So good afternoon, everyone. I was thinking what better encouragement of giving a talk on the body than to have one of the migraines that I've been dealing with for the last few years be present with me right now. So that will help me be a little bit more real about what I'm talking with you about, I think. It seems that over the last few weeks we're beginning to weave a fabric with certain themes to this practice period. And one of the themes I feel most strongly is the theme of faith. I think it underlines our study of light and it's what's underneath the koan that is mine to present, we'll be hearing more about at some point. And it was really what is underneath the talk I am about to give, which is about the trust and confidence to live our lives no matter what the circumstances are.

[01:07]

And that's really my definition of faith from a Buddhist perspective. So this is the second Way Seeking Mind talk for the Shuso. And I'd like to spend it speaking somewhat about what I've learned by the practice of medicine for the last 25 years, and particularly over the last decade where I've taken care of primarily older people, people like a lot of us in this room and older. And for the last two years, my focus has been primarily on palliative care and hospice medicine. So the title of this talk is The Tao of Old Age, Sickness and Death. Tao having its two meanings. The one of being in complete oneness with your activity with no separation between you and the person and the material and the activity that you're doing. And the other meaning being just the ordinary. Get up in the morning, make your lunch, go to school, attend class like David

[02:13]

Saturday, just that part of living our lives. And it's another way of taking the jade thread of our lives and threading the golden needle to sew the fabric. So I'm going to start by, because I tend to fall on the faith side of things, the absolute side of things fairly readily, I wanted to be sure to ground us in the reality of having a body and the reality of what it means to face one's death and the fears and reluctances, the dreams that people have as they look at that moment by reading to you Dylan Thomas's Goodnight. Do not go gently into that goodnight. Do not go gentle into that good night. Old age should burn and rave at the close of day. Rage, rage against the dying of the light.

[03:15]

The wise men at their end know dark is right. Because their words had forked no lightning, they do not go gentle into that good night. Good men, the last wave by, crying how bright their frail deeds might have danced in a green Rage, rage against the dying of the light. Wild men who caught and sang with sun and flight, And learned too late, they grieved it on its way, Do not go gentle into that good night. Brave men near death who see the blinding sight, Blind eyes could blaze like meteors and be gay, Rage, rage against the dying of the light. And you, my father, there on the sad height. Curse, bless me now with your fierce tears, I pray. Do not go gentle into that good night. Rage, rage against the dying of the light.

[04:17]

The themes for my life, have been about loss and longing to reconnect. I think maybe in some ways that's true for many of us here. The initial loss that we have for which we're bereaved that takes us, took me over 40 years to resolve. A resolution that happened finally one day as I was walking in the magic of Abiquiu in the Southwest and suddenly realized that I didn't have to live my life, feeling the loneliness and believing that that would always be so. In those moments, that disappeared forever in that way. The longing that we have, I think the longing maybe everyone in this room has had to reconnect and find themselves whole in some way.

[05:26]

You know, I really like looking at words in the dictionary, and the longing includes the feeling of longing for something that cannot quite be fulfilled, and I thought, well, this word has read Dogen, because there's that piece that once you really find your way, you've had some experience of it, you know that you'll always be incomplete, because somehow you'll always be separate. Yearnings and other I like it because it has a wistfulness to it. It has an emotional undertone which is very familiar. And it's a great word because it comes from the German which means greed or hunger. How many of us aren't hungry for that wholeness, to have that loss somehow filled? And it also comes from the Greek which means to urge or encourage or Eucharist. It is about grace and rejoicing.

[06:32]

So I really have come to understand that that's what my work is as a physician, just like it has been as a person. As my stories have calmed down and I'm able to find my presence within them, I'm able to tap into that joyful place. In medicine, about 20 years ago, we made quite a big deal of the medical narrative. This was a revelation to doctors that it was important to understand the story patients told themselves about their illnesses, at least to modern doctors it was. To understand what those stories are, to know what the place of the illness was in people's lives, how they related to it, and how to transform it as such. And the stories are good to a point. They stop serving if they continue to codify an idea of what someone is. And so the healing in that is to find a way to thread the eye of the needle with the story, to find the wholeness, to smooth away, to take away the obscurations for that person's health, because there's always health.

