The Bardo of Cancer

I have been diagnosed and treated for cancer three times.

My first go happened in 2004, when I was diagnosed with Hodgkin’s disease. At that time, my kids were 3, 7, 9, and 13, respectively, and I was a laboratory professional looking to advance my career. I felt that I couldn’t tell my bosses immediately because I was worried about what their reaction might be. My company was going through a merger, which meant that either my counterpart or I would have a permanent job, but not both. There can’t be two people for one role. I was sure they wouldn’t give the job to a guy who was just diagnosed with a deadly disease. 

I didn’t know anything about Zen then. I had heard about meditation from a coworker, but I only tried it a little by listening to tapes from Wayne Dyer and Deepak Chopra.

The next time I had cancer was in 2019. I found a small lump on my neck. I visited my primary care doctor, who referred me to an interventional radiologist. The radiologist performed a fine-needle biopsy and sent the tissue to a pathology lab. The lab confirmed that I had triple-hit NHL, a fast-growing and aggressive type of non-Hodgkin’s lymphoma. My new oncologist said I needed chemotherapy and a stem cell transplant to increase my chances of survival. I was practicing Zen by this time and remember my teacher instructing me to “think about the one who is not sick.” My body might be ill, and I might not survive, but did I have to identify as an ill person? The occurrence of cancer served as a powerful reminder of the transitory nature of life, also known as impermanence (Pali: anicca). Life was changing, and it would require acceptance not to inflict additional suffering upon myself.

I had a three-year remission before the NHL would return again. My wife and I were living in England for her work, and I was semiretired and enjoying life after work. Once more, cancer reared its dreaded head. Being a laboratory professional, I knew how serious a relapse could be. I also already knew the diagnosis and treatment processes, having been through them before.

I was quite ill by the time the physicians diagnosed me. My cancer came back, but in a different place in my body, and it made me very sick, which didn’t happen the first time I had the disease—I thought I had some type of gastric disease. I was diagnosed by a fine needle biopsy of a mass in my liver.

In all three experiences, I had symptoms that caused me to seek medical help. I had diagnostic biopsy procedures to make a definitive diagnosis and radiographic procedures, including PET and CT scans, to stage my cancer. There was always a delay between the test and when the doctor would inform me of my diagnosis and situation. Each delay was challenging.

Bardo is a Tibetan word translated as “gap, interval, intermediate state, transitional process, or in between.” It usually refers to the gap between lives. However, it can also refer to a gap between moments. Before my diagnosis, I was simply a person experiencing symptoms (albeit of increasing severity). After my diagnosis, I was a cancer patient who would struggle to survive. There was an intermediary state of waiting for the diagnosis. Once diagnosed, there was the intermediary state of treatment—would it work? After completion of therapy, there were follow-up exams to monitor my remission.

Having a life-threatening diagnosis involves a disruption to your life and mental well-being. Having cancer, whether easily treatable or aggressive and life-threatening, brings a sense of loss and a feeling of losing control. It makes you realize that life is about to change.

My life story up to that point had been one of health and vitality. I was a young father the first time I was diagnosed and a newly retired person the third. I had just been skiing before the last diagnosis. I sensed that my life and perception of myself as an adventurer were going to change. Would it last forever? Would I survive? My identity was one of a fit outdoorsman, not a patient in a cancer ward. It was a shock.

My kids were grown, but now I had grandkids. I had negative thoughts about my future. I knew that if I didn’t address them, it would be difficult to make any progress. This is the phase of entering the bardo. You have transitioned from a state of health into a body-mind state of uncertainty. This transition will likely be emotionally intense and frightening. As an oncology patient, one’s mental attitude is key to fighting the disease. It is as important as the medical treatments for your well-being. The latter requires the former to be effective. You want to be very focused on what’s arising. Any lingering feelings, resentments, or yearnings will cloud your body-mind. You need to embrace what is happening now.

The challenge is to accept your feelings of fear and uncertainty while dealing with changes to your body-mind. I know from personal experience that fear and depression can psychosomatically cause physical discomfort in the body. Anger is the second step of the grieving process and often surfaces to avoid sad and grieving emotions. Stress and anxiety may have already surfaced, making it difficult to fully experience or even accept the feeling of loss.

