using the arrow buttons.
by clicking on the page.
the page around when zoomed in by dragging it.
the zoom using the slider when zoomed-in.
by clicking on the zoomed-in page.
by entering text in the search field, and select "This Issue" or "All Issues"
by clicking on thumbnails to select pages, and then press the print button.
displays sections with thumbnails and descriptions.
displays a slider of thumbnails. Click on a page to jump.
allows you to browse the full archive.
about your subscription?
Buddhadharma : Win 2012
60 BUDDHADHARMA: THE PRACTITIONER’S QUARTERLY WINTER 2 0 1 2 Ileafed through the man’s medical file. A CT scan showed extensive disease, and the histology was unfavorable. He was younger than me, with two children, and worked in the ship industry. He lived in a middle-class neighborhood where the hedges were neatly cut. Symptoms of his illness had shown up a year ago, but he was against further investigation. As I shook his hand in the waiting area and felt his firm grip, I looked into his determined, suntanned face—and the fearful eyes of his wife. In my office, I started with my questions. Before I had finished the second one, he angrily grabbed his file and said, “Nothing in here is true. It is wrong, wrong. I am well and I have no idea why I am here.” His wife looked at me and I could see her secret tears. I smiled at her. Slowly, with the kindest voice I could muster, I started again. In my work as a physician, I often have to break bad news—to initiate a conversation with someone who has just learned that they have cancer. The ideal opening to a conversation about terminal illness simply does not exist. Time is short, and a lot of facts have to be covered, a task often hindered by strong emotions, mostly anger and grief. More important, a container—a medical-treatment plan, as well as an emotional one for the next months—has to be created and put in place. This conversation is always an approximation. The process is similar to translating a poem or to the experience, midway in painting, when it becomes clear that we might not stay with our initial intention. The options then are either to stop, which is easier on paper than during a conversation, or to do my best with what we have. Even the most skillful opening statement is only the best one possible in that moment. Although I cannot deny a certain sense of routine after having had thousands of these conversations, I still have to start anew every time, by both seeing and unseeing the course of cancer I know all too well. At the end of another long day, a patient’s husband and children appeared at my office door. I did what I could to explain to the two wide- eyed teenagers and their father why I thought pursuing further treatment was no longer a wise choice. She had endured so much. A complicated bone-marrow transplant almost took her life, then left her unable to find a job, which resulted in a period of severe depression. A brief sunrise of ease and enjoyment was soon followed by the cruel relapse of her illness. Now, not even forty, she was a paraplegic and bedridden. Day after day, cancer cells conquered the islands of independence she had once held so dear. “When?” I was asked. “Soon.” I looked into their three sobbing faces, and my voice seemed to echo forever. Finally her husband said, “I understand. Thank you.” They simultaneously put on their sunglasses as they left, stepping into the sunlit hall. I sighed and released them from their sad movie as they headed into the warmth of a beautiful summer evening. Later, from afar, I saw them downtown standing closely side by side and enjoying ice cream. Life goes on. They would survive. With Zen practice it is much harder to shrink back into habitual tendencies when faced with the reality of death. Because of my practice, I am grateful for every patient who gives me the opportunity to apply my understanding of mindfulness in this process. How do you think not thinking? Beyond thinking. This is the essential art of zazen. —Dogen Here With You “When confronted with a patient’s fatal illness,” says physician Friederike Boissevain, “we are expected to know what to do.” But Zen practice has taught her that being present with a mind of not knowing is sometimes the best medicine. FRIEDERIKE BOISSEVAIN, MD, works in medical oncology, hematology, and palliative care. A leader of the Wind and Wolken Sangha in Germany, she translates the writings of Dogen and Ryokan into German.