[07:53]

inside a person. Medical care has a lot of problems. I was trained very well to find the problem. What's the disease? What's the illness? If someone doesn't feel well, there's something there that must be fixed. There's something wrong and out of place. Despite what Kaiser says with all their great ads, even preventative medicine is about preventing particular diseases. It's not about seeing what's already right and whole and good and bringing that forth. And that really is, I think, the work to do, particularly when people are aging, sick, and dying because you're not going to fix it. but you can't heal it. Those are very different things. The Buddha talked about how lucky it is, how fortunate it is to be born with a human body, that we need to have a human life in order to practice.

[08:57]

We need to have this human life because we have a consciousness. We can reason, we can understand cause and effect in a way that animals and tiles and pebbles can't. I think it's also true because we have a body, because we have a physical body. The longer I take care of people, the more I realize that's the most precious possession any of us has. Your fortune can go in the stock market. Your house can burn down. Your marriage can fall apart. But as long as you have your health and your body, you can continue on in your life. You feel whole in yourself. But when your body is threatened, you really don't know who you are or what to do. I remember being 40 and I was fairly fit in those days and I have always been, had always been, see there I go again.

[09:57]

off and looking at myself in the mirror one day and wondering how despite how physically active I was, I had somehow developed bulges in places I had never had before. Who was this person? It was shocking. And in a certain way, no different than how I felt how my mother felt. My mother had been at the end of her life ill in intensive care and skilled nursing for six months and at the end of it, in the last days of her life, she walked with her little walker, my proud, strong, Straight-ahead clear-minded mother and saw herself in the full-length mirror I'm not sure that she's seen that image since she had gotten sick and she said With her dry Manhattan immigrant sense of humor.

[11:01]

Who's that? Both half meaning it and half laughing at herself for meaning it And I think over and over again, as we age, we come up against that. How many of my patients have said to me, but I've never been a diabetic. But I've never needed to take so many medications. But my wrist has never hurt before. Oh, this body has changed. What do you mean it's changed? You know, and even now having had this last seven years a great deal of difficulty with this particular body, having received or carrying a diagnosis of something that's like lupus, having arthritis and fatigue that really limit me, and having developed sensitivities to things that used to be enjoyable.

[12:03]

I still have a 25-year-old's mind, and I think, well, you know, next week I'll be able to get up and ride my bike 50 miles like I just did a decade ago. I think maybe this is a common experience of how to adjust to the fact that the body has changed, but the mind and spirit and idea of who we are hasn't. It's like you don't really get another life, you know. Sometimes I wake up and I still think, well, tomorrow I'll have that life I thought I always wanted. The marriage for 40 years and the three kids. But life is rather like being on a river rafting ride where you get on And if you want to get off at the end, you have to keep going in the same direction.

[13:08]

There's no going back again. So having a body is about being real. It's about being real about what you really can and what you can't do. In this most recent, I'm trying to get a sense of how much time, maybe I'll stop, not do that, and say, you know, one of the wonderful things about being ill and having limitations is that you realize that you have limitations and that your body really is the one that calls the shots. So during a time period when I had a terrible episode of sciatica and could work four hours and basically be flat on my back the rest of the time, there was enormous relief knowing that that's all I could do. The go, go, go, energetic, get everything done, always have a list that I could multitask on person had to go someplace else because I was in bed watching the prison rainbow go across my bedroom as the day went on and that actually was really wonderful to be real about what I could and couldn't do and for those of you who've had pain or have conditions that are fatiguing you know that if you try to push against that all you get is more misery

[14:28]

And so the first thing about having a body and aging is that you have to be real about what's happening. Your body always wins. There's a playwright whose name I don't know, he's from the last century, who talks about what it's like to have an aging body with a great deal of encouragement. He says, You know, there are three kinds of beginner's mind, but for our purposes, maybe we can call it ordinary mind. Ordinary mind is where you just deal with what's in front of you, because that's really all there is to do, and you can't kid yourself anymore that you've got a choice about doing other things. So, in his explanation, The first kind of beginners or ordinary mind is the very first time you do something.

