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One Moment at a Time

By Vidyamala Burch, first published by the Buddhist Hospice Trust, 2005.

 I am a forty-five-year-old woman who suffered a spinal injury thirty years ago that has resulted in a legacy of partial paraplegia and on-going physical pain. Of course this has been difficult to live with, but some twenty years ago I had a significant experience that radically changed my perspective on life and plunged me into the wonder of living in ‘the present moment’.

I was in an intensive care ward at the time, with an acute deterioration of my condition. I had been bedridden for several months and unable to sit up, but on this occasion I had undergone a diagnostic procedure that required me to sit up for several hours afterwards. During this long night of intense pain I felt myself sliding towards the edge of madness.

I spent hours with two internal voices locked in combat - one voice convinced I could not stay sane till morning and the other willing me to do so. It was an incredibly intense, brittle, heart-breaking experience.

Then, suddenly, my experience completely changed when I heard a quiet inner voice saying: “You don't have to get through till morning; you only have to get through the present moment”. It was like a house of cards collapsing, revealing the space that had been present all along, if only I could have recognised it. My experience immediately changed from an agonised, contracted state to one that was soft and rich - despite the physical pain. At that moment of relaxing into the present moment, just as it was, I intuitively knew I had tasted something true.

I later found a way of making sense of this experience through the teachings of Buddhism and have spent the past twenty years training my heart and mind, using meditation and mindfulness. Over the past few years I have founded a project called Breathworks, along with two colleagues who are experienced meditators, where we teach meditation and mindfulness practice to others who live with pain and illness.

Below are some tips and pointers drawn from the methods I have developed that you might find helpful if you are living with discomfort or pain. Please explore these as you wish, alongside any other treatments or therapies you may be receiving. Mindfulness practice can complement conventional medicine in a helpful way.

The first thing is to learn to distinguish between primary and secondary suffering. Primary suffering is any unpleasant physical sensations you may experience as a consequence of illness, injury, fatigue etc. You may not be able to do anything about this level of suffering and the task is to accept it and make peace with it as best you can. Secondary suffering is the human anguish we all experience as a reaction to primary suffering: feelings like anger, fear, depression, anxiety and despair that we instinctively pile on top of any unpleasant sensation or event in a dense web of reactivity. With mindfulness, or awareness, we can learn to modify and reduce these experiences of secondary suffering. This can greatly improve our quality of life, even if the primary suffering remains unchanged, or even worsens.


The tips that follow are aimed at helping you to accept your primary suffering and reduce your secondary suffering.

  • See if you can stay in the present moment as much as you can. Whenever you notice that your mind has wandered off into the future or the past, gently bring it back. this doesn't mean you can't think about the past or future, but try not to get too caught up with these thoughts.
  • Investigate the process you call ‘pain’. You will notice it is in fact a mass of sensations, not a thing. Get to know it as actual, felt experience, rather than getting too caught up with thoughts about it. Notice how it is always changing from one sensation to another, no matter how dense and solid it may feel.
  • Move towards the pain. See if you can soften around any resistance you may feel towards it. This is counter - intuitive but if you try to ignore it or push it away, it will just scream louder. Use the breath to help with this (see meditation that follows).
  • Kindness and gentleness are crucial. Treat pain as you’d treat an injured loved one. See if you can find a tender attitude of heart.
  • Once you have gently acknowledged the pain you can then broaden out your field of awareness to look for any pleasure that is also going on in the moment. Notice experiences such as sun on the skin, being with a loved one, noticing flowers by the bed etc. There will always be something pleasurable in your experience, no matter how subtle. Let the pain be just one of several things you are aware of in the moment.
  • With this honest, tender attitude to all the shades of physical, emotional and mental experiences in the present moment you can then choose how you respond to things. This is the point of creativity – how we respond or act in this moment sets up conditions for the next moment. You can always insert a moment of choice no matter how far down the line you’ve gone into distress and anguish. Any moment can be an opportunity for learning if we come back to the actual sensations of the present moment rather than getting lost in thoughts and reactions. See if you can let both pain and pleasure be held within this broad perspective: neither contracting tightly against pain nor clinging tightly to pleasure. Allow all sensations to come into being and pass away moment by moment.

