HOSPITAL VIGIL

The Practice of Presence

Many years ago, I visited a hospital ward each day for three weeks to keep vigil beside an old friend and fellow monk. Perhaps from decades of inhaling incense in poorly ventilated temple rooms, his lungs had weakened. The rhythmic beeps of the vital signs monitor and the mechanical hiss of the ventilator produced a monotonous harmony as though the machines were chanting their own special sutras. My friend's palms rested motionless atop the thin blanket, fingers twitching slightly, as if remembering an unfinished task.

He had asked me to come, and I came.

The hospital was at the foot of the hills near the eastern edge of the city. From his fifth-floor window, I could see the distant mountains where our temple rested, though he could not. His bed faced a beige wall adorned with a television. The floor was gray linoleum worn thin near the doorway where countless feet had entered and exited.

The chair where I sat was molded blue plastic with a thin cushion that flattened entirely by midmorning. I would shift position every hour or so, less from discomfort than from habit. In the meditation hall we did not sit longer than forty minutes without walking meditation between periods.

Early the first evening, a young nurse arrived displaying brusque efficiency. She glanced at the monitors, adjusted the IV, and asked me to move aside without glancing at my face. I moved my chair to give her space.

Her eyes on the monitor, she asked, “Are you family?”

“No.”

“Only family can stay overnight,” she said abruptly.

I nodded, neither agreeing nor disagreeing.

When she left, I remained.

A different nurse arrived later  that evening. She was older, her gray hair pulled back from a face lined by years of night shifts. She placed a blanket at the foot of the bed. Then she brought a second blanket and placed it on my lap without comment.

“Night shift starts at eleven,” she said. “The supervisor doesn't do rounds until two.”

She dimmed the lighting and left. I understood what she had indirectly said. I could remain through the night if I were unobtrusive. This was the first instance of wordless dialogue. Unspoken and kind.

On the morning of the fifth day, a doctor arrived with three residents in white coats following like ducklings. He spoke in the language of numbers: oxygen saturation, white blood cell count, lung capacity. The residents took notes. None of them looked at my friend's face, only at the parts of him that could be measured. The doctor noticed me in the corner.

“You should step out during rounds,” he said.

I remained seated, palms folded in my lap. The doctor hesitated, then continued his recitation of numbers. When they left, a resident glanced back at me with a curious expression.

The next day, I arrived to find the television on. A game show was in progress. The sound was harsh and loud after the pre-dawn tranquility of the temple where I had begun my morning. I located the remote control and turned it off.

An hour later, a different nurse entered and turned it on again.

“Most patients like a bit of distraction,” she said helpfully.

“He has lived in temple serenity for sixty years,” I replied.

She looked at me, then at him. “I didn't know,” she said, and turned it off.

That afternoon, she posted a small note beside the door: “No TV please. Patient preference.” It was the second instance of mutual understanding. Direct but simple. A small territory of calm was established.

The most difficult hours came during shift changes. It was a transitional period when information was exchanged, responsibilities transferred. Conversation filled the hallway, some hushed, some loud. Carts clattered past. A phone rang somewhere, unanswered. Inside the room, the machines continued their duet of beeps and hushes.

Each day, I brought his zuhatsu, his black lacquerware rice bowl from the monastery. Each morning, I would place it on the windowsill where it was brightly illuminated in the early morning radiance. The bowl established a focal point which drew the eyes away from the machines. One of the nurses asked about it.

“It is his rice bowl from the temple,” I explained. “For a great many years, he has used this bowl, never taking more than needed.”

After that, each time she arrived, her gaze would linger on the bowl framed by the window like decorative art. A small bridge had been formed between our worlds.

On the eighth day, my friend's respiration became more labored. The numbers on the monitors flickered and fell. An alarm sounded and the room quickly filled with staff. Someone pressed a button on the wall. Someone else checked pupils with a small flashlight. A third adjusted medications through the IV line.

I moved to the corner beside the bathroom door, neither leaving nor interfering. A young doctor turned to me.

“You must wait outside,” he said.

Our eyes met. He began to speak again and then stopped. There was an interval of calm between us. An unspoken exchange of understanding about authority and territory. He turned back to his patient.

That evening, the room hushed again, the older nurse with the gray hair returned to monitor vitals. She glanced at the corner where I sat.

“You were here during the code,” she said. It wasn't a question.

“Yes.”

“That's unusual. Most people can't manage it.”

“I have sat with dying monks before,” I said. “In our tradition, we do not turn away.”

She adjusted a pillow with practiced palms. “Neither do we,” she said. “But we have different methods.”

“Yes,” I agreed. “Though perhaps the same intention.”