[15:30]

It's completely new and you have no idea how you're doing it. The second time is when you're doing something artistic. When you're playing jazz or creating and then the force, the activity just comes out. You have no idea what it's going to be. Maybe a good Zen talk is like that. I don't know. And the last is when you're old, he says, because when you're old, you don't know what your body is going to do. You just have to get up and do each thing one at a time. So like we just have a cup of tea or we just wash our bowl, you just get up. Am I going to make it to the bathroom today or not? Am I going to be able to stand today or not? Am I going to be able to prepare my meal today or not? How am I going to do it? What will that look like? I've never done it this way before because my body's never been this way before. And so it's an alive, creative endeavor.

[16:32]

It seems to have been my my way to have been drawn to work and death and dying. And I think maybe I won't say a whole lot about this because I know I'm going to run out of time sooner than I think for a couple of other things I want to say. But the very first experience I ever had in the hospital was having an older man, a doctor near his retirement, a community doctor. And when you are going to the hospital for the first time and you're all excited about learning, you really don't want the old community doc to be the one who's initiating you. You want to have the smart, brilliant university doctor to do that. But he took me, Dr. John Shore, blue suit and gray hair, took me to the bedside of a man who was about to die of lung disease. And we stood there with him. He put me forward. We stood there with him as he breathed his last breath.

[17:46]

And there's something so real about just being with that person as life passed from him. So real and so complete that I knew that I was in the right place. Dogen says, and I'm sorry if this is too heady, but it really calls to me. In Dogen's fascicle on birth and death called Shoji, Sojin likes to translate it birth and death, but there's another translation which is life and death that I think is probably is more relevant to what I'm saying. The opening lines of Shoji are, since there is Buddha in life and death, there is no life and death. It is also said since there is no Buddha within life and death, we are not diluted by life and death. So what that means to me is that since there is Buddha in life and death, Buddha is everywhere, everything is Buddha nature.

[18:54]

There is Nothing we have to worry about. Our ideas about birth and death, we don't have to worry about them. There is no life and death. It's all Buddha. Since there is no Buddha within life and death, meaning Buddha is not outside of life and death. Life and death are completely Buddha. We're not deluded by life and death, meaning we can see life and death for what they really are. When we're alive, we're purely alive. We're not dead. When we're alive, we're purely and totally ourselves. Whether our body behaves the way we think it should when we were 25 or whether it behaves in an old and crickety and unreliable way like we do when we have a flare of our arthritis or when we're 80 and we're just slowing down, we're totally alive. And when we're dead, that's something else again. You can think of Dogen's analogies in the Genjo Koan of firewood is firewood and it does not become ash again.

[20:05]

Ash does not become firewood. They're each their own discrete thing. And I think we get into trouble when we think about time in a continuous way. We think, oh, I'm still what I was when I was 25, now that I'm 53. But actually right now I'm just 53 and I'm just here with a migraine and a flare of arthritis sitting here in front of you having this conversation. I'm not 25 and I'm not 82, you know. It's just this here right now. Thank you. I have a real fear of things that die. I have two more stories to say and then I'll open it up to questions. I have a real fear of little things dying, like your pet fish floating on the top of the bowl, or your pet parakeet or canary finding them dead at the bottom of the cage.

[21:16]

Something that I've always been aversive to, and so on Sunday I was on my way to the farmer's market for my little community ritual, and I get out the front gate and Ananda pulls me back to bring my attention to a dead sparrow, a dead chipping sparrow that's lying right there in the front of my walkway. And I'm abhorred, I'm aversive, oh my God, a dead bird, I don't want to see it. And I think, well, I'm a Zen priest, it's not so good of me to leave this poor little sparrow here in the middle of the sidewalk. And so I went and found a troll and a trowel and I carefully picked him up and took him over to our front yard where we have a Jizo garden while I was chanting for him. And I noticed the wonderful feathers The beautiful chipping sparrow is beautiful with the rust colored head and the gray and white and black patterns on its wing and its perfect black eye and the keratin forming its beak and the ridges on its outstretched little legs.