This phase’s opportunity is to help prepare you for what is ahead—treatment, navigating new and unfamiliar work and life concerns, and acknowledging what is happening in the body. This will help develop a level of mindfulness of the current moment but, moreover, help you to focus on doing the next right things. I used this time to become more aware of what was important to me, prioritizing what I valued the most. 

Practice: Allow yourself to release the past that is no longer here. Take time to mourn the loss of your previous life, but also be open to the opportunities that the future still holds. Organize a meaningful and intimate ceremony for yourself. Since I was going to lose my hair during treatment, I asked my kids to shave my head. They were able to participate in helping me to embrace my new reality.

Formerly, I was healthy, fit, and semiretired, enjoying my travels and living my best life. But then, I took on a different role. Time would reveal how that role would evolve.

In this realm, we have the chance to clarify what is truly important to ourselves while also exploring our current moment more fully and discovering what interesting aspects they contain. This very moment, while daunting, holds an invaluable significance.

The time between the initial diagnosis and the following processes can be frightening, but this time can turn the problem into a solution. You might even be able to create joy in the process. The key is to accept and have the courage to navigate through this bardo. Embrace it as an important moment in your journey. Personal authenticity arises naturally from leaning into the emotions present now, acknowledging the thoughts and emotions, and letting them go. To deny them is inauthentic. As Suzuki Roshi once wrote, “Leave your front door and back door open, let thoughts come and go, just don’t serve them tea.”

Thus, the bardo, in its essence, becomes not a void to fear but a threshold to cross with a newly awakened consciousness. This could sound harsh, but navigating this uncertainty is not optional. It will happen whether one wants it to or not. The question is whether one can use it to promote self-growth and transformation.

It is practically impossible not to experience fear during this process. As I write this, I am mindful of a follow-up exam and further treatment that I will soon have. Fear may not disappear, but changing our approach to fear can help reduce the impact of old thought patterns that no longer serve us. Embracing the uncomfortable challenge of the “in-between” helps us navigate cancer treatment and find deeper and more rewarding ways of living. 

I have hiked 4,000 meter peaks in Colorado and skied some of the hardest runs in North America. At the time of my diagnosis, I was training to trek the Camino de Santiago. But in an instant, I had to give all of this up (at least for the time being). For me, one of the most powerful aspects of that rupture is the loss of my former identity.

Another potential identity loss for me was the grandfather role I was just coming into. I have four grandchildren now, and I started to feel as if I was losing my identity as a loving grandparent. I also resigned from my position as a laboratory director, where I provided clinical and quality oversight to laboratories. In doing so, I lost my sense of self and purpose that was bound up in my work identity.

All of these former self-identities, however strongly they defined me, were over. Even now, months after my diagnosis and treatment, I am still capable of participating in only a small fraction of the physical activities I enjoy as before cancer (BC). I suffer this as a loss. Major illness is one of the five principal life stressor events—personal identities are deeply ingrained. It can be very challenging just to acknowledge this loss. However, it is crucial to come to terms with this loss before proceeding ahead with purpose. 

It is liberating to release these former aspects of yourself. They do not need to be gone forever, but for now, they may not serve your immediate needs. You might find that you have new space to discover in nascent parts of yourself. This is an opportunity to be creative. 

Letting go of an identity or aspect of oneself can be difficult. The challenge is to enter a place of not knowing and just let the sensation of uncertainty about what will emerge be present in your body-mind. Instead of rushing for a definition, breathe into the uncertainty and self-doubt that naturally arise when facing a diagnosis.

Embracing a “not knowing” posture allows you to embrace the opportunity to reinvent yourself. This is a time for you to be creative, develop new skills, and redefine your identity based on your emerging interests. I created a list of activities to do after the cancer treatment process, such as taking online courses, getting more involved with the Leukemia & Lymphoma Society, helping other cancer patients and survivors, writing, and playing music.

Embracing a “not knowing” posture allows you to embrace the opportunity to reinvent yourself.

Practice: Allow yourself the time to grieve the loss of your previous identity. Have some alone time for introspection. You may appreciate what there was before without being attached to it. Also know that it may not be a permanent change. But, in the end, release your old BC self. Hold a private ceremony to say goodbye and thank you for what is now gone. I took a personal, solo trip to celebrate and prepare. A friend went on a long trek before returning home to receive her treatment.

You must let go of your old life and old self. Holding on is attachment, which causes suffering (Pali: dukkha) and does not serve you in your journey through the cancer process or the bardo. Do not take this as a repudiation of your previous life (which you might rejoin later) but breathe it in and let it go. 

