Learning to Live Fully with Serious Illness

Susan Bauer-Wu: I think having an illness is the moment that we touch into our own suffering, and that’s a doorway to other suffering, and that expands our compassion. So I actually think being unwell ourselves helps us to be more compassionate for others who are going through a hard time.

James Shaheen: Hello, I’m James Shaheen, and this is Life As It Is. I’m here with my cohost Sharon Salzberg, and you just heard Susan Bauer-Wu. Susan has worked as an oncology nurse, a mindfulness teacher, a clinical researcher, and a retreat facilitator for people living with serious illness. In her book, Leaves Falling Gently: Living Fully with Serious Illness through Mindfulness, Compassion, and Connectedness, she lays out accessible meditations and practices for cultivating resilience and in the face of serious illness. In our conversation with Susan, we talk about what it means to live fully with serious illness, methods for finding spaciousness in the midst of constriction, how to adapt mindfulness practices in the context of pain, and how the quality of each moment can determine the quality of our lives. Plus, Susan leads us in a guided meditation. So here’s our conversation with Susan Bauer-Wu.

James Shaheen: OK, so I’m here with Susan Bauer-Wu and my co-host Sharon Salzberg. Hi Susan. Hi Sharon. It’s great to be with you both.

Susan Bauer-Wu: Hi James. Hi Sharon. 

Sharon Salzberg: Hello there.

Susan Bauer-Wu: Nice to be with both of you.

James Shaheen: Good to be with you. So Susan, we’re here to talk about your book, Leaves Falling Gently: Living Fully with Serious Illness Through Mindfulness, Compassion, and Connectedness. I love that title, Leaves Falling Gently. The book was first published in 2011 and was reissued this year. But before we get to the book, I’d like to ask you a bit about your background. So you’ve worked as a nurse in oncology and palliative care, you’re a trained teacher in MBSR, a clinical researcher, and a workshop and retreat facilitator for people living with illness and their loved ones. Can you tell us a bit about these different roles and how you bring them together? There are so many.

Susan Bauer-Wu: Yeah. You know, it’s a combination of my professional roles, but also a personal journey. It’s not easy to just disentangle our professional hats and the lives that we live every day. So I’ll just walk you through a little bit of my background to kind of show the thread of how it comes together. Back when I was in my late teens, my mother was diagnosed with advanced cancer. I was in nursing school at the time, and so I was already on a path of working in healthcare and being a healer. When I was 23, she died, and I took care of her at home. So that was even before there was hospice. It was in the early eighties. And fast forward, in my clinical practice at the same time, working in oncology I noticed that how people live their lives really mattered. There wasn’t a lot discussed about mind-body connection at the time, but as a 20-something-year-old, I was observing that the meaning that people had in their lives and how they approach their lives really made a difference not only to their quality of life but also to their health outcomes. That sparked me to go to graduate school, and I was in the early days of a new emerging field at the time called psychoneuroimmunology, which was a science of the mind-body connection. I found myself working in an immunology lab and doing interviews with people, and it was a really wonderful experience. I was in Chicago at the time and grieving my mother’s loss, and I left a marriage and I was all alone, and right on the next block there was a Zen center. I started meditating, and it really made quite a difference in how I personally was navigating my life and the challenges. And so I kind of held that in the back of my mind, thinking about my clinical experiences, and how maybe meditation might be able to come back and make a difference.

I did a postdoc in behavioral medicine, and my first full-time faculty job was at the UMass Medical School, so I was close to Sharon right around the corner. I was living in Rutland, Massachusetts, on a little pond close to IMS. I was at UMass, and I had a joint appointment in nursing and preventive behavioral medicine, and the Center for Mindfulness was there. And that’s when I started becoming a teacher in MBSR. In the late nineties, I met a really good friend and colleague, and this relationship, I think, as I reflect on it, was really pivotal. It was with Elana Rosenbaum. You may know of her, and Elana was one of the first teachers of the MBSR program at UMass, and Elana had a serious form of lymphoma and went through a stem cell transplant. I don’t know how long it’s been, it’s been close to thirty years since, and Alana’s still alive and well. That was the start of me doing research in that area. And so I became basically a meditation researcher, and Elana and I, from that time in the late nineties even to this day, have done groups and retreats for people living with serious illness.

