On their first night in class, the students receive alarming news. They have only nine months to live.
The news is fictional. But the nine-month course, titled "How To Live This Year As If It Were Your Last," helps students consider the myriad ways their lives would change if the timeline were real.
The series is offered by New York's Zen Center for Contemplative Care, founded by two charismatic Buddhist monks, Robert Chodo Campbell and Koshin Paley Ellison. In addition to public courses and direct care for patients who are dying, the Center offers training programs for physicians and caretakers in contemplative end-of-life care. Partners include major medical centers like Mount Sinai and Beth Israel.
Students often make profound changes after taking the course, Chodo said. "We've had one woman, halfway through the nine months, she was diagnosed with breast cancer. She had a double mastectomy. At the end of the nine months, she said, 'I always promised my sister that when I retired I would go live with her in Hawaii.' And she said, 'I'm not waiting. I'm leaving at the end of this year.' She was like 50. And she did. She quit her job. She moved to Hawaii. We got a postcard a few weeks later saying, 'I'm here. Thank you so much. I have no breasts. And I'm in Hawaii.'
The annual gala for the Zen Center for Contemplative Care takes place on October 19. Earlier this year we spoke with Koshin and Chodo about finding personal fulfillment, how to think about death, and the moving experiences they've had with their patients and students.
Can you talk about what happens in your "How To Live This Year As If It Were Your Last" course? What kind of changes do you see in people?
Chodo: We just finished a course recently. It was incredible in so many ways. We had people from all walks of life, professionals on Wall Street, a couple of nurses, house wives. Mainly the age range, though, was 40s to 60s.
On the first evening of the program, we meditated. I did a guided meditation, a visualization of being in a doctor's office. You're sitting there, you'd been in for your checkup, and you're waiting to see the doctor the next week. You're just hanging out reading the magazines. You come into the doctor's office, and he says, "I have some really serious, bad news for you. You have nine months to live." This is the meditation that they're contemplating.
From that moment, we ask, what do you intend to do for the next nine months of your life? If this were real, how would your plans change?
Some of the exercises that we did over the course of the nine months were to make sure they had their advance directives and their living wills in place. Most people don't have that. It's shocking. When we're in a roomful of people, even with a roomful of doctors, we ask, "How many of you have your advance directives in place?" It's a very low percentage. So we get that sorted out.
We go through the process, through the months, building up to the final month. I ask them to write letters, to make reparation with anyone that they need to make reparation with. I ask that they visit a funeral home, so they can find out how much it actually costs to bury someone so that they can, if they want, pay for all the expenses up front before they die. This way they have chosen the casket, they have chosen the memorial service.
We ask them to write a list of all the people they want to be with them when they die, and the people that they don't want there when they die. It's surprising when you ask people, "Who do you actually want there?" The number of people that say, "Well, you know what? I really don't want my children there, because I don't want to be leaving them in such sorrow. For whatever reason, I don't want them there."
We ask people, "Do you want to die suddenly? Do you want a lingering death?" It's surprising the number of people that want a death that is slow, pain free, so that they are able to have their friends, their relatives, their children present. Those that choose not to have their children or their spouses present -- they want a heart attack. They want to go out like that [snaps fingers]. When you actually ask people to think about these things, it's kind of surprising what people come up with.
During the course of the last four or five years doing this, we've had people get divorced. We've had one woman, halfway through the nine months, she was diagnosed with breast cancer. She had a double mastectomy. At the end of the nine months, she said, "I always promised my sister that when I retired I would go live with her in Hawaii." And she said, "I'm not waiting. I'm leaving at the end of this year." She was like 50. And she did. She quit her job. She moved to Hawaii. We got a postcard a few weeks later saying, "I'm here. Thank you so much. I have no breasts. And I'm in Hawaii."
We had a couple of married couples. One of the married couples, he said, "You know what? I'm buying that fucking Harley Davidson. I don't care what she says." The wife was sitting next to him. She said, "Go for it." They were in their 60s, late 60s. She said, "Honey, go for it. And you know what? I'm going to Paris without you." So, you know, it's such a wonderful, enlivening experience.
