An Exemplar of Personal and Spiritual Knowing

Contributor – Vrinda Hymavathy

As a nurse practitioner, I have cared for many patients and families as they faced the end of life. Their experiences have taught me that people can approach death in very different ways. One patient, a relatively young man with a progressive neurological illness for which there was no cure, has remained in my memory. As his disease advanced, he continued to hope for recovery and was not ready to consider hospice, despite conversations about how his care needs were changing. When the disease eventually affected his breathing, he chose hospice care and died not long afterward.

I have cared for other patients who approached the end of life differently. Some seemed able to acknowledge that death was approaching and found a sense of acceptance and peace. Witnessing these different journeys made me reflect on a question that cannot be answered by medicine alone: What helps a person find peace at the end of life?

As healthcare professionals, we can treat disease, relieve symptoms, support comfort, and sometimes prolong life. But when cure is no longer possible, patients may be facing questions that extend beyond the physical illness: What does death mean to me? Am I ready? What gives my life meaning? What will bring me peace?

These experiences have reminded me that dying is not only a biological event. It can also be emotional, relational, cultural, and deeply spiritual. My own understanding of life and death has been influenced by the Bhagavad Gita, a sacred text within the Hindu tradition.

More than a sacred scripture, the Gita explores enduring questions about the nature of the self, the purpose of life, duty, suffering, death, and the search for spiritual peace. It unfolds as a dialogue between Arjuna, who is overwhelmed by the prospect of death and loss, and Lord Krishna, whom the Gita reveals as the Supreme Lord. Through this dialogue, Krishna guides Arjuna beyond his immediate fear and grief toward a deeper understanding of the self and the meaning of life and death. Chapter 2 is especially meaningful to me because it teaches about the eternal nature of the self, the temporary nature of the physical body, the inevitability of death, our responsibility to act without attachment to outcomes, and the possibility of finding steadiness in circumstances we cannot control.

These teachings have shaped my spiritual understanding of death, but they have also influenced the way I care for others. The Bhagavad Gita has made me more aware that, just as my spiritual perspective influences how I understand death, each patient may approach the end of life through a spiritual or personal perspective of their own.

For me, this is an important part of end-of-life nursing care. My role is not to give patients my understanding of death, but to make room for theirs—to ask what they believe, listen to what matters to them, and respect what may help them find meaning and peace as life comes to an end.

Looking Beyond the Physical Body

Healthcare necessarily focuses much of its attention on the physical body. We monitor its functions, identify disease, prescribe treatments, and intervene when those functions begin to fail. Chapter 2 of the Bhagavad Gita, however, invites us to look beyond the body when thinking about life and death.
In verse 2.13, Krishna describes the body passing through childhood, youth, and old age while the ātman, or self, continues through these changes. Verse 2.20 describes the self as neither born nor destroyed with the death of the body. Verse 2.22 uses a particularly simple image: just as a person discards worn clothing and puts on new garments, the self leaves an old body and continues onward. Verse 2.27 reminds us of the inevitability of mortality: for one who is born, death is certain. Together, these verses offer a spiritual understanding of death in which the death of the physical body does not represent the destruction of the self.

This perspective has helped me reflect on an important distinction in end-of-life care. Clinically, we may see a body becoming weaker and recognize the physiological signs that death is approaching. But the person experiencing those changes may understand what is happening through an entirely different lens.

A patient may view death as a transition rather than an ending. Another may anticipate an afterlife, rebirth, or reunion with loved ones. Someone else may not believe in existence beyond the physical body. Still another person may approach death with uncertainty, questioning beliefs that once seemed certain. Knowing the medical condition does not necessarily mean that we know what dying means to the person experiencing it.

Spiritual Understanding at the End of Life

The Bhagavad Gita has shaped my spiritual understanding of death. Yet one of the most important lessons it has given me as a clinician is not to assume that my understanding should become my patient’s understanding. Instead, it has made me more aware of the need to ask: What gives you strength when things are difficult? Are there spiritual or religious beliefs that are important to you as you think about the end of life? What would bring you peace?

Questions such as these can open conversations that a routine medical assessment may never reach.
Spirituality at the end of life is not limited to religious affiliation. It may involve meaning, hope, relationships, forgiveness, connection, beliefs about suffering, or questions about what happens after death. A patient may want prayer or a sacred reading. Another may want family nearby, music, silence, nature, or an opportunity to repair a relationship. For some, simply being heard may be what matters most.

