Exploring Consciousness at the Lost Borders of Hospice and Wilderness - the InnerView with Scott Eberle, MD by Werner Brandt

There is also an audio version of this interview

“to be blessed in death, one must learn to live.
to be blessed in life, one must learn to die.”

Scott Eberle, MDScott Eberle, MD, is Medical Director of Hospice of Petaluma, California, and a physician specializing in end-of-life care. He is also a wilderness guide at the School of Lost Borders. In the 1980s he learned the art of medicine at the bedside of many people living and dying with AIDS. He survived this difficult time by regularly seeking sanctuary in monasteries and the natural world, completing over 100 retreats during a 15-year period. He is also author of The Final Crossing: Learning to Die in Order to Live, in which he writes about his experience attending the death of Stephen Foster, a Rites of Passage guide and founder.
~ Contributing Editor/IT Specialist Werner Brandt interviewed Scott Eberle in October, 2010.

Welcome, Scott, Thanks for the opportunity to talk with you.

It’s great to be here with you.

I am curious, being trained as a physician, and working with hospice for so many years, how did this work lead you to becoming a wilderness guide?

I became a physician during the time of the AIDS epidemic. So, very early on in medical school and residency I was overwhelmed by what was surrounding me. As a matter of professional and personal survival, I started to go away on retreats, initially in monasteries because they provided a safe container, but then more and more learning the best place was in the natural world. Eventually the practice became a minimum of 4 to 5 days every month. Most of those were camping or road trips, invariably where natural beauty provided a sacred setting for the inner exploration I was doing. That eventually evolved into my first vision fast, where I discovered this beautiful way to offer that same kind of container to others with a similar need to do inner and outer reflection. So it’s been a long journey and I love the work. I feel like I’ve found the calling of the first order.

You write, “So now I am a physician who specializes in supporting life transitions. I am a hospice doctor who sits with the dying in their homes, and I am a rite-of-passage guide who sits with ‘the dying’ out in the desert.” One death is physical, the other symbolic. How can this “dying out in the desert” prepare us for the final crossing?

The beauty of the vision fast work is it’s the same kind of work I do at the bedside of a person who is physically dying. A vision fast in the desert brings up the big questions—how to address issues of legacy, keeping relationships clean and current—to a person when they are alive and well—hopefully years before they face closure of life.

When we talk about a symbolic death, it could be a loss of a loved one, loss of job, even an unexpected illness.

Any major change in our lives, yes. In particular, I would underscore changes in how we define who we are in the world. Certainly relationships and jobs are a big part of that, but any way in which we begin the story of, “I am...”. Those ways of self-defining have to evolve over life, otherwise they become clearly stuck and potentially a walking dead sort of thing.

In a flyer for one of your courses, you ask, “Are you willing to risk everything (which ultimately we all must do) that your rebirth might bring you a life purpose strong enough to carry you all the way to your final dance with Death?” What is one really signing up for here?

Doing a vision fast or wilderness rite passage will not make your life easier, but it will make it more authentic. That’s what I’m here for, that’s what I’ve signed on for in this lifetime. And the invitation is for other people who have a similar calling to be as present and real and authentic about their own true-life story, to come and explore that. I can’t imagine a better way to serve that work than in the natural world, especially the desert. There is something quite miraculous about wide-open skies, with life on the edge of precarious living and dying, that invites a human being to recognize his or her own animal nature, and to look at the big life-and-death kind of questions. It’s not for everyone to be really honest. But at the same time, fabulous and wonderful stuff happens out there. I can’t say it enough.

The central themes in your book are centered around ancient teachings based on what you refer to as Decision Road, leading to Death Lodge, Purpose Circle, and the Great Ballcourt. Can you explain what this framework represents?

Major rites of passage are a kind of symbolic death. Arnold van Genapp, the man who coined the term “rite of passage”, recognized three different phases of such a rite, and it becomes a kind of map: Severance (dying), Threshold (between the worlds), and Incorporation (being reborn). There is an old Mayan teaching, Decision Road, that is an expansion on that same map. Decision Road is saying, ‘I’m going to show up consciously, put my feet on the road that leads ultimately to own my death, be it symbolic or physical. I’m going to do that with as much consciousness as I can.’ Decision Road leads to the Death Lodge—a stop metaphorically at a lodge where a person who is dying is brought to, and the community knows, if I am going to finish my business with this person, now is the time. Often, this is the place for forgiveness and healing old wounds, but it is a place for love and gratitude as well. The idea is, if you’re going to die, be it symbolic or physical, you have to finish up the relationship stuff in your life, so it doesn’t hold you back from the transformation that is to come.

