How to Be Sick

by Toni Bernhard

  It’s a challenge to make peace with the Buddha’s list. This is partly because we’ve evolved to seek pleasant experiences and to avoid unpleasant ones. After all, doing so might be crucial to our survival; if we were living in the wild and didn’t run fast from some unpleasant experiences, we’d have ended up as some animal’s dinner! In our modern world, however, this bias to continually seek what’s pleasant and react with aversion to what’s unpleasant doesn’t always serve us well.

  The first noble truth helps me gracefully accept being chronically ill. The Buddha’s list assures me that my life is as it should be because it’s unfolding in accord with the human condition, difficult as that can be at times. “Our life is always all right,” says the Zen teacher Charlotte Joko Beck in Everyday Zen. “There’s nothing wrong with it. Even if we have horrendous problems, it’s just our life.” Her words resonate powerfully for me every time I read them.

  For me, “just my life” has meant ending my professional career years before I expected to, being housebound and even bedbound much of the time, feeling continually sick and often in pain, and living with the anxiety that pops up now and then that the cancer might return. Using Joko Beck’s words, I’ve been able to take these facts that make up my life as a starting point — to bow down to them and to accept them. From there, I work on looking around to see what life has to offer.

  And I’ve found a lot.

  The End of Dukkha

  In the second noble truth, the Buddha said that what gives rise to dukkha is a specific type of desire I often refer to as “Want/Don’t-Want Mind.” The Buddha referred to this unskillful desire as “the unquenchable thirst.” We experience it as an intense wanting — even a felt need — to have only pleasant experiences and not to have unpleasant ones. But neither of these two desires can be satisfied because they don’t reflect the realities of the human condition.

  When we react to life’s unpleasant experiences by launching a militant battle against them — for example, by denying that we’re chronically ill or by turning away in aversion from the need to grieve our losses — we create dukkha (suffering, stress, dissatisfaction). We also create dukkha when we expect to have only pleasant experiences, even though no one’s life is pleasant all the time. In short, when we’re unable to accept that our lives will be a mixture of joys and sorrows, pleasantness and unpleasantness, successes and disappointments, we make things worse for ourselves because we’re adding dukkha to the mix.

  In the third noble truth, the Buddha proclaimed that the end of dukkha is possible. It’s important to note, though, that bodily pain and suffering are an inescapable part of the human condition. Everyone experiences them at some point in life. The good news is that we can reach the end of suffering in the mind — even while in this suffering body.

  In the fourth noble truth, the Buddha set out the lesson plan to accomplish this: the Eightfold Path. Most of the elements on this path make an appearance in this book. Wise understanding, which refers to seeing the truth of the human condition so we know what to expect in life, is the subject of this chapter and the two that follow. Wise intention — which manifests as kindness, compassion, empathetic joy, and calm abiding — is the subject of chapters 6 through 9. Also covered are wise speech, wise action, wise mindfulness (keeping ourselves in the present moment), and wise effort (effort that helps alleviate suffering in ourselves and others).

  With the end of dukkha comes enlightenment, awakening, liberation, freedom — I suggest you pick a word that resonates best with you. We may not be able to complete the lesson plan of the Eightfold Path in this life; we may not become fully enlightened beings any time soon. That said, a glimpse of awakening, a moment of liberation, a taste of freedom is available to us all — and it can take us a long way toward easing our experience of dukkha.

  4

  The Universal Law of Impermanence

  Better a single day of life seeing the reality of arising and passing away than a hundred years of existence remaining blind to it.

  — THE BUDDHA

  A CRUCIAL STEP ON the path to freedom and peace of mind is understanding what the Buddha called “the three marks of experience” — three experiences that are common to the life of every human being. We looked at the first mark — dukkha — in the previous chapter. The other two are impermanence (anicca) and no-fixed-self (anatta). They’re the subjects of this chapter and the next one, respectively.

