How to Be Sick

by Toni Bernhard

  Try Thich Nhat Hanh’s Mindfulness Exercises

  In The Miracle of Mindfulness, the Vietnamese Zen master Thich Nhat Hanh offers several exercises for staying mindful of the present moment as we engage in activities of everyday life, from brushing our teeth to making the bed to washing the dishes. Many of them start with the instruction to “half-smile” — a wonderful practice in itself. Try a half-smile and see how your mind and body immediately relax and how a touch of serenity arises. Here are two of Thich Nhat Hanh’s mindfulness exercises, which you can easily apply in your own life:

  Half-smile while listening to music. Listen to a piece of music for two or three minutes. Pay attention to the words, melody, rhythm, and sentiments. Smile while watching your inhalations and exhalations.

  Mindfulness while making tea. Prepare a pot of tea. Do each movement slowly, in mindfulness. Do not let one detail of your movements go by without being mindful of it. Know that your hand lifts the pot by its handle, know that you are pouring the fragrant warm tea into the cup. Follow each step in mindfulness. Breathe gently and more deeply than usual. Take hold of your breath if your mind strays.

  Take a Break from Discursive Thinking

  Of course we need to think. Thinking about the past and the future is essential at times so we can make wise decisions about our lives. That said, there are benefits to not always engaging in discursive thinking — that familiar experience when one thought piles upon another in a seemingly endless stream. Not only can this be exhausting, but it also keeps us from enjoying any pleasant experiences that our senses might be offering up in the present moment.

  Here’s an example of how discursive thinking can happen. You start to practice mindfulness of the present moment by resting your attention on what you’re seeing or what you’re hearing all around you. After a few minutes, you’ve relaxed into a pleasant feeling of calm receptiveness. But then the thought arises, “I wish I weren’t sick.” You could stop the thinking process right there by treating “I wish I weren’t sick” as nothing more than an arising thought that will soon pass away. Instead, you embark on what I think of as the equivalent of a guitar riff. You take that simple “theme” — “I wish I weren’t sick” — and the riff begins: “I’m going to have a horrible day”; “I may never feel well again”; “My life is going from bad to worse.” Soon that initial thought has mushroomed into a series of thoughts that contain every stressful scenario you can come up with. It’s taken you away from the relaxing practice of simply being mindful of what you’re seeing or hearing in the world around you. In fact, it’s colored everything about your day and left you feeling miserable.

  No one can empty the mind of thoughts altogether, but with practice, when a thought such as “I wish I weren’t sick” arises, you can learn to simply acknowledge its presence and then let it pass out of your mind the same way the sound of a bird singing arises in your awareness and then is gone. Taking a break from discursive thinking by resting your attention on what’s going on around you puts you in touch with the present moment. It’s also calming and restorative. In the words of Ayya Khema from her book Being Nobody, Going Nowhere:

  If we didn’t give the body a rest at night, it wouldn’t function very long. . . . The only time the mind can have a real rest is when it stops thinking and starts only experiencing. . . . Once verbalization stops for a moment, not only is there quiet but there is a feeling of contentment. . . . That quiet, peaceful space is the mind’s home. It can go home and relax just as we do after a day’s work when we relax the body in an easy chair.

  The next two practices provide further help for learning to curb the constant stream of thoughts in the mind.

  Three-Breath Practice

  I adapted this from a practice that Tony devised to teach mindfulness at Folsom Prison, where he’s a volunteer chaplain. He calls it the “three-breath trip.” It’s been tremendously helpful to the inmates, especially because they live in an environment that’s not conducive to formal meditation.

  Here’s how it works. Whatever you’re doing at any moment, switch your attention to the physical sensation of three in-breaths and three out-breaths. That’s all there is to it. It’s a simple but powerful practice — and only takes a few seconds.

  Three-breath practice grounds you in your body, which brings your attention to what’s going on right now in your life, because your body is always in the present moment. Most of us spend a lot of time unaware that we’re lost in thoughts — often stressful and judgmental ones. They may be about the past or about the future, or they may even be a running commentary on our present-moment experience. Three-breath practice brings you into the present moment and, by doing so, provides healing relief from all that mental chatter. Because I don’t seem to be able to control the scenarios my mind cooks up whenever it pleases, some days it feels as if three-breath practice is the only thing that keeps me sane!

  One afternoon, during the time I was working on the revised edition of this book, I lay down for my daily nap — a necessity with my illness. But instead of being able to relax my mind and body, my mind started churning with a half dozen ideas for new material I wanted to include in the book. Then I started worrying that I’d forget these new ideas. And so I gave in, grabbed a pad of paper and a pen, and took a few notes. Then I returned to the task at hand — that nap — but my mile-a-minute thinking resumed. It was anything but restful.

  I could feel the tension escalating in both my mind and my body because I badly needed to nap. So I tried three-breath practice. I took three conscious breaths by paying attention to the physical sensation of the breath as it came in and went out of my body. In that short space of time, all that mental activity — which was exhausting physically, too — gave way to a sense of ease. Then I said to myself, “It’s time to nap,” and I was able to. I’d only add to these instructions: “Repeat as necessary!”