This could be with people living, or who have passed away even.

Absolutely. It is much easier to do this kind of work with people who are still alive, because you can have a real exchange. But forgiveness and healing around a relationship can continue even with people who are gone. So the teaching continues. Once you have done that relationship work, Decision Road then leads you to the Purpose Circle, a place beyond the world of relationships and other people. It’s a place where a person sums up their own life. They really try to make peace with themselves. If they’re a religious person, they make peace with their God. Or if you think in terms of the Great Spirit, you make peace inside with your own journey up until that point. Issues that become really critical are often self forgiveness, owning up to personal failures, and making peace with that, but also celebrating the joys, strengths, talents, victories and whatever else you have managed to make manifest. The Purpose Circle is also often called the Circle of Self. It is a place for becoming as current as possible—all of who you’ve been in all of who you are, up until this final transition.

The Great Ballcourt is also a metaphor that comes out of the Mayan teachings. So the dying work is Decision Road, Death Lodge and Purpose Circle. The in-between worlds is actually making the journey across to the other side. For someone physically dying, there are examples of what in-between worlds might look like, such as Purgatory or the Buddhist Bardo states. But for people who are still very much in the middle of their lives, going through a major rite of passage, they’re in-between the old identity, the old relationship, the old job that died, and yet they don’t have a new identity, a new relationship, a new job. It’s often referred to as the time of being ‘no name’, really a difficult place, especially in our culture that doesn’t support such uncertainty. Yet at the same time it is really rich fertile ground with lots of possibility and lots of potential, lots of opportunity for-self definition and shifting to more authentic ways.

Some of this work seems to suggest that there is a correct way to die—if I don’t do this work, I won’t be prepared. Any thoughts on this?

You raise a loaded question and a very important one. A basic teaching I offer hospice volunteers is, whatever your own stories about dying, you leave them at the door when you walk in to be with someone who’s going through their own physical experience of dying. Because the truth is, what might be right for me is not necessarily right for the person I am going to serve. So it is really important not to have a big judgment about what’s the right way to do this. For me, there is a lot to be said about being conscious, about how you do things, but also recognizing even if I do this consciously, I’m a fallible human being who makes mistakes and messes up relationships, and does things badly, and all that. My right way inevitably means I am going to make mistakes, and I just want to be as aware and conscious about that as I can.

In your years as a wilderness guide with the School of Lost Borders, what can you say about the people who are attracted to this type of process?

Actually I’m reminded of going to your website Alternatives Magazine. You use the phrase “cultural creatives”. I love the kind of people who come to a vision fast or rite of passage program, people who want to re-instill the culture of our world, but who also live their own lives with creativity and awareness and consciousness. The richness of the work comes from the varied stories that people bring. It is a great blessing. I was once asked while doing a talk at the San Francisco Zen Center hospice volunteer program, what percentage of people who are dying physically are willing to do this in a real conscious way? And the truth is, in my experience, it is only about 10 to 20% of people. It’s that same 10 or 20% who tend to show up in the desert, wanting to do the work well before they get to their physical dying.

For myself, the attraction to this type of work is how I participate more fully in life. It gets back to the title of your book, learning to die in order to live.

On the title page of the book there is a wonderful medieval quote:

to be blessed in death, one must learn to live.
to be blessed in life, one must learn to die.

For me, that is the essence of the book, and the essence of how I live my life. I want to show up and learn how to do the symbolic dying right now, as well as I can, so I can be fully present with my life now. If I really show up to live my life as fully as I can, when my time comes I will be that much more ready for the physical dying.

There is a poem by Rainer Maria Rilke, “What I Want”

You see, I want a lot.
Maybe I want it all:
the darkness of each endless fall,
the shimmering light of each ascent.