We have them write their obituaries. How many times do we read an obituary and think, "Oh, god. Is that who they really were? It's not really telling you much." When you actually sit down to write your own obituary -- it's pretty amazing the stuff that I want people to know about me that maybe Koshin or my brothers or whoever wouldn't even think to put out there. And the stuff that they do put out there, it's not important to me. I want people to know I did this, this, this, and this.
Our last evening together, we have a big celebration, because we all made it through, and we're alive. I have everyone give me their favorite song. We have a memorial playlist. We have them bring in objects that they would like on their altar at the memorial. We set up the room. There are all these beautiful photographs and mementos of their life. There's music, all their favorite songs playing in the background, and food. And it's just a party. It's like, if I go out like this, I'll be just fine. It's beautiful.
It's always struck me as unfortunate that the people who have died don't get to enjoy their memorials. Is there a better way to allow people at the end of their lives to celebrate their lives before they've passed?
Chodo: Absolutely. Actually, a good friend of Koshin and myself -- she's a well-known analyst. Her husband was a renowned analyst and writer. When he knew he was dying, in his last months, he hosted his own memorial service. All his friends came to this beautiful home. They all came up to him, paid their respects, told him what they loved about him, what they didn't like about him. They had this incredible meal and drinks. And it was a party. He knew very well that he was not going to be around for another month or so.
It was such an incredible experience for someone to be so wholeheartedly looking at their ultimate ending, their death. It's like, here I am. I've had a great life. I'm going to die. Let's celebrate. And that was it.
So at the time of death, there was no need for a memorial service or any kind of eulogies. Very simple burial with the family, and that was it. How amazing is that?
I think many people are appreciative, maybe even envious, of the way that you approach your lives, but perhaps are skeptical that they can be mindful in the midst of their hectic, busy days. How do you manage that?
Koshin: For me, it's the practice of doing what you're doing now -- and of not doing the next thing while you're doing what you're doing. So, I'm talking to Nico until I'm not talking to Nico, and then I'm going to the next thing, because that's what the next thing is.
We have a fantasy of busyness. "Oh, I'm so busy. I'm so crazy." We hear that all the time. It's becoming the thing to say, as if it's a badge of honor. "I'm busy, so it must mean I'm important or my life has value because I'm busy." What I keep learning about busy is that it's really painful. No one's actually in their experience, they're already on to the next thing.
Our friend Marie Howe, she's the poet laureate of New York state, and a marvelous person. She has a great line about busy people. She says, we have this fear from the science-fiction movies that robots are going to take over. Well, they already have, just not how we thought it was going to happen. [laughter]
So to me, throughout my day, say when I'm walking on 23rd Street in Manhattan, or doing whatever, it's about noticing where I am.
What I love about doing that is that you start to notice that there are some other people on the street who actually are present, too. It's so sweet, because then you actually recognize each other. "Oh, there you are." There's like this little glint. "We're here." And everyone else, you see just masses of people, and they're vrroooom.
Our cat is dying right now. He is such a wonderful creature. The depth of our love for our animals sometimes... in our culture, we have a tendency to trivialize people's relationships with their pets. But they're beings that populate so much of our life.
So being with him and understanding, rather than the idea of his dying or the idea of his death, actually, it's being with him. This morning, there he was on the pillow, like, "Hello," you know.
In some ways, the insight is that our life is just these moments where incredible intimacy is possible, if we're attentive and caring and not caught up by our distractions. Whether it's being with our cat or being with our partners or being with the people that are on the street, to me, all of these things are reminders that it's not going to last. They are continual reminders that are both inspiring and heartbreaking and gorgeous.
You and Chodo led a session where you asked people to turn to a stranger and stare into their eyes for several minutes. What's the purpose of this exercise?
Koshin: Our life is all about relationships, allowing us to connect to each other. For much of my life, I was avoiding that. Actually, I used my Zen practice to retreat from engaging.