James Shaheen: Something that jumps out at me. You said in the early eighties when there was no hospice—that’s amazing. It doesn’t seem like that long ago, but I wonder how did working in these different roles lead you to writing the book?

Susan Bauer-Wu: Well, you know, the simple answer is that I was doing groups and retreats. Even in my academic work, I always did this on the side, and people would often ask, “Do you have a book?” So that was one of the things. I was like, “No, I don’t, but maybe I should.” I found it relatively easy to write the book based on the clinical experiences that I had, and also the research I was doing. I had done a number of different studies, particularly with people with cancer, but not limited to that.

Sharon Salzberg: So the basic premise of the book seems to be that living fully with serious illness is possible. I wonder if you can explain what you mean by living fully.

Susan Bauer-Wu: Yeah, because people kind of don’t get that. If you have really, really serious diagnosis and treatment, how can you live fully? Well, first of all, we have to realize that living fully changes depending on where we are with our lives. Like even now, think about how old you are and what it means to live fully and what it meant forty years ago, right? It’s different. And so the same goes for whether or not you’re living with an illness. And so you begin to shift in what that means. But in its essence, to me, it’s living with ease and contentment and finding joy and meaning and being curious to what is possible regardless of what the circumstances are and how you’re feeling.

James Shaheen: You know, I’ve noticed one of the challenges of people who are quite ill is that people treat them as if they’re less present, less there, so I suppose living fully despite that is quite a challenge. You say that the heart of the book is demonstrating how mindfulness, compassion, and connectedness can be tools in learning how to live fully with serious illness, as we just mentioned. So let’s start with mindfulness. How are you defining mindfulness when you talk about it in the context of serious illness?

Susan Bauer-Wu: Well, to me, I look at mindfulness, whether or not you have a serious illness or anything, I’ll first approach it in general, how I think about it. So it’s our capacity to intentionally bring awareness to present-moment experience with an attitude of openness and curiosity and using our senses and also noticing the changing landscapes of our mind, like being aware and noticing that. In essence, it’s coming home, coming back home to ourselves and living from moment to moment to moment.

I see mindfulness as much more a way of being and being in relationship and being in relationship with ourselves, our circumstances, one another, and the world around us. And so as it relates to serious illness, really looking at our relationship with ourselves and with our circumstances, and not just rejecting and pushing away, but just being present, being present with it. Whether or not the circumstances are having a medical diagnosis or going through treatments or being more dependent on other people, those are our circumstances. How do we relate to that? To me, that really makes a difference. And that can be at the heart of mindfulness with living with serious illness.

I want to point out something that I like to think about is that we know that mindfulness is cultivated through meditation practices, and so meditation and medicine have the same root words. They come from the Latin word meditare, which is to care for. So, in many ways, meditation is another form of caring for ourselves. Just like medicine is, meditation is as well.

James Shaheen: You anticipated a future question, but what I’m getting anyway is that mindfulness is mindfulness, regardless of your circumstance. Sharon?

Sharon Salzberg: Yeah. Well, sometimes we say mindfulness is a relational quality. It’s not so much about what’s happening; it’s about how we’re relating to what’s happening. And that’s what makes it so liberating, because it doesn’t only depend on the sweet times, you know, and the lovely experiences. It’s how we are relating to whatever we are perceiving in the moment, and that is really its superpower. So you say mindfulness, as many schools of Buddhism might, is an innate human quality, and as we get older, we tend to lose touch with that sense of openness and curiosity and presence, and so I wonder how we can reconnect with this innate ability. Certainly meditation seems to be one vehicle for that.

Susan Bauer-Wu: Yeah, you know, I think the first thing is to realize that we’re not really connected to that innate quality, that we’re basically caught up in our thoughts and in our planning and our doing. So the first is to begin to become aware, and once we can begin to do that, we can begin to shift our relationship and our connection to the world that’s around us. So, yeah, the first thing is beginning to notice.

Sharon Salzberg: I wonder if part of what happens as we get older is what James was referring to before, which is that we tend to take in the stories others tell about us and our capacity and our limitations more and more, and certainly with illness, we might do the same thing. And so we really have to try to become aware of what’s actually true as a limitation and what is just a story.

