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For the past twenty-five years I have been compelled to use everything I know from my Zen training to understand how we can best face the suffering of others

Zen Training outside the Dojo

8 February 2020

I finally self-published the book I’ve been working on: once called Wrestling with Angels, now called Facing Suffering. When originally describing it, I would say that it is an account of my three months of training as a hospital chaplain. Now I’m realizing that is not what the book is about. Out of the numerous review copies I sent out to chaplains, including ones who intimately know that same training program, only one sparked a response. I’m guessing that the book must seem to have little to do with others’ experience in chaplain training.

But I also heard from people training in Zen who read a review copy. And from their insightful responses I realize that what I really wrote was about my form of Zen training, Zen training that took place in a hospital and not a Dojo. Given that, I thought it might be useful to capture here some of what I needed in order to train intensely in Zen outside of a Dojo setting.


  1. “I didn’t ask for this.” – The first necessity is a compelling question, one that cannot be answered within a dualistic perspective. And it is not a question that you simply thought up – it is one that is overwhelming in its demands. In my case, I needed to find out how to face suffering. Suffering lies at the core of Buddhism, at the core of medicine, at the core of family struggles. And those three arenas – Zen, patient care, and family – are the core of my life.
  1. “I own this place.” – The second necessity is the place where you can face that question. Those grounds can be anywhere but I use that word “own” deliberately. By that I mean that you feel that everything within that environment is yours to use as a tool for training. Nothing is off limits. In my case, it was a community hospital, full of patients, staff, technology…and suffering.
  1. “Don’t give up!” – You need a commitment not to quit until the question is resoundingly answered. If it is a compelling question, it won’t crack easily. You’ll find yourself in some dark places with no way out. In my chaplain training, I needed help to remain committed. I hit one of those dark places – a place where I felt that I was injuring a fellow chaplain – and turned in my letter of resignation. Fortunately, it was rejected.
  1. “No!” – So that’s another thing you need in order to train outside a Zen dojo: someone to say “no” repeatedly. In most contemporary learning environments, it seems like the teacher’s job is to nurture, guide, offer reinforcement. But for those of you who do koan training, contrast that with your Zen teacher’s refusal to accept your most heartfelt answer when he or she knows that it is not genuine. In my chaplain training, I had a supervisor who likewise had the radar to know what was genuine and what was not. There were a lot of “no’s” in my conversations with him. As a result, I had to push deeper and deeper, working to get beyond what was genuine.
  1. “Take away every habit since the day you were born.” – The fifth necessity is a willingness and an ability to take yourself apart. By that I mean that you challenge everything about yourself that you think is true. Whoever you think you are going into your training, you are willing for that all to fall apart. Most likely you are not as strong, as smart, as kind, as sensitive, as friendly, as accomplished, as anything, as you think you are. The world doesn’t work the way you think it does. People don’t behave the way you think they behave. Things don’t get done the way you think they get done. As a result, you find yourself on a life raft with very few things left: in my case, my breath and my sense of gravity.
  1. “Keep throwing yourself against that brick wall.” – If you accept #5 as a necessity, you are going to make mistakes as “you” is taken apart. There has to be a willingness to accept that there is no taking apart without there also being mistakes. It is not a neat or pretty process. If you accept that, then you have no problem with picking yourself up off the ground after one failure, knowing that another failure is just around the corner.


I’m now rereading what I just wrote – not pretty stuff. Not the way in which Zen training is usually portrayed in America. Are those six elements necessary for any student training in Zen? I can’t say. I do know that I needed them for my training with Tanouye Roshi and I needed them to learn how to face suffering.

If you are interested in reading Facing Suffering, send an email to If you wait a few months, you can also order it from any bookstore or online sources, both in paperback and e-book format.

Blog #5

Aug 9, 2018

One reason I like mowing the meadow is the fresh smell every few seconds as different plants are sliced while the tractor chugs along. There is a news stream to the nostrils that I can’t decipher but I love to receive it anyway. What the plants are expressing is important, and maybe of even greater significance than what I read in the actual morning news, but I don’t understand them.