Spiritual beliefs can also shape how patients and families understand suffering, make decisions about treatment, and define a “good death.” This is why knowing that someone belongs to a particular religious tradition is not enough. Individuals within the same tradition may understand illness and death very differently.

We have to know the person. This connects naturally with Nursology.net’s concept of Personal and Spiritual Knowing. Nursing knowledge includes what we learn through science and clinical evidence, but knowing a patient also requires attention to the person’s experience, values, meaning, and spiritual understanding.

Caring When We Cannot Control the Outcome

Another teaching in Chapter 2 resonates strongly with end-of-life practice. In verse 2.47, Krishna teaches that we have a duty to act while not considering ourselves entitled to the fruits of our actions. Verse 2.48 continues this teaching by encouraging steadiness in success and failure.

As healthcare professionals, we are accustomed to working toward outcomes. We want medications to work, procedures to succeed, symptoms to improve, and patients to recover. Yet there are times when the course of an illness reaches a point that another treatment cannot reverse. This can be difficult for patients, families, and clinicians. A transition from disease-directed treatment toward comfort-focused care may be perceived as “giving up.” But recognizing the limits of treatment does not mean recognizing the limits of care.

There is still much that nursing can offer. We can relieve pain and breathlessness. We can communicate honestly about what is happening. We can protect dignity, honor a patient’s wishes, support families, and advocate for care that reflects what matters most to the person. We can also recognize spiritual distress and make space for practices or relationships that bring comfort.

Sometimes, we can simply remain present.

For me, the teaching of verse 2.47 offers a meaningful way to reflect on this aspect of end-of-life care. Our responsibility to care does not lose its value simply because we cannot determine the final outcome. At the end of life, we may not be able to prevent death, but we can profoundly influence how a person is cared for while dying.

From Fear to Peace

We often speak of wanting patients to experience a “peaceful death,” but peace cannot be defined in the same way for everyone.

For one person, peace may mean freedom from pain. For another, it may mean being at home or surrounded by family. It may involve prayer, reconciliation, completing a spiritual ritual, saying goodbye, or simply knowing that one’s wishes will be respected.

Chapter 2 of the Bhagavad Gita speaks about developing steadiness in circumstances that cannot be completely controlled (2.48). I do not understand this as an absence of emotion. Grief, sadness, and peace can coexist. A patient can grieve leaving loved ones and still experience acceptance. A family can feel tremendous sadness while finding meaning in being present. A nurse can mourn the loss of a patient while recognizing that providing comfort and dignity was meaningful care.

Perhaps peace at the end of life is not the absence of sadness. It may be the presence of meaning, dignity, connection, acceptance, or whatever peace means to that particular person.The Bhagavad Gita was written long before modern hospitals, hospice programs, advance directives, ventilators, or palliative medicine.

Yet the questions raised in Chapter 2 remain deeply human: What is the self? What does death mean? How do we act when the outcome is beyond our control? How do we find peace when facing something we cannot change?

The Gita has helped me reflect on these questions in my own life. As a nurse practitioner, however, perhaps its most important lesson has been to remind me to ask how my patients understand them.
At the end of life, caring for the whole person requires more than asking, “What else can we do medically?”

Sometimes we also need to ask: “What matters to you now?”

And then we need to listen.

Making room for a patient’s own understanding of life, death, meaning, and peace may be one of the most deeply human forms of nursing care we can offer.

References

A C Bhaktivedanta, Swami Prabhupada. (2014). Bhagavad Gita as it is. Bhaktivedanta Book Trust.
Verses discussed: Bhagavad-gītā 2.13, 2.20, 2.22, 2.27, 2.47, and 2.48.

About Vrinda Hymavathy

Vrinda Hymavathy is a family nurse practitioner with more than 20 years of nursing experience and over a decade of experience as a nurse practitioner. Her clinical experiences caring for patients and families facing serious illness and end-of-life decisions have shaped her interest in advance care planning, spiritual care, and compassionate end-of-life care. She is currently pursuing a PhD in Nursing Science at Texas Woman’s University, with scholarly interests focused on advance care planning and end-of-life care. Her perspective is shaped by her experiences as a clinician and her belief in caring for the whole person, including the cultural, personal, and spiritual values that give meaning to life and death.