Susan Bauer-Wu: Right, right. Well, the stories that are often told as it relates to illness, and again, it’s not limited to it, but I think they’re really maybe even more pronounced, is living in the past and looking at maybe what we might have done to have caused this illness if we had done things differently, or the worrying of that we’re running out of time and what’s gonna happen and are we going to die of this? Or when that’s going to happen, what’s going to happen to our family? And then we have our own expectations of how we can be a good patient or what we always thought we’d be like when the time came. Or a big one that I see in working with people is others’ expectations. I just spent time with a woman yesterday actually, and so much of her day is consumed thinking about what her kids are thinking about how she should be. And it’s just a constant struggle of how you can show up for yourselves in a way that’s authentic but at the same time not be sucked into what others want of you.

James Shaheen: Yeah, what I was referring to and what Sharon just mentioned is the hardest thing, as I’ve spoken with people who are quite ill, is that people are treating them like they’re not there, or they’re not fully there. And the reverse could be true. In fact, they may even have a better chance of being fully there than people who take their lives for granted. But mindfulness can often be introduced through attention to the breath, but you point out that breathing can pose considerable challenges to some people experiencing serious illness. So what are some of the alternatives to breathing mindfulness when attention to the breath is challenging?

Susan Bauer-Wu: Yeah, the breath is often the anchor, right? And so the invitation is to explore what other anchors might we have, and of course looking at anchors that are present in the body because the body is always with us. So whether or not we’re in a hospital room or in the car or a bedroom, we have that anchor there. So what is a neutral anchor, a neutral point of awareness, that’s not the breath? And for everybody, it’s different. So again, I work with people and help them to explore. But one possibility could be our fingertips, because there are sensations there, and fingertips are oftentimes neutral. Not always. A lot of treatments now these days cause numbness and tingling in fingertips, so it may not be neutral, but if it is neutral, that’s one possibility. So hands, feet, ear lobes, body just resting and connecting with the seat. 

Sharon Salzberg: You know, clearly as you’re pointing out, tuning into the body can be challenging for people living with serious illness. So I want to just pick up your emphasis, which is something neutral in the body can be a place of respite or some kind of refuge. And I’m wondering if you could talk about listening to and attending to the body and how it creates space to cultivate a different relationship with the body.

Susan Bauer-Wu: Yeah. So if the body has let us down or the body is experiencing something that’s really unpleasant, we can resist and reject and push away, right? And so how can we begin to explore what is possible in this body? And the ways that we can do that are, you know, I like to work with pain, if you will. Pain is something that we very quickly don’t have spaciousness around. We have constriction around when we feel pain. But bringing awareness and having mindfulness, being mindful with pain, is an opportunity to begin to befriend our bodies in a new way and to also help lead us to wise action.

So I’ll say a little bit more about that. So when we have pain, lots of times pain can be all-consuming, and it becomes this thing that’s just like so large. By stepping back and having a little bit more awareness of the pain, we can begin to see the subtleties of sensations associated with it. That’s the first thing. Then we begin to realize that, ah, those subtle qualities and sensations actually can change and they do change. That’s super liberating. It’s like, ah, it’s not so much and so tight and so constricting, but there can be more space around it. And that relates to recognizing impermanence and then recognizing that all of us isn’t in pain, that there are parts of us that are working well, that feel OK, another liberating realization. Little by little we begin to realize that wait a second, maybe there’s some information here about this pain that tells me I need to rest right now. Or, oh, this is actually different than what it used to feel like, and maybe I should call the doctor and let them know. So there’s a lot of information that comes with it. And so rather than automatically rejecting, it’s an invitation to explore what is and to change our relationship.

Sharon Salzberg: Well, it’s so hard not to feel betrayed by your body, which just isn’t behaving the way you want it to, and you also talk about the power of befriending the body, and I wonder if you could say more about what that actually looks like.

