O nobly-born, although one liketh it not . . . one feeleth compelled involuntarily to go on; . . . noises and snow and rain and terrifying hail-storms and whirlwinds of icy blasts occurring. . . .
         —The Tibetan Book of the Dead

On September 13th, 2010, I lay in a Tokyo hospital, my joints aching and my skin burning hot. Only a faint glow of daylight penetrated my curtained cubicle. The routine of temperature-taking, breakfast, and doctors’ rounds hadn’t started yet, so the room was silent except for the beeping of monitors and an occasional rattling snore from the elderly woman in the next bed.

Sunk in that dimness, and staring up at the white ceiling, I remembered my grandmother’s account of a morning in 1912 when her father, my Tibetan great-grandfather, was coming down into India by pony. He lived in Darjeeling but, deeply involved in the affairs of British India and Tibet, had been carrying out a diplomatic mission in Lhasa. On the way home, he was caught in an avalanche and buried along with several of the men in his party, their ponies, and their mules. But somehow my great-grandfather was able to work his arm loose. He thrust it through the snow and waved his rosary back and forth, muttering to himself, “Save me, Guru Rinpoche! Save me!” Someone spotted him, and he was saved.

I imagined that winter day: the turquoise Himalayan sky, the sun glittering on the ice-encrusted pines; the groaning of the pack animals, their musky smell; the labored breathing of the trapped men as panic rose in their throats. I saw my great-grandfather struggling in his twilit underworld to pull his rosary free and reach for the air; heard him call to his beloved Guru Rinpoche, the eighth-century Indian sage who brought Buddhism to Tibet.

I’d been admitted to the hospital a week earlier, suffering from a severe headache and nausea, an unremitting fever of 103, and violent chills. My husband David and I, American professors at Japanese universities and residents of Tokyo for over twenty years, had been on summer holiday with our children in Indonesia, and my doctors thought I might have contracted dengue fever or malaria. None of my symptoms had abated and every day new ones were appearing: a jaundiced tinge to my skin, tiny red petechiae dots on my hands from subdermal bleeding, a pebbly rash on my knees, photophobia. The pain in my joints was so excruciating that I now understood why dengue, if that’s what I had, was known as “breakbone fever.” The only way I felt slightly less miserable was lying motionless with a gauzy hand towel over my eyes, hour after hour. All I could eat were giant purple kyoho grapes—their burst of coolness a fleeting relief in my fevered state—so I’d been put on an IV. When Dr. Ando, the internal-medicine specialist, stopped in later that morning and saw my untouched tray of mackerel, rice, and miso soup, he asked if I couldn’t try to eat just a little. A slight, somber man of about fifty, he stretched out his arms in a pleading gesture and smiled. “You may have whatever you want,” he said. “Even ice cream.”

~

My Tibetan grandmother was psychic. On Christmas Day 1936, as my great-grandfather prepared to travel to a town near Darjeeling to campaign for an assembly seat, she went to him and whispered, “Father, I didn’t have a very good dream. I don’t think you should go.”

“I can’t help it, darling,” he said, picking up his valise. “All the preparations are made, everyone is waiting for me. I have to go. I can’t let the people down.”

“If you do, Father, you will never come back.” She’d seen his body being brought up to the sky, with a few drops of rain, but also sunshine. Everyone was saying, Look! Look!, and pointing as his body rose to heaven.

“I pre-saw all of that,” my grandmother told me fifty years later over tea in her sitting room in Darjeeling. I was perched on the leathery elephant’s-foot stool that had fascinated me as a small girl, next to the ancient gramophone my grandparents played when they threw parties and everyone danced the Tibetan Charleston. Outside, the snowy peaks of 28,000-foot Mount Kanchenjunga glistened in the sun, towering over the Raj-era bungalows and tea gardens of the fabled former British hill station. “But he wouldn’t listen. On the platform he spoke for five or six hours, and the same night, his heart failed. In his sleep he expired. When the servants went to knock with the tea and toast, he was dead.”

If my grandmother were still alive, I wondered that day in the hospital, what would she prophesy for me? I’d had strange feelings before getting sick. Had I inherited her powers? David, the children, and I had been in Indonesia during Ramadan, and every morning I lay sleepless, listening to the muezzin sing the call to prayer in the still, blue dawn. Regret over matters large and small flooded through me. Hurtful things I’d said or done, lost opportunities, actual and imagined slights—it all flowed past in an endless loop. As if mirroring my inner state, the surroundings were surreal: women in white burkas, their faces veiled, gliding along the roadside; a band of silvery langurs leaping from a tree.