It’s not fair to say “of greater significance,” but it is hard to read that written morning news because there too I find myself saying I don’t understand. How is this day’s story possible? Without understanding it is easy to go numb. Easy to just live here in the woods day by day.

One of the recurring themes I use when teaching physicians is learning how to face suffering. But it is one thing to face suffering of the sort that seems to just be part of our lives – the loss of an aged father – but it is far more difficult for me when the suffering is seemingly caused by someone’s cruelty, ignorance, hatred, or greed. Those are the difficult stories.

I’ve been struggling with that second form of suffering, wanting to understand, wanting to speak, but not wanting to just add to the noise of the moment. But I was thinking of the late Japanese Zen Master Omori Sogen this morning, the teacher of my Zen teacher. And I was thinking of the physical character of his life – recognizing that everything seemed to align. How he breathed, how he walked, how he wrote, how he taught. Everything seemed to just line up, no loose edges. People who met him said every encounter left them with a clean feeling, nothing muddy.

Those who know of his training in the old sword school that includes the form or kata we call “Hojo” would say of course that is how he was. His physical training in swordsmanship was so severe that not only did “straightforwardness” (jikishin in Japanese) go into his bones but into his life. My teacher, Tanouye Roshi, lived the same way. Who he was in the morning was the same as who he was in the evening.

The older I get, the more I understand how incredibly difficult that last step is. Every step, every word, every breath, every encounter feeling like it is just one thing. Without shugyo (intense physical/ emotional/ spiritual training) early in life, it is very difficult to do the necessary shugyo later in life that leads to this straightforwardness.

I think I landed on this quality in Omori Sogen’s character this morning because I realized that is what I long for in every politician, every businessman, every teacher, every police officer, every physician who has a large impact on the lives of others. “Longing for” by itself is an empty phrase but I had to get all of these things I’m describing to the surface before I could look at my own alignment, my own straightforwardness. That’s yet one more step along the way…

Blog #4

June 13, 2018

Here’s a strange bit of suffering, something of my own. It feels vague, ill-formed, self-indulgent, but also real. Something I often tell medical students when talking about suffering is that I try not to judge degrees of suffering – “this suffering is much more significant than that suffering.” We first have to really feel it before you take that kind of comparison anywhere. Point being, I’m giving those instructions to myself right now.

I’m embarrassed to write the following sentence but I will. I’m suffering from a loss of what I felt was the American Dream. Or at least the American Dream as it was for a white, middle-class boy born in 1950 in small town Illinois. Certainly this feeling has been amplified by our current political landscape but it was brought to a fine point while watching the 2016 documentary about Noam Chomsky called “Requiem for the American Dream.” Nail by nail, plank by plank, he builds a framework for understanding the changes that occurred following the 1950s and 1960s, the era he calls “the golden age of the American dream.”

For Chomsky, the tale is told in terms of what has happened to wealth, power, and democracy since the 1970s. For me the more personal story is the question of what happened to our ability to think about the needs of others. I was a naïve fringe participant in the Vietnam protests of the late 1960s – lots to ridicule in what some writer once called something like the sound of thousands of small children banging their spoons on their highchair feeding tables – but my memory of the outrage back then was a sense of why should we be killing so many people for reasons that don’t make sense. We had lived through those elementary school drills of ducking under our desks if a nuclear bomb was dropped nearby but I don’t recall any particular fear of Communism. Stopping the spread of Communism by decimating the land and people of Vietnam made no sense. So stop.

My point is that the outrage was personal – abstractions about world order were given more weight than questions about how we take care of the needs of others.

I was a bit too young for involvement in the Civil Rights movement, but there was that 1968 takeover of my college’s administration building. And long talks with the college chaplain, a man who had been imprisoned with Martin Luther King when King wrote “A Letter from a Birmingham Jail.” All of the injustices of the past hundreds of years – emotional, political, social, economic, educational – made no sense to me. Given a chance to start to correct them, why wouldn’t we?