Susan Bauer-Wu: Yeah. It is different for different people, but I think the first thing is to begin to realize that there are parts of our body that are working well, that have worked well and have served us for our lives and are still serving us, and that we don’t lots of times give ourselves an opportunity to recognize that because we’re so focused on what’s wrong with it. And so how can we just be kind to our bodies and know that our bodies are doing the best that they can and that here we are, this is it, and what can we do? Instead of beating ourselves up and being mad at ourselves and being mad at our bodies for betraying us, it’s like, OK, how can we be a little bit kinder, softer, gentler? And when we can do that, actually that can lead to more relaxation in the body, which then also can make us more comfortable, which then can also cause a positive response to our immune systems, which may actually make us healthier. So there could be a positive vicious cycle too. But befriending the body is like befriending a good friend.

Sharon Salzberg: Our friend Sebene Selassie has framed it as finding belonging in the body. So is that a way you might express it?

Susan Bauer-Wu: Yeah, there’s an ease and a trusting that our bodies have basically been with us through an awful lot, and they’re pretty resilient. Even in those times when it’s super challenging, there’s still a resilience and this belonging that Sebene says. Yeah, that really resonates.

James Shaheen: You know, sometimes cultivating awareness in the body can help us notice all the stories we’re telling ourselves, and you point out that for people living with serious illness, the stories around pain and symptoms can sometimes spiral into catastrophizing. So what are some of the ways to create some distance from these stories and not get swept away?

Susan Bauer-Wu: Yeah, the stories often become the life of the person living with illness. It’s not just that you’re physically feeling unwell, but it’s the stories that we add to it. And so an example would be, you know, you’re feeling a new ache or pain, a new symptom, more tired, and the catastrophizing is, “Oh no, this is it. This is it. I’m not going to get better. I’m getting worse.” And then it continues to spiral because then we feel worse, and then the pain gets worse, and the stories get even more exaggerated. So what can we do? So some simple ways, and these are in the Buddha’s teachings, is first to notice our thoughts and not judge them. Notice they’re just thoughts, and look at what is true and what is the story and also not immediately rejecting the thoughts and being with the thoughts, observing the thoughts and noticing the flow of the thoughts. By doing that they actually can not have as much power over us.

Then, we can bring more energy to it and actually redirect or counteract the thoughts. Those worrisome thoughts could be counteracted with more wholesome thoughts and or images, so wholesome thoughts, aspirations for ourselves and others, where it can be an image or literally going from your thoughts to maybe looking out the window, noticing the trees swaying, noticing the light coming through the leaves, the clouds the birds, the people walking by. And that can get us out of the cycle or the spiral that we’re in.

James Shaheen: Yeah, you talk about the practice of turning toward rather than resisting. So what does it look like, say, in the context of serious illness?

Susan Bauer-Wu: You know, I think everybody is different, and for some people that perhaps have had some personal trauma it can be especially hard. And so it may not be the most skillful thing to do for everybody, but for a lot of people, it’s the quick rejection and reaction of pushing away that actually can perpetuate more suffering. And so the turning toward is beginning, and Sharon, I think you said something like this earlier, of turning toward in a way of seeing more clearly what is happening, that things are impermanent, things do change, or things aren’t as bad as they seem to be. And so the turning toward is possible with gentleness.

James Shaheen: Mmm. Sharon?

Sharon Salzberg: You also described the sense of constriction that can come with illness, where someone’s world might feel like it’s closing in, and of course, in truth, your world may have shifted, at least for the time, sometimes pretty radically with an illness. I mean, I’ve had two hospitalizations in the last six and a half years, one with sepsis, the second one with pneumonia, having to learn to walk again with a walker, with the pneumonia leaving the hospital on 24-hour oxygen. And so things can be very different. But I also notice it’s really what you’re talking about, you know, how there can be a sense of shrinking that that’s coming not even from the circumstance, which can be very challenging, but almost more from the projection into the future that I’ll always be this way, or this means I’m lesser. It’s all of those add-ons that really produce that sense of constriction. So I’m wondering if you can say some more about that sense of shrinking or constriction and ways to cultivate spaciousness within these constrictions.

Susan Bauer-Wu: Yeah, thanks for sharing that, Sharon. It’s hard. It’s really, really hard. And constriction is, I think, a self-defense mechanism because it’s unpleasant and it’s painful, right? And so we want to protect ourselves from feeling it. And then it comes back to this moment, this moment, like, OK, what is true right now? Could I read a little bit from the book?