In mid-August we flew back to Tokyo, and a few days later our children started the new school year. But my unease continued, especially one evening toward the end of the month. Our neighborhood—an old area of the city where wooden tile-roofed houses and temples sat among high-rise apartment buildings and international supermarkets—was quiet, as if resting after the sweltering heat of the day. We’d opened the windows, and a twilight breeze brought in the odor of damp earth from the garden, along with laughter from a neighbor’s TV, the occasional cooling ting of a glass wind chime, and the plaintive song of the gyoza dumpling vendor as he wound through the streets in his little truck. An evening like so many others, but glancing up from the newspaper I was transfixed. David sat at the dining table in a tattered Cape Cod T-shirt and khaki shorts, working on his computer. Fourteen-year-old Sophia was sprawled on one of the Tibetan carpets doing geometry problems and eating mikan tangerines, her earphones in and her head nodding to the beat. Twelve-year-old Henry, his cowlick standing straight up as always, sat cross-legged on the sofa, mainlining gummy bears and writing out Japanese kanji characters. Our Westie, Mac, slumbered under the table next to his bone, paws twitching as he dreamed his doggie dreams.

Before long it would all fade away. Sophia would leave for college. Henry would go soon afterward. Not much later, Mac would be dead! I saw David and myself retiring from our universities and growing old, someone else living in the house we’d built. All the things that hadn’t happened yet but inevitably would.

The passing years are like dust, the Buddha said. Regard this phantom world as a star at dawn…a flash of lightning in a summer cloud, a flickering lamp…and a dream. Even though I’d been raised without religion in 1970s California (my mother, after marrying an atheist American, had cast aside the rituals and prayers of her Darjeeling girlhood), I felt a deep connection to Buddhism. At first this tie was only a familial inheritance, but as I grew up it became a secular affinity, a way to better know myself and the world. I understood—or thought I understood—the fundamental principle of impermanence especially well, having written a novel based on the Tibetan Buddhist belief in an after-death journey to rebirth. This journey was one of the “between states,” or bardos_,_ we are said to experience, including periods during life when ordinary reality is suspended, as during sleep or illness. I was aware nothing lasts forever, but until now, I realized, I’d never really felt impermanence.

~

On the day I was admitted to the hospital, Dr. Ando stopped by. Turning the bedside chair around, he straddled it, resting his arms on the back. He gazed at me with an expression both intrigued and perplexed, as if he were wondering how this very sick American woman had come to be under his care. Rubbing his jaw, he asked, “Have you…been in Japan for quite a long time?” When I told him I’d lived in Tokyo for almost a quarter of a century, he looked surprised. When I told him I was a mother of two, writer, and literature professor, he looked astonished. I shared his amazement: in my diminished state, the person I’d described seemed like someone else. I’d taken leave of my full, rich life and was viewing it from afar, just as a spirit hovers in the after-death bardo, gazing back at the existence to which she can never return.

I told myself these feelings were only a symptom of whatever illness I had, some kind of temporary hallucination disorder. I was at the Japanese Red Cross Medical Center, a state-of-the-art hospital that attracted the best doctors in the country, and there was no doubt they would cure me.

“Dr. Ando said there was a guy in much worse condition than you who was here with dengue,” David said as he helped me get settled that first night in my surprisingly attractive room. The hospital had recently been renovated and, with its cream-colored walls, muted lighting, and panoramic views of the city, seemed more like a hotel than a place of suffering. The effect was intensified by the willowy, soft-voiced nurses and the Japanese custom of patients wearing their own nightclothes rather than hospital gowns.

“The guy lasted eight days,” David said, plumping my pillow and arranging my slippers next to the bed.

“And then he died?” I asked, appalled. Why hadn’t they been able to save him? And how could my husband act so offhand?

David laughed and hugged me. “No, he was discharged.”

The first week passed in a blur of pain and confusion as my symptoms worsened and Dr. Ando and his junior, Dr. Kondo, a cheerful, earnest young man who wore scuffed white Crocs, tried to figure out what was wrong. New words entered my Japanese vocabulary: samuke (chill), darui (extreme lassitude), enshou (inflammation), tenteki (IV). I had head CT scans and full-body CT scans; regular MRIs and contrast-enhanced MRIs; X-rays and echocardiograms; agglutination and nephelometry tests; SGOT and SGPT liver function tests; tests for lupus, Sjogren’s syndrome, and rheumatoid arthritis, including ANA (antinuclear antibody), ESR (erythrocyte sedimentation rate), and CCP (cyclic citrullinated peptide antibody). The CRP (C-reactive protein) test, an indicator of inflammation in the body, showed that my level was 16 instead of less than 1, and my CBC (complete blood count) showed thrombocytopenia, an insufficient number of platelets in my blood. If my platelet count got too low, I’d need a transfusion to prevent spontaneous internal bleeding. Too weak to walk, I was taken for the tests in a wheelchair, and though Tokyo was experiencing a record heat wave, I needed an electric blanket to ward off my intensifying chills.

Every night I prayed for heavy, narcotic slumber, but whenever I managed to drift off, it was into a world of nightmares. I dreamed that my credit cards and ID had been stolen and wild dogs were attacking me. Driving on a dark winding road in torrential rain, I lost control of the car and plunged off the edge. I was trapped inside a shack in the hottest desert in the world, dust blowing through gaps between the floorboards, everything shriveled, brown, desiccated. Once, I shot up in bed and called to David, who was dozing in the chair next to me, but he didn’t wake. This is the after-death bardo, I thought. I was in the stage of the journey where, not yet realizing we are dead, we call out to our loved ones, but they cannot hear us.