She looked at me directly for the first time. “Perhaps,” she conceded.

A quiet shift passed between us. It was a recognition across different disciplines, different approaches to the same experience.

The next day, she brought a new cushion for my chair.

By the second week, small changes had appeared in how the staff entered the room. Many would hesitate at the threshold, as if adjusting their internal rhythm before stepping inside. Some lowered their tones without being asked. A few would acknowledge me with a slight nod, neither approval nor disapproval, simply recognition of my continued presence.

I had not complained. I had not demanded. I had not lectured anyone about proper atmosphere for the dying. I had simply remained, embodying an alternative way of being with illness and impermanence.

The young resident who had glanced back at me began to linger for an interval after rounds, watching how I sat, how I attended.

“Are you meditating?” he asked on the twelfth day.

“Just sitting,” I replied.

“What's the difference?”

“One has a purpose. The other is simply presence.”

He considered this. “We're taught to always have a purpose,” he said finally. “A diagnosis, a treatment plan, a goal.”

“A worthy approach for many circumstances,” I acknowledged.

“But not all?”

I gestured to my friend in the bed, to the machines, to the monitors with their flickering numbers.

“Has your purpose made space for his experience?”

The resident did not answer immediately. When he left, his steps were measured, more deliberate.

On the fifteenth day, a specialist arrived from another hospital. He spoke rapidly about experimental treatments, statistical outcomes, aggressive interventions. His energy filled the room like smoke, making it difficult to exhale. When he finished his recommendations, he looked at me.

“Are you the one making decisions?” he asked.

“No one is making decisions now,” I said. “Only witnessing what is already happening.”

He seemed confused by this response. “There are options available,” he insisted.

I looked at my friend's face. The hollowed cheeks. The bluish tint to his lips despite the oxygen. The skin drawn tight across his cheekbones. I had watched him rake the stone garden at the temple, his back straight despite his eighty years. I had heard him chant the sutras, his tone unwavering through the night vigils. I had seen him sit in meditation through winter cold that frosted his eyebrows white.

“What do these options offer?” I asked.

“More time,” the specialist said.

“For what purpose?”

The specialist's expression changed, his certainty faltering for an instant. He looked at the patient, perhaps seeing him clearly for the first time, not as a collection of failing systems, but as a person completing a journey.

“That's not a medical question,” he said finally.

I agreed. “No, it is not.”

Experimental treatments were not added. This exchange, brief but necessary, had introduced the act of seeing beyond the reflexive drive to extend life without asking why.

Three days later, before dawn, my friend's respiration changed. The machine continued its mechanical rhythm, but his body had found its own cadence. More gradual and less regular. I moved my chair closer to the bed. I placed my palm near his. Not grasping, just adjacent, the way river stones rest against one another after years of the same current.

The night nurse entered to check the vitals. She paused, sensing the shift before the monitors confirmed it. Then, without a word, she brought over a second chair and sat across from me at the bedside. She remained there, quiet and unhurried. “It won't be long,” she said with quiet certainty.

We sat together in the dim illumination. Two people from different worlds, witnessing. She did not summon doctors or adjust the IV. She simply remained and with her presence, honored what was happening. It was the most important instance of shared presence. It established a tacit agreement to allow this passage its natural unfolding.

When the monitors finally registered what we already knew, she muted the alarms before they could sound. She checked her watch and noted the time. Her movements were precise and professional yet infused with a reverence for the significance of the passage.

“I'll give you some time,” she said, and left the room.

I sat with my friend's body until the first light appeared. It illuminated the wooden bowl. I stood, straightened his blanket, and bowed in farewell.

Later, a young monk at the temple asked what I had learned at the hospital. He anticipated stories of institutional coldness. Battling medical bureaucracy. Standing fixed against technological intrusion into the transition.

I told him about the nurse who brought a cushion. About the resident who measured his steps. About the night nurse who sat and witnessed without intervention. About the doctor who recognized the limits of medical questions.

“I did not change the hospital,” I explained. “Nor did it change me. But in the space between our worlds, there were intervals of mutual recognition that required neither conversion nor compromise.”

Beside the bochi, the small cemetery on temple grounds, the cherry trees are blooming today. Their petals fall on the stone marker, on the moss. The morning light continues to illuminate the wooden bowl, now returned to its shelf in the temple kitchen. The petals do not fall with intention or purpose. They are released from the tree when their time comes, their descent neither hurried nor delayed.

The most effective approach to resolving conflict contains neither argument nor persuasion. It is the practice of authentic presence. Being fully who you are in places designed for other purposes. Not to convert or confront, but to complement. Sometimes, through the serene demonstration of an alternative possibility made visible, this changes everything.