  Impermanence is recognized as a universal law in other spiritual traditions and in science as well. At a Spirit Rock retreat in the late 1990s, Joseph Goldstein gave what has become my favorite description of impermanence as I experience it in everyday life: “Anything can happen at any time.”

  Initially I reacted to his statement the same way I reacted when I first encountered the Buddha’s teaching that everything is impermanent; I thought, “Yeah, tell me something I don’t know.” But when I didn’t recover my health, I began to deeply contemplate the meaning of “anything can happen at any time” — such as getting sick and not getting better, such as having to give up my profession, such as rarely being able to leave the house. Yes, anything can happen at any time.

  How are we to find any solace in this universal law? The thirteenth-century Zen master Dogen offers a clue in the Eihei Koroku:

  Without the bitterest cold that penetrates to the very bone, how can plum blossoms send forth their fragrance all over the universe?

  When we begin to see the truth of impermanence, there’s a tendency to focus on Dogen’s “the bitterest cold that penetrates to the very bone.” Having had to give up my profession still feels like that on some days. The challenge becomes finding the fragrance sent forth by those plum blossoms. Without the bitter cold of being bedbound most of the day, I wouldn’t be so attuned to the changing seasons; I never realized they are on view right outside my bedroom window. Without the bitter cold of having to give up my profession, I wouldn’t have discovered the joy of growing trees in my bedroom. (Yes, bonsai, but trees nonetheless!) I return to Dogen’s verse over and over for inspiration.

  The writings of the Vietnamese Zen master Thich Nhat Hanh have also helped me see the beauty inherent in the fact of impermanence. In his biography of the Buddha, Old Path White Clouds, Thich Nhat Hanh points out that impermanence is the very condition necessary for life. Without it, nothing could grow or develop. A grain of rice could not grow into a rice plant; a child could not grow into an adult. There are so many ways in which I’ve “grown” only because of this illness, from a heightened awareness and compassion for the chronically ill and those who care for them, to a deep appreciation for the hard-working people who go unnoticed but keep our infrastructure running. (I see them from my house — delivering mail, climbing power poles, cleaning the streets — whether it’s over a hundred degrees outside or pouring rain.)

  Uncertainty and Unpredictability

  With impermanence comes uncertainty and unpredictability. These two characteristics of the human condition can be a deep source of anxiety and stress for us because we crave the opposite: security and assurance. We wish we could control what happens to us. If we could, life would never be difficult or painful. We’d make sure of that by ordering up only pleasant experiences. “Body: feel good all the time, and don’t get old! Mind: get calm, and I mean now!” Has barking orders at yourself ever worked for you?

  We control much less of our experience than we realize. Not only do we lack the control we’d like to have over our bodies and our minds, but we also don’t control what’s going on around us — from how people treat us to the tragedies and violent conflicts around the world. Recall the second noble truth and how our Want/Don’t-Want Mind operates. We want pleasant experiences and we don’t want unpleasant ones. We want people and the world to conform to our wishes, and we don’t want to feel that we lack control of our bodies and our minds.

  Here’s one way to work on coming to terms with life’s uncertainty and unpredictability. First, with kindness and comp
assion, gently acknowledge that we’re not sure how our lives will unfold and that this can feel mightily uncomfortable — even scary — at times. Second, work on keeping our attention in the present moment so as to avoid spinning and feeding stressful stories and scenarios about a future we cannot predict anyway. The more we’re able to do this, the less we’ll suffer.

  Weather Practice

  Here I offer a practice to help us make peace with life’s uncertainty and unpredictability; I call it “weather practice.” It was inspired by, of all things, the 2005 movie The Weather Man, starring Nicolas Cage as a character named Dave Spritz.

  Dave is adrift in life, even though he has a steady job as the weatherman for a Chicago TV station. In reality he’s just a “weather reader,” dependent on a meteorologist to tell him what to say. When the meteorologist gives him a forecast with an eighteen-degree variance, Dave complains that he needs something more concrete. The meteorologist responds, “Dave, it’s random. We do our best.” One day the meteorologist preps Dave for his TV spot by saying, “We might see some snow, but it might shift south and miss us.” When Dave protests that the viewers will want a more certain forecast than that, the meteorologist tells him that predicting the weather is a guess. “It’s wind, man,” he says. “It blows all over the place.”

