On the occasion of the 40th Anniversary of the parinirvana of His Holiness the 16th Karmapa, here an extract from the corresponding chapter of Radiant Compassion
The hospital in Hong Kong was like a charnel ground. It had all the smells, sights, and sounds of the suffering of illness and death. The most shocking thing was to see His Holiness sitting in the middle of all of this, himself in the throes of pain and death, smiling and being concerned for those around him. John Seonaidh Perks
In August 1981, Karmapa’s health became more precarious, with such extreme stomach pain that he could no longer eat solid food. His personal doctor Dr. Tsewang Pemba advised him to enter a hospital as soon as possible, one that could provide modern examination methods. They had to determine whether his cancer was once again active. Dr. Pemba proposed a Hong Kong clinic whose chief surgeon Dr. Guan Bee Ong enjoyed an international reputation. On September 9, His Holiness again spat blood. Gangtok Hospital was informed, and Dr. Raj Kotwal went to Rumtek. In his own words, Dr. Kotwal “always looked at things very critically,” and had “no trust in anything except science,” but on this occasion he witnessed Karmapa’s capacity to read people’s minds: his condition was extremely alarming, and he was going into hypovolemic shock (anemia) with his diabetes becoming acute. In addition, he was hypoglycemic. As had already happened earlier, he was in critical danger of falling into a coma. Dr. Kotwal commented, “I warned point-blank that if we did not act quickly, it would be fatal for him.” But at the same time, he did not know exactly what to do: “I closed my eyes and prayed silently that if he really is who these people and others claim he is—let him guide me as to what I should do next.” Of course, this did not escape Karmapa’s awareness, and when Kotwal opened his eyes again, His Holiness indicated that he needed intravenous fluids, which were immediately provided. Karmapa then asked the doctor to accompany him to Hong Kong, and he agreed. A couple of days later, His Holiness left Rumtek. (…) Of course, a great master’s farewell could not happen in secret. Devotion to Karmapa among the Sikkimese people had increased steadily during the 20 years he had lived in Rumtek. Word quickly spread that it was uncertain whether he would return there alive. When Karmapa, accompanied by the Gyalwa Yabses,* Drupon Dechen Rinpoche, General Secretary Damchö Yongdu, and others drove to the Gangtok helipad, all Gangtok was astir: thousands flanked his convoy on the roadside, while the entire government of Sikkim came to bid him farewell. He took a helicopter to the nearest commercial airport, where thousands of people from Darjeeling and Bhutan, including hundreds of monks and nuns, had come to say goodbye. With the military presence that the Indian government had put at his disposal, about 25 lamas, followers, and friends accompanied him to Hong Kong. Treatment in Hong Kong The local Karma Kagyü sangha received Karmapa in Hong Kong with a warm and solemn reception. He stayed a few days in the newly opened Kagyü Center, and ceremonially consecrated it. Despite his advanced illness, His Holiness steadily continued to pursue his Dharma activities. The Queen Mary Hospital was completely overcrowded, down to the last bed. Via diplomatic channels and with the help of the Hong Kong Buddhist Association, the Bhutanese princess Ashi Chökyi and her husband Topga Rinpoche contacted the government. As a result, Karmapa was given the hospital suite usually reserved for Hong Kong’s British Governor. Lamas and students had been arriving from all over the world. At the Kagyü Center about a hundred people had come to see His Holiness every day. Although this had tired him considerably, he wanted to be accessible to everyone. Now, in the clinic, however, the access was limited on the doctors’ advice. Eventually, visitors could see him only through the glass door or bow respectfully, often with tear-filled eyes. A growing number of rinpoches also came to Hong Kong. Soon the Gyalwa Yabses Shamar Rinpoche and Jamgön Kongtrül Rinpoche as well as Dudjom Rinpoche, Kalu Rinpoche, Trungpa Rinpoche, Jigme Rinpoche, Topga Rinpoche, and the small six-year-old Karma Trinlay Rinpoche arrived. Two teams—one consisting of Shamarpa and Jigme Rinpoche, the other of Jamgön Kongtrül Rinpoche—alternately cared for Karmapa with their respective students. At the Nyingma Center and the new Kagyü Center high lamas like Kalu Rinpoche and Dudjom Rinpoche conducted longevity rituals. Dudjom Rinpoche gave Karmapa a White Tara empowerment, associated with long life, in his hospital room, while holding his hand. Ani Ea Hiss: “It was an amazing time, so greatly blessed, intense, magical…” Not only did human beings visit him, again and again a certain bird appeared at his window. One day it flew against the glass and fell two floors. His Holiness asked for the creature to be brought to him. It was injured and required veterinary treatment. Eventually, Karmapa