  I use this practice several times a day. I like doing it at random; no matter what I’m engaged in, I’ll stop long enough to take three conscious in-breaths and out-breaths. As a bonus, when I exhale on that third breath, a feeling of peaceful calm comes over me, sometimes strong, sometimes slight — I’ll take either one.

  Three-breath practice is beneficial in a second way. When you find yourself in a difficult or antagonistic situation where you might react impulsively and later regret it, intentionally switching your attention to three conscious breaths gives you the time and space to reflect before speaking or acting. This makes it much more likely that you’ll react in a skillful way to whatever situation you’re facing.

  Drop-It Practice

  I devised this practice one day when I was particularly fed up by my constant worrying about the effects of chronic illness on my future. To try it, start by learning a simple exercise. First, consciously take your mind out of the present moment and into the past by remembering something you blame yourself for, something you regret, or something that simply makes you sad. For me, the sad memory might be of the profession I gave up or of the missed birthday parties for my two granddaughters. Also, there are treatments I regret having tried, and recalling them gives rise to stressful thoughts such as “Am I sicker today because of that potentially toxic antiviral I took for a year with no positive results?” For a caregiver, the memory might be of a trip that had to be canceled because your loved one was too sick to go.

  Now, keep this sad or stressful memory strong in your mind and then . . . drop it. As you do this, immediately direct your attention to some current sensory input. It could be something you see or hear or smell. It could be the feel of your feet on the ground or the sensation of the breath coming in and going out of your body. Can you feel the relief?

  If not, try the exercise again. After a few repetitions, you’ll find that at the command, “Drop it,” the stressful memory is gone and so is the suffering that accompanied it. With your mind in the present moment, maybe you hear a bird chirping or feel the sensation of a breeze on your body or see a beautiful print
on the wall or smell something cooking in the kitchen. As Thich Nhat Hanh says in the epigraph that heads this chapter, “When we settle into the present moment, we can see beauties and wonders right before our eyes.” If you’re not having success with this exercise, try it while keeping your eyes closed as you focus on the memory. Then, as you drop it, open your eyes and pay attention to whatever sensory input is there in the present moment.

  Now let’s move to part two of the exercise. Consciously take your mind out of the present moment by thinking of something in the future that you’re worried about or that’s a source of stress or agitation for you. It could be something personal or it could be thoughts about the future of the world. I have a recurring thought that is a tremendous source of stress — it’s the fear that Tony will get ill or have an accident and will need me at his side in the hospital to deal with doctors and to care for him, which I won’t be able to do.

  Whatever unpleasant thought you’ve brought to mind about the future, as you did in the first part of the exercise, keep this thought strong in your mind and then . . . drop it. Again, immediately direct your attention to what’s going on right around you at this moment — a sight, a sound, a physical sensation.

  In a nutshell, that’s the exercise:

  Take your mind back in time to a stressful memory, and drop it.

  Take your mind forward in time to a stressful thought, and drop it.

  When you drop it, you relax into the present moment and the suffering that was generated by your thoughts lifts as if you’ve shed a heavy weight.

  Once you’ve learned this as an exercise, you can turn it into a mindfulness practice without consciously bringing to mind a stressful thought about the past or the future. Here’s how. Whenever you realize that you’re ruminating about the past or worrying about the future, say to yourself, “Drop it.” And there you’ll be, in the present moment. As with three-breath practice, even if that moment is accompanied by bodily discomfort, it will be easier to relax into the discomfort, riding it like a wave, because you won’t be making it worse by adding to it the mental suffering that comes with stressful thoughts. I know my mind will wander into that past- and future-suffering territory again and again, but I also know that I can bring it back to the present moment with a simple “drop it” instruction.

  Drop-it practice was tremendously helpful to me a few years ago when I was nervous about an appointment with my surgical oncologist to discuss the results of a breast MRI I’d had a few days before. This was my first MRI since the surgery I’d had to remove the lump in my breast.

  To get to the appointment, I had to do something unusual for me: drive forty minutes on the freeway by myself, because Tony (who usually drives me) was out of town. There I was, driving sixty-five miles per hour on a freeway packed with cars, but my mind was elsewhere, worrying about the test results. I was busy mocking up one worst-case scenario after another. Then I remembered a quote from Thich Nhat Hanh: “If we practice mindfulness, we always have a place to go when we’re afraid.”

  Inspired, I gently but firmly said, “Drop it.” Then I turned my attention to the present moment. The first thing I noticed was that I was moving really fast. I told myself to try to stay in the moment by experiencing what it was like to be driving a car on a freeway. And what an experience it was. I felt as if I were on the Autopia ride at Disneyland. It was quite a feat to stay exactly between the painted lines while driving so fast. I was impressed with my skills! And I was amazed at how dozens of cars right around me were going just as fast but not crashing into each other. It occurred to me that this was an exquisite example of social order at work. I enjoyed every minute of the drive. And that MRI result? It was normal.