  I found this amusing at the time, but it’s turned out to be extremely useful in life. When uncertainty and unpredictability throw me for a loop, I like to say to Tony, “Here it is again, life and the weather. Just wind, man, blowing all over the place.” Then returning to the verse from Dogen, I remind myself that the wind that’s blowing the bitterest cold at me may be setting the stage for something joyful to follow.

  I work on treating thoughts and moods as wind, blowing into the mind and blowing out. We can’t control what thoughts arise in the mind. (Telling yourself not to think about whether you’ll feel well enough to join the family for dinner is almost a guarantee that it’s exactly what you will think about!) And moods are as uncontrollable as thoughts. Blue moods arise uninvited, as does fear or anxiety. By working with this wind metaphor, I can hold painful thoughts and blue moods more lightly, knowing they’ll blow on through soon — after all, that’s what they do. Here are two examples of Weather Practice in action.

  One night I felt so sick that I wanted to throw out all the work I’d done on this book. Dark thoughts. A blue mood. My eyes welled up with tears. But instead of those tears turning into sobs, I took a deep breath and began this weather practice, remembering that thoughts and moods blow all over the place and that if I just waited, these particular ones would blow on through. And they did.

  When it became clear that the Parisian Flu had settled into a chronic illness, Tony and I began to consider if it was feasible for him to go on a retreat for an entire month during which he’d be out of contact with me unless I called with an emergency. I badly wanted him to go because I saw it as a way I could feel like a caregiver for him. He went for the first time in 2005 and each February thereafter. The retreat became a major annual event for him. The preparations he made ahead of time were like those that people make who are in the path of a coming hurricane. He brought a month of supplies into the house. He filled the freezer with food he’d cooked ahead of time. He set up people in town for me to contact if I needed help. My promise to him was to be extra careful in everything I did and to call him home if I needed him.

  The forecast inside our house for February 2009 called for “calm weather” despite my illness. But at nine A.M., two days after Tony left, things changed in a split second. One moment I was at the top of the two steps that lead down to our bedroom; the next moment I was writhing in pain on the bedroom floor, having slipped down the steps and landed on my right ankle.

  When the pain began to subside, I pulled myself up on the bed and went straight to my laptop to research the only question on my mind: Was I going to have to go to the doctor? Medical appointments can be an ordeal for the chronically ill — the round-trip drive, the possibility of a long wait, the energy it takes to effectively communicate with the doctor. It’s so much easier to have a caregiver along. When I go to the doctor, Tony drives me, stands in line to check in for me, and accompanies me to the examining room. I never schedule medical appointments during February.

  Despite the rapidly increasing swelling and discoloration on my ankle, my Internet research convinced me that I only needed to go to the doctor if I still couldn’t put weight on it in twenty-four hours. So I waited. When I needed to go somewhere off the bed, I crawled. Our dog, Rusty, acted as if I’d finally seen the light and was joining his species. This appeared to be a cause for great celebration for him, so my added challenge became to make sure that in his exuberance he didn’t step on my right foot.

  That first day, as I lay in pain on the bed, I thought of the meteorologist’s comment to Dave the weather reader: “Dave, it’s random. We do our best.” Tony and I had indeed done our best to prepare for a calm February, but, as we all discover again and again, anything can happen at any time. We can take precautions, but predicting the future is as futile as predicting which way the wind will blow.

  The next morning, when I still couldn’t put weight on my right foot, our friend Richard took me to the doctor. Diagnosis: fractured fibula. The forecast: no weight bearing on it for several weeks; a cast so heavy that it took all my energy to move my leg; crutches and crawling to get around. I toughed it out for one more day. Even with people offering to help, the injury on top of the illness proved to be too much. One or the other I could have handled alone but not both. I knew I needed to call Tony home when, before going to sleep for the night, it took me ten minutes to negotiate a trip to the bathroom even though it’s only footsteps from the bed. After making one round trip, I lay back on the bed in exhaustion and then realized that the light over the bathroom sink was still on — a light that shines right in my eyes. I had no choice but to start the process of getting to the bathroom and back all over again.