~

On September 15th, my tenth day in the hospital, a woman I’d known since our daughters were first-grade classmates came to visit. We adored books and fashion and parties, and always had fun together. Her horrified expression when she saw me pale and listless in my sweat-soaked nightgown sent waves of dread through me. We struggled to reassure each other by acting as if all was—almost—normal, chatting about our book club and whether our girls would make the basketball team. Gradually the talk of everyday things soothed my nausea and terrible headache. It even began to seem that my affliction might vanish as mysteriously as it had appeared. Spontaneous remission sometimes happened—why not for me?

A clattering in the hall interrupted our conversation. Moments later, two nurses charged in with a wheelchair. One of the blood cultures had yielded a positive result and the doctors thought there was a nest of bacteria in my heart.

“Everything will be fine,” my friend said, in tears, running by my side as they rushed me out for another echocardiogram. I noticed how lovely her feet looked: the rose pink polish on her toenails, her strappy lavender sandals.

Two hours later, I was lying in bed with the hand towel over my eyes when Dr. Kondo hurried in. No matter how bad my condition, he always remained calm and upbeat, striving to find what he called “happy points,” like my temperature dropping by a few tenths of a degree. But now something was very wrong: his face was flushed and the armpits of his blue scrubs were dark with perspiration.

“Final diagnosis!” he announced breathlessly, flinging his arms wide like an umpire. “Endocarditis.”

He spoke fast, yet unbearably slowly: endocarditis was a life-threatening infection of the heart lining. Bacteria got into the bloodstream, attached to the endocardium—often in a heart valve—and formed a mass, or vegetation. The vegetation in my mitral valve had proliferated to 20.3 mm—so large it would have begun forming four to six weeks earlier, which explained my strange feelings in Indonesia. “It is lucky,” Dr. Kondo said, “that you have not experienced a heart attack.”

“How does this happen?” I heard myself ask.

How could this happen? I’d been running and doing yoga for years. I didn’t smoke, drank in moderation, and ate well.

“Sometimes such an illness arises due to a dental procedure!” Dr. Kondo said, his voice still animated from the excitement of the diagnosis. “The bacteria may enter through the gum. Also when you are old or have some defect in the heart, this disease is somewhat possible.”

I hadn’t had dental work, I was young, and my heart, he said, was strong and healthy.

“In your case,” he told me, “it just happened some germs got into your body.”

I’d need to stay for four more weeks to receive intravenous ceftriaxone and ciprofloxacin, antibiotics that might or might not work.

That might or might not work. I contracted into a knot of fear and bewilderment.

They’d called David and he was on his way. I lay frozen, listening for my husband’s step outside the door. A siren shrieked from somewhere in the city. The rhythmic swish and pulse of a ventilator sounded from one of the other curtained cubicles. Whispers floated on the dim air: unmoved by the no-cell-phone rule, the elderly woman in the next bed was chatting on her mobile. I stared at the travel clock on my night table, tracking the second hand’s oblivious, circular march. Near the clock, the delicate freesias sent by a friend (cut, not potted, because the Japanese believe plants with roots suggest a permanent hospital stay) glowed spectrally white and funereal.

Everything would be fine as soon as David arrived. We’d been inseparable since we met on a rainy March evening in 1985, two English teachers at a Tokyo beer party, and together we always knew what to do. A child of divorce, I’d planned never to marry, to live by the sea with a dog and write. David—witty, irreverent, brilliant, with the bookish good looks I found so attractive—had changed my mind. As soon as he got to the hospital we’d talk, because that was what we did, whether going over the day’s events while we made dinner, critiquing each other’s work (a keen editor, he’d read drafts of my novel more times than anyone should ever have to do anything), sharing funny things the kids had said, brainstorming ways to help our aging parents, ruminating on the future. Ideas, crises, musings—we talked it all through.

But when David strode in, still holding his wallet and the receipt for the ten-minute taxi ride, he sat mutely on the edge of the bedside chair. His shoulders were slumped and he smelled of fried onions from the dinner he’d been cooking for the kids when Dr. Kondo called. I waited for him to say, Everything will be okay, as he had on the way to the hospital the summer we’d rented a cottage on Cape Cod and I’d had a miscarriage. He’d been right: though we lost the baby, I’d gotten pregnant with Henry just a few months later. But for the first time, he was silent.

When we spoke at last, it was to seek control in logistics. He would contact my university to tell them I couldn’t start teaching at the end of the month, call the organizer of a Tokyo writing conference to say I wouldn’t be presenting, and cancel the appointments in my datebook. Each step felt like a cutting of another of my ties to the world, an ever-deeper entombment in bardo.

Soon David left to finish making dinner. Friends had been offering to help, but we felt it was important for the children that David be home as much as possible and keep to the family routines. After he went, I hobbled with the IV stand to the hallway computer to google endocarditis. The smooth, cool feel of the keys under my fingertips calmed me, as always. Now I’d be able to see the whole picture. I would put my thoughts in order and formulate a plan. But as the information flashed onto the screen, my mind grew charged and staticky, my breathing ragged: Complications include congestive heart failure, severe organ damage, intracranial hemorrhage, stroke, neurological failure. Difficult to cure. Significant mortality.