Spiritual Practice is often associated with the upper world journey or ascent, while soul work is associated with the underworld journey or descent. How does the work you do encompass these two worlds together?

I’m of the opinion that the way we become more enlightened and aware of our lives is that we have to go to the deep dark places as well as to the high places. You can’t do one without doing the other. I have my own Buddhist practice and I sit every day. A lot of that is about going to the deep dark shadow corners of my psyche and shedding some light so all of it is part of what I bring into the world, not just the upbeat, happy, enlightened love and light type of experience.

Sometimes this is referred to as a spiritual bypass, where you just dwell in the positive and ascension part, but avoid the shadow and the dark.

The ascension part is great, I don’t want to give love and light a bad name ... but can we be really all of what we are in this world, which is the light and the shadow?

In our modern technological culture, the pace of life seems to be ever increasing. How do we invite people to slow down, to begin the journey towards exploring their own inner voice or calling, their own story?

The most important thing we offer you out in the desert is the opportunity to cross off a bunch of days from your calendar, where you don’t have to do anything but dive into your own story. And then, the great challenge on the back end of 10 days in the desert becomes, how do you bring that spaciousness back into your regular life? It all begins with creating again the spaciousness, the open time, as you get back into your daily routine. It’s why I sit every day. And every Sunday, I don’t do computers, I don’t do phones. After I finish my morning sit, the first thing I do is go outdoors 4 to 5 hours minimum, going for a walk just to be able to keep that spaciousness. This is part of the weekly routine, not just when I go out to the desert.

Can you talk about our connection with the natural world that nurtures us in this special way?

You have to be careful not to romanticize the natural world. If you go out in the wrong weather with the wrong clothes, it’s nasty and dangerous. The natural world needs to be respected. When we do our programs, safety first is absolutely a foundational part of the practice. But as long as you have taken care of yourself in a good way, the natural world is this exquisite mirror. We mirror it and it mirrors us. The wide-open space of the desert, for example, invites the human experience inside to have a wide-open inner spaciousness. By contrast, going into the loud cacophony of the city invites you to be chaotic and noisy inside. It is very important to be careful to choose where we go if we want to do deep inner work.

Without even knowing what I was doing 15 or 20 years ago, I found myself more and more drawn to beautiful natural settings—because what I was doing inside was mirrored by what was going on outside. Another piece of the answer goes back to the very first time I did a four-day vision fast in Hanupah Canyon, in Death Valley. It was over the new millennium. What was just mind blowing at the time, like never before, and I was already in my 40s, was feeling that I was a tiny speck in the vast Cosmos as I would watch the night sky slowly inching across in front of me, and getting, in a visceral way, that I could not possibly get in the confines of my house in the little town in the Bay Area, that I was a speck of dust in the universe. It sounds sort of cliché, but go out there for four nights and four days, it stops being cliché and becomes the deepest wisdom I have probably ever known.

And it’s more than just being out there for days and nights, it’s with no food and minimum shelter.

The three taboos of the School of Lost Borders is: first, no four wall shelters, you bring a tarp and plenty of warm clothes and you stay safe, but you don’t live with walls around you, including the walls of the tent. Part of what I described with being that little speck on the hillside with the big vast night sky, I wouldn’t have experienced that if I was inside a tent. You don’t get that connection with the hugeness of the natural world. Second taboo is, no food but plenty of water. The fasting has lots of different dimensions to it. One is the way we use food to fill ourselves up physically, but also emotionally and spiritually. Then there is also just the physiology of fasting and how that is an altered state, particularly by the fourth day. Humans have done fasting as a spiritual practice for millennia, and not by accident. It is an altered state that invites slowing down and deepening of the real kind. And the third taboo is, doing it alone. We have other people fasting and there is a base camp that provides a safety net, a lifeline if there is any trouble. But for the four days and four nights they are there by themselves and finding their own self-definition—from their own inner world and the mirroring of the natural world—rather than the ways human relationships define how they see and feel and experience themselves.

There are a couple other elements that are really critical to vision fast. One is doing it in a circle, because there is something about having compatriots who are doing the same kind of journey that makes it that much more powerful. And the other is doing the journey with intention. Spending a really good time trying to get clear why I am doing this. What am I marking and what is the vision I am trying to call into my life. For me, after all those solitary retreats, those were the two elements that were missing. I was doing a lot of alone time and inner journey, but I didn’t have the community or the clarity how to do intentional practice.