requested that the bird remain in his room during his entire stay and did not even want to be separated from it when he left the hospital, but more about that later. Second surgery In-depth examination revealed that His Holiness had contracted pneumonia. His diabetes, diagnosed in Rumtek, was out of control. Since he had eaten only soup for months and had symptoms of severe deficiency, he had to be nourished with a gastric tube. On September 29, Karmapa underwent an operation, where it immediately became clear that nothing more could be done—cancer had metastasized throughout his entire body—and the intervention was terminated. Awakening from the anesthesia, he asked Dr. Kotwal how the surgery had gone. The tulkus present had asked the doctor to conceal the situation’s seriousness, so he answered only vaguely. Immediately, Karmapa responded, “You are telling lies! That’s not the truth!” (…) After all possible treatments had been tried in Hong Kong, with little effect, about ten physicians from Japan, India, Tibet, and the USA were contacted for advice. (…) Deciding to leave nothing undone, the lamas and doctors on hand invited Dr. McKee to Hong Kong. When he came, he said that in his experience people at the late stages of cancer had about a 20% chance of survival with intensive treatments based on natural medicine. In His Holiness’s case, however, because of his strong “will” or “mind” the chances could be up to 60%. Dr. McKee suggested treating him with natural medicines at a hospital in America, an idea that was accepted immediately. Many Asian disciples and friends came to say goodbye to Karmapa before he left. Dr. Ong, the Hong Kong hospital’s main surgeon, had been so deeply touched by His Holiness’s compassion that he refused to accept payment. (…) Chicago—Gateway to Death Since his top-secret arrival here ten days ago, the American International Hospital in the northern suburb has been swarming with saffron-robed people, family members, and medical specialists flown in from all over the world. The Chicago Tribune Given His Holiness’s precarious health, travel on an ordinary scheduled flight had been extremely exhausting. Dr. Kotwal, the only physician who knew the proper dose of insulin (premixed in Karmapa’s IVs), had to wait for a US visa and so could not travel on the same flight. As a result, Karmapa received insufficient insulin, and arrived in Chicago on October 19, 1981 exhausted, over-sugared, and dehydrated. From the airport he was driven an hour to the American International Hospital in Zion, Illinois. The local Kagyü sangha had been approached only a couple of days before. In this much too limited time they made the impossible possible and organized places for Karmapa’s entourage to stay. The Gyalwa Yabses Shamar Rinpoche, Situ Rinpoche, Jamgön Kongtrül Rinpoche, and other important Rinpoches along with attendants and cooks all took apartments in Zion close to the hospital. “An incredible array of master teachers such as the Vidyadhara [Chögyam Trungpa] also traveled to Zion to visit with His Holiness, and express their love.” This—relatively small—hospital specialized in cancer and the first investigations confirmed that the disease had metastasized into Karmapa’s bones. Dr. Mitchell Levy: “From a medical point, he should have tremendous pain, which he denied.” Instead, he remained “relaxed, serene, peaceful and calm” during his entire stay in the intensive care unit, behavior that astonished the clinic staff. Diabetic patients often have weak kidneys and insufficient blood pressure, and Karmapa suffered kidney damage on the long high altitude flight.. To remedy this, His Holiness had to undergo dialysis until his kidneys resumed functioning. When they recovered, he contracted bacterial pneumonia and showed signs of apparently life-threatening sepsis. The doctors agreed that Karmapa required a blood plasma exchange, and a plasmapheresis device had recently been developed for such cases. Only one existed in all of Illinois, and it was brought to the hospital. Once again, due to His Holiness’s spiritual influence in the world of “tendrel,” the right circumstances gathered: the hospital developer who had previously disapproved of using the new approach in the clinic and wanted it stopped, was told of His Holiness’s presence and declared that he intended to come to Zion immediately. The plasma exchange provoked extreme breathlessness in Karmapa. The situation dramatically peaked, and blisters formed in his mouth. The rinpoches were extremely concerned, but Karmapa broke into his typical infectious laughter, calming everyone down. Another time, the plasmapheresis had a glitch. The technicians did not know why and felt lost, but half an hour later the machine spontaneously began running again. His Holiness smiled, seemingly knowing why. The power of Karmapa’s meditation affected even those who were less involved, among them a particular technician, who once reported feeling unusual heat coursing through his body when he left His