Six weeks after two open-heart surgeries in 12 days, Roshi Joan Halifax invited me for a visit. She was recovering, but feeling ‘weak as a kitten’. When I’d last seen her, three or four years earlier, her hair had been shorn in a Zen tonsure; now it hung in a lush, grey-streaked braid to the middle of her back. She was pale and short of breath.

As a physician and her friend, I was reluctant to press on with the interview, but she wanted to begin. She was staying with Wendy Lau, her close friend, an emergency physician and Zen priest whose home overlooks Upaya, the Zen centre Halifax established in 1990 in the foothills above Santa Fe in New Mexico. We sat on Lau’s back porch, drinking tea.

Halifax is a medical anthropologist, a Buddhist teacher and a caregiver to the dying, who has worked with the suffering of others for more than 50 years: in burn units and jail clinics, in remote Himalayan villages, at the bedsides of people for whom there was nothing left to cure. She learned that the qualities that drew her there could also pull her under, and more than once they did. When she found her way back, it was Buddhist practice that helped her remain steady enough to help.

Halifax had almost died. She had gone into the operating room at Stanford cheerful, she told me – upbeat, confident. Surgeons repaired her heart’s mitral valve. Coming out of anaesthesia, intubated, she was certain the tube was positioned incorrectly. She couldn’t speak, so she made writing motions until someone put a pen in her hand, and – stoned, half-conscious – she wrote glottis. Wendy Lau understood. They fixed it.

Then came what she called the worst 12 days of her life. The valve replacement was failing. Her blood pressure plunged; she bled internally; she had a dangerous arrhythmia, and had to be shocked to restore a normal heart rhythm. ‘Death is easier than this,’ she told Lau. She meant it. ‘I actually wanted to die,’ she said. ‘I just was so sick.’

She was still on a gurney from the latest resuscitative shock when the surgeon appeared in his scrubs and told her: ‘We have to take you back in.’

‘I had a moment of Yikes!’ she told me.

In the intensive care unit after the second operation, she awoke convinced she was hanging upside down against a wall of moss. A warmth enveloped her chest and expanded, and kept expanding, into utter bliss. Then a male voice said: ‘You’re not done with your work yet,’ and she found herself back against the moss-covered wall. The cycle began again. ‘My recognition was: this is death. It’s fine,’ Halifax said.

Halifax has spent much of her life crossing thresholds, sometimes knowingly and sometimes not, and in the process delivering a grittier, more hands-on and help-oriented form of Buddhism to the West. Now aged 84, facing her own mortality, she names the charnel grounds where she practised her art: refugee camps, prisons, cancer wards, war zones. To that list she adds one more. ‘My latest charnel ground was being hospitalised for this heart surgery,’ she said.

Halifax’s first encounter with illness had come 80 years earlier. Aged four, she woke one morning unable to see and partially paralysed on her left side. She remembers feeling her way along the wall into her parents’ bedroom. Later, when a doctor picked her up in his convertible, she knew the top was down only from the wind.

She spent much of the next couple of years in bed with polio, away from other children. ‘I discovered that I had a spiritual life, an inner life,’ she said. Even now, she can walk through a building in her mind, imagining its rooms and passages, ‘because that’s what I did when I was four.’

Her parents hired Lila Robinson, a local Black woman, to care for her, keep house and cook. The Halifaxes lived in Coral Gables in Florida, a restricted, all-white enclave where neither Jews nor African Americans were allowed to live. Robinson and her three daughters lived across the railroad tracks in West Coconut Grove, then known as ‘Coloured Town’, in what Halifax called a ‘concrete monster’ – one of the mould-filled, roach-infested semi-high-rises baking in the Florida heat. To Halifax, Robinson was ‘the most incredibly kind person in the world, a manifestation of unconditional love and brightness – the woman who raised me.’

As Halifax recovered, she sometimes rode with her father to pick up Robinson. The journey carried her between ‘two different universes’: one had a country club and an all-white school, and the other: understocked shops, tired cars, good music and warmth. She saw the gulf between the two but was not entirely convinced that hers was the better world. Looking back, she traced her attraction to places of suffering to that early collision of inequality and love.

‘You could be both contemplative and a social activist. I want to be like that’

At the H Sophie Newcomb women’s college of Tulane University in New Orleans, the disparity Halifax had registered as a child became something she could act on. It was 1960 and, with the civil rights movement gathering force around her, she joined protests and the fight for racial justice. ‘There was a whole cadre of us who felt that racism was abhorrent,’ she said.