James Shaheen: Certainly.

Susan Bauer-Wu: It kind of speaks to this, and it’s in the chapter that’s about looking and listening, or listening and looking, inside and outside. It’s about a woman who I worked with who was in the hospital undergoing a stem cell bone marrow transplant for many weeks and was not wanting to be there and not feeling very well and was rejecting everything.

Inside the hospital room, beyond the blaring television, intercom announcements, and the buzzing and beeping of high-tech machines, Julie was able to bring her attention to the background hum of the ventilation system; she was comforted by the constancy of the specialized system designed to purify the air and keep out harmful germs. She could also hear the clock; she would catch her mind in stories about what the clock represents—such as time passing slowly or running out of time—and simply come back to the sounds and movement of the second hand ticking one second at a time. She gradually found it quite settling to listen to and watch the clock ticking, as it became a neutral point of focus that she was able to use to calm the rhythm of her breathing. She also began to notice the intravenous (IV) fluids continually dripping and flowing into her body. She recognized that she had viewed the IVs as tying her down and also a reminder of being sick. Pausing and looking at the fluid move allowed her to drop into the moment, literally one droplet at a time. Eventually Julie’s resistance to the IV dissolved, and she realized the life-giving intention of being connected to it. Then, when the IV machine would beep (indicating the medication had finished running in or it was time to change the fluid bag), rather than tensing up, she used it as an opportunity to center herself, a reminder to pay attention to her breathing. Looking around her room, Julie noticed the colors of the countless cards and drawings on the windowsill and taped to the wall, and she had a revelation that filled her with boundless love: she had the deep realization that so many people loved and cared about her that they took the time to think of her and send her good wishes.”

I then proceed with her looking out the window, because she actually had, now I’m just talking, she had the curtains closed. She didn’t want to look out the window; she didn’t want to be reminded by what was going on outside. But once she could begin by opening the window, she could connect with nature, connect with the outside world, and then begin to realize that actually in whatever small way, she’s still a part of it. And that’s where spaciousness comes in. But it all comes back to the practice of being in the present moment.

Sharon Salzberg: That’s very beautiful, and you know, I don’t know how many listeners are in the United States and how many are in other places dealing with other kinds of healthcare systems, but clearly the healthcare system in the United States is not easy to navigate, and it strikes me that we don’t often associate that spaciousness with strength to advocate for yourself, strength to see more clearly, perhaps what your options are, things like that. And so I just wanted to bring that forth. And you have many interesting practices for finding spaciousness, even within the kind of claustrophobic environment of the hospital, but it’s not just claustrophobic; it’s maddening, often. And I think those practices are really crucial not only for our own well-being in the moment, to have perspective, but for really doing well in that kind of system.

Susan Bauer-Wu: Yeah. Good points. Thank you.

Sharon Salzberg: So you note that mindfulness, which is really what we’re talking about, can help us bring that sense of vividness to ordinary everyday experience and help shift us out of autopilot. And I wonder if you could say more about that and how bringing this awareness to everyday experience helps us accept the inevitable changes in our bodies and our lives.

Susan Bauer-Wu: Well, the spaciousness and the vividness is a resource for us. It’s an opportunity for us to. begin to see the possibilities of what we’re experiencing. So it’s much like the story that I just shared. It’s like, “Ah, it’s not what I thought it was.” Actually the ticking clock, there’s space between the different ticks. There’s space between the droplets of the IV, right? It’s just like there’s a big exhale. And when we have that exhale, I haven’t talked much about this and it leads to the other parts of the book, but that vividness and spaciousness relates to our relationships as well, because we can just come back to the simplicity of being present to one another.

Sharon Salzberg: That’s beautiful too. You know, I wonder if you could say a little bit more about that, in that sense of being part of a whole, like if you’re relating not only in your personal life to those friends and family who are maybe supporting you in some way, but healthcare professionals, you know, as we go about the process of being ill or healing.