Holiness’s room. Other skeptical staff members did not believe him and went to see Karmapa themselves, and had similar experiences. Play Between Live and Death His Holiness approached death more than once during his stay in Zion. But whenever the doctors felt that the Karmapa’s 16th incarnation was ending, he surprised them with new vitality. The staff would ask whether he was in pain, and he regularly answered with his warm, kind smile and a clear “no.” Soon knowing which answer to expect, the question became a running joke. In addition, he refused painkillers. Eventually Karmapa developed acute pulmonary edema, and his lungs filled with fluid. He had to have a breathing tube attached to a respirator—a “breathing machine”—inserted into his lungs. This was extremely painful, and so the doctors injected him, against his declared will, with a continuous infusion of low dose morphine. Patrick Wooldridge: The vital signs just began to fade, nothing you would see from an ordinary person being injected with morphine, and they had to immediately inject Narcan (a narcotic antagonist) to counteract the morphine. Right after that injection, the vital signs started to come up again, and they realized that it was the consciousness: as soon His Holiness’ consciousness and awareness decreased, immediately his body began to fall apart. It was quite something... As Dr. Levy said, “His Holiness’ will was keeping him up.” The morphine enfeebled the mind, and his vital functions collapsed. “For me as a physician, this was a real lesson about the power of his will.” His Holiness transcended everything that is generally held to be medical truth. Cancer usually follows a particular path and according to certain symptoms one can tell when the end is approaching, but the Karmapa’s case was completely different. After examining him on October 28th, Dr. Levy left the room and told the gathered rinpoches and lamas, “His Holiness has two hours to live, maybe three hours.” Dr. Levy explains: He had every symptom I have seen in that situation, and he was going downhill very rapidly. Every system was failing. He was having trouble breathing, he was vomiting up blood and coughing up blood, his blood pressure was dropping, even on blood pressure support medication. Karmapa fell unconscious. Due to his experience with critically ill patients, Dr. Levy knew the signs that announced an imminent passing. “You just feel it,” he commented, “because you see the stress the body is under, and you know it can’t carry on much longer.” He told the high tulkus the time had come to ask about the prophecy letter, which most previous Karmapas had left behind, to facilitate finding the next incarnation. The rinpoches entered His Holiness’s room. Dr. Levy: “They came out in about forty-five minutes, and they said, ‘Well, His Holiness said he is not going to die yet, and he laughed at us’.” He let them know he wouldn’t write any letter. When Dr. Levy himself walked into the room, … he was sitting up in bed. Just up. And his eyes were wide open, and the force of his will was immense, and he turned to me and said in English (of which he knew only a few phrases), “Hello. How are you?”… He literally opened his eyes, and he willed himself back to health. He filled his body out with his will. Visually, I could almost see his will coming out of his body. I have never experienced anything like that. Trungpa Rinpoche later said to me, “Now you see what is really possible.” Medically this is unheard of; the nurses were all white. One of them lifted her sleeve to show her arm, covered with goosebumps. For no apparent reason, Karmapa’s health had improved in a very short period, as was mirrored by the monitors checking his vital signs. Again Dr. Levy: It was almost as if someone had unplugged the monitors and fiddled with them and then plugged them back in, and they were normal. The blood pressure was normal. He stopped bleeding, but not from anything that we had given him; he just turned the whole process around. After that, Karmapa’s health remained utterly stable for a couple of days. Then again he felt much worse, and once more the doctors believed he had only a short time left to live. Shamar Rinpoche remembers: Dr. Mitchell Levy informed everyone that HH Karmapa’s condition was completely hopeless. He suggested that if the lamas wanted to ask about the reincarnation according to tradition, now was the time to do so. Hearing this portentous news, the assembled lamas held an impromptu meeting on how to talk to Karmapa about his reincarnation. This is very important in Tibetan tradition. Along with me were Situ, Jamgön, Topga, and Trungpa Rinpoches, and Lama Karma Trinlay Rinpoche, who had just arrived. That afternoon all the rinpoches entered Karmapa’s room. I was the chosen spokesman, and I asked for instructions about his next incarnation, but Karmapa was only able to speak one nearly unintelligible word and could not say anything about it. Once again, the Karmapa soon afterwards felt better, and remained completely stable