The Living Heart of the Dharma

The Pali Vinaya recounts a moving story about how Gotama [the Buddha] and his attendant Ananda visited a community of mendicants, one of whom was suffering from dysentery but lay uncared for in a pool of his own excrement. When the Buddha asked why no one was tending him, the man replied that because of his illness he was of no use to the community. Gotama instructs Ananda to go and fetch some water so that they can bathe him. Once they cleaned him, they laid him on a couch and went to find the other mendicants. The Buddha berated them for ignoring their sick brethren, then said:

........Bhikkhus, you have not a father, you have not a mother, who might tend you. If you do not tend ........to each other, then who is there who will tend to you? Whoever would tend to me, he should
........tend to the sick.

This remarkable passage shows us three things: Gotama takes it upon himself to offer nursing care to a sick mendicant who has been rejected by his community, identifies himself with those who are sick, and declares that those who care for him, that is, what he embodies, should care for the sick. This passage goes further than simply comparing the Buddha to a physician and his dharma to a course of medical treatment, which has become a Buddhist commonplace. Here we find Gotama non-metaphorically getting his hands dirty by caring for a sick person. It raises the possibility that Gotama actively encourages his followers to serve as doctors and nurses, that his early community was not concerned solely with spiritual well-being but also with attending to the very real sufferings caused by birth, illness, aging, and death. That mendicants were regarded as physicians is reinforced by a passage in the Mulasarvastavada Vinaya, which tells how King Pasenadi "several times mistook doctors for Buddhist mendicants on account of their similar costumes."

The episode likewise offers another perspective on the first of the four tasks. To comprehend suffering means to embrace concretely the condition of those who are unwell by regarding them in the same way as one would regard the Buddha.The helpless newborn, the person tormented by disease, the elderly man who can no longer take care of himself, the terminally ill woman aware that her life is drawing to an end—these people reveal the dharma to us as effectively as the Buddha himself. In the presence of such suffering, there is no room to ponder the meaning of the term dukkha or to speculate about what its end might be. We are challenged to respond to the immediacy of the situation in a way that is not determined by our habitual reactivity. There is no correct "Buddhist" way of speaking or behaving in such cases. We are called upon to say or do something without hesitation—just as Gotama and Ananda immediately attended to the sick mendicant's needs.

That more and more people encounter the dharma today through their firsthand experience of the effectiveness of mindfulness in treating a medical condition points to the centrality of this kind of care and healing in Gotama's dharma. Such people are not drawn to this practice because of an interest in Buddhist philosophy or doctrines. The idea of becoming a Buddhist might be the last thing on their minds. They have found a meditative strategy that works in coming to terms with specific physical or mental ailments. Yet rather than dismissing their experience as the result of a secularized practice of mindfulness from which the rich philosophical and ethical context of Buddhism has been removed, I would prefer to think that they have experienced the living heart of the dharma, around which, over the centuries, numerous layers of religiosity, morals, and belief have been superimposed.

Stephen Batchelor, in after buddhism