As with all forms of grief, it is impossible to anticipate the direction your feelings might take. But if you are intentional about the process, you will support a quicker resolution. There is no saying how long this will take for you. You may have a resolution in a week, a month, or more. But now is the time to meet yourself in the bardo.

Congratulations on releasing your old self’s grip on your identity. You have the freedom to be fully present in what is happening now and to directly experience and dwell in the bardo. 

I should warn you, as if it were not obvious, that the uncertainty and formlessness of the bardo can be extremely upsetting. My teacher urged me to breathe into this feeling and think of it as a koan.

Zen, and all of Buddhism, teaches several key concepts: impermanence, dependent co-arising (Pali: paticca-samuppada), and that attachment leads to suffering. During times of health and prosperity, these felt like conceptual teachings, at best. Now, they were utterly real. All the practice and preparation one can muster cannot fully prepare one for losing this precious assurance of life. Losing our hold on health is so daunting that many of us cannot face it directly. It is easy during times of health and abundance to intellectually consider impermanence. It is quite another to be staring into the void. We might resist the notion (one of the five stages of grief) of our illness. The hardest part for me was accepting that I could have less time to live than I expected.

While the diagnosis was daunting, a part of me knew how much stress my mind was adding on top of it. In his book The Heart of the Buddha’s Teaching: Transforming Suffering into Peace, Joy, and Liberation, Vietnamese Zen master Thich Nhat Hahn wrote about the need to cultivate mindfulness in times of great uncertainty, explaining: 

“Yes, there is tremendous suffering all over the world, but knowing this need not paralyze us. If we practice mindful breathing, mindful walking, mindful sitting, and working in mindfulness, we try our best to help, and we can have peace in our hearts. Worrying does not accomplish anything. Even if you worry twenty times more, it will not change the situation of the world. Your anxiety will only make things worse. Even though things are not as we would like, we can still be content, knowing we are trying our best and will continue to do so. If we don’t know how to breathe, smile, and live every moment of our life deeply, we will never be able to help anyone.” 

Although our impermanence can be difficult to accept, when we do accept it, we can feel more connected and grounded in the process.

Uncomfortable situations can cause our body-mind to react with fear or anger. This is known as the second stage of grief. Another response is fixating on false beliefs, which is the third stage of grief. These can compound our suffering, creating higher levels of stress, anxiety, and depression. You have the gift to meet each moment of each day with freshness and embrace its possibilities. Formlessness affords us this opportunity. The gift of embracing formlessness and impermanence is a profound sense of freedom and the potential to meet each day afresh and roll with the changes.

Practice: One can lean into this formlessness by practicing equanimity. Do not allow yourself to get too high or too low. Regardless of any progress or setback, such as an improved test result or spending time in the ICU, always keep in mind that you should respect the unknown nature of the universe. Ultimately, you can’t predict what will be fortunate for you or not. Being fully present in the experience of this roller-coaster ride can make your fear disappear. My teacher once asked me how I wanted to acknowledge my suffering—both on and off the cushion. She encouraged me to bring awareness to my pain, anxiety, and discomfort. I could label it as “this is anxiety” or “this is fear.” This practice could help me yield to the sensation but not be defined by it. In other words, when I am having a certain feeling of discomfort, I can be aware of it, and notice it and reflect on how it feels. My fear might rest in my belly. I can ask myself how I feel about it. Where is the one who is not suffering? The circle of pain and suffering usually ends after a few cycles and becomes more about curiosity than suffering. In an Insights at the Edge podcast interview, the Buddhist teacher Jack Kornfield explains:

“With growing awareness, you can see where you’re caught or where you suffer or where you create suffering. You can then turn toward the difficulties that arise in your life with compassion, bow, and say these too are part of human incarnation.” 

Life after cancer can be difficult to envision, especially if the prognosis is uncertain or disappointing. But this time of rebirth allows us to project what our new form looks like as it emerges.

To create an ideal environment for brainstorming your new project, make sure to set aside enough time for self-exploration, self-care, leisure activities, spending time with family and friends, and nurturing your creativity. Commit to taking a formal vacation or retreat. It’s better if you must travel and spend at least one night away from home. As I am writing this, my wife and I are on the northern coast of England watching the autumn storms roll in.