Through that work, Halifax met Hodding Carter II, the progressive Southern newspaper editor who had established the Delta Democrat-Times in Greenville, Mississippi. Carter was going blind. ‘For a time, I became his kind of eyes and feet and hands,’ Halifax said – his assistant in civil rights activities. Carter and his wife supported her, but her activism put her at odds with Tulane. ‘I graduated early from Tulane with Tulane’s help, so to speak,’ she recalled. ‘They really wanted me out of the system.’

In 1963, she left for New York, where her civil rights work opened into a wider world of artists, musicians, filmmakers and political activists. There she met Alan Lomax, the folklorist and ethnomusicologist whose field recordings of folk, jazz and blues musicians had taken him around the world. His project studied music, dance and language across cultures. The work carried her from a huge computer in a university basement to field trips in Morocco, the Bahamas and rural Arkansas. ‘I was in anthropology heaven,’ she recalled. ‘I just wanted to learn everything about anthropology that I possibly could.’

Two years later, a different kind of encounter opened a path inward. Halifax heard the Vietnamese monk Thich Nhat Hanh speak when he came to New York to urge an end to the bombing of his country through the calm of his Buddhist practice. Halifax was then ‘angry all the time’ – at the war, racism, the government and the suffering around her. She understood that ‘you could be both contemplative and a social activist. I want to be like that,’ she thought. But for almost a decade, she remained a ‘book Buddhist’, absorbing what she could from reading alone.

For now, her focus was anthropology. By 1968, she was in Paris, indexing ethnographic films at the Musée de l’Homme. There she met Germaine Dieterlen, a French anthropologist who had spent more than 20 years among the Dogon people of central Mali. Dieterlen told Halifax that the Dogon were midway through the Sigui, a seven-year cycle of ceremonies moving through 289 villages and held only once about every 60 years. Most Dogon would attend just one Segui in a lifetime. To Halifax, it was a rite of passage that ‘reconsecrated an entire culture’.

The attraction was also personal. Robinson’s family had roots in the Bahamas and, farther back, in Africa; her grandmother had been a slave. Halifax knew little more – not when the family had been taken, nor from where. ‘I really wanted to go to Africa,’ she told me, ‘to understand the cultural roots of this woman who had raised me.’

In early 1969, Halifax drove a VW bus, modified for desert driving, from Germany to Marseilles in France and on to a ship bound for Oran, on the Algerian coast. From there, she drove alone to Gao in Mali – including 1,600 miles of unpaved track across the western Sahara. There was no map. The route was marked by oil drums filled with rocks, like buoys set in an ocean of peach-coloured sand stretching to the horizon. She encountered only three transport trucks on the entire crossing; the drivers dug her out when she was stuck, and she rewarded them with oranges.

Three and a half weeks after setting out, she reached Gao, an ancient trading centre on the Niger River at the southern end of the Sahara. From there, she put the VW bus on a barge down the Niger, then drove on to the Bandiagara escarpment, a wall of sandstone cliffs extending more than 100 miles. ‘The Dogon villages were spectacular,’ she told me. ‘The ceremonies and incredible masks and dances were extraordinary. The ceremony began with elder women who had been alive and present in a previous Sigui cycle, 60 years before. These were powerful women, their torsos completely exposed, not big people, but very, very thin. Old, muscular women, marching out in front of all the men.’ She spent about five months interviewing Dogon spiritual leaders and photographing the Sigui with her Pentax. Among the Dogon, she found a cosmology in which death was a passage, one that bound the living to their ancestors.

In Bamako, Mali’s capital, she realised she had contracted hepatitis. ‘There was a war going on with Chad,’ she recalled, ‘and there were no hotel rooms, and I ended up sleeping in an iron bed in a whorehouse, listening both to the war and to people having sex, and I was so sick.’ She made her way to the train station. The manager saw how ill she was and arranged passage for her and a flatcar for the bus to Dakar. The US embassy and her parents helped her to fly to Miami for medical care. She doesn’t know what happened to the bus.