This makes me think of the new museum in Montgomery, Alabama – the one that pays homage to the thousands of people lynched since the Civil War. I can’t quite imagine stepping into the pain that museum captures, but I feel that I must. How can I not say “I was part of this?” I have some of this cruelty within my DNA. We have only a few family stories about Quaker ancestors participating in the Underground Railroad. But those are noble stories so of course they are remembered. But there must have been men in my lineage who watched one of those lynchings, or saw the body afterwards, or heard the news, and then did nothing.

The Civil Rights movement was meant to begin our healing from all of this, but I don’t see much of this these fifty years later. There are enough like me that we helped elect a Black president, and watched his family set example after example of forebearance, but what of all that now? It feels like we watched a movie about such a fantasy and then all went home.

News cycle after news cycle, there is somebody new that we don’t want to help take care of. Puerto Rico still suffering after the hurricane – who cares?

The Weight of Suffering

24 April 2018

I’ve just finished participating in a day-long symposium on Suffering and Caring: Perspectives from Medicine, Philosophy, and Zen, held at the University of San Francisco. I was the Zen representative, working with two philosophers and a physician and an audience primarily of USF students. Over the course of preparing for the symposium, the meaning of some core words played an increasingly interesting role in the discussion. With this blog, I want to discuss how those meanings sounded to me as a Zen teacher and chaplain.

Gravity and Grief

Two of the contributions were made by Geoff Ashton, a philosophy professor at USF. He first told me of the direct linguistic relationship between “gravity” and “grief,” both of them stemming from “gravis,” a Latin word for “heavy.” And it makes sense that they are related. For example, we have the phrase “with a heavy heart” as one way to express sadness. The phrase now is mostly used in a metaphorical sense but we would have once been more familiar with grief as a visceral sensation of weight in the body.

I know this because I was with my mother when she died and I can still feel the sensations of just sitting silently at her bedside for the thirty minutes before my sister arrived in the room. I felt drained of all thought. Every part of me sagged, felt pulled toward the floor. Draining and sagging are gravity at work. Gravity and grief as one.

We will circle back to the role of gravity in learning to face suffering, but for the moment I want to flag gravity’s core significance in our style of Zen training. The focus of the work of zazen (Zen meditation) is learning to lengthen one’s exhalations. In order for that to happen, numerous muscles throughout the body need to “wake up” and to relax. For muscle tissue to wake up, it needs to feel the pull of gravity.

That process of feeling the work of gravity throughout the body takes a great deal of time because of the ways in which we identify with our habits. For the most part we are not aware that the ways we hold our body in the gravitational field is all based on neuromuscular habit. This means that literally we don’t feel gravity in the majority of the muscles in our bodies. At least we don’t feel that gravity until we are struck by grief, or we train intensely in Zen.

Suffering – the Sanskrit roots

The second contribution from Geoff was a new look at the meaning of “duhkha,” the Sanskrit word usually translated as “suffering” and a core concept in all forms of Buddhism. One common derivation of the original meaning of duhkha is “having a bad axle hole.” This refers to the effect of an off-center hole in one of the wheels that holds the axle for a two-wheeled cart. As you might imagine, if you were in that cart you would have an uncomfortable ride. You would suffer.

But Geoff, as a Buddhist scholar with significant learning in Sanskrit, pointed to another derivation of the meaning of “duhkha.” The Sanskrit dictionary compiled by the Oxford scholar Monier Monier-Williams, states that the word “duhkha” was originally formed from “dus,” meaning “bad,” and “stha,” meaning “to stand.” Thus, a root meaning of duhkha can be expressed as “bad posture,” with the resulting discomfort being the visceral basis for suffering.

Suffering – the Latin roots

The final core word that was discussed during the symposium was again this “suffering.” For Tom Cavanaugh, also a philosophy professor at USF, the significance of suffering lies in its Latin roots. The two parts are the Latin “sub,” meaning “under,” and “ferre,” meaning “to carry” or “to bear.” His translation becomes “be under what one carries.” For example, one can carry a heavy bucket of sand in your hand but one would not be “under” that load. You would not be suffering in the sense that the Latin root words present. But place that same bucket on your head or your shoulder and now you are under that load.