Create a diary for yourself covering the next three to six months. Spend time on activities that are important to you, such as family, personal matters, and professional priorities that may have recently changed.

The primary obstacle for me was to balance this period of regrowth with ongoing health concerns. One or the other (or both) might be present for you and resist your need to explore your bardo in an open-ended way. This inner voice may be providing less than helpful guidance. Without a new structure, you might find yourself guided by fears and anxieties. You may spend a lot of time reading medical reports, participating in chat rooms, and searching for information about conditions and symptoms. I found it best to remove myself from these chat rooms and not search for information.

A new structure allows you to find time, confidence, and focus to do things that were not a priority before you had cancer. Setting limits on your health activities will make them more focused and effective. This will also create room for new aspects of yourself to develop.

Practice: Try creating a daily schedule that provides ample time for creativity and socialization. Plan your next vacation or retreat and make unforgettable memories. Have calls with friends, family, and loved ones. Create a tentative schedule for your next two to three months, without being attached to it.

During the bardo of death, your mind manifests and shapes its upcoming reincarnation. The mind is the creator of all experiences in life and death. Similarly, during a health transition, subtle signals and signs appear that can shape your new personal path.

Naturally, you will be actively monitoring and reacting to any health conditions that arise. You will also get more subtle signs. But by being attentive to your dreams and emerging ambitions, new and unexpected possibilities will emerge, inviting you to take part.

By paying close attention, you will be able to identify new potential and possibilities consistent with your authentic self. Your mind will be free to guide you forward into your new reality. 

Engaging in these practices more deeply will lead to more frequent and richer invitations. 

By being attentive to your dreams and emerging ambitions, new and unexpected possibilities will emerge, inviting you to take part.

Amidst the chaos of medical treatment and suffering, it’s easy to lose sight of the present moment. It’s easy to get caught up in the past, wondering what caused it or what you could have done differently. It’s also common to worry about the future, thinking about the possibility of relapsing. However, it’s important to focus on the present moment. As we mentioned before, our usual patterns will lead us toward a “rebirth” that represents our strongest psychological tendencies. Failure to pay attention to subtle signs may keep you in a rut.

By embracing “not knowing,” you free yourself up to shape your future. By staying open to the signals from the universe, you can find new opportunities for your life, even if your illness has caused unexpected and unwanted health changes that may be long-lasting. 

Practice: Pay close attention to emerging dreams, intentions, and plans. Discuss synchronicities with your friends. Be in tune with what the universe is providing. Be prepared to accept new invitations from new and old friends to connect. I reached out to a priest friend who helped me find a sangha to meditate with on weekdays. This has been extremely helpful for my recovery. Seemingly out of the blue, I also came across an ebook by Paul Gyodo Agostinelli Sensei on the bardo of work, which partly inspired this essay. Developing mindfulness is essential to recognizing and grasping these new potential opportunities. This heightened awareness will guide you toward aligning your work with your most authentic self.

At its heart, the lessons of the bardo are concerned with the core teaching of impermanence, both in life and in death, and with the liberation that comes with recognizing the real nature of the mind amidst all that changes.

Thus, the bardo teaches us to meet these transitions consciously and, as far as possible, without fear. Dealing with anxiety, stress, confusion, and uncertainty is challenging because they occur naturally and can be difficult to manage. Facing these conditions, acknowledging the physical sensations, and embracing these thoughts can provide clarity and warmth to a path that otherwise feels isolated and gloomy. 

Facing life transitions, especially when dealing with a challenging health diagnosis, is a profound voyage through your own personal bardo. To handle this time of change gracefully and purposefully, honor the break, embrace formlessness, let go of your old self, and pay attention to what is emerging. Self-transition, like the bardo of death, can bring about rebirth and transformation, leading to a new chapter characterized by growth, fulfillment, and authenticity. You don’t know how long your bardo will take. Many people seek to end it prematurely by moving on as quickly as possible from the diagnosis and treatment processes to what they feel they should be doing next. I know that that was my intuition. But if you endure the discomfort of this formless place, unexpected opportunities will arise. 

I can’t suggest that you will immediately find resolution to your anxieties about cancer, its treatment, and its aftermath. If you are like me, you might even exhibit a residual PTSD-like condition. But I do think that you will feel more empowered in your life if you lean into the uncertainty. When your new life path arrives, it will be more rewarding than you ever imagined. I wish you peace and ease as you navigate whatever bardo comes your way.