The hepatitis that sent Halifax home to Miami changed the direction of her work. The city had been remade while she was away. Hundreds of thousands of Cuban refugees had arrived after the revolution and, by 1969, the local healthcare system was overwhelmed – not only by the numbers but by the differences in culture. Mainstream medicine was often inaccessible or inadequate to Miami’s growing Latin American and Caribbean communities, and many people instead sought care from alternative, often unlicensed practitioners – a clínica, a storefront doctor’s office of uncertain legality, or a santero, a priest of the Afro-Cuban religion of Lukumí, or Santería.

Recuperating in her parents’ apartment on Key Biscayne, she met Emanuel ‘Manny’ Papper, a neighbour in the building and dean of the University of Miami School of Medicine. ‘That’s how I made it into the anthropology department at the medical school,’ Halifax said.

There, she joined the Miami Health Ecology Project, led by Hazel Weidman, a senior medical anthropologist in the University of Miami School of Medicine’s psychiatry department and a founder of the Society for Medical Anthropology. The project studied five ethnic communities surrounding Jackson Memorial Hospital – Bahamian, Cuban, Haitian, Puerto Rican and Southern Black – and asked what illness meant to the person who had it: what caused it, who could heal it, and what being made well would mean.

He believed Jose had been cursed, and recommended an exorcism. I called Halifax. She came immediately

Soon, Halifax was pursuing her PhD in medical anthropology and doing fieldwork in neighbourhoods, clinics and houses of worship. Because of her experience in Africa and the woman who had been her caregiver when she was first so sick, she was drawn to Dade County’s ‘co-cultures’. She began identifying healers, especially in Miami’s Cuban communities. In the cabildos – ‘cult houses’ devoted to different orishas (deities) – she watched ‘different qualities manifesting through the members who were possessed’.

‘It was just fascinating,’ she said. She became ‘a kind of cultural broker’, bringing Santería healers into the medical system at Jackson Memorial. That’s how I met her, in 1972, when, as a family medicine resident, I attended one of her lectures on the ceremonies, spells and healing traditions practised among South Florida’s Caribbean communities. Not long after, at the Dade County Jail clinic I’d helped start, a 20-year-old Cuban inmate named Jose – ‘normal’ when arrested for burglary the night before – sat staring and unresponsive in what appeared to be a catatonic trance. Needle tracks marked his hands and forearms. I wondered about schizophrenia or conversion hysteria. Ron, a former Navy medic and the clinic’s physician assistant, had apprenticed with a Santería priest. He believed Jose had been cursed, and recommended an exorcism. I called Halifax. She came immediately.

Ron pulled a beautiful king conch shell out of a grocery bag and smashed it into a hundred pieces on the floor. With a sharp piece of shell, he made a cut halfway up Jose’s forearm, blood oozing. With another piece of shell, he matched Jose’s cut on his own left forearm. Jose didn’t flinch, but Joan and I reached for each other’s hands and squeezed. Ron bound their arms together, palm-to-palm, with a red bandana, and spent the night in the clinic with Jose. The next morning, Jose began to speak.

He said he had used heroin since his early teens. After his mother threw him out and he consulted a Santería priest, he robbed a convenience store and returned to the family house to hide. A king conch stood beside the door; police waited in the bushes. To Jose, the shell embodied Elegua, the orisha of the crossroads, who had placed him under a curse. Only an exorcism could lift it.

Given permission by the warden, we all met the following morning in the jail laundry room, flanked by banks of industrial washers and dryers. I spoke and understood Spanish, but Ron’s incantations sounded like no language I had ever heard. I drew Jose’s blood, finding a vein despite his years of heroin use, and squirted it into a bowl. Jose’s hair and nails were clipped into other bowls and covered with red bandanas. Candles flickered in a semicircle; across the room, the glass door of a dryer gave back a distorted reflection of the ceremony. I could feel my pulse beating in my ears and shivers up my spine. At the end, Jose buried the red bandanas containing his hair and nail clippings in a grassy plot inside the jail’s security doors. The ceremony was deemed successful by all of us, most importantly, Jose. Looking back, I can hardly believe we exposed ourselves to one another’s blood – or that the warden had even allowed the ceremony.

When, over 50 years later, I asked Roshi Halifax, by now a Zen Buddhist priest, to reflect on the exorcism, she said: ‘By the time we first met, my life had been so intense and filled with challenges, this was just an interesting experience for me. It wasn’t a big deal. We were like characters in this strange drama. I felt a lot of compassion toward Jose. You could feel the pain in him, and I look at drug addiction as a way to cover pain; the whole thing was beautiful and bizarre. There was a suffering human being, and we did what he wanted and needed, and that was good.’