for a few days. Nevertheless, he had increasing difficulties speaking, so those who took care of him gave him the “Order Book,” every morning. There he could write down his wishes, which he did playfully. The next dramatic event to alarm the doctors—a disseminated intravascular coagulopathy—came on November 2nd. Karmapa’s blood clotting was so weak that, due to his sepsis, he experienced strong internal bleeding that was—once more—life-threatening. Within two hours, however, the bleeding stopped and the levels returned to normal. His Holiness sat up in bed and talked to people as if nothing had happened. Over the following days, Karmapa repeatedly and profoundly astonished his physicians and nurses in this way. The more difficult his condition became, the more he astounded the staff with his kindness and his unlimited concern for others. (…) (see also Bardor Tulku Rinpoche’s account about Zion here) “Your Holiness, You Are Dying” After these weeks during which His Holiness demonstrated perfect and playful mastery over his body, his condition worsened drastically. The external world seemed to mirror this event: a sudden cold snap led to mist, and Zion’s first snow fell. On November 3rd Karmapa’s pneumonia grew so acute that his lungs began to fail. When he asked chief surgeon Dr. Ranulfo Sanchez about his condition, the doctor answered after some hesitation: “Your Holiness, you are dying.” Finally came his last day in this incarnation: November 5th, 1981. At four o’clock in the afternoon he exhibited the first signs of an imminent heart attack, which became acute around nine in the evening. Dr. Levy describes what happened: His heart stopped for about ten seconds. We resuscitated him, had a little trouble with his blood pressure, brought it back up, and then he was stable for about twenty-five minutes, thirty minutes, but it looked like he had had a heart attack. Then his blood pressure dropped all the way down. We couldn’t get it back up at all with medication. His Holiness’s heart stopped beating. But once more he took the opportunity to astonish those with him. Dr. Kotwal explains: Karmapa left us with one last miracle. After ten minutes in which the heart had not beaten on its own, and the blood circulation could only be artificially maintained by cardiac massage, we agreed to end the life-prolonging measures and remove the tubes and cables from His Holiness’s body. Dr. Levy went to inform the rinpoches that Karmapa had gone. But once more things changed. Dr. Dwight McKee: What was very amazing was that several minutes, probably about ten minutes after his heart stopped for the second time, and we had stopped the breathing machine and were in the process of taking the tubes and IV and intra-arterial lines out, suddenly his heart started, he generated pressure, he started to breathe spontaneously, he literally came back to life. Since this was theoretically impossible, Dr. Levy shouted: “Who’s leaning on the pressure monitor?” He remembers: Actually nobody was. Then a nurse almost literally screamed, “He’s got a good pulse! He’s got a good pulse!’ And one of the older rinpoches slapped me on the back as if to say, “This is impossible, but it’s happening!” His Holiness’ heart rate was eighty, and his blood pressure was 140 over 80, and there was this moment in that room when I thought I was going to pass out. A lot had happened with His Holiness, but this was clearly the most miraculous thing I had seen. [click here and see the video of Dr. Kotwals account of the situation] Five minutes later his heart again stopped beating. Dr. Levy: “It felt as if he realized that it wasn’t workable, that his body couldn’t support him anymore, and he left, he died.” This time he went definitively. Gyalwa Karmapa Rangjung Rigpe Dorje, one of the twentieth century’s greatest bodhisattvas, ended his 16th incarnation at 11:30 pm on November 5, 1981. (…) After death meditation Following their weeks with His Holiness, when those present clearly saw a high bodhisattva dealing with sickness and death, they thought nothing further could surprise them. But following his clinical death, Karmapa completely cut through the rational assumptions of those who were with him while he remained in the samadhi* of his post-mortem state, in Tibetan called tugdam. For the medical staff it was beyond question that they would agree to the Tibetans’ request not to move His Holiness’s Kudung* but, rather, leave it in his room as he went through the stages of his after-death meditation—despite violating all Western hospitals’ practices and norms. He had touched them so profoundly as to make it unthinkable that they would disturb him before the end of his samadhi, which the staff witnessed. Moreover, even if they mostly had Christian or atheistic backgrounds, they fully respected the Tibetan tradition. Michael Chender: Situ Rinpoche bathed His Holiness’ body and then drew protective mantras on his psychic centers (chakras). His Holiness’ body was then left alone in the room while the monks began