  So Tony came home four days into his treasured month-long retreat and, for a month, traded his caregiver role for that of nursemaid. Life and the weather — one moment it’s calm and the next moment a nasty storm has blown in.

  Weather practice is a powerful reminder of the fleeting nature of experience, how each moment arises and passes as quickly as a weather pattern. A week after I fell, I went to see an orthopedic surgeon. My regular doctor arranged the consult in case I needed surgery to insert a plate and pins. A resident came into the examining room first. Looking at the x-rays, he said that, given the nature of the break and the damage to the ligaments, I might very well need surgery to stabilize the area. He left the room to report his findings to the orthopedic surgeon — and dark storm clouds gathered as Tony and I contemplated the effect on my illness if I had to go through surgery. I was expecting heavy rain to accompany the surgeon into the room, but he walked in and immediately said, “Surgery? No, no, no! The area is stable. You just need to stay off the ankle as long as it hurts and get physical therapy to regain your range of motion.” In a flash, the sun had burst through the clouds. Tony and I were elated.

  But a half-hour later, as I lay on the bed trying to nap, a cold dense fog settled in as I thought, “What does it matter that the surgeon gave us such good news? Even when I can walk normally again, I’ll still be sick and bedbound most of the day and Tony, despite all this extra care he’s giving me, still won’t have my company out there in the world.” In a little over an hour, I’d experienced dark storm clouds, the threat of rain, the sun bursting through instead, and now a cold dense fog. Recognizing the fleeting nature of each moment, I was able to smile and the final verse of the Diamond Sutra came to mind:

  Thus shall you think of all this fleeting world:

  A star at dawn, a bubble in a stream;

  A flash of lightning in a summer cloud,

  A flickering lamp, a phantom, and a dream.

  I knew it wouldn’t be long before the sun would burn off tha
t cold dense fog and I’d smell the fragrance of Dogen’s plum blossoms.

  Broken-Glass Practice

  Finally, to help me live gracefully with the truth of uncertainty and unpredictability, I rely on what I call “broken-glass practice.” This practice was inspired by a passage in Food for the Heart, a collection of teachings from the Thai Buddhist monk Ajahn Chah. He trained many Westerners at his remote forest monastery and has had a strong influence on the shape that Buddhism of South Asia has taken in the West. As we shall see in more detail later, he offers powerful teachings on equanimity: the ability to greet whatever is present in our experience with an evenness of temper, so that our minds stay balanced and steady in the face of life’s ups and downs.

  Here is Ajahn Chah talking about a glass:

  You say, “Don’t break my glass!” Can you prevent something that’s breakable from breaking? It will break sooner or later. If you don’t break it, someone else will. If someone else doesn’t break it, one of the chickens will! . . . Penetrating the truth of these things, [we see] that this glass is already broken. . . . [The Buddha] saw the broken glass within the unbroken one. Whenever you use this glass, you should reflect that it’s already broken. Whenever its time is up, it will break. Use the glass, look after it, until the day when it slips out of your hand and shatters. No problem. Why not? Because you saw its brokenness before it broke!

  I use broken-glass practice all the time. The Buddha taught that all that arises is subject to change, decay, and dissolution. So when Tony or I break something, or the power goes off, or the landline goes dead because the neighborhood squirrels have been chewing on the wires again, we try to laugh and say, “Ah, it was already broken.”

  As a metaphor, broken-glass practice has helped me accept one of the consequences of being chronically ill — one that my online wanderings tell me would show up on the “top ten most difficult adjustments” list of most people who are sick or in mental or physical pain: the same activities that used to bring us the greatest joy are now the very activities that make our condition worse. This was a bitter pill for me to swallow; it still is sometimes.