Susan Bauer-Wu: Yeah. You know, we have the ability to take a look at the love and care that we receive. You know, being in the hospital is sort of the extreme experience, as you know, but when you’re there, people come in and they wipe the floors, and they bring the food trays in, and you have different people that are nurses’ aides that are helping you bathe yourself, and there’s countless people that are there. You know, you are you because of the care that everybody is giving to you, and we are on a day-to-day basis, but we’re not aware of it. And I think being sick, being ill, is an opportunity to really check in and to notice all the different webs of connection that help us to feel whole and to be well.

Sharon Salzberg: I wonder if you could say something about the examples you use of adapting mindful eating practices and mindful movement to illness, which is sort of another extension from the kind of formal internal practice of bringing these tools to life. So in times of illness, how might we adapt these practices as well as mindful acts of caring for ourselves?

Susan Bauer-Wu: Yeah. So mindful eating, you know, when you’re really sick, you don’t feel like eating, so that doesn’t make sense. Or the things that you used to like to eat don’t taste as good, or you may literally have difficulty swallowing as well as lack of appetite. But a practice that we adapted for the transplant setting was eating ice chips and just one ice chip at a time, and feeling the ice chip on your lips dissolving in your mouth. You can even look at the ice chip in the light and the way it melts. There’s a whole lot of mindfulness that can come into that.

And then mindful movement, again, if you don’t have much energy or you literally can’t move, you can’t get out of bed, as an extreme example, you begin to just have a mindful range of motion. Either you can do it yourself and lift it up, or you can have loved ones or professionals help to just lift your arms around and rotate your joints so you can have more comfort and increase circulation.

James Shaheen: Susan, another major theme of the book is compassion, not surprisingly, and you suggest that we all have the ability to strengthen our innate capacity for compassion. Could you say more about that?

Susan Bauer-Wu: Yeah, I think having an illness is the moment that we touch into our own suffering, and that’s a doorway to other suffering, and that expands our compassion. So I actually think being unwell ourselves helps us to be more compassionate for others who are going through a hard time.

Sharon Salzberg: So the last theme of the book is connectedness, and you say that it can sometimes be hard for any of us to speak authentically from the heart, and serious illness can add an extra layer of challenges around communication. So what are some methods for staying steady and present during difficult conversations?

Susan Bauer-Wu: Well, beginning the conversation by being grounded. And I think mindfulness practices can help to ground us in such a way that we’re in tune with what our heart wants to say. After that, by being grounded, you can also listen. You’re not quick to judge what another person is going to say, but you can be open to listening. And so an example with serious illness that I’ve seen is about making decisions, treatment decisions. Oftentimes, say the person going through the illness has this idea of how far they want to go with accepting treatment and they have this idea of when they want to stop treatment, and then the loved ones are like, “No, no, no, no, you can’t do that.” And so what tends to happen, and this relates to something we were talking about earlier, is others’ expectations. So we go along if we have an illness and we don’t want to get the treatments, but we don’t want to talk about it because we don’t want to upset the other person. We don’t want to upset them by bringing this up. So what do we do? We go along with it. And I’ve seen people, a good friend comes to mind immediately who I know that she did not want to continue treatment and that she just wanted to let go, and she basically could not share it with her parents and her partner and she went along with it. And I don’t think the last months of her life were consistent with what she wanted and what she really valued.

James Shaheen: Susan, we talked earlier about the woman who looked out the window and saw life outside. So in addition to human connectedness, you also emphasize the power of connection with the environment. So how can connecting to the environment strengthen our capacity for meaning making in particular?

Susan Bauer-Wu: So many ways. Well, I’m really into the power, the healing power of nature. And this was a new chapter added to this book. There were a few in this new version, and it was like, we have the last section on connectedness, but you need to go to the nonhuman connectedness, whether it’s animals or other parts of the natural world. So, I think one of the quickest ways is that it gets us out of our selves and our constricted lives into something much larger. We can just easily see and feel something beyond ourselves. The natural world is full of this beautiful sensory stimulation, whether it’s colors or the air on our face or looking at shapes or looking inside the center of a flower. I mean, there’s wonder all around in nature. And then if we really look at nature, there’s impermanence. And so what’s at the heart of all this, what brings us ease, what helps us to live fully is the spaciousness of recognizing impermanence. We are all in this flow of life that is impermanent, and the lessons of nature are right there. And that, to me, makes it a whole lot less scary for us as humans.

