Caregiving and the Art of Presence

In this tender, candid memoir looking back over the last seven years of her mother's life, a Vietnamese American Zen teacher shares the deep challenges, unexpected gifts, and the pathways she found through the responsibilities of caregiving and the long-term aftermath of loss.

Ordaining as a Buddhist nun right after university, the young Sister Tuệ Nghiêm (Sister Insight) set out to study and practice mindfulness under the tutelage of the celebrated Zen master Thích Nhất Hạnh, a war refugee and celebrated peace activist. When the health of her beloved mother begins to decline, she is confronted with the challenge of applying Zen teachings on impermanence to real life. Through caring for Má, a widow who had taken her five small children on a rickety boat onto the open seas to seek refuge from the war in Vietnam and raised them in America singlehandedly—the author discovers insights on self-care and healing in her own mind and body.
Zig-zagging in space and time between the United States, Vietnam, and France, Sister Tuệ Nghiêm reveals how developing the art of presence can be a key to resiliency, connection, clarity, and peace, even in the most difficult moments of caregiving and anticipatory grief. Drawing on her lifetime of mindfulness practice and the ancestral wisdom of Zen, she shares how taking a silent retreat ten years after her mother's death helps her integrate her love for her mother into her love for all beings, and explores how a caregiver can remain grounded, compassionate, and free while navigating the emotional weight of a parent's declining health.

As well as being a moving story of a woman's love for her mother, the book includes a resource section with Zen teachings on presence for caregivers.Sister Tuệ Nghiêm (“Sister Insight”) ordained as a novice nun on December 11th, 1993, in Plum Village France. She was authorized to teach by Thich Nhat Hanh on February 19th, 1999. She regularly leads retreats in Europe, Asia, Australia, and North America.

Born in Vietnam, Sister Tue Nghiem grew up in California and studied psychology at university, with a strong interest in the mind and the aspiration to alleviate the mental pain she saw around her. The same interest and aspiration then brought her to Plum Village France, to train and ordain in mindfulness practice under Zen Master Thich Nhat Hanh.

Sister Tuệ Nghiêm balances her time in teaching and administrative roles in the monastery with growing organic vegetables in the gardens. She firmly believes in taking care of the body to sustain the practice, thus sharing her experience in holistic medicine, yoga, Qi Gong, and nutrition with the community.Preface: We Can Suffer Less

Ten years after the passing of my mother, I sat down to write about my experience of caregiving for her during her final years, a difficult and spiritually transformative period of my life. I have been practicing mindfulness a long time; soon after graduating from university, in 1993 I ordained as a Buddhist nun in the Vietnamese Zen tradition of the great teacher Venerable Thích Nhất Hạnh, “the father of mindfulness.” As a nun, my vocation has been to serve others and to share the path of mindfulness in daily life, to help bring about more peace in myself and in the world.

Yet for many years—while I was caregiving during my mother’s last illness and for a long time afterward—I couldn’t write about my experience. During that time, if someone had asked me, “How are you?” I might have said, “I’m okay.” The truth is, I was so overwhelmed by my mother’s needs and my own suffering that I didn’t fully realize the physical and mental toll of caregiving until many years later. I didn’t have the words to express what I was going through, or even the time to reflect. It took all my powers of concentration just to be present for my mother and offer her my love and care, to try to meet her changing needs as her health deteriorated.

As a nun and Dharma teacher, I’ve given many talks over the years, but whenever I share about my mother, I receive the most heartfelt responses. People approach me afterward and say: It’s happening to me too. My mother (or father, or grandparent, or spouse, or sibling) is aging. Someone I love is losing their memory and becoming confused. They behave in ways that don’t make sense. I don’t know how to support them. It’s so painful. What can I do?

In Plum Village, the monastery and practice center where I live, we nuns are often occupied taking care of guests who come for retreats, sometimes hundreds of people at a time. We practice mindfulness together and learn how to embrace our difficult emotions and how to cultivate joy. The retreats are a time of much activity and growth. Afterward, we have a rest period called “lazy days,” when we close the monastery to visitors. Last year, I set aside ten days during this time to stay in solitude and write. My teacher, the Venerable Thích Nhất Hạnh, whom I and other students affectionately and respectfully call “Thầy” (“master” or “teacher” in Vietnamese), often encouraged us to write down our life stories to process our impressions and develop our power of insight, to learn from our mistakes and increase our capacity for living mindfully. To have time alone to reflect on and write about my experiences was an enormous gift for which I’m deeply grateful.

Writing this book is a way to honor the memory of my mother, who lives on in me, my siblings, and in everyone whose lives she touched. And, because we human beings are not separate, I hope any insight or understanding I can share within these pages may be helpful to those undergoing similar experiences of loss after caregiving for a loved one. In writing this book, I understood that by delving into my mother’s life—her joys and her sorrows—I could also gain insight into myself and comprehend the impact she had on me through our life together. I could begin to release unconscious tensions I had buried for many years.

