.
The other thing that happens is this use of metaphors. And the metaphors change as people are further into the trajectory of dying. And it's real subtle. You may be with someone for 12 hours and you may hear three of them. Or you may hear one of them. But they're indicators. And they're indicators that people are a little bit further along in their journey.
It's... I tell people they're not predictive. They are signposts. They just show you a little bit where people are and help you know that they're in process and doing what they need to do and I think that helps the people who are family members and friends to prepare their hearts maybe a little bit more too.
You wrote a book, by the way, I want to mention, called Signposts of Dying, and I'm sure this is the type of thing that you describe and explain in that book, correct?
Yeah, these are those kinds of things. Sure.
The pre-death visions, as you call them, we have these stories ingrained in our culture, and they're kind of part of our lore. Books and TV always portray them. The seeing of the loved one at the foot of the bed, talking to people that we can't see, the relatives that come to get you to take you on...
How many of those kind of pre-death visions are real patterns in the experience of the dying?
Oh, I think everybody has them. I think we just see probably 70% of them. 70% of the people we see, and the other people are so far in their process that they're doing their own thing behind closed eyes.
And I watch people, like they're dreaming but they're not dreaming. It's a very different away-ness that happens, as people are in the bed and they go away to another place and then they come back and then they go farther away and they come back for a little less time and it's not as deep here as it was before. You...
The quality of the experience with the people in the room changes. Because they need to be in that other place and it's... it is trackable and it does happen with just about everybody I see.
So this may put you on the spot, I don't know you can tell me if it does, but based on your observations, do you personally see compelling evidence that the soul is moving on beyond the physical body to another location?
I do think that now. And I have hedged my bets on that for a long time, but I do.
We cared for a woman not long ago who was just, if you can imagine, heels dug in and hands out, she did not want to go. It was all she could do to keep from dying and she was going to do it, and.... wasn't eating... I bet she weighed 70 pounds when she finally died. And she was angry. And she spent most of her time angry. And then she was getting up from a commode in the bathroom, somebody was helping her get up, and her heart stopped. And one of the navigators, our people who do the bedside work, we call them In the black navigators, and one of the navigators caught her and thought, Ohmygosh, she's died.
And then she came back! Her name was Anna.
And she was a little softer, and a little sweeter, and then she went away again, 4, 5, times she died and came back. One time, we were just talking about this last night, we gathered everyone around the bed and we were breathing with her because we thought this was it. And her eyes kind of opened and she looked around the room at all of us and she said, It's so beautiful! Can you hear the flowers? Can you see the colors and just this... all of this landscape that she was seeing.
And she... It wasn't crazy talk. It wasn't... I don't know... It was a continued preparation for whatever it was she needed to do and she got to the end of all that and she looked around and said, Can we have coffee?
Like, Ohmygod yes, we can have coffee. So we made coffee and we all had coffee together.
And she ended up dying a couple of days later. She wanted selfies that night. Part of her process was shifting this anger into an opening for her. And not everybody does that. Lots of people do. There's a feeling to it, there's a texture to it. There's an energy and the energy in the room shifts and I do think there's something else. I do.
You said that your attitude had shifted from the time you were, say, in your 20s doing this work to who you are now doing this work.
And so, is that the direction that you've shifted in? Has it allowed you to maybe relax or feel more peaceful in some way?
Yeah. I think that's a beautiful way to say it. Yes.
I helped care for my first human who died was an infant, and being in a hospital setting in the medicalness of all of that, and the fast moving people and the medical language and there wasn't much pause for honoring the spirit of that child. The mentor I had in that moment, happily, called me over, had me put my hand on the baby. She put her hand on the baby. And she looked at me and she said, Sometimes they forget.
They had done a code on this kid, and when they finished, everybody just ran out of the room.
And so this woman paused for a minute, and wanted me to pause for a minute, and I've never forgotten that. And as I have continued to care for people from my 20s to now, that piece of the dying process has gotten stronger and more rooted in me.