To summarise

Essentially you are learning three skills:

  • Moving towards the pain with a kindly, gentle attitude, experiencing it as moment-by-moment changing sensations.
  • Then broadening out awareness of the moment to include and embrace pleasurable dimensions as well.
  • On the basis of this broad, rich and more spacious experience of the moment making choices about how you respond to what you encounter.
  • Learning to ‘respond’ rather than ‘react’. This can enrich your experience of life enormously, even when living with pain and illness.

Guided meditation practice

(You may like someone to read this to you, or to dictate it onto a tape or CD)

To begin with make sure the body is in as comfortable a position as possible, either sitting in a chair or lying down on the bed or the floor. Allow the weight of the body to settle down towards the earth, taking a few deeper breaths and letting go a little bit more on each out breath.

Now allow the breath to settle and to find its own natural rhythm, letting the breath breathe itself. Try not to interfere with this process, and notice how the body moves in response to the breath: the chest expanding and relaxing, the belly rising and falling. If your breath is affected in any way by your illness or pain, then just noting this with a kindly, gentle awareness. Try to let go of any ideas about how you think it ought to be, and just rest with an awareness of how things actually are for you in each moment.

- Pause -

Sometimes it can help to include an image with a sense of the breath: you can imagine a wave flowing up the beach, turning, and flowing back out to sea again, noticing how the movement of the breath has a rhythm very like this. Or you might have another image that you find evocative and calming. Use your imagination in your own way to help the mind and the body settle around the breath.

- Pause -

Notice how each breath is unique, how no two breaths are the same. Notice the texture, the quality, and the duration of each breath. If you notice the body or the mind tensing up around your experience, in the noticing you can gently let go again without judgement. Do this over and over again if necessary with a kindly, gentle awareness.

Include any pain or discomfort in the body within your broad field of awareness. Very often we resist feelings of pain or discomfort, and this just leads to more tension, more pain and more discomfort. Use the breath to help soften the hard edges around the pain and allow a tender, gentle awareness to permeate the in- and the out-breaths. As you use the breath to soften resistance to the pain or discomfort, you may notice how the experience of pain is in fact a constantly changing mass of different sensations. Experience how it comes into being and passes away moment by moment.

- Pause -

Now you can broaden out your experience even more to invite in the pleasurable dimensions of your field of awareness. They might be very subtle, such as tingling in the fingers, some sort of pleasure around the breath, or maybe the sun is shining through the window onto the skin. In your own way scanning through your whole experience and noticing little moments of pleasure, no matter how fleeting - arising and falling with each moment.

You may notice that each moment of life contains elements that are painful and elements which are pleasurable. This is the way things are in this world for everyone. Notice the tendency to harden against pain and to grasp after pleasure, and in the noticing relax back into the broad field of awareness.

- Pause -

Now broaden out your awareness still more to include an awareness of others. Become aware that all humanity experiences a mixture of pain and pleasure moment by moment in much the way that you do. The stories of our lives are unique, but the range of basic human experience and emotions will be very similar. We all have hopes and dreams, fears and regrets, no matter where we live, our age, colour or wealth. In this way we can allow our own experience of pain and illness to become a moment of empathy for others who are in pain, or who are ill, rather than a moment of isolation. All life suffers in one way or another. All life experiences pleasure in one way or another.

In the same way that you imbued the breath with a kindly awareness towards your own experience, you can now allow a kindly awareness to permeate the in- and the out-breaths as you think of others. Maybe you can get a sense of the whole world breathing - all life breathing like waves on the ocean. Rising and falling. Allow a sense of the hard edges of separation to soften, letting go into a sense of all that we share and a feeling of connection with all life as you sit or lie here resting quietly with the breath moment by moment.

Rest with this quality of awareness for as long as feels appropriate for you at this time.

- Pause -

Now in your own time bring the meditation to a close. Come back to a full awareness of the body lying on the bed or sitting on the chair. Feel in firm contact with the earth. Tune into the movements of the breath in the body and gradually externalise your awareness. When you’re ready gently open the eyes, take in your surroundings, and re-engage with the day. See if you can take this quality of awareness with you on into your life as it unfolds moment by moment.

Letting go of outcomes

When practising meditation it is important to let go of craving a certain outcome, for example a reduction of pain. The pain may go on for a long time! This does not mean you’ve failed or not meditated correctly. It is just the way things are when one is ill or has an injured body. There is no need for blame or judgement. But remember that even if the body is painful and ill, the mind and heart can experience moments of peace and calm, even a sense of freedom. Meditation can guide us through the doorway to these moments and teach us how to rest there with an honest heart.