At Jackson, Halifax had encountered another kind of suffering as well. She worked in the burn unit and sat with dying patients, watching young clinicians confront an injury they could no longer cure. Many had entered medicine wanting to help, yet she felt conventional medical training was not grounded in compassion. ‘What does healing mean in our culture?’ she began asking herself. ‘What is the difference between healing and curing? … What is the relationship between compassion and equanimity? Can compassion be taught?’

Several months after the exorcism, at a meeting of the American Psychiatric Association in Dallas, Halifax met Stanislav Grof, a Czech psychiatrist who had pioneered LSD research and was studying its effects on patients dying of cancer at the Maryland Psychiatric Research Center. They were married five weeks later in a volcanic crater in Iceland. Halifax wore a black Icelandic dress and a peaked crown representing a glacier; the world religions scholar Huston Smith officiated, and the mythology scholar Joseph Campbell gave her away. She had taken 600 micrograms of Sandoz LSD – what she called a ‘single overwhelming dose’.

‘There I was – married. All of a sudden!’ she recalled. ‘I was kind of in an altered state.’ The ceremony was ‘so archetypal’, she said. ‘And, needless to say, our marriage was a little bit like that.’

After leaving Miami, Halifax joined Grof’s research with dying cancer patients in Baltimore. The study was funded by the National Institute of Mental Health, and every patient knew the treatment would include LSD. The work began with preparation, including meetings with family members; on the day of the LSD session, Halifax might remain with a patient from 7:30 am until midnight, through the experience and the crucial period of integration afterward.

Aged 30, Halifax thought she was already somewhat experienced in medical settings and in being with suffering and death. She later wrote that she ‘was not prepared’ for the work or for the depth of the relationships she developed with people who were dying. Most were in extreme suffering, seeking relief from pain and fear and, as Halifax put it, the possibility of a ‘gentle death’. Death came to seem to her less like medicine’s failure than ‘the final developmental stage in a person’s life’ – one that called for attention even when curing was no longer possible.

Being a woman gave her ‘the permission and latitude to ride straight into a catastrophic mental and physical state’

At the same time, Grof had become her LSD therapist. She believed the drug might enable her ‘to know my mind completely. Talk about hubris. Oh my God.’ Instead, frequent high doses dissolved her defences and left her mentally fragile. The marriage approached a breaking point even as she continued the work. ‘It took me to the brink,’ she said. ‘Not only were these cancer patients suffering, but I was about to join the list of casualties as I plunged into the depths of physical and mental confusion. But it was also incredibly inspiring.’

In 1973, amid Halifax’s personal crisis, she and Grof went to Esalen, the experimental community on the cliffs of Big Sur in California, where psychedelics mingled with Zen and other contemplative traditions. There, she designed and produced ‘Buddhism in Mind’, a month-long gathering of teachers and scholars. During the programme, she confided to Jack Kornfield, a young American Buddhist teacher recently returned from monastic training in Asia: ‘I feel like I really need a teacher.’ Kornfield suggested Seung Sahn: ‘There’s this crazy intense Korean person. He might be a good match for you.’ Halifax invited the Korean Zen master to the gathering. ‘He and I connected,’ she said.

Halifax and Grof divorced in 1975. By then, she was experiencing what she described as extreme confusion and anguish, with full-blown hallucinations. She found herself ‘deeply identified with the so-called psychotics I had worked with in Florida’ – the people she had once approached as an anthropologist and could no longer regard from outside. Looking back, she thought her gender had made the descent possible: little was expected of her, and a man in her position would have had a harder time falling that far. Being a woman, she wrote, gave her ‘the permission and latitude to ride straight into a catastrophic mental and physical state’. She was, she said, ‘assigned and resigned to “my fate”’.

Her own summary of those years ran to four items: ‘A failed marriage, a failed career, my mind disordered, reputation lost.’

She looked for help in two places. The first was anthropology: Indigenous cultures have people who go crazy, and some of them go on to heal themselves and become healers. So she left the laboratory for the field. She went to Mexico several times a year, not to study the Huichol but to study with them, and ask for their help. There she met an old man named Don José Matsúwa: ‘No right hand, no teeth, Don José was dexterous and sharp in ways of the mind,’ she wrote. ‘With him, through him, and with the help of peyote, my humour was unearthed.’ All this helped her write the book Shamanic Voices (1979), gathering the testimony of shamans across more than a dozen cultures – accounts of initiation, of visionary journeys, of the healer who has first been broken, then healed.