~

Tibetan birth horoscopes indicate the year you will die. I’d never asked about my horoscope, partly because I didn’t want to know when my end would come, but mostly because I felt sure it wouldn’t be before my time.

Yet after the diagnosis I realized with chilling clarity that, in the Tibetan way of looking at things, there was no such thing as “before your time.” When my grandmother died on a winter night in Darjeeling, the moon setting over Mount Kanchenjunga and dogs barking in the mist-shrouded valleys, she wasn’t sick. Her body had just wound down. “It was her time,” explained one of the monks who came to do the prayers from The Tibetan Book of the Dead—she’d reached the end of her allotted lifespan. Calculating age from the womb, as the Tibetans do, she had made it to one hundred.

When my grandmother suddenly couldn’t get warm in the drafty wooden house where she’d lived for over sixty years, the family moved her across town to Tinkerbelle’s Cottage. This was a homey bungalow on the grounds of the Windamere, the Raj-era hotel my grandfather had taken over after India became independent in 1947 and the two Britons he owned the hotel with returned to England. At Tinkerbelle’s, my grandmother felt more comfortable but stayed mostly in bed, not talking or eating much. Sometimes she sat on the veranda and gazed out over the houses and shops of the storybook town where she and my grandfather had ridden through the streets on horseback the day of their wedding in 1930, where her five children had been born, and where her husband had been cremated. This continued for three weeks, until at 1:16 a.m. on November 30, 2004, her heart stopped and, peacefully, she exhaled for the last time.

If this was the end for me, I wanted to embrace it with the same equanimity, and yet I refused to accept that I might be fated to die in my forties. There had been moments when I could have died but didn’t: at nine, I was chased through the woods by a knife-wielding man; at seventeen, I missed an oncoming car by inches as I flew around a curve, driving to my boyfriend’s house one sunny California morning. Surely getting sick with endocarditis was just another one of these moments.

~

From the day I’d been hospitalized, David had been in contact with everybody who might know something, anything, about my condition. Each morning he hurried to the hospital with a legal pad full of notes to discuss with my doctors, trying frantically to understand what was wrong and what could be done. By an improbable stroke of luck, it turned out his family physician back in the States, Dr. Karchmer, was a world-renowned expert on endocarditis. Dr. Ando was awestruck: “Your home doctor is famous!”

Dr. Karchmer confirmed that the ceftriaxone and ciprofloxacin treatment was appropriate and, two days into the antibiotic therapy, Dr. Ando reported that the vegetation in my mitral valve had shrunk almost 40%. David and I were overcome with joy; finally, our luck had turned. It wasn’t my time after all. At this rate, I’d probably even be discharged early. I glanced around the tiny cubicle: it would only take a moment to pack my nightclothes and travel clock, the tube of cooling lavender body lotion a friend had sent. I told David I’d start planning a trip to help our family recover from all that had happened—maybe to Kyoto to see the autumn foliage at the old temples and eat the nama yatsuhashi sweet rice cake that Sophia and Henry loved.

Dr. Ando was standing motionless at the foot of the bed, frowning deeply. At first I attributed this to Japanese reserve or the professional caution that doctors naturally had to exercise. But the gravity of his expression made me shiver. “When the vegetation appears to have shrunk rapidly,” he said, “one possibility is that parts of it have broken off and embolized into the circulation.” The emboli might reach my kidneys, he went on, leading to renal failure. They might travel to my brain and obstruct a blood vessel, causing a stroke. Or they could block a coronary artery, resulting in a heart attack.

I took three sleeping pills that night instead of the prescribed two, but still I hardly slept. Hot spikes of pain radiated from my joints, and I was tormented by the usual feverish nightmares and my fears of the emboli that might be moving through my veins like time bombs. When dawn came at last, gray and dreary, blue-black crows cawing from the rooftops, I felt so grateful to be alive that the morning looked beautiful despite its melancholy.

I decided to try to eat some of the grilled tuna on my breakfast tray. As I took hold of the chopsticks, I realized I couldn’t feel them against the tip of my pinkie. I tested it with my other hand; it was numb. There was also a shimmering at the edge of my field of vision, like heat rising from a road.

The doctor on duty, a quiet man with lank hair, poked his head through the curtains and smiled. “How are you feeling?”

His smile vanished as I told him about the new symptoms. He excused himself, then returned a few minutes later: I’d be taken immediately for an emergency MRI and CT scan. This is how it was discovered that a piece of the vegetation had lodged in the occipital lobe of my brain, causing a large abscess, or pocket of infection, to form. If the abscess cut off blood flow to the surrounding tissue, I could suffer irreversible cognitive impairment or—the doctor paused, searching for the right words—”even more critical complications.”

He hooked up a bag of glycerol, a diuretic that might reduce swelling around the abscess. Then he left, closing the curtains around my bed like a shroud.