His illustration for this derivation of “suffering” is an early painting by Vincent van Gogh called “Miners’ Wives, Carrying Sacks of Coal.” The women are bent over by their loads, some of them almost bent over ninety degrees, as they trudge through the snow. For Tom, this is what one form of suffering looks like. You bear something – physical, emotional, spiritual – and you walk on.

It strikes me, however, that there are people who are “under what they carry” but without any appearance of suffering. For example, imagine a sailor home from the sea, leaving his ship with his heavy seabag on his shoulder and a smile on his face. Or one of the women who have learned to carry a heavy load – a basket of fruit or a vase full of water – balanced on her head, walking with grace over a long distance. Why does such a sailor, such a woman, not personify suffering?

The answer clearly lies clearly in how the weight of that load is being transferred through their bodies to the ground. One can of course let their body sag under the weight, but there is also the opportunity to somehow redirect that weight, to push up, push skyward. Paradoxically perhaps, this seems to lighten the load, most likely because the body comes into better alignment and more of the weight passes through to the ground without being “held” by muscles in-between.

We seem to have some kind of instinct for this pushing up. I first noticed it in my training in zazen (Zen meditation) as I worked endlessly with my breath and posture to find the “right” position. Finally it came to me that if I directed my exhalation down – not literally breathing toward the ground but feeling the sensation of exhaling going down through my torso and abdomen – my back, neck and head seemed to naturally straighten and push toward the ceiling. It felt like working a hydraulic car jack. The jack takes the downward pressure of your hand on the lever and transfers it into the upward pressure needed to raise the car. As a result, the zazen seemed to come alive.

Learning to Face Suffering

To go back to the meaning of duhkha – bad posture – notice how that suffering can benefit any of us if we use that weight to teach us the breath and the posture needed to carry that weight with less suffering. Another paradox then: suffering helps us to end suffering.

This phenomenon – this standing up against the weight of suffering is significant to me for two reasons. One reason is the one just mentioned about learning a more effective form of zazen. As you learn to push up from the hips, through the back and the neck, with the crown of the head then pushing toward the ceiling, your senses become more open and your exhalations become longer. If you instead simply sit there like a rock – all gravity and no countering lift – your thoughts rather than your breath will dominate the experience and your zazen never comes alive.

The second reason is a more public one. For many people whose work is to alleviate the suffering of others – whether physical, emotional, or spiritual – one of the toughest skills is to learn how to face that suffering without it becoming a burden of your own. For example, you might be someone who works to ease the suffering of a woman not unlike the miner’s wife that van Gogh painted. If you become bent over with the weight of her burden – coal or sadness – then all of my experience as a hospital chaplain suggests that you won’t be of much help to her.

Instead, whatever words might be spoken with that woman, I would want to also be showing her what’s possible in her own body. I can show her what it means to let the weight of that load – physical, emotional, spiritual – flow through me as efficiently as possible. Just enough use of muscle and bone to hold that weight, but no more than necessary. And a use of breath that drives the countering lift.

The gravity of grief is countered by the lift. The suffering of bad posture is countered by good posture. And the suffering of being under what you carry has been transformed into a form of grace. Suffering has been faced.

Given a choice between Heaven and Hell…

I got a phone call from a long-time Zen student, one who knows how to cut to the chase in most conversations. He asked, “Does suffering end?”

Without thought, I answered, “No.” We then got into the story of his suffering and I explained more of my “no.”

But later I was reflecting on why that “no” came so easily. In most descriptions of Buddhism in America, one usually finds something along the lines of “It’s a religion focused on finding the end to suffering by living according to certain principles.” That’s a straightforward contradiction of what I told my student.

