Caregiving in the Shin Buddhist Way
Since last September, when my husband underwent his first foot surgery, I have been his primary caregiver. Unfortunately, his foot did not heal properly. He required two additional surgical procedures at a hospital in Los Angeles County, followed by a stay at a rehabilitation center in Tustin. He finally returned home on January 11.
At home, he has been receiving intravenous antibiotics connected to medical equipment. During the first week after his return, a home nurse visited daily to care for the IV and the wound. After that, I needed to learn how to manage these tasks myself under the nurse’s guidance. Through this experience, I realized that I had once walked a similar path: thirty-five years ago, I cared for my mother at home in Kyoto for one year before she departed to the great nirvana.
I am sure some of you have had similar experiences, or you may currently be caregivers for your parents, siblings, spouses, or loved ones. In this article, I would like to share some reflections on caregiving in the Shin Buddhist way.
The Current Caregiving Reality in California
Currently, there are an estimated 4.5 million caregivers in the state of California. Family caregivers include spouses, partners, adult children, other relatives, friends, or neighbors who care for adults with illness or disabilities. Caregivers are disproportionately female (53–60%) and typically middle-aged, with an average age of 49. At the same time, one in four caregivers today are Millennials.
California’s older adult population is increasing rapidly. By 2030, nearly one-fifth of California’s population is projected to be over the age of 65. As a result, an even greater proportion of Californians will take on the role of family caregiver. (California Caregiver Resource Center)
Focusing on What Matters: The Parable of the Poisoned Arrow (Majjhima Nikāya)
There is a well-known Buddhist parable in which a man is struck by a poisoned arrow. Instead of seeking immediate medical treatment, he insists on knowing who shot the arrow, the shooter’s background, and what materials the arrow is made from. Before his questions are answered, the man dies.
This parable teaches the danger of prioritizing unnecessary questions over urgent, life-saving action. The arrow represents immediate human suffering, while the questions symbolize intellectual speculation that does not relieve that suffering. The Buddha reminds us to focus on removing the “poisoned arrow” rather than becoming lost in unanswerable or irrelevant concerns.
In the same way, instead of asking how or why my husband developed his foot condition, I try to focus on his present physical pain and mental suffering. As a caregiver, my task is not to solve every question, but to offer loving care here and now, as fully as I can.
Addressing Burnout: The Buddha’s “Harp” Teaching (Soṇa Sutta)
In another teaching, the Buddha speaks to a monk named Soṇa, who was practicing meditation with such intensity that he became physically and mentally exhausted. The Buddha reminded him of his earlier life as a musician. If the strings of a harp are too tight, they break; if they are too loose, they make no sound. Only when the strings are properly tuned does the harp produce beautiful music.
In the same way, spiritual practice—and caregiving—requires balance. Excessive, rigid effort leads to strain and burnout, while too little effort leads to neglect and disengagement. The Middle Way is a state of balanced energy: alert yet relaxed, diligent yet gentle.
As I care for my husband and manage his IV treatment, I often recall this teaching. I try to maintain a mind of calm attentiveness rather than frantic effort. In my heart, I imagine a well-tuned harp making a gentle, comforting sound for my husband.
Encountering Life’s Realities Through Caregiving
Shakyamuni Buddha taught that life is marked by four fundamental forms of suffering (dukkha): birth, aging, sickness, and death. These realities form the basis of the First Noble Truth and reveal the impermanent nature of human existence.
Birth (Jāti): Entering the cycle of existence, accompanied by physical and mental pain.
Aging (Jarā): The gradual decline of the body and loss of vitality.
Sickness (Vyādhi): Illness, pain, and physical discomfort.
Death (Maraṇa): The fear, pain, and separation involved in the end of life.
These four encounters famously motivated Siddhartha Gautama to seek awakening. Along with separation from loved ones and not obtaining what one desires, they help us understand the true nature of existence.
As I watch my elderly husband face illness and physical limitation, I am reminded that these realities will also come to me without exception. Caregiving brings these truths close to home. Yet, engaging with them can open a path to deepened understanding and compassion. Through caring for others, we embody the Buddha’s teaching that compassion is not abstract—it is lived through everyday actions.
Living Together in Amida Buddha’s Primal Vow
As Shin Buddhists, we live with deep joy in Amida Buddha’s Primal Vow—the promise to liberate all sentient beings without discrimination. It does not matter who we are, what we have done, or where we come from. Amida’s compassion reaches all equally.
Shakyamuni Buddha expounded this profound assurance in the Larger Sutra of the Buddha of Immeasurable Life, teaching that when beings hear Amida Buddha’s Name, awaken an entrusting heart filled with joy, and aspire for birth in the Pure Land, they immediately enter the stage of non-retrogression.
When we recite Namo Amidabutsu, we hear and receive Amida’s Vow. In the midst of caregiving, uncertainty, and fatigue, this calling fills me with spiritual gratitude and quiet strength. Amida’s unconditional liberation embraces us in every circumstance, in all directions, exactly as we are.
Cultivating Wisdom, Compassion, and Self-Care
Sympathy is understanding another person’s misfortune. Empathy is feeling their pain. Compassion is taking action to help alleviate that suffering.
As a caregiver, I learn daily—sometimes through difficulty, sometimes through small moments of joy. I try to listen carefully to my husband, to understand his pain and discomfort, and to respond with patience and care. Day and night, caregiving becomes a practice of compassion grounded in a settled mind. I find myself increasingly grateful for each moment we are given.
When we sit together at dinner, sharing our day and laughing at small things, I am reminded that caregiving is not only about hardship—it is also about connection and presence. At the same time, caregivers must remember the importance of self-care. Without balance, compassion can turn into exhaustion.
We all face the four great challenges of life. May we cultivate sympathy, empathy, and compassion—for others and for ourselves—without turning away, without excluding anyone, while living a life grounded in hearing and receiving the Nembutsu.
Namo Amidabutsu