All that filtered in were the hoarse ravings of the elderly woman, who in her sleep kept calling out “Iya da!” It’s not okay! The optimism David and I had felt when the antibiotics seemed to be working appeared childish and desperate now. I cast about for encouraging thoughts, a Buddhist principle to hold on to, but my mind was blank.

When David arrived with Sophia and Henry for their Saturday visit, he was lively as always, demonstrating basketball moves for the kids and making them laugh by squeezing into the top to the polar-bear-print pajamas they’d brought me. I forced myself to concentrate as Henry told me how many dango rice flour dumplings he planned to eat at his school’s upcoming otsukimi autumn moon-viewing celebration, the one we always went to together. Sophia showed me photos on her cell phone of possible outfits for a karaoke party that evening, and we debated the merits of a skirt versus a dress, then fell into a heated discussion of how short was too short. She insisted she was old enough to decide for herself: “I’m the one who’s going to be wearing it, not you!” Her strong will was sometimes exasperating, but now I treasured her pluck and passion.

Henry had brought his ondoku Japanese reading-aloud homework, which he liked to do with me. I listened to his usual earnest and dramatic rendition, this time a story about two cranes flying south for the winter, one being killed by a fox and the other lamenting not having been nicer to his now-dead companion. At the end, Henry sighed with satisfaction. A gentle, thoughtful boy, he spent time pondering the workings of the world and liked stories that affirmed a moral order. He especially adored fairy tales, where problems had solutions, right triumphed over wrong, and loyalty and love were eternal.

When he was small, Henry told me, “I’m going to like you forever. Are you going to like me forever?”

“Forever and ever.”

“A lot of evers?”

“That’s right.”

Now he pressed against my hospital bed and smiled, his blue-gray eyes radiant with love and trust. “You’ll be coming home soon, won’t you?”

David and Sophia had been talking, but they stepped close to listen.

“It’ll be just a little longer,” I said, struggling to push down the tide of grief and horror inside me.

Sophia fiddled with the braided strap of her shoulder bag and refused to meet my gaze.

Henry burst into tears. “But you’re going to get well, right?”

“You bet, buddy!” David said, clapping him on the shoulder.

~

Two days later, on the evening of September 20th, David and I had a consult with the neurosurgeon. We gathered in a cramped room down the hall with fluorescent lighting, a bare desk, and molded plastic chairs. David and the surgeon chatted for a moment about the flash flooding caused by the latest typhoon and about the dispute that had erupted between Japan and China over control of a chain of islands in the East China Sea. Then the surgeon, a gracious man with slim, tapered fingers that looked well-suited to his specialty, opened his laptop to show us an image of the brain abscess from the MRI I’d had that morning.

As the computer booted up, David and I held hands, hopeful that the glycerol had reduced the swelling. But the foolishness of our optimism was revealed again.

“Quite a bit more enlargement has taken place,” the surgeon said, clicking open the file. As they’d feared, this had led to infarction, or obstruction of the blood supply, resulting in the death of the surrounding tissue.

I stared at the ghostly gray ovoid on the laptop screen. At the lower left, a black orb was expanding, destroying my brain.

I thanked the neurosurgeon and started back to my room in the wheelchair. The sound of David pressing the doctor with questions faded as I inched past other patients’ rooms, other lives and fears. The big stuffed Snoopy and Hello Kitty on the counter of the nurses’ station looked forlorn, as though they knew what little consolation they could offer in this outpost of misery.

Flipping through papers David had left on my night table, I found the syllabus for the course he was teaching on social identity in postwar Japan and a list he’d scribbled on a yellow Post-it: “sleepover party, bank, change ortho appt, parent-teacher conf, cucumbers.” Tucked in the back was my living will. It seemed responsible to read through it, but the words that had once made perfect sense now appeared to be written in a language I didn’t speak: “there can be no recovery….my death is imminent…”

I returned the will to the folder.

The cold hush of night descended on my room, on the hospital, on the encircling labyrinth of the dark city, its crooked alleyways and dead ends. What seemed to be happening to me couldn’t be happening. I couldn’t die. I was born in the Tibetan Year of the Ox, and not only that, I was a Metal Ox, strong as steel. At the age of eight, I could lift my 200-pound father, and, the sole girl in fifth-grade judo, I threw and grappled my way to the top, beating all the boys and winning the championship. Speaking only classroom French, I moved to Paris by myself at eighteen and worked for a year as an au pair, zipping around the city in a beat-up Ford Escort I bought for a few hundred dollars. In my twenties, I traveled alone through India and Mexico, and interviewed writers in Cuba while being followed by the secret police. I arrived in Japan with $800, no job, and not a word of Japanese, and became a university professor. I wasn’t going to be struck down now by a random illness.

David returned to the room, his eyes red, his face drained of color. “The doctor says the glycerol still might work!”

I heard the despair but clung to his words.

“Did he say anything else?” I asked.

He said the doctors were considering drastic measures to relieve the pressure building in my brain. They might try drilling a small burr hole in my skull to drain the abscess. If this failed, the only hope might be a craniotomy, where they would remove a piece of my skull bone to expose and evacuate the abscess. But there was a good chance I’d end up paralyzed or a vegetable, or maybe worse.

