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What Matters Most


When Elizabeth Hamilton is diagnosed with breast cancer, she and her husband Ezra Bayda learn the real value of life, love, and holding our attachments lightly. Here, both Zen teachers recount their experiences of Hamilton’s illness and recovery.


In April 2008 I spoke at Zen Center of San Diego about how fortunate we are if we begin Zen practice before an unwanted diagnosis is staring us in the face. A month later I was called about a mammogram that showed dubious calcifications in one breast. A biopsy confirmed early stage breast cancer.

The diagnosis wasn’t on my wish list and—being literally attached to that breast—my first reaction was aversion and fear. But a cancer diagnosis isn’t awful, unfair, or tragic. Thinking that it is, is an emotional reaction—an addition that we bring to the situation, based on our personality and predilections. Unexamined, reactions sap aspiration and vitality, and sour our disposition. Thich Nhat Hanh’s comment, “I arrive in each moment, in order to laugh and to cry, to fear and to hope,” reminds us that Zen training isn’t about floating unaffected above life. That’s usually premature transcendence.

Considering the location of the cancer cells, the best option in my case seemed to be a mastectomy rather than a lumpectomy. It was difficult to face the idea of losing a breast, given that many cultures, including ours, have a veritable fetish for breasts. Concerns about desirability and appearance regularly overshadow concerns about natural functioning. Over one-third of women report dissatisfaction with their breast shape and size, and breast-augmentation becomes more popular every year. One ironic symptom of our preoccupation with breasts is that while magazines featuring semi-naked women are available in many supermarkets, women may feel unwelcome to breast feed, even at family functions. Two diseases are at work here: the breast fetish, and the epidemic of chronic dissatisfaction.

Unlike many men, Ezra—my practice and life partner—isn’t preoccupied with breast size, or even the absence of a breast. His attitude has eased the process of adjusting to a mastectomy, as have two particular practices: loving-kindness meditation, and the ability to distinguish between skillful and unskillful thinking. Skillful or clear thinking is the kind that sees situations objectively and determines appropriate courses of action. Unskillful thinking includes the emotion-laden, egocentric if only’s, poor me’s, and why-why-why’s.

A particularly pernicious form of unskillful thinking is the belief that if we have an illness or physical condition, we are somehow to blame. This misconception is a second disease, because it makes us feel worse by setting forth a welcome mat for guilt or shame. Did we “create” our illness? If so, shouldn’t we be able to “un-create” it? Obviously, thoughts and emotions co-arise with physical conditions; however, when we turn this fact into a distorted version of causation, we’re assuming that our tiny ego rules the universe. Sadly, such notions reflect self-centeredness and a corrosive lack of compassion.

Another unskillful mind-set is the belief that our state of mind is primarily determined by our life circumstances. This is clearly not so. Don’t we all know people who are healthy yet chronically unhappy? Through hospice volunteering, I’m fortunate to meet people in dire straits who remain capable of gratitude and equanimity.

Prior to my surgery, I started practicing an interesting meditation that involved greeting the cancer cells and inviting their input. They didn’t seem to have much to say, and eventually I let them know that, even though they were going to do what they were going to do, their continued proliferation would eventually send all of my body’s cells, cancerous ones included, down the tubes together. I mentioned that an eviction party was scheduled, on the day of the surgery, and that my hope was that they’d vacate.

This meditation made something strikingly obvious to me: the cancer cells were my children, since they undeniably took birth in this body of mine. How could the cancer cells and breast that were removed not be part of my very self, no matter where they were now?

The eviction party has passed, yet there’s no guarantee against future cancer. If a body produces cancer once, it can do it again, and that’s a fact, not a catastrophe. The markers following surgery indicate that the margins and lymph nodes are cancer-free, good news that can readily precipitate yet another deluded disease: the disease of turning being currently cancer-free into one more branch to grasp at, even though we’re all up to our necks in the quicksand of impermanence.

My current cancer and surgery pilgrimage is one small example of why Zen practice has to take us where we don’t necessarily want to go. If it’s not clear what’s required in order to be present during difficulties, practice might just fall flat when we need it most.

Once again I’m grateful to Stephen Levine, the first teacher who helped me see the value of greeting life’s inevitable jolts with charitable awareness. In one of his retreats, he spoke of a cancer patient who said, “Cancer is the gift for someone who has everything.” At the time I couldn’t imagine ever understanding such a thing, but guess what? I have everything! Zen assures us that we are one with everyone and everything. In that case, how could cancer be excluded?

Losing a breast is a tangible reminder of what matters most. This means that, as a central component of spiritual practice, we must continually investigate our ego. We must learn to understand the reactions we add to the present moment and nurture loving-kindness. As practice goes deeper and we become less preoccupied with our me-stuff, the balance shifts, and more of reality gets in. Hopefully we realize that we’re the lucky ones. We, after all, have the opportunity to walk the path of awakening—detours, precipices, and all. I know of no more direct route for accepting Thich Nhat Hanh’s invitation: “May the door of our hearts be left open—the door of compassion.”


My wife, Elizabeth, and I were on a wonderful retreat-vacation in the beautiful and peaceful area of Lake Como, in northern Italy. We spent hours walking through the idyllic towns of Bellagio and Varenna, eating pasta at almost every meal, meditating in a different church each day, and appreciating how lucky we were to have the health and resources to share our life together. Then, shortly after our return to San Diego, Elizabeth was diagnosed with breast cancer.