The second source of help was Buddhist practice. LSD had opened Halifax’s mind without giving her a way to steady it. Meditation did. She described the essence of the practice as finding ‘the iron pivot in the spine that does not move even in the midst of great suffering’. A Buddhist metaphor.

For the next 10 years, Halifax travelled and practised with Seung Sahn’s community in the United States and abroad. One day, he casually asked how she had been spending her time. Halifax recited her recent ‘“good” deeds’. He paused and, as she later wrote, ‘growled: “You are a bad bodhisattva!”’

She felt like she had been ‘struck by lightning’. In Mahayana Buddhism, a bodhisattva dedicates her life to relieving suffering. A bodhisattva’s commitment requires humility as well as compassion. When Halifax recited her ‘good deeds’, Seung Sahn heard that she was keeping score. Her service had become tangled with a need for approval and with a habit of doing so much for others that she sometimes diminished their power to act for themselves. ‘I felt chagrined,’ she wrote, ‘but also grateful for the tough lesson he had given me.’

Halifax calls qualities such as empathy and altruism ‘edge states’. Altruism, the impulse that sends a person toward others in need, for instance, can curdle into its own kind of harm – resulting in helping that costs the helper great distress, or strips the one being helped of the power to act for themselves. So too with empathy, integrity, the drive to do good work: the qualities ‘without which we cannot serve, nor … survive’, she writes, are the same ones that can undo the server. She also argues that compassion can help restore the balance when those qualities turn destructive.

‘It wasn’t gritty enough for me. I always felt like a bull in a china shop’

Around 1980, she moved to California to develop the Ojai Foundation, where Buddhist teachers and their communities could gather and practise. Early each morning, a bell called the community to meditation, and through the day it called them back for meals and meetings. They sat in council, shared the work, and tried to work through the difficulties of living together. Seung Sahn returned each year to lead sessions in a tepee on the grounds. ‘I practised really hard under his aegis,’ Halifax said.

That same year, friends living in Nepal invited Halifax to travel into the Himalayas with some of her students. ‘What I saw,’ she said, ‘was really powerful because I had the medical school experience in my background and I saw so many sick people.’ In the remote mountain villages, illness was widespread and medical care nearly absent. The journey became the beginning of the Nomads Clinic, which has returned to the Nepalese Himalayas year after year.

By 1985, Halifax had reached the limit of what Seung Sahn could offer as a teacher. ‘He had real boundary problems, a serious crush on me,’ she said. ‘Because of his feelings for me and also … he wasn’t involved in social action, I just had to leave that community.’

That winter she went to Plum Village, Thich Nhat Hanh’s monastery in southern France, and met him for the first time – nearly 20 years after he had drawn her toward Buddhism in New York. For four days, she sat and walked with him, with Sister Chân Không and Richard Baker Roshi, ate silent meals of white rice and mustard greens, walked in fields of early jonquils, and talked about what a socially embedded, American Buddhism might look like. She studied and travelled with Thich Nhat Hanh for about 15 years and became a dharma teacher in his order, authorised to teach its practices.

But she ‘had some feelings of ambivalence in that community’ too. There was abundant loving-kindness and a stated dedication to social engagement, she said, but few projects involving the direct action she wanted. ‘It wasn’t gritty enough for me. I always felt like a bull in a china shop,’ she said.

Halifax had met Bernie Glassman in the 1970s, and their paths had crossed on and off over the years. Now, as her ambivalence about Plum Village grew, she encountered him again. ‘I realised, you know, I need to practise with a Western teacher,’ she recalled. She wanted a Zen that entered the places of suffering she already knew – someone ‘gritty’, she said, and ‘visionary, tough, open, radical’. She found that teacher in Glassman, a former aeronautical engineer who had turned Buddhist practice toward homelessness, poverty and AIDS. She became his student and told him she wanted to ordain as a Buddhist priest.