I’d always imagined that if a moment like this came for us, we’d say what we didn’t say in our ordinary, busy lives: There has only ever been you. We had important things to tell each other, now. But we fell silent, alone together in the beeping, hissing night.

Something long forgotten came back to me. In the late eighties, soon after we married and before we had children, we took a holiday to a volcanic island in Fiji. It poured rain all week, turning the dirt roads to muddy rivers, so we spent our time diving. One morning we did a drift dive, the kind where you descend holding on to a rope until you get below the strongest part of the current, close to the ocean floor. But we let go too soon and, unable to see the bottom or the surface, were lost together in the endless blue.

~

Tibetans believe that when someone dies, the surviving relations may encounter obstacles. This was why, on a cold Darjeeling morning in December 2004, a few days after my grandmother’s cremation, an obstacle-removing ceremony was held at the family home. Clouds wreathed Mount Kanchenjunga and the usual cacophony of car horns sounded from the lower part of town. The sharp scent of sacred burning juniper rose from a fire that had been lit in a corner of the back garden. Together with family members, I watched as long prayer flags tied to metal poles were erected for us on the hill behind the garden, where the household staff had arranged plates piled with sugar, curd, biscuits, tsampa barley flour, incense, butter, bananas, and apples as offerings for the deities. The guardian gods of the ten directions had been invited, along with those who had been in meditation for thousands of years.

A senior monk, who’d fled to India from eastern Tibet after the Chinese invaded in 1950, had come from a nearby monastery to perform the ceremony. He took his place at a low, brightly painted table in the garden and, turning the two-headed damaru drum back and forth, ringing a Tibetan bell and rotating a small brass double-scepter dorje in the air, intoned guttural prayers for every wish to be fulfilled, every obstacle removed, every sentient being benefited.

As the ceremony ended, the sun broke through the clouds, and a golden ray fell on the assembled group of aunts, uncles, and cousins bundled in wool shawls and down jackets. A breeze unfurled my prayer flag, revealing the invocations written in Tibetan script next to an illustration of a parasol, one of the lucky symbols, for protection from evil forces, accidents, and disease. Although I didn’t really believe in the ceremony, this did all seem highly auspicious. As if hearing my thoughts, the monk turned to me and said, “You must have faith.” There was no need, he explained, for deep-mind analysis because the scriptures had already been dissected by scholars over the centuries. He added, “It is the same when you visit the gold dealer. You don’t analyze the gold yourself. You trust that it is real.”

I decided I would try to have faith in the ceremony. I didn’t know how exactly to do this, but at least I could suspend my doubt.

After the meeting with the neurosurgeon, I returned again and again to what the monk had said. Buddhism had been a philosophy for me rather than a religion, but now I felt there might not be such a big difference between the two. I wondered whether I’d had enough faith—whatever this meant in my case—in the six years since that morning in my grandmother’s garden. Because I’d at least been present at the obstacle-removing ceremony, I took solace in something else the monk had told me: even if your faith was insufficient, you could gain protection through the ritual, in the same way an ant could earn merit if it inadvertently circumambulated a temple on a piece of swirling dung in a flood.

~

The next day, David got the kids off to school and then rushed to the hospital to talk with my doctors about a corticosteroid called dexamethasone. He’d been up most of the night in frantic contact with Dr. Karchmer, who’d recommended that, in addition to the glycerol diuretic therapy, high-dose dexamethasone therapy be initiated to try to decrease the brain swelling. The situation, Dr. Karchmer said, required “very careful following.” The new therapy was started that morning.

When Dr. Ando stopped by on his rounds, David and I thought he’d say my chances were improved now that I was on steroid therapy. But there was only grave discussion of neurological complications and additional tests; of the possibility of open-heart surgery to replace my mitral valve; of the danger of a stroke since the infection could weaken the blood vessels in my brain. I closed my eyes and listened numbly to their talk, to announcements on the PA system and the shrill sound of doctors’ pagers, to the elderly woman in the next bed grumbling to a visitor about the minuscule food portions and asking him to smuggle in tonkatsu, deep-fried pork. The headache that still hadn’t subsided after nearly a month pounded at the base of my skull, and my body felt stiff and cold.

Dr. Ando said he needed to go and would keep us updated. “But the remaining three weeks of antibiotics must be completed,” he told us, “before we can evaluate what is required.”

The days passed slowly. I slipped into a dream within a dream, drifted into an eerily calm bend in the nightmarish river that had engulfed me. Clouds bloomed like surreal flowers in the azure sky; rain slanted across the cityscape. The sun rose and set over the tidy houses and streets, where somehow life was proceeding as usual. Girls in sailor-style uniforms walked to and from a nearby school; salarymen hurried to work, carrying their suit jackets in the early autumn heat; women rode past on shopping bikes with fat white daikon radishes poking out of the basket; vendors drove along in mini-trucks with loudspeakers on top, hawking things like laundry poles and buckets; fireworks from one of the city’s festivals lit up the distant sky.