And that's primarily how we work with people at Abode. It's not the medical. We don't have IVs, we don't take blood pressure. It's not about any of that. It's about accompanying people. And I like that much better. And it feels, as you say, it's more relaxed and more peaceful and just... it just works better for me.
A little over a year ago, my mother found her companion of 20 years on the floor of his bathroom and he had collapsed, probably had had a heart attack, and after she called 911, as she was waiting for the ambulance, she sort of held his head in her lap and she talked to him as he died. And she says that she feels like he knew that she was there and could hear him.
And before speaking to you today, I was talking to her and you know sometimes I'll tell her about people that I'm interviewing or whatever, and I told her a little bit about you and why I was excited to have you on the show, and that I was preparing questions and everything, and she said, Ask her if they can hear us!
She really wants to know if they can hear us as they're going.
Yeah, I 1000% believe they can. And I 1000% believe the conversations we have in the room in front of them can help or hinder.
So if we, we had a guy with us a couple weeks ago who wanted to make sure his wife was cared for. They'd been married for 55 or 57 years, and so I purposely started a conversation with the children about how they were going to care for their mother, and then purposely started a conversation with the mother about how she was going to be cared for by the children, so he could hear all that. And he died later that night.
Did the same thing with another couple who had been married for a long, long time, and she was 87 and hadn't decided where she was going to live. And I started asking her questions in front of him and every once in awhile, I'd holler, Did you hear that? Did you hear that?
He hadn't been talking for a couple of days. And somebody probably would walk in and think I was nuts. That he couldn't hear all that. And we've surely had doctors come in and say, They're not in their bodies, they can't hear.
I don't believe that at all.
I believe that the people who are dying, by and large, make a decision when they're going to go. They pick the moment, if they can. They decide who's going to be in the room or not. And I have seen it again and again and again, waiting 'til that very last person pulls up in the parking lot and they walk in the door and they're gone a minute later. Or they wait until somebody goes to the bathroom or goes to the kitchen, which is 500 yards away, and they go and come back and the person's gone by the time they get back.
It's energy. It's energy. And what kind of energy they want or need in the room, and who they want or need in the room, and who they want to protect or not. Who can hold the space for them?
The 26 year old, died of colon cancer. The day her mother got a colonoscopy was the day the woman chose to die. And she, we called her mother that morning and her mother was all dopey and couldn't drive over and there was another woman at our place who had connected really, really well with Tai and very much a mother figure and Tai was restless and we, you medicate as much as you can medicate and sometimes there's still a restlessness. And as soon as that woman walked in and started stroking her brow, that child calmed. It was amazing. And very soon after that, she died.
She didn't want her mama there. Her mama was taking care of her babies, and her mama was taking care of herself. Very headstrong, neat, neat, neat woman.
But I'm, yes, tell your mother, Yes they can hear, and how kind of her to offer that reassurance to her person as he was leaving.
It's a good thing.
I think that's one of my biggest takeaways from this conversation is the idea of, we hear that so much. That they're hanging on, and that they don't want to let go because they're anxious about things that they're leaving unsettled. And to actually, to settle that in their presence so that they can overhear it, or that they can just feel on some level that some of those things that they're anxious about are being taken care of, I will remember that.
I will remember that and that will change how I handle that kind of situation, for sure.
One thing I really love to ask people on the show is, what do you think is missing from the conversation about dying?
What a great question.
We're at a really tenuous point in our American history, about how we are going to care for our dying in the coming years. There are 10,000 baby boomers a day turning 65, and in the next 15 years, we're going to have a plethora of people who are sick and need help and the way we operate now, we're mostly medical and a little bit holistic. And I think what's missing is how we were 50 years ago, but we need to innovate and re-engineer that, not 50 years, probably 75 years ago, when people died at home and we knew what to do. And we knew when somebody was dying, that it was okay to let them go. And we knew how to sit and be present and hold space.
That doesn't happen so much anymore because people get sick, they go to the hospital. We send them to rehab and then they get sent to hospice. There's a missing link of how to be present with somebody, and I think that's a vital conversation we need to start having again.
