To live with serious illness such as dialysis-dependent kidney failure, heart disease, and pulmonary embolism (blood clots in the lungs) is not simply to endure physical suffering. It is to walk daily along the edge of impermanence. Yet from the perspective of Zen practice, this path is not tragic. It is an opportunity to meet life exactly as it is, moment by moment, with clarity, dignity, and compassion.
In Zen practice, we do not look away from suffering. We meet it directly. The Buddha’s First Noble Truth states that life includes dukkha (unease, discontent, and suffering.) Chronic illness does not make this more true, it only makes it harder to ignore. Each dialysis session, needles in the arm, the steady hum of the machine, the annoyance of your blood pressure being taken every 30 minutes, the fatigue after, is a dharma gate. So too are the moments when breathing becomes difficult, when the chest tightens and fear arises, or when the heart goes into atrial fibrillation and you start to panic. These experiences are not interruptions to our spiritual life. They are our spiritual life. In Zen, we do not seek to escape or transcend something. We seek intimacy with all things. That includes the fatigue, the pain, and even the bureaucracies of medical field. Nothing is left out. Dogen taught that practice is not separate from daily life. Whether stirring a pot of soup or sitting on a cushion, each activity is the entirety of the Buddha Way. In illness, the scope of action may be limited, but not the possibility for practice.
When walking becomes labored, we bring attention to each step. When our breath catches in the lungs, we rest in the breath we can take, rather than grasp for the one we cannot. This is not passivity, it is profound engagement. To say “just this” is not resignation but a vow to live fully, exactly where we are. Sitting zazen with a body in decline may be difficult, but the essence of zazen is not physical posture. Whether in a chair or a hospital bed, we can embody shikantaza, just sitting. In Zen, this means sitting with no gaining idea, no goal. Not even health or recovery. Zazen is the enactment of our inherent Buddha-nature, even when we are hooked to machines, even when our organs are failing. Dogen reminds us that “practice and enlightenment are one.” We do not wait until conditions are ideal. We do not wait until the body is strong. We do not wait.
Illness often isolates. Others may not understand our condition, or may even see our lives as diminished or burdensome. But from the perspective of Zen, every being is a manifestation of the dharma. No one is outside the circle of compassion. To live with serious illness is to become intimately aware of the suffering of others... those with tubes, scars, pills, and fears. In this way, we wear the okesa not just over our shoulder, but across the shared ground of human vulnerability. Our practice, though silent, becomes a vessel of compassion for all beings.
Facing mortality each day, when each clot could be the last, when the heart’s rhythm wavers, when the back pain is so intense you can't possibly sit still, is not merely frightening, it is intimate. It strips away illusions of control and certainty. Zen does not offer answers, but it does offer intimacy. Not knowing becomes our ally. We try to open to each moment not with fear, but with wonder. What is this? In the face of death, we do not reach for beliefs or promises. We return to this breath, this step, this bowl of rice. We let go again and again, not just of hope or fear, but of our very selves. This is the liberation Zen speaks of, not beyond suffering, but through it.
Living with dialysis, heart disease, and pulmonary embolism is not easy. But it is not in conflict with the Buddha Way. In fact, it may offer the rarest gift of all, the chance to live every moment with full awareness of its fragility. Zen does not promise that we will live longer. It offers something far more profound... that we might live fully, and die fully, without clinging, without regret, and with an open, awakened heart.
As Dogen Zenji wrote:
“When you find your place where you are, practice occurs, actualizing the fundamental point.”
This body, this moment, this breath... this is our place. And we practice endlessly.
gassho
kojitsu
In Zen practice, we do not look away from suffering. We meet it directly. The Buddha’s First Noble Truth states that life includes dukkha (unease, discontent, and suffering.) Chronic illness does not make this more true, it only makes it harder to ignore. Each dialysis session, needles in the arm, the steady hum of the machine, the annoyance of your blood pressure being taken every 30 minutes, the fatigue after, is a dharma gate. So too are the moments when breathing becomes difficult, when the chest tightens and fear arises, or when the heart goes into atrial fibrillation and you start to panic. These experiences are not interruptions to our spiritual life. They are our spiritual life. In Zen, we do not seek to escape or transcend something. We seek intimacy with all things. That includes the fatigue, the pain, and even the bureaucracies of medical field. Nothing is left out. Dogen taught that practice is not separate from daily life. Whether stirring a pot of soup or sitting on a cushion, each activity is the entirety of the Buddha Way. In illness, the scope of action may be limited, but not the possibility for practice.
When walking becomes labored, we bring attention to each step. When our breath catches in the lungs, we rest in the breath we can take, rather than grasp for the one we cannot. This is not passivity, it is profound engagement. To say “just this” is not resignation but a vow to live fully, exactly where we are. Sitting zazen with a body in decline may be difficult, but the essence of zazen is not physical posture. Whether in a chair or a hospital bed, we can embody shikantaza, just sitting. In Zen, this means sitting with no gaining idea, no goal. Not even health or recovery. Zazen is the enactment of our inherent Buddha-nature, even when we are hooked to machines, even when our organs are failing. Dogen reminds us that “practice and enlightenment are one.” We do not wait until conditions are ideal. We do not wait until the body is strong. We do not wait.
Illness often isolates. Others may not understand our condition, or may even see our lives as diminished or burdensome. But from the perspective of Zen, every being is a manifestation of the dharma. No one is outside the circle of compassion. To live with serious illness is to become intimately aware of the suffering of others... those with tubes, scars, pills, and fears. In this way, we wear the okesa not just over our shoulder, but across the shared ground of human vulnerability. Our practice, though silent, becomes a vessel of compassion for all beings.
Facing mortality each day, when each clot could be the last, when the heart’s rhythm wavers, when the back pain is so intense you can't possibly sit still, is not merely frightening, it is intimate. It strips away illusions of control and certainty. Zen does not offer answers, but it does offer intimacy. Not knowing becomes our ally. We try to open to each moment not with fear, but with wonder. What is this? In the face of death, we do not reach for beliefs or promises. We return to this breath, this step, this bowl of rice. We let go again and again, not just of hope or fear, but of our very selves. This is the liberation Zen speaks of, not beyond suffering, but through it.
Living with dialysis, heart disease, and pulmonary embolism is not easy. But it is not in conflict with the Buddha Way. In fact, it may offer the rarest gift of all, the chance to live every moment with full awareness of its fragility. Zen does not promise that we will live longer. It offers something far more profound... that we might live fully, and die fully, without clinging, without regret, and with an open, awakened heart.
As Dogen Zenji wrote:
“When you find your place where you are, practice occurs, actualizing the fundamental point.”
This body, this moment, this breath... this is our place. And we practice endlessly.
gassho
kojitsu
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