And, purposefully I imagine, this process invites fear.

Yes, absolutely! Fear is an important part of the ceremony. First of all, whatever fear you have is an ally because the fear is asking you to have your senses heightened so that you stay safe. That’s really critical. But the other element of fear is how it elevates the ceremony. You are not just going out camping for four days and four nights. You’re going out elevating your story and experience and bringing alive all of who you are. Fear does that for us. It is a double-edged sword. You always want to make sure people are not pushing their envelopes so much that the fear overwhelms them. But at the same time, a healthy dose of fear and anxiety brings us alive and that’s a good thing.

Some people reading this would think, ‘why would I want to do this’, right?

On the School of Lost Borders web site, one of my favorite lines goes something like: “OK, now that you have had this crazy idea, throw it away and go back to your life.” This work is not to make life easier, but for the right kind of person ... I count my life kind of before and after my first vision fast. Truthfully, it’s fair to say, that single event changed who I am in the world. I have done a lot of spiritual stuff and medical school and on and on, but that was the big one; that was a threshold.

You refer in your book to the shared experience between hospice work and rites of passage, and the magic and electricity that was present between Stephen Foster and you.

Stephen was so full-on present for what was going on! You get a few people in your lifetime doing this work who are so fully all there that what they ask of you, as a hospice physician, is that all of you show up. There was that electricity with Stephen and I that has happened only a few times in my career.

They become your teachers.

Absolutely. All throughout my career the most important teachers who helped me learn how to be the kind of physician I want to be in the world are the people who I’ve gotten to take care of at their deathbed. The special people who really show up for it, asking the big questions—those are the people I want to sit with and listen to, and learn from, and then have that open up how I do my own journey as well.

What is the most challenging part of this work that is an edge for you?

In the hospice world I live for the full-on big story—but there are a lot of visits I do where what we talk about is pretty superficial. I’m OK with that. I don’t need people to feed my need for intensity, and yet there is a lot of same-old-same-old, visit after visit. But the truth is, I don’t do more than two or three visits a week because most of my role as director is backing up the nursing staff—the hospice and nursing and social worker driven model. I’m holding the container for the work they do. Then, every now and then, there is that exquisite visit that each of us—nurse, doctor, social worker—lives for when we do the hospice work.

In the realm of wilderness work, the biggest edge is, will people be physically safe? I have no doubts or misgivings about where people go emotionally, psychologically, and spiritually, that’s the stuff we’re out there to live for. But you don’t want people to get hurt or die. We had a wilderness guide who was with us in this last program who actually had someone die in one of her programs a couple years ago. It wasn’t a vision fast program, but it was a wilderness program. That will never change. One of my standard lines in the wilderness is, “We’re doing symbolic death work out here; not physical dying work.”

What is the one most important thing you might want to say to our readers that you have gathered from your own personal experience through life.

The biggest and most important lesson I have ever learned from being at the bedside of people who are dying is the Death Lodge piece, the completing relationships, which is to say, I don’t want to wait until I am on my own deathbed, or someone who I really deeply love and they’re dying, I don’t want to wait for that waning energy last bit of life, to be doing the work of forgiveness and healing of old wounds. I want to do forgiveness work—not every day, I hold on to grudges just as much as anyone—but to really try to be current around the personal transgressions so when the time to close up comes, it’s really the love and gratitude. The corollary of that becomes, can I live my life from the place of love and gratitude now, as much as possible? That is what I am here to do.
The desert work is the invitation to open my heart, take all these incredible stories from other people and give it back with as much love and gratitude as I can. That’s where I am at this stage of life.

Thank you, Scott for taking the time to share your wisdom with us.

It’s a pleasure to do this with you. I live for the opportunity to have real conversations. And you certainly have given me a wonderful opportunity for that.

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This interview was published in Alternatives Magazine

The real ceremony begins where the formal one ends, when we take up a new way, our minds and hearts filled with the vision of earth that holds us within it, in compassionate relationship to and with our world.

Linda Hogan