Introductions to Buddhism usually outline one of the core teachings of the Buddha – the Four Noble Truths. In English at least, these Truths are usually presented in sentence form, expressing something like:

  1. The first truth is the existence of suffering for all humans.
  2. The second truth is that suffering is caused by ignorance of the true nature of existence.
  3. The third truth is that suffering ends when you understand the nature of existence.
  4. The fourth truth is that the there is a method to ending suffering called the “Eightfold Path.”

In my own lineage of Zen, we would say that expressing these things in this manner doesn’t cut to the core of suffering. We would say these things more simply and we would not call them “truths” because that implies something to believe. For a Zen person, these things only have meaning once experienced, and experienced in your bones. We might say:

  1. To be alive is to experience suffering.
  2. The experience of suffering occurs because we are attached. Attached to ideas, to things, to illusions and delusions, to people, to a sense of who and what we are.
  3. To become detached from any of those does not lead to an end of suffering. Rather it is transcending the duality of attachment/ detachment that leads to an end of suffering.
  4. The method of transcending duality is through severe mind-body training.

Coming back to my student, what would it have meant if I answered his painful question with a “yes”? For one thing, I would have reinforced a duality – the sense in which he could end suffering without ending himself. Another duality I would have reinforced is that it would be possible for him to not suffer while those around him are suffering. I don’t understand how that would be possible – how can my well-being be separate from that of other people? Hence my “no” to a Zen student.

That’s where I get the title for this entry. In my lineage of Zen, the traditional instruction for a priest is, “Given a choice between Heaven and Hell, go straight to Hell.”

Now, I also work at times as a hospital chaplain and can easily imagine a patient asking me the same question, “Does suffering end”? It would be heartless in that context to say “no.” What do they care about duality? But that doesn’t mean I would easily say, “Yes, it does.” More often than not, I ask them to tell me about this suffering. I’m listening for the story of this suffering. And sometimes, given the right conditions, the suffering starts to ease. Not because any of the objective causes of the pain have ended but because I have now stepped into the suffering with them and they are no longer alone.

When Breath Becomes Air

I saw a man in the intensive care unit last night, close to brain death. Tubes and monitors all around. The hospitalist on duty is carefully explaining to the family of this forty-three-year-old man the sequence of events likely to take place over the next several hours as his skull continues to fill with blood following a fall earlier in the day. The blood at some point will put so much pressure on his brain stem that too many of the brain cells that support his breath and heartbeat will die. Determining the point of death in such circumstances seems to be an imprecise art as the patient is tested for the presence of several key reflexes. The final check, however, seems to be the delivery of pure oxygen into his lungs as the ventilator is shut off. By testing his blood in the minutes that follow, it is possible to see if his body is doing anything useful with that oxygen. If not, he is said to be dead and the ventilator is restarted in order to keep his organs in the condition needed if they are to be “harvested” for possible transplant.

All said carefully with care and compassion to the family. But I’m watching them trying to figure out when in this progression of events their brother, nephew, son actually dies.

Here’s what is filling me as I watch and listen. Go back a few years ago. It’s early evening and the rooms and corridors of my mother’s nursing home are still and quiet. Mother is dying, her hospice nurse earlier saying, “maybe tonight, maybe tomorrow.” I’m alone with her, singing what I can remember of “Swing Low, Sweet Chariot.” I’ve been counting her breaths ever since arriving at her bedside that morning. My brother-in-law calls to ask how she is doing. To give him some form of a quantifiable answer I say, “I’ll count her breaths for you. There’s one…” I wait. There are no more. Her nurse comes in, listens to her heart and chest and says, “I’m sorry.” It’s 8:45 pm. And she is dead. I say goodbye to my brother-in-law, not quite absorbing that her death would be so distinct. This said by a hospital chaplain who has watched many dozens of last breaths.

I’m alone now, still hearing the sound of her last breath, coming as it did from far off down the arroyo she knew so well in Santa Fe and then sweeping onward, up the slopes of the Pecos Mountains to the east. A breath of air that never really had a beginning or an ending, just a puff that filled her for the moment and then was gone. Death was clear and certain. Clear in a way that was not to be available to that family in the ICU that night.

(with thanks to Paul Kalanithi for the title phrase)

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