The curtains around my bed were usually closed—a relief since I felt too ill for small talk. But I was greatly cheered one afternoon when the elderly woman, who’d finally been discharged, stuck her wizened face through my curtains, hair pinned into a lopsided beehive and a smudge of rouge on her cheeks. “Ganbatte, nee,” she said in her creaky voice. Hang in there. I realized I’d felt a kinship with her as the other patients came and went. I was touched but not surprised—considering her illicit cell phone use and request for contraband tonkatsu pork—that she’d breached the barriers of patient privacy and my foreignness to encourage me.

I started to feel a little less afraid as my periodic echocardiograms and CT scans showed a gradual decrease in the mitral valve vegetation and brain swelling. The abscess began to scar over, and the dexamethasone was tapered. Dr. Ando said I could try walking, so every couple of days a nurse disconnected the IV tube and I shuffled down the corridor to the bathing room. Exchanging my beige bed slippers for pink rubber bathroom ones, I showered wearing a plastic bag over the IV needle. The soap had the same fresh, clean smell as the soap we’d used to give Sophia and Henry their first baths as newborns in a hospital only a few blocks away. I could still feel their downy, wrinkled skin and the way their tiny bottoms and backs fit into the curve of my hand, the wild joy and hope that had overtaken David and me as our children’s lives began.

David would come for lunch, bringing Starbucks lattes, my mail, and the laundry he’d washed for me. We talked about stories in the news and how his teaching was going, household matters, and how Sophia and Henry were doing in school. Later in the afternoon, Sophia would stride in wearing the high-heeled black espadrilles she’d found in my closet, her long legs tan, her skin smelling of fruit-scented body lotion, her oversized sunglasses pushed up to hold back her flowing brown hair. Moving the IV stand aside, she would show me cell-phone photos of her friends, ask me to test her on French verb conjugations or paint her nails with red polish she’d brought from my bathroom drawer at home. Henry would text first—”On my way, want anything?” with an emoji of a boy running—and zoom over on his bike, in his basket the ginger ale I’d started to crave, along with “a little candy” he’d thrown in for himself at the store with money from David. A great foodie, he sat close, his breath smelling of gummy bears, and told me about the best (“yummy”) and worst (“really gross”) school lunches David was making, or his favorite dishes at all the neighborhood restaurants they were getting to know.

Sometimes Sophia and Henry stayed through the afternoon, and to the amusement of the nurses, we lay in the bed together—the kids making it go up and down with the remote control—and watched movies on my laptop: Le Divorce, Last Chance Harvey, Roman Holiday. Careful not to dislodge the IV needle, the kids stretched out, draping their arms and legs on me, the way they’d done when they were little, and snacked on Japanese comfort food: onigiri seaweed-wrapped rice balls, salty senbei crackers, and cold mugicha barley tea. “Let’s go to France!” Sophia said as the Hermès Kelly handbag in Le Divorce sailed like a red balloon over the Paris rooftops. We made a pact to go together en famille, and I promised to show them the tiny maid’s room in the Marais where I’d lived when I was an au pair.

After Sophia and Henry left, I would replay in my mind the movie scenes of daily life: Naomi Watts opening mail in her bohemian Paris apartment, Dustin Hoffman walking Emma Thompson along the River Thames to her writing class, Audrey Hepburn eating an ice cream on a sunny day in Rome. The Buddha taught that only when we truly experience our impermanence can we perceive the profound beauty in everyday existence. Indeed, the ordinary now seemed sublime. If I made it, I would sew Sophia and Henry costumes for Halloween. I’d plant rosemary in the garden and buy plump goldfish for the moss-covered stone basin. After writing all day, David and I would go for walks, stopping to chat with friends and lingering over aki-agari autumn sake at an izakaya bar, with Miles Davis’s Sketches of Spain or Birth of the Cool playing in the background. I would cook for my family: Moroccan chicken with preserved lemons and olives, spinach and fenugreek with Indian paneer cheese, tagliatelle with hazelnuts and prosciutto.

Nights were a journey through realms outside space and time, only the steady beeping of monitors reminding me that the hours were passing linearly. During the long insomniac darkness, I visited my grandmother’s cozy house in the crook of a Darjeeling lane. Climbing the polished wooden stairs to her prayer room, I heard the happy shouts of children playing outside in the Himalayan twilight, the high-pitched whistle of the train as it eased into the station down near the bazaar. I sat on the silk brocade cushions before the carved altar and studied the framed photos of deceased family members, looking long enough to feel the thread linking us but not too long, because I didn’t want to see my own photo next to theirs. Breathing in the earthy odor of the burning butter lamps, I meditated on the golden statue of fierce, wild-eyed Guru Rinpoche, the Buddhist sage my great-grandfather had prayed to when buried in the snow, who was believed to have hidden spiritual teachings under rocks, in lakes, in the mindstream, to be revealed to future generations in times of adversity. One of these teachings was the eighth-century Tibetan Book of the Dead, written to guide travelers on the terrifying journey through the after-death bardo and difficult bardos experienced in life, like accident and illness, to urge them to accept reality but not lose hope. Buried in the hills of central Tibet, the Book of the Dead was discovered centuries later; in the same way, I now felt, my great-grandfather’s lesson about faith had been hidden in our family’s mindstream, to be revealed when it was most needed.

