Bedside Yoga as a life affirming practice

It was more than a decade ago that I entered the room of Allyson, a sweet 23-year-old woman who was facing the last weeks, or possibly days, of her life. I was there to offer Bedside Yoga as a form of end-of-life care. She looked quite unlike most of the other people I had met at the end of their lives—her youth was striking. She sat nimble and upright in her bed; her face was framed by shoulder-length brown hair with purple ends. She was wearing a T-shirt and pajama shorts and her skin retained the luminous glow of youth. She still looked full of vitality.

“Come on in, sit down,” she said, as she smoothed the blankets next to her and patted the place where I should sit. Thus began our only session together. We started by talking about how her body was feeling, what she thought she needed, and what might help her to be more comfortable. I asked if she would like to do some gentle stretching and she said she would—that her body felt stiff and stagnant. 

After a period of easeful movement and candid conversation, I asked Allyson if she was afraid to die. Questions like these are integral to Bedside Yoga. Those of us who do this work are there because the person is dying and one of the things we value and talk about extensively is that dying is not a subject to be avoided. Dying is the reality of that person’s life, and discussing what is arguably the foremost topic on their mind can be profoundly comforting for them. 

She responded without hesitation: “I’m not afraid. I feel like I have accomplished everything that I wanted to in my time here. I only feel sad for the people who will miss me. I wish they could know it is all okay.” 

I can still recall the quality of the afternoon light that softly fell across her face when she said those words: “I’m not afraid.” There was a profound sense of clarity and acceptance in her voice. I have experienced this clarity in many others who are near the end of their lives. It seems as though they are able to access an inner knowing of something eternal—an energy that is birthless, everlasting, and ancient that seems to powerfully ground them in the face of the ultimate unknown.

Yoga and End of Life Care

I established a Bedside Yoga program in 2006 at a local end of life care facility before extending my reach to friends and community members, and then finally to my own sister, who died in 2018. My specific approach was born out of my work with yoga for grief and loss, a focus that began quite unexpectedly in my early years as an Ashtanga yoga teacher. I had a student who contacted me for private yoga sessions after losing her baby at seven months’ gestation. 

When she entered the studio for our session, I immediately saw that it was not Ashtanga she needed, but the profound gift of the breath and of simply being witnessed in her grief. Later, she suggested that I begin teaching yoga for grief as a regular group class. As soon as I put it on the weekly schedule, the classes routinely filled. People experience so much grief and loss that goes unaddressed and unacknowledged and they are often desperately alone in that experience. Supporting those at the end of their life seemed like a natural adjunct of grief support.

Over the years, three components of yoga philosophy and practice have proved to be the most important and useful in my experience addressing end of life care. If you teach this population, or plan to, perhaps you will find them helpful too.

Svadhyaya: Self-Study and Faith Foundations

Svadhyaya is a profound self-inquiry into the nature of who we are and what our purpose is. In classical, philosophical terms this sense of self is related to a “true Self,” a primordial consciousness.

It’s important for people who work in Bedside Yoga to engage in this kind of self-inquiry. If we don’t it will be difficult to connect with, and be a wise presence for, someone who is facing existential questions in a very immediate way. We must have some steady faith foundation that includes our own sense of “true self” in order to connect with that unlimited true self in the person who is dying. 

Only with this kind of inquiry, with a commitment to contemplation, can we guide people toward a sense of interiority, a capacity for stillness and quietude, so that they have the ability to find some semblance of comfort during the profound liminal experience of dying. This comfort comes from knowing who they are at their core. To be clear, there is no one way to define faith, and you don’t need to be religious or even a yoga practitioner to provide the kind of deep, spiritual care that is Bedside Yoga. However, connecting to something larger than ourselves (which some might call consciousness), is a crucial component of the work. 

Yoga’s Perspectives on Death and Dying

The yogic perspective on death and dying is also a critical aspect of Bedside Yoga. As we work with people, we can turn to core teachings, including the first and most central tenet of Raja Yoga (that we have a true eternal nature) and the principles laid out in the yamas and niyamas, among them the practice of being with what is (satya), non-attachment (aparigraha), and surrendering to the divine (ishvara pranidhana). 