And yet the practice of Zen, for me, has become about intimacy. It is about me looking at you and actually allowing you to enter me, and for me to see you, to really have that experience.
One striking aspect is how much we're busy turning away. This experience of looking at another person -- it's not about staring. It's about allowing ourselves to be that open, even vulnerable, to experience the part of us that wants to turn away. The part that makes you say to yourself, "Oh, my god, I feel so uncomfortable."
Look at how busy we are moving away from what is intimate, moving away from what is natural, moving away from what is possible. We're so into preserving ourselves and not trusting the moment, not trusting that what is here is perfect and complete, just as it is. We want to believe all of our old shit. So much of our life is built on protecting and controlling and distrusting. It's very moving to allow yourself to have an experience that lets you give that up.
So looking into someone's eyes, we can begin to look at another and just say, "Oh, who are you in this moment? I've never seen you in this moment, Nico." You know? You're different than when we first met a few minutes ago. And so am I.
Are there any books that have had a profound impact on your intellectual development, on the course of your thinking about these topics?
Koshin: I would say two books, if I were sent away on an island. One is "Zen Mind, Beginner's Mind" by Suzuki Roshi, Shunryu Suzuki. The other one is "Appreciate Your Life" by Taizan Maezumi. Those are two of the most exquisite Zen books. They're really just about life. Basically: this is it; are you going to show up? Because what is here is exquisite.
The other book I love is Edith Hamilton's book, "Mythology". Those stories tell the human story, and about how it can be so challenging. I love those stories so much. I turn to them to realize that our challenges today -- the busyness, the difficulty, the strife, the beauty, the courage, the fear -- have been around forever. Seeing ourselves in these larger stories is always such a delight to me.
Is there an important matter in life about which you have changed your mind?
Chodo: That's a big question, Nico. For many years, I was living with addiction. This was in my teens, 20s, and early 30s, and I was thinking, "What's the point of this life? Let's just get fucked up. Let's do as many drugs as we can. Let's drink as much as we can and party down. Because it's not that important." This was me speaking from my own experience of my own life, not life in the big picture, but my own life.
When I got sober, which is now 28 years ago, I began to see that actually I could have a more spiritual approach to my life. And then when I began my Buddhist practice, which was 25 years ago, I realized the importance of my life, that there was a reason for my addictions. If it were not for those behaviors and that path, that particular path I was on in my early years, I wouldn't be where I am now, doing this work.
If you'd have asked me at 25 what I was going to be doing for the rest of my life, it certainly wouldn't have been accompanying the dying, or educating people around this topic. It would be like, "Yeah, man. Who gives a fuck? I want to be dead. I have a needle in my arm, some coke up my nose, hanging out, having a party."
What has changed is my respect for life and how precious it is. We have a chant in our practice every evening, which is: "Let me respectfully remind you, life and death are of supreme importance. Time swiftly passes by, and opportunities are lost. Each of us should strive to awaken. Do not squander your life."
That is something that I chant every evening. It's so important for me to remember not to squander my life. I did that for a long time. So when I was given the opportunity, or the opportunity presented itself, to see it differently, thankfully I took that path of sobriety.
It is possible to think too much about death, to be overly concerned with it. Is there an approach to thinking about death that you recommend?
Chodo: Death is always imminent. In Zen, our practice is the understanding that at each moment, we're born and dying. In meditations, we talk about with each in breath, I'm bringing life. You know [inhales] this is life. Each out breath is like a mini death. We all die on the out breath. It's the last thing we do.
And moment to moment, we have no idea the extent of our lifespan. There could be a tornado heading for this building right now, or a 747 jet. We just don't know.
So death is always imminent. When we're living with that appreciation of life, we don't have to get so caught up in the morbid thoughts of, "Oh, my god. When's it going to happen? When am I going to get sick? How am I going to die?" Because it probably is not going to turn out the way I thought it would.
Koshin: Most younger people don't think about it often. But then again, most older people don't think about it. Mostly, everyone's busy trying not to think about it. There's this idea that it's actually morbid to think about death, which is ironic.