“If you know how to suffer,” says Thầy, “you suffer less.”[1] My experiences in caregiving for my mother brought me in touch with unknown levels of anxiety and stress as well as the truth of impermanence. I’m not an expert in eldercare and aging, and this book contains little advice on the practical aspects of caregiving. What I can offer you is my story and insights, with the knowledge that sharing from the heart helps us to realize we’re not alone in our suffering. Importantly, through sharing our real life stories of Zen practice, we come to understand a central Zen teaching: there is a way to embrace our suffering so we suffer less. If you’ve come to this book seeking clarity on your own caregiving journey, I sincerely hope my sharing will be useful to you in some way.

When I was caregiving for Má, and later, when grieving her loss, at times I felt that mindfulness of my breathing was the only thing keeping me from sinking into despair. If there is anything helpful in these pages, it is due to Thầy’s teaching and the understanding support of my monastic sangha, my spiritual siblings, and the steadying effects that mindfulness of breathing can offer to anyone. We all have a body and we all breathe, after all.

Suffering can be the start of a journey of awakening. The word Buddha itself means “to be awake,” and the teachings of the Buddha wake us up to our true nature of love and wisdom. In the life story of the historical Buddha, the Buddha began his quest to find a way out of suffering after encountering three people embodying old age, sickness, and death, whom he called “the three heavenly messengers.” These messengers represent universal experiences that, if we live long enough, we must witness and finally go through ourselves—challenging experiences that can reveal to us the beauty and impermanence of life. Fortunately, there is a fourth messenger: the figure of a spiritual seeker, a wise person who showed the Buddha a path out of suffering through cultivating mindfulness, meditation, and wisdom. This messenger is one we feel fortunate to meet, for they carry the teachings of the wise—the Dharma.

The path of awakening is deep and rich, but it starts with a simple practice that anyone of any or no religion can do: when we suffer, we anchor ourselves in mindful breathing and embrace our suffering. It may seem counterintuitive to go toward our suffering, because our habit is usually to turn away from discomfort and pain and try to avoid them. But if we tenderly turn toward our suffering as if it were a hurt child who needs our attention, this process can be transformative. As we breathe with awareness, we gradually learn to take care of our strong emotions, and we may even grow a bit wiser with each in-breath and out-breath. This mindfulness of breathing is the first step on the path out of suffering.

You can try it now.

Breathing in, I know I am breathing in.
Breathing out, I know I am breathing out.
In.
Out.

If, as you read these lines, you follow your breath and the sensations in your body as you breathe, you may find that your awareness—your mindfulness—increases. Don’t try to control your breathing but gently follow it with kindness and curiosity. When you cultivate mindfulness and compassion toward yourself and others in this embodied way, the path of happiness begins to open up before you.

Breathing in, I know I am breathing in.
Breathing out, I know I am breathing out.
In.
Out.
Breathing in, I am aware of the painful feeling in me.
Breathing out, I smile to the painful feeling in me with compassion.
Painful feeling.
Smile with compassion.

The body is a wonder. It is within this body that everything is possible. Mindfulness is an invitation for us to go back to ourselves, to breathe, smile, and love our body as it is. It's a wonder to be alive, our senses still intact, and to experience the world. The living body is the means through which we touch the present moment deeply.

As a Zen nun, I’m lucky to be able to spend my days practicing mindfulness in spiritual community or Sangha, the third of the Three Jewels that Buddhist teachings say lead us out of our suffering. The first jewel is the Buddha, the quality of awakening; the second is the Dharma, the teachings of nature, which lead to freedom; and the third is the Sangha, the beloved community that lives in harmony and awareness. Taking refuge in these three jewels, I have found inspiration, guidance, and support to help me meet the three messengers of sickness, old age, and death with love and care.

As I wrote down my and Má’s stories during those ten days of silence, I came to see that many elements of Zen practice in Plum Village—formal meditation, yes, but also the sound of the bell and the company of kind and compassionate friends—point us toward developing our capacity for presence, the quality with which we show up in life. I realized that the way we are helps our loved ones as much as the things we do. Through this book, I hope I can share some ways of becoming more present and alive in all the dimensions of our lives—especially in how we meet our own needs and care for those who depend on us. The art of presence, a kind of open curiosity about the experience of being human, helped me show up for my mother even when some aspects of our lives were unstable or even unbearable.

Mindfulness is not only to be practiced so we can have beautiful experiences of serenity and calm, but also to help us navigate the most agitated, anxious, sleepless, messy areas of our lives. Mindfulness can help us maintain or regain our presence of mind during life’s intensity. Being present for ourselves and others helps us transform our suffering so we can suffer less and experience life with more joy.

Breathing with you,
Tuệ Nghiêm
Plum Village New Hamlet, Dieulivol, France
July, 2025
[1] Plum Village Online Monastery, “If You Know How to Suffer, You Suffer Less” Dharma talk by Thich Nhat Hanh, 2013.07.29, https://www.youtube.com/watch?v=DTgv4iPgQ2o.