performing a pūjā outside. His body did not follow the usual progression of rigor mortis and decay but seemed to remain just as it had been when he died. After a while, it was noticed that the area around his heart was still warm, a sign of being in samādhi. Dr. Sanchez: They brought me into the room about 36 hours after he died. I felt the area right over his heart, and it was warmer than the surrounding area. It‘s something for which there simply is no medical explanation. Dr. Kotwal: When I came Situ Rinpoche took me to the Karmapa, he took up the clothes and let me touch the heart region—it was warm! The shape of the nose was the same, and the skin as well. My curiosity took me also to another region and I touched the nose as well... It was warm, the skin was the same, there was no rigor mortis. All this was typical of the after-death-meditation of an experienced practitioner and continued for three days. In Tibet, over the centuries, thousands of masters had moved through their transition in this way. Entering the section of the hospital where Karmapa remained was the privilege of only a few, but even those who lacked access experienced profound peace and joy, as Pema Chödrön recalls: I was with Trungpa Rinpoche when His Holiness passed away, and a group of us sat up with him all that night. We just sat hour after hour with Rinpoche saying almost nothing, and it felt spacious and loving rather than sad. It was a powerful time to have been there and was one of the most memorable events in my life. In the days after His Holiness’s parinirvāṇa, the previously busy hospital corridor became silent. Monks sometimes quietly chanted appropriate rituals in a low undertone in an adjacent room, as Dr. Kotwal remembers: The tranquil and intensely calm stillness was overwhelmingly pervasive. I could hear my own breath clearly as I gazed around the room. I felt amazed to enter the room since the entire second floor was devoid of any activity or sound. I experienced the sound of silence as though I was high in the mountains. The intensive care unit, which had been a beehive of activity from October 19, Karmapa’s admission date, until the early morning of November 6 was now an oasis of silence and peace. Dr. Levy: Trungpa Rinpoche described Karmapa’s presence as a vacuum that sucked up all the mental veils, as he told a close disciple: “There was no mental chatter. It was absolutely still. Everything was starkly simple and direct. He said that it was so one-pointed that there was no room for any kind of obstacle at all.” The paradox of many feeling His Holiness’s presence even more intensely despite his being no longer physically present resulted from his mind being no longer tied to his body after he passed away. Karmapa’s disciples could sense his strong spiritual influence not only near the kudung, but also more distantly, for example when they gathered at their centers to practice together after his death. Many of Karmapa’s followers had experiences like Jeremy Hayward’s during this time: “When I thought of him, I would feel a welling up from within of bliss, joy, love—a feeling with no name. (…) I remained in this extraordinary state for many weeks.” In Karmapa’s American headquarters, Karma Triyana Dharmachakra, his disciples observed light phenomena similar to northern lights, something that had never before been observed there. The day before the flight which was to bring His Holiness’s mortal remains to India, he was still in the after-death-meditation (tugdam). Khenpo Karthar: "Tenzin-la became somewhat anxious that they were going to miss the plane, and he asked Kalu Rinpoche if there was anything they could do. Kalu Rinpoche said, 'Don’t worry, the fathers and sons,' in other words, His Holiness and the lineage holders, “are in complete control of their samādhi. He will take care and make sure you don’t miss the flight.” [And that was what happened...]
 Perks, John Riley: The Mahasiddha and His Idiot Servant. Crazy Heart Publishers 2006, chapter 11.
 Cited in: Lama Karma Wangchuk: Response to selected errors of fact in Mick Brown’s book [Dance of 17 Lives], part 2.
 A rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels.
 Dr. Levy in: Ray: Secret of the Vajra World, op. cit., p. 475.
 Dr. Kotwal: God’s Own Death, op. cit., p. 222.
 All this is confirmed by Pema Chödrön’s account. She was at the hotel with Trungpa Rinpoche when they received a call that Karmapa had died. They wanted to leave for the hospital immediately, but the phone rang again: His Holiness had regained consciousness.
 Dr. Levy in: Chender: His Holiness Dies…, op. cit. p. 28. In later accounts Dr. Levy spoke of an hour of cardiac arrest. Dr. Kotwal and Dr. McKee both agree that it was about 10 minutes. The discrepancy can be explained because in such situations the sense of time is even more subjective than usual.
 They were so inspired that they installed a shrine for His Holiness which is said to remain still today.
 Chender, Michael: His Holiness Dies in Zion, Illinois, op. cit., p. 28.