To me, the only reason it's helpful to think about it is to appreciate this moment. From a Zen perspective, we talk about the birth and death or happening moment by moment. This moment that we're having right now will never happen again, because it will die. In a Zen perspective, it's always happening. There's no future moment. There's only this constant stream of moments.
So to me, it's about using death to help you to be here and to realize that this is it. The reason I love working with dying people is that it's actually not depressing, as many people think. People who are dying always remind me: "I can't believe I wasn't here for most of my life." That's probably one of the most common things I hear, and the biggest regrets. Many people have not actually inhabited their life, because they're just waiting for other moments.
Whether you're young or old, it seems to be across all the values this desire to think that you're preparing for your life and then it's going to be great. Actually, this is it. The more you can actually be alive and attentive and aware that this is it, it is very energizing.
It's like the great energy drink. Who needs Red Bull?
You've said before that caretakers need to be taught how to care for themselves so that they can care for others. What do you mean by that?
Chodo: The first thing that we have to understand is that doctors and nurses are incredibly dedicated to their profession, that in most cases they go into the profession because they want to make a difference in how people are cared for, how they're treated when they're in times of illness.
And yet it's only recently that some medical schools have had end-of-life conversations in the curriculum, how to care for the dying, from more of a personal relational standpoint.
What we try to do is in our education is to convince doctors and nurses and social workers that there doesn't have to be this veil between them and the patient. You often hear stories from them: "If I don't have this wall up, I'm going to burn out."
Well, there are many studies now that show that the clinicians who are most empathetic to their patients are the ones that suffer less with burnout. Because they're able to really separate from what's yours and what's mine. I can journey with you, and I can companion you on your journey. But it's you that's going through the process of dying of this illness right now. I'm bearing witness to it. I don't have to get so enmeshed, but I do want to be with you. Does that make sense? It's like, I can be with you. I can journey with you. And I don't have to get enmeshed.
If I can really see that -- on the one hand, in Buddhism there's no separation between you and I. The paradox is, you're the one that's in the hospital bed right now. I'm not.
You've spoken about expanding the idea of medical ethics in the context of contemplative care.
Koshin: Western bioethics are wonderful and important; issues of autonomy and all of those important things to consider. What we bring in, in addition to that, is looking at, for instance, what does it mean to harm? How am I causing harm to myself or others with my decisions, my actions, and my thoughts? For instance, most physicians speak 75 percent of the time during a patient visit. Is that appropriate? Or can they be a little bit more receptive?
Like everyone else in the culture, caretakers talk about how busy they are. The average patient visit with a physician in the hospital is three minutes. So we look at what they can do in three minutes in terms of ethics, in terms of how they want to hold the space, how they reflect on how they use their time. These are things that we work with the physicians on, helping them get back to their own values.
You have some very emotional interactions with people who are dying, or whose loved one is dying. Have there been any memorable recent experiences?
Koshin: There was a patient recently who really wanted to talk about her sorrow. She kept talking about how sorrowful she felt, to the entire clinical team. This was a young woman, she was 35 and had metastatic cancer and was dying. Everyone kept talking about how she was so sorrowful.
I said, "Well, what's she sorrowful about?" And people said, "Oh... I don't know." It made me realize how rarely we actually take in what someone says, and let them know that we hear them, and are curious about it. "You're sorrowful? What are you sorrowful about?"
When that question was brought to her, she was so delighted. So thankful. She said, "I really appreciate you asking me. And I would like to talk about it."
She realized she was never going to go home again and be able to see her dog. And because we were able to talk about it with her, we were able to make arrangements for her to visit with her dog before she died.
I have a friend who is a wonderful physician. She often says that her first question to her patients is, "Who are the people who really know you and you feel received by? Before we work together as patient and doctor, I want to know about your life and who are the people you can really depend on, who really hear you."
She talks about how diminishing those numbers have been in her practice, that sometimes people look embarrassed or sad. Maybe they can think of one person who really can just hear whatever they have to say.