[22:34]

It was just that. It was this form that had been a bird. It was no longer a bird. It was dead. It was ash of the firewood and I could see it that way and feel complete ease and appreciation for it. I have had many experiences with patients as they've been dying. And there's one I'd like to share. I know Mr. William Young would be really delighted to have his name mentioned here. He knew that this was a part of my life and liked that very much about our relationship. When I met him about five years ago, he was already very ill and frail. He'd been on dialysis for many years.

[23:36]

He didn't like being so ill and he was rather afraid of death, even when it seemed like he was close many times. Mr. Young was an extremely generous man. He was quite sick from his diabetes and he had liver disease left over from having had substance habits when he had been younger. And yet, he lived a life of real openness with people. He used to have a restaurant and he cooked for people. and made food for the homeless people in the community when he owned the restaurant. When he became quite ill and lived on a small amount of disability, he'd take his little walker with food that he'd prepare and take it across the street and down the road to the laundromat that was near him and leave it for the homeless people he knew stayed there. He was the kind of person who would come out of the clinic and everyone would say, oh, how wonderful it was that he was here today. We really like him so much. Over the last months of his life, as end-stage renal disease does, his body couldn't keep up with the metabolic demands that it had.

[24:51]

The dialysis was not a perfect fix and he was beginning to melt away. his muscle mass and his strength and his body's ability to even maintain his blood sugar. He reluctantly agreed that going back to the hospital didn't do anything for him and going to the emergency room wouldn't do anything for his chest pain. So we made the decision not to send him back to those places. But he wanted to stay on dialysis because he didn't want to give up on life. He loved it so much. He loved life so much. He was so completely alive in himself. Even as he was dwindling away. And he was just so beautiful. And on the day before he died, I sat down with him and we chatted for a while. And he said to me, You know, I'm not going to die. I'm not ready to die yet.

[25:52]

I'm not going to die. Don't give up on me. And I said, no, I won't. I know you're not. Knowing that he would be dead within a few hours, live or dead. I won't say he was completely alive and he lived completely alive. And I think that's really, that's the health within our aging is to continue to be who we are, to feel that bright longing to be ourselves, no matter what's going on, and to be present to it in whatever way that we can. This image of the loom, the thread, and the needle in I'm blanking on the name of the other book we're reading, but there he talks about it as the jade loom, the jade loom meaning our life and the workings of our life, and the gold thread, the gold thread that we take these moments, our conditions, and we see their wholeness in the presence, and we weave that golden fabric of our lives.

[27:12]

So with that, thank you for listening, and I welcome any comments, questions, shared experiences that you may have. Patrick? How's your migraine? Yeah, it's much better, thank you. The words are still a little bit silly, but thank you. Catherine? Your story about the man who was completely alive until the very end reminded me of something that happened with one of my sons and a friend of ours who was getting near the end of her life. And he went to her house to help with some yard work. And he said to me afterward, I didn't know how it would be to be with somebody who was dying.

[28:21]

I didn't know what to say or how to do that. But it wasn't a problem. She's not dying. She's alive. And I remembered that often when I've been with hospice patients. that we're dying can color and overwhelm a lot of light in a way that distracts us from the aliveness. It's very well said. It's the same thing as when you're given a diagnosis of a difficult, life-threatening illness. You don't become the cancer. You don't become the lupus. You are still thoroughly who you are. You just have this other thing that you deal with in your life. And so even though there's something going on where you think you can see the end of your life, you're still thoroughly alive.

[29:27]

For those of us who have family members and friends and people that we're with, it's so important to remember, and with ourselves, stay alive. Stay alive for every last second of it. This, I think, is what Dylan Thomas is warning us away from when he says, do not go gently into that good night. I'm getting the clunk. So thank you very much for your attention. We'll have more time to talk. Practice periods still heating up.

[30:04]

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