~

On Wednesday, October 13th, the four weeks of antibiotic therapy at last came to an end. My temperature had returned to normal and the headache, nausea, chills, joint pain, and visual disturbances had almost disappeared. The echocardiograms showed that the vegetation in my mitral valve had shrunk from 12.7 mm to 5 mm, a reduction Dr. Ando believed was due to the ceftriaxone and ciprofloxacin. The brain abscess had decreased from 53 mm to 47 mm, and my blood cultures were clear of haemophilus parainfluenzae. Yet another happy point, Dr. Kondo said, cautiously hopeful, was that my mitral valve hadn’t been damaged, so valve replacement surgery wouldn’t be necessary.

I was still at risk for a cerebral hemorrhage. If the infection had created weak spots—aneurysms—in the vessels of my brain and one of the aneurysms ruptured, blood would leak out, putting pressure on the brain tissue and compromising its oxygen supply. Hemorrhagic stroke was, Dr. Ando said, “a catastrophic event” that often proved fatal or resulted in permanent brain damage. They now needed to perform a cerebral angiogram to check for impaired vascular integrity. A catheter would be inserted into my groin and up into one of the neck arteries, which supplied blood to the head; contrast dye would then be sent through the catheter into the blood vessels of my brain. Watching animated images, the radiologist would study the movement of the dye through the blood vessels. If aneurysms were detected in the vessel walls, I’d have to stay in the hospital for two more weeks of antibiotic therapy and, possibly, brain surgery to try to repair the weakened areas.

I set my sights on making it to Henry’s cross-country final that weekend. This was the first season he was competing and I had missed all his races. I would, I decided, make it to that last one.

On Thursday afternoon, I was given a sedative and a local anesthetic, then wheeled to a brightly lit room. Two nurses lifted me onto an examining table, positioned me under a camera, and dimmed the lights. The radiologist, a middle-aged man in blue scrubs and white running shoes, chatted with me about the time he’d spent studying in Los Angeles as he observed the flow of the dye through my brain on a big screen along the wall. A strap held my head in place, but I could see the image: a tangle of gossamer branches anchored by a thick, dark trunk, like an Ansel Adams photo of a California oak in fog. “I’m from the San Francisco Bay Area,” I told the doctor, and we talked about how beautiful the city looked from the Golden Gate Bridge, the lush green of the Marin Headlands above the blue Pacific. Lulled by the sedative, the memories of where I grew up, the hum of the machinery and the warmth of the room, I felt safe for the first time in many weeks and wished the exam would never end. But in only an hour, the doctor had finished.

“There’s no problem,” he said, patting me on the arm.

It was finally over.

The next morning, the October light golden on the gingko trees, David came to take me home. I could hardly believe that at long last I was walking out of the sterile, airless room where I’d been suspended in bardo, the room I might very well have left on a gurney, covered by a sheet.

I was filled with gratitude toward my great-grandfather. His faith no doubt sustained my grandmother as she approached death, and it had sustained me. In bardo, The Tibetan Book of the Dead says, we are pilgrims in search of a lost harmony. I’d thought this meant we seek to restore our old life, but I understood it differently now: it was about the harmony we lose when we forget that impermanence is the central truth of existence.

Some nurses helped David and me pack, exclaiming over and over, “Yokatta desu nee! Yoku ganbarimashita, nee!” It’s great, isn’t it! You really hung in there!

We gave the nurses a tin of chocolate chip cookies the children had baked and a note they’d written, since they were at school:

Thank you for taking care of our mother.
                                 Sincerely,
                                              Sophia and Henry

Dr. Ando and Dr. Kondo stopped in to say goodbye.

“Your case was very difficult,” Dr. Ando said, his worry lines softened by a relieved smile. With typical Japanese humility, he added: “We learned a lot.”

We thanked them again and again, but no words seemed adequate. How could you just say thank you and goodbye to people who’d saved your life? Would I never see them again? Part of me wanted to clutch on: Let me stay! What if they’d missed something and I had a heart attack or a brain hemorrhage? I could be dead by the time I reached the emergency room.

After more thank-yous and goodbyes and lots of bowing all around, David and I left. We dropped my things at home, where Mac launched himself at me, barking with joy, and then we went to lunch at a neighborhood trattoria. After so many weeks in the hospital’s beige and white, I felt like I was in The Wizard of Oz at the moment when everything turns to color: the trees, the flowers, the signs, the cars pulsed in a dazzling array of greens, oranges, pinks, and reds; the sky was a brilliant turquoise. I’d lost ten pounds, my hair was thin, and I had track marks on my arms from the IV needles. But I was eating tomato-and-tuna pasta with my husband on a sunny fall day, my dog at my feet, people talking and laughing at the tables around us, a baseball bat pinging in a nearby field.