It goes back to the question of: how do we sit with ourselves? How do we have the courage to be ourselves? How do we look at each other? These are, to me, the most healing.
We've been talking about contemplative care, but sometimes we play with this idea of contemplative medicine. How are you contemplating what is healing for you in your life? And how are you using that medicine, or how are you moving away from it?
The Zen Center for Contemplative Care will celebrate its 10th anniversary soon. You seem to be broadening your focus. What are the next challenges you hope to take on?
Chodo: When we began this journey, when Koshin and I first met, we had both read a book by a man called Issan Dorsey, who was a Buddhist monk. He was a homosexual, drag queen, drunk, drug addict, in the '50s and '60s. Turned his life around and really created the first Zen hospice in San Francisco for men who were dying of AIDS. Out of his passion for that particular population grew this amazing project in San Francisco, the Zen hospice in San Francisco.
When Koshin and I first met, we had both just finished reading that book. We talked about how incredible it would be to build a Zen hospice in New York. So that was the impetus in the beginning for our journey into chaplaincy and this whole work that we're doing now, educating clinicians and caregivers.
My hope for the next 10 years is that we would eventually have a building that could house not only our education programs, but also end-of-life suites for folks who are dying, that we could use our students as volunteers in the end-of-life suites, and that we are able to get doctors, clinicians, social workers to rotate through our organization as part of their learning.
So you have doctors who are in residence or, you know, coming through, doing three months in our place, to really be with people who are dying and to be with spiritual caregivers, so it could all be under one roof. For me, my dream for the next 10 years is to really manifest that.
I think it's so important that we, as a culture right now -- and it's happening -- begin to really, really appreciate the fact that people are dying in ways that are not necessary. We don't have to be hooked up to machines. We don't have to be dying in hospital beds. We can go back to a more relational, connected way of ending our lives, or facing our lives' end.
In the course of spending so much time with people who are dying and who are reflecting on their lives, has that given you a different perspective on what makes up a good life? If someone asks you now what makes up a good life, do you have an answer.
There's a guy that I meet every morning on the way to the center outside of Starbucks who is homeless. He sits there every morning. Wonderful man. And he's there all summer. He's there all winter, you know, asking people for a buck. He has the most engaging qualities about him. He's bright. He has his demons. I think he's probably schizophrenic. But he's incredibly intelligent.
Every morning we engage in dialogue. I always give him like $2, or I buy him a hot chocolate, whatever. I asked him one day -- I'll call him Christopher, that's not his name. I say, "Now, Chris, why don't you get off the streets? You're smart. You have great ideas. You're presentable."
He said, "You know what, Chodo? I'm perfectly happy. I don't have a home. I have my storage container with my belongings, which is like two backpacks and a bike. I don't want to live in the shelters, because everybody in the shelters is crazy, or they're going to steal all my shit. I'm really, really happy. I sit here on 7th Avenue, and I watch the entire world unfold before me every single day. Sometimes it sucks because it's cold, and sometimes it sucks because it's hot. But I love it."
And here's me thinking, you know, my own value judgments. If he just got a job, he could start to earn some money, go move into like an SRO. Then he'd get an apartment and -- "No. I don't want that."
So I don't know what a good life is. I know what a good life is for me. There was a time when I had a home in the Hamptons with a swimming pool and a couple of cars and dogs and a great career. This is all what I was, before I got sober, I was in a world of fashion and glamor. And I was incredibly miserable.
I came from England when I was 30. I wanted the American dream. I wanted the house in the Hamptons, apartment in New York City and this and that. You know what? I was so unhappy with the whole thing.
When I left that life and moved towards what I'm doing now, it's the happiest I've ever been. A one-bedroom apartment. Have to pay rent every month. Don't have a car. I don't have a swimming pool.
The joy in my life is my practice, and the fact that I'm awake to who I am. So I guess, in a nutshell, a good life is being awake to who you are and the life that you have; appreciating your life, whatever it is.