We can also frame our understanding of the inner process of death and dying through an understanding of the kleshas (obstacles) outlined in the Yoga Sutra, including ignorance of our own divine nature (avidya) and our natural fear of death and clinging to life (abhinivesha). We can also find practical and theoretical inquiries into the nature of death and dying in the Bhagavad Gita and especially the Katha Upanishad (the only specific vedic text that is about death and dying, and is in fact often referred to as “Death as Teacher”).

The yogic perspective offers a spacious container as we move toward this most profound of life experiences. But, more than anything, before working with people who are dying, we have to work toward reconciling our own fear of death. Without doing this work within ourselves, we can’t hold compassionate space for others. The philosophical resources above, paired with our practice of self-study, can help us get there.

Movement Practices

The third and final component is asana, yoga’s unique approach to movement and physicality.

The movement practices in Bedside Yoga are all about how the person is presenting in the moment. 

They may be up and walking around, which would give us one set of ideas of what to offer, but they might also be drifting in and out of consciousness in their bed, which would invite an entirely different set of ideas. Just as in any yoga practice, the possibilities around movement are almost infinite, and should be based completely on the person we are offering them to, without any preconceived ideas about what is needed.

End of life looks very different for everyone. Some people are relatively active until their last day, others have been in bed for weeks; some people are at peace, others are afraid and looking for you to reassure them. We can’t have any agenda about what we want to do or what we think people “should” be doing during this time. This is a deeply sacred time in which we are being honored by being invited to be present. We want to show our gratitude for this honor, not squander it by trying to “do” or “accomplish” anything.

One of the things I quickly became aware of in this work is how end of life is typically considered a condition to be managed. Because it becomes a crisis of medical management, we often lose sight of the ability of the dying person to actually feel as good as they can in their body even as they are dying.

We also tend to have a lot of fear around hurting the person, or contributing to their pain or discomfort, which of course would be the last thing we would want to do. However, in my experience, including in the very last days of my own sister’s life, when very, very gentle movement and touch is offered not in the spirit of teaching or pushing in any way, but only as an available option, those who desire/are able to move and who are interested in trying, are almost always grateful and report feeling better, even when they are feeling really bad. The two can co-exist. I often think about when we are really sick with the flu how the last thing we want to do is move, but in fact our body aches from lying in bed. Sometimes, if we can rally just a tiny bit and move ever so gently, we will still feel icky with the flu, but our body can experience some relief. 

Concluding Thoughts

One of the most beautiful aspects of Bedside Yoga is that anyone can be trained in it, including chaplains, nurses, hospice workers, and volunteers—it’s not just for yoga teachers, yoga therapists, and yoga practitioners. 

More than anything, I have found this work to be life changing. Death is inevitable. When we guide people at the end of their lives, when we serve a family, and we act as companions to another on the journey toward death, being open to being in service for whatever they might need us in this precious and painful time, we are also given the chance to process our own mortality and our own capacity to serve, through a yogic lens.

Alysson died the day after I saw her. Her words still ring in my heart. “I wish they could know it is all okay.” 

In a collective sense, I understand what she means. Death was always going to happen. We have skills and practices that can ease the journey—both for those who are dying and those who will be left bereft. I often tell my students, “Death is not sad. Losing people, leaving life, feeling bereft and unmoored, are all terribly sad and difficult. And dying is often how those states occur. But we can decouple those things and hold space for both. Dying and losing people may be the hardest things we ever do, but they are only natural, and by many counts, beautiful and profound—we are entering back into the realm of Brahman (pure consciousness), the realm of pure love from which we came.

As end of life stewards, by using our understanding and practice of the deepest yoga we can enter into this okay-ness, as hard as it might be, and be of great and loving service to others facing this intense moment in their lives. We can show them that, in spite of the grief, in spite of the pain and sadness, it can also be okay. And that may be just about one of the most loving things we can offer to another human being. 

“The knowing Self is not born; it does not die. It has not sprung from anything; nothing has sprung from it. Birthless, eternal, everlasting, and ancient, it does not die when the body dies.” 

- Katha Upanishad 1. 2. 18