  Here’s a second example of when I used this practice. In retrospect, it was a situation that was quite mundane. Recall when I broke my ankle right after Tony left for a month-long retreat. The ankle healed, but I was left with an uncomfortable swelling and tingling in the ball of my foot and in my toes. My primary doctor referred me to a podiatrist. I thought, “What a treat — a doctor’s visit that has nothing to do with my illness!” Tony had a conflicting obligation, so I drove myself to the two thirty appointment.

  By three o’clock I was on the examining-room chair, my mind spinning with a list of grievances about the past thirty minutes and with anticipatory irritation about the future. First, the person who’d scheduled the appointment gave me faulty directions to the office, so I drove in circles for ten minutes, worried that I’d be late. Second, once I found the place, I had to sit in the waiting room for more than twenty minutes. Third, the person who showed me to the examining room said the doctor was currently seeing a patient and had one other person ahead of me. Fourth, the special podiatry examining chair appeared to be designed for my discomfort.

  Angry about the past thirty minutes, irritated about the future (just how long would it be until the doctor came in?), I closed my eyes and silently said, “Drop it.” In the space created by those two words, the thought arose that I knew nothing about the room in which I was sitting. What color were the walls? Did the room have the same kind of false ceiling that I came to know so well as I lay on the couch in my law school office? What tools of the podiatrist’s were in view? Was there a window? Was there a picture on the wall? I’d been in this room for ten minutes and couldn’t answer one of those questions.

  And so I opened my eyes and I began a mindful investigation of the room. As I was doing this, I noticed that my anger and irritation were gone. In fact, the exploration was so absorbing that when the doctor came in, it felt too soon because I was in the middle of examining the details of the collage on the wall. This is an added bonus of drop-it practice: it can turn an unpleasant experience into a pleasant one!

  I think of moments of mindfulness, no matter how short, as moments of liberation. I’ve discovered that truly being present for my experience brings with it a feeling of contentment that’s often tinged with awe, as I pause and take in the wonder and mystery of being alive at this moment.

  Recently, one of our town’s most treasured citizens passed away after a good long life. The obituary in our local paper noted that Martha loved to say, “The past is history. The future is a mystery. The present is a gift.”

  I hope you’ll take refuge in this gift.

  14

  Wise Action

  WHAT TO DO AND WHAT NOT TO DO

  Today, like every other day, we wake up empty and frightened. Don’t open the door to the study and begin reading. Take down a musical instrument. Let the beauty we love be what we do. There are a hundred ways to kneel and kiss the ground.

  — RUMI

  IN TEACHING US how to alleviate or put an end to the suffering in the mind, the Buddha presented the Eightfold Path, which I briefly described earlier. This chapter explores one of the practices on that path: wise action, which has a lot to teach the chronically ill and their caregivers about how to take care of themselves. Simply stated, actions that lead to the cessation of suffering are to be cultivated and actions that enhance or amplify suffering are to be avoided. Wise inaction can thus be thought of as simply not engaging in those actions that make our condition worse.

  Since becoming sick, I’ve learned how crucial — yet difficult — it is to practice wise inaction, that is, to avoid actions that intensify my symptoms. Worsening symptoms give rise to both physical and mental suffering — sometimes so severe that I break down in sobs of despair. Dukkha in abundance — a total meltdown. This used to happen frequently, but now it’s a rare occurrence, thankfully. A meltdown is not only hard on Tony but also leaves me feeling sicker.

  Obviously those of us who are housebound must forgo activities that take us away from our dwelling place. I’m physically able to leave the house, but I’ve learned that the exacerbation of symptoms that results is seldom worth the journey. For example, a few years ago, when Tony was out of town, I discovered that the front door wouldn’t open, either from the inside or the outside. The door
knob turned, but it no longer pulled the latch out of the door frame. The problem had an easy solution — install a new doorknob, something I can do. But I was feeling particularly sick that day; I knew that going to the hardware store to buy a doorknob would inflame my symptoms. And so I went front-doorless for a day.

  Wise inaction is a challenge because I’m still working to overcome a lifetime of conditioning that led me to believe it was essential to my family’s quality of life for the house to always look its best, from making sure the windows were washed to keeping the yard and walkways leaf-free in autumn. Suddenly and unexpectedly, these became actions that exacerbated my symptoms — or that I simply didn’t have the energy to do in the first place. It takes tremendous discipline to avoid overexertion, even within the confines of the house and yard. I fear that my house is slowly becoming a fixer-upper. I’m trying to accept this with as much grace as possible. I keep a haiku by the eighteenth-century poet Kobayashi Issa posted in the kitchen. It’s about nonharming, but I use it as a reminder to let go.

  Don’t worry spiders,

  I keep house

  casually.

  Recently, I discovered a positive side to wise inaction in the form of a practice I call “doing nothing.” Many years ago I heard a story about a college student in Japan who went to a Zen monk and told him that she wanted to meditate but was under too much stress to do it.

  The monk said to her, “Don’t meditate. Just sit and do nothing.”

  I never forgot this story, and a few months ago I decided to turn it into a practice. Whether this is what the monk had in mind, I can’t say, but it works for me. Once or twice a day I stop whatever I’m doing and do nothing for five to ten minutes. I’m usually lying down, but sometimes I’m sitting. It can also be done standing.