James Shaheen: Yeah, I’ve known a few people who, at the end of their lives, wanted to be in nature. They wanted to be in a place where they could look out the window and at least see it.

Susan Bauer-Wu: Mmhmm.

James Shaheen: Susan, your latest project is called Coming to Life, which offers guidance and tools for living purposefully in the face of illness and aging. Can you tell us a little bit about Coming to Life?

Susan Bauer-Wu: Yeah, so, first I want to say a bit about the name of Coming to Life. It’s like, wait a second, illness, aging, and also preparing for death, and you call it Coming to Life? And yes, because it’s when we can begin to touch into the finiteness of our lives, we begin to realize how precious this moment is. And when we can do that, we begin to come to life. And the vividness and spaciousness, the connectedness, all that becomes much, much richer.

A lot of people do not find it easy to deal with the challenges of illness and the changes that come with aging, and also we generally avoid and procrastinate thinking about death and really preparing for death. I’m going to say that there’s a lot more to preparing for the end of our lives that goes beyond estate planning and an advance directive of which is under the extreme circumstances of somebody making decisions for you. There’s a lot that can make the last stages of our lives much more beautiful and whole. And so I feel like I’m fortunate to be doing this work, and it’s kind of the culmination of partly where I started early in my career, but also through the wisdom of living and journeying with illness and aging and death with lots of loved ones. And through the research that I’ve done, I feel like contemplative wisdom actually is foundational to this work. And so I’m really enjoying it.

James Shaheen: Thanks so much, Susan. Anything else before we close?

Susan Bauer-Wu: You know, there’s one thing I’ll mention, and it relates to illness, but it relates to all of us. It was a conversation that I had with Matthieu Ricard many years ago, and it was out at Mind and Life Summer Research Institute. When he shared it, I immediately jotted it down, and it relates to quality of life. A lot of people care more about quality of life than quantity of life. The bottom line is we all want a good quality of life, right? We want to live a good life. How you define it, James and Sharon, is different than how I define it. But in our own way, we want to have a good quality of life, and our lives are just made up of moments. We can quantify from the moment we’re born until the time we die how many moments there are, or seconds, right? And so the quote that Matthieu shared is that the quality of our experience moment by moment will determine the quality of our lives. So it comes back to now. It comes back to this moment. The quality of this moment and the next moment and the next moment is ultimately going to determine the quality of our lives, and we do have some choice in how we view this moment.

James Shaheen: Susan Bauer-Wu, it’s been a great pleasure. Thanks so much for joining us. For  our listeners, be sure to pick up a copy of Leaves Falling Gently, available now. We like to close these podcasts with a short guided meditation, so I’ll hand it over to you, Susan.

Susan Bauer-Wu: OK. Let’s take a moment to be aware of the space we’re in, maybe checking in and noticing what’s present for you, a lot of activation and topics that may have stimulated the mind or the body and just noticing what’s alive in you right now. Noticing the body, checking in with your heart, and allowing the breath to be a little bit fuller, and taking a long, slow, deep breath, filling the belly and the chest, noticing the pause and exhaling fully. Just doing that a few times. As we transition and end the call, it’s taking a moment to set an intention for the rest of the day. Perhaps it’s being curious, being gentle, kind to yourself and to others, breath by breath, moment by moment, right here, right now. Thank you.

James Shaheen: Thank you Susan, and thank you Sharon.

Susan Bauer-Wu: Thank you so much. Good to be with both of you.

James Shaheen: Same.

James Shaheen: You’ve been listening to Life As It Is with Susan Bauer-Wu. Tricycle is a nonprofit educational organization dedicated to making Buddhist teachings and practices broadly available. We are pleased to offer our podcasts freely. If you would like to support the podcast, please consider subscribing to Tricycle or making a donation at tricycle.org/donate. We’d love to hear your thoughts about the podcast, so write us at feedback@tricycle.org to let us know what you think. If you enjoyed this episode, please consider leaving a review on Apple Podcasts. To keep up with the show, you can follow Tricycle Talks wherever you listen to podcasts. Tricycle Talks and Life As It Is is produced by Sarah Fleming and the Podglomerate. I’m James Shaheen, editor-in-chief of Tricycle: The Buddhist Review. Thanks for listening!