What, if you could change something, what would you change about end of life care?
I would enhance palliative care in our country.
Palliative care and hospice care often get lumped together and they're different. Palliative care is about alleviating suffering. And if we can get more people who have chronic illnesses with palliative care people earlier, I believe that would help the way people die and help them die better. Because we would be talking sooner rather than later, and waiting 'til that crisis happens in the hospital, or you know, however it happens.
Somebody falls down and hits their head. Do we put them on a ventilator for the rest of their life, or do we let them go? And what have they said? And having those conversations with the family, or having them with your chosen family, having them with your friends, about what you really want, and bringing in the people who are wiling to stand toe-to-toe with the so-called experts, many of them are, I say so-called because they're not experts on you. You are an expert on you and you need to let the people around you know what you want so you can express those, or they can express those wishes when you need them expressed.
In addition to your book, Signposts of Dying, is there any other resources that you would recommend for someone to go check out?
Yeah, there's a really beautiful book by Frank Ostaseski, who was Buddhist, who started Zen Hospice in San Francisco. His book is called The Five Invitations, and I think there's words after that, but you'll be able to find it with that. Really beautiful book about dying and dying well. Beautiful stories.
What else would I recommend?
There's a beautiful book called, When Breath Becomes Air, which is about a surgeon who finishes medical school and then finds out he's got cancer and how he grapples with that and how his family grapples with that. It's a really beautiful book as well.
I'll think about some others.
Yeah! I was going to say, I kind of put you on the spot with that question, but absolutely you can send me some things after the fact. I'm sure as soon as we hang up you're going to be like, Oh, I should have said this!
Oh yeah, Here's five more things...
So everyone can check the show notes and we'll have recommended resource links from you.
I wanted to throw in one. It just kind of came to me. But, the novelist, Isabel Allende who wrote House of the Spirits and a lot of fiction. She's, I think, Columbian. She wrote a memoir called Paula that is about the death of her daughter from cancer at a really young age. Like in her early 20s. And she talks about, I know it sounds, all this stuff sounds depressing, yet when you read it, it's such a beautiful reverent articulation of the experience and I remember, you know, her talking about what it means, the honor of being present when someone comes into the world and when they leave it.
It gives me chills thinking about it. So if there's anybody, especially who has lost someone recently, and they're looking for something to kind of talk them through the beauty of that, I definitely recommend that book and I'm going to stick that in the show notes too.
Yeah, that's a good one.
What's next for you? What's on your horizon?
The next thing for me, I'm going to start teaching people who want to engage more in death and dying work. I really, the way we're set up right now in this country to care for our dying is not going to be sustainable in 15 years. So part of what I want to do is to start to teach people. There's a number of folks who are doing doula training, which is from the birth doula movement. And they've transferred that to dying. And there are many, many similarities.
So I'm going to start doing that and doing some apprenticeship work at Abode. Bringing people to Abode so they can be with our people and see that they're people first and dying second, and think about their own life and ways to live meaningfully. Because I think, at the end of the day, we are all going to die. And how are we living now and how do we want to live? So helping people investigate that and move into more of that.
And I want to do the same.
That's a big job and I'm glad you're doing it.
You know what? Somebody may hear this and that may speak to them and they may be called to do that because of your conversation .
Martha Jo, it's been really wonderful capturing your perspective on something, you know, we talk so much about the veil on this show, we're often on the other side of it. So to get to capture your impressions from the side where you're at, the sort of threshold, is really cool.
Tell everyone where they can go to find you, if they want to read more about you.
So my personal website is marthaatkins.com and then Abode's webiste is Abodehome.org and you can find out all kinds of stuff about those places.
Wonderful. That was fantastic, Martha Jo. Thank you for coming on to the show.
You have got such a radio voice. It's awesome.
It is! It's brilliant!
Oh, that's sweet. Thank you. That'll be cute. That's a good way to end it. :-)