Stories from Dr. Yukari, Story 26, Archaic Smile

[ Stories from Dr. Yukari ]

Guided by the hope of St. Nichiren, we continue to work towards a peaceful society. Honolulu Myohoji Mission collaborates with Psychologist Dr. Yukari Kunisue, a trained and experienced therapeutic life coach, to offer a safe online space: Stories from Dr. Yukari


Miroku Bosatsu 

Maitreya Bodhisattva sitting in the half-lotus 

At Koryu-ji Temple, Kyoto, Japan



Sakura first came to the US to study music during her mid 20’s. Her dream was to teach and heal both children and adults by playing piano. After a few semesters in her master’s program, she was diagnosed with cervical cancer. After the diagnosis, her parents rushed to tend to the needs of their only child and I was asked to be a translator between the medical team and her parents. Unfortunately, her cancer progressed rapidly and spread to her ovaries, bladder, and then to her colon.

Her mother recently lost her sister who was in her late 50’s due to colon cancer. The trip from Japan to the United States was a heartbreaking journey for Sakura’s parents. They took turns staying by her bedside to watch over their daughter. Her father ran a manufacturing company developing precision medical equipment but dropped everything in order to spend time with his daughter. 

The first day I visited Sakura, her father asked the doctor if he could use pain relief patches, also known as Salon Pas as an effort to relieve some of his daughter’s pain. Sakura’s legs were also visibly swollen and they doctor approved her father’s request along with any other measures that can be taken to reduce her discomfort. Despite the medical team’s efforts, we all knew that death was imminent and that she was going through an active dying process.

Many of us do not have a medical background and are unfamiliar with the actual dying process of a person. I, too, had no idea how we actually die. I was unfamiliar with the process we go through and how our body is programmed, when the clock runs out on our precious life. Death is often depicted on films and on TV and it is a topic that we avoid to think about or talk about. 

The dying process is something I became familiar with when I was working as a hospice volunteer. Dying is still a gift of nature and it is a natural process of life. When considering the birthing process, a mother’s body knows and naturally prepares her body in order to give birth. The fetus and the mother’s body work together to actively prepare for this process. Whereas the other end of this spectrum involves the active dying process. In this case, the human body stops cooperating with nature and some stop eating, begin to withdraw from human interactions, begin hallucinating, or even “meeting” deceased relatives and loved ones. At this stage of the active dying process, death may be few weeks away.

It is common that during the last few days, one will often refuse to consume food or water. Blood pressure is also known to drop significantly along with noticeable changes to breathing patterns. Our skin can appear to be a different color and our feet may become swollen and cold. Occasionally, our consciousness may return to give us time to say goodbye to our loved ones. It is also known that our muscles may twitch and move involuntarily. Our throat makes a “death rattle”, a known indication that death is approaching. Around this time, our brain also secretes intracerebral narcotics, an endorphin that gives us a strong sense of euphoria. 

My friend Kayoko, the director of Nagomi homes, a hospice center in Hawaii, also taught me that she often notices a similar facial expression among her patient’s around their time of death. She called it the “Archaic Smile”, an expression named after Greek sculptures. Even after struggles of pain and discomfort, people later show a visible expression of relief and peace. It is a face that accepts and transcends life and death as we have seen in the Maitreya Bodhisattva. Kayoko also taught me that one of the most important parts of hospice work is giving palliative care and sending the dying patients off with the “Archaic Smile”.

Sakura passed away with her parents holding her hands. Her mother told me over the phone that she was only 27 years old. While I was not present at the time of her passing, I pictured the final moments of her life with a beautiful archaic smile on her face.