It felt like the ground had been pulled out from under me. My fear was palpable. In spite of my ten years as a hospice volunteer and my many years of practice, I couldn’t deny that I was still somewhat caught up in the illusion that we had endless time. This illusion, which we all hold to some degree, leaves us convinced that our life will continue indefinitely into the vague future. We are rarely aware of the extent to which this belief keeps us skating on thin ice, oblivious to the very real fact that our lives can end or be drastically altered at any time, without any warning.

Yet as we baby boomers get inexorably older, it becomes increasingly difficult to maintain this illusion of endless time. We hear of more and more people we know being diagnosed with cancer or some other serious condition, and it is no longer unusual for someone close to us to die. My former wife and very close friend for over thirty-five years died of breast cancer last year. And many students whom I work with are dealing with the very difficult circumstances surrounding aging and dying parents. We can continue to try to ignore the evidence, but the cracks in the thin ice seem to be getting bigger as each friend passes.  

We may think it’s not fair, but that’s just the point of view of the small mind of ego—the sense of entitlement that life should go the way we want it to go. In historical perspective, our times are relatively safe and comfortable, and perhaps that fortifies the illusion of control. Yet, it can seem daunting when this illusion gets shattered, as it did with Elizabeth’s diagnosis.

As we become aware that our loved ones have limited time, we are bound to feel alone and disconnected, which can manifest as fear of abandonment and loss. On some basic yet very deep level all of us feel fundamentally alone, and until we face this directly, we will fear it. Most of us will do almost anything to avoid this fear. Many, when faced with the fear of aloneness, get extra busy, or try to find some other escape. Ultimately, however, the willingness to truly feel the fear of aloneness and loss is the only way to transcend it. It’s also the only way to develop intimacy with others, because genuine intimacy can’t be based on neediness or on the fear of being alone. When we need people we can’t truly love them, because we see them and relate to them through the small mind’s filter of neediness.

It’s a given that we fear disconnection when faced with possible loss. I certainly felt it when I was told Elizabeth had cancer. But we can’t forget that true connection comes when we’re willing to acknowledge the uncomfortable feelings that are part of our human condition. True connection comes when we breathe the aching fear of loss into the center of our chests and simply let it be there, no matter how uncomfortable we might feel. Once we truly learn to reside in our fear of aloneness, we will no longer expect those close to us to assume responsibility for taking away our fear or making us feel good. Instead we will know reality; we will know love.

Facing our aloneness and fears exposes our deepest attachments, leaving us without the false props of our illusions. Although this can be painful, the good news is that mindfulness practice can help make it less so. The melodrama doesn’t have to take over, and instead we can begin to see through what we are most attached to.

Am I attached to Elizabeth? Absolutely! In fact, one of the things that has become clear to me since I heard she had breast cancer is how I’ve held the belief that I can’t be happy without her. So her diagnosis helped me to realize the degree of my attachment—to her, to her good health, to our life together. This situation has given me an opportunity to look more deeply. Aren’t our difficulties always our best teacher, taking us to the places we will rarely go on our own?

As I’ve watched my mind, it’s become clear that thoughts such as “I need Elizabeth to be happy” are thoughts based on self-centeredness and fear. And it’s become clear that every one of these thoughts prevents me from really being with Elizabeth, because they’re not about her, but about me.

Practice helps us accept our feelings of groundlessness and disconnection and leads us to become more willing to feel and reside in our fears—our fear of the loss of control, our fear of the loss of the familiar. Residing in our fears without doing what we usually do to get rid of them is what erodes our attachments and helps us see through our illusions—the illusions that we have endless time or that we can make life go the way we want.

How can we face these fears directly? First we must be willing to drop the story line—the thoughts that the spinning mind keeps churning out. Once we decline to indulge thoughts like “This is awful,” “I can’t handle this,” or “Poor me,” the melodrama loses its steam, and we’re left with something that is much more workable—the actual energy of fear and loss. We can then say yes to them, which means we are willing to feel them rather than run away from them.

It may seem counterintuitive, yet when fear of loss arises, if we breathe the sensations of anxiety right into the center of our chests, we may find that our usual dread is replaced with a genuine curiosity. As the familiar thoughts that normally fuel our fear begin to fall away, we can experience the healing power of the heart. This is a non-conceptual experience—it does not come from words or explanations, but rather from the spaciousness of a wider container of awareness. As the fear of living as a separate being dissolves, we naturally tap into the connectedness and loving-kindness that are always available to us, and that are the real fruit of the practice life.

The result of all this for me is that I’m even more appreciative of Elizabeth, and more able to be present with her. It’s not that I wasn’t appreciative of her before, but being caught in my attachments prevented me from being fully present with her. This is not to say that I’m now totally free of attachment to her, but my attachment is much more lightly held. Practice can transform our need for a particular thing into a less emotion-based preference for that thing. Having preferences isn’t a problem, nor is enjoying them. The problem is when we’re so enslaved by our attachments that they run our lives. As the demand loses its hold, we can simply enjoy it as a preference.

Of course, no one wants to reside in the sinking groundlessness that is triggered when we fall through one of the cracks in the thin ice. Nonetheless, it’s only when we’re able to reside in the physical experience of no ground—no longer clinging to our fantasies of how life is supposed to be—that the power of our attachments begins to diminish. This is the path of practice. When we see through our attachments, that is, when we fully experience them, the result is freedom. When we see without the filters of our judgments and desires, the result is appreciation and the quiet joy of being. When we see through our fears, the result is love.

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