His training took her to Schoolhouse 86, an abandoned school in the Bronx, where they pulled on heavy gloves and cleared condoms and needles from the ground. Glassman also took his students to Auschwitz. On one retreat, some 150 people sat in the November rain on the railway tracks at the selection site, eating little more than soup and old bread as the names of people who had died there were read slowly ‘in the four directions’. In the museum, Halifax passed glass cases filled with children’s shoes and suitcases. Then she came to a case of human hair. ‘I felt like throwing up,’ she recalled. ‘And I almost passed out. I was just so horrified by the magnitude of the cruelty.’ Glassman called this ‘charnel ground practice’: entering places of suffering without averting one’s gaze.

His gesture made her see the pity within her grief – and that she had to let him go

Meanwhile, Halifax returned to a question she’d been asking since Miami: what could she offer someone when there was nothing left to cure? Toward the end of the Ojai years, her mother’s death made it personal. ‘If I were to die tomorrow, what would be left undone?’ Halifax asked herself. After leaving Ojai, and then spending time at a Zen centre in Crestone in Colorado, she retreated to a hermitage in Abiquiú, New Mexico. Each day, she sat alone beside the brown, churning Chama river. ‘Nowhere to go; nothing to do,’ became the refrain of her days. After a year, she knew one thing: ‘I wanted to be with people who were dying.’ She wanted to return to work that, for her, had begun at the University of Miami, now ‘more seasoned by age and practice’. ‘In being with dying,’ she wrote, ‘the true nature of the human mind and heart might be revealed.’

Halifax encountered that lesson again with Issan Dorsey, a Zen teacher and founder of Maitri Hospice in San Francisco. In a lecture at Harvard Divinity School, she described visiting him in the hospital near the end of his life. He was sitting up in bed in a simple cotton robe, ‘quite thin and transparent’. She sat beside him, looked into his eyes and began to cry. Dorsey reached over with a frail hand and touched hers. ‘Please don’t cry; it’s not necessary,’ he said, and smiled. Halifax had entered the room thinking of herself as the caregiver. ‘In fact, Issan was the bodhisattva,’ she later wrote. His gesture made her see the pity within her grief – and that she had to let him go.

In 1990, she moved to Santa Fe and founded Upaya. Four years later, she brought Being with Dying to the centre and invited me to join its faculty. There, clinicians and other caregivers examined what happened inside themselves when they faced catastrophic illness and death; neuroscience, ethics and communication were taught alongside contemplative practice. Most participants had no previous experience with Buddhism.

Anthony Back, an oncologist and palliative care physician who has worked with Halifax for more than 30 years, said her distinctive contribution was that she ‘brought contemplative care into palliative care’. ‘One of the words that comes to me is that she’s fierce,’ he said.

In the summer of 1996, Halifax sewed an okesa, a Buddhist robe made from clothing belonging to people who had died. Wearing that robe, she was ordained as a Zen Buddhist priest in an AIDS clinic in Yonkers, New York. Glassman later gave her dharma transmission – formal recognition as a teacher and an heir to his lineage. She remained his student until his death in 2018. As Halifax explains in Standing at the Edge, Glassman’s form of Buddhism – and hers – meant letting go of fixed ideas, attending to suffering and joy, and allowing that encounter to guide how one helped.

The Nomads Clinic kept bringing her back to that approach. Over the decades, the work had grown into a shared undertaking: Nepali doctors, nurses and dentists joined international clinicians, practitioners of Eastern and Western medicine learned from one another, and the clinic opened paths into medicine and nursing for Nepalis.

During a 2018 clinic journey, the limits of helping became the issue. The writer and conservationist William deBuys watched the team examine a young man paralysed by a stroke in infancy. ‘He moved across the ground by punching his calloused fists into the earth, one rigid leg stuck out,’ he wrote in his book The Trail to Kanjiroba (2021). The clinicians discussed Botox and physical therapy in Kathmandu, but the young man’s mother understood that such treatment could throw their lives out of balance. ‘Roshi cautioned us on the need to recognise limits, not just what is obtainable,’ deBuys wrote. Halifax raised the danger of pathological altruism: the desire to help could overwhelm the caregiver and disrupt the life of the person being helped.

‘It’ll be apparent after I’m dead, if I have any legacy at all. I haven’t tried to build one’

‘I was an altruist, and I went to the other side,’ she told me. ‘I became a pathological altruist.’ She had given beyond her capacity as an activist and caregiver, and her natural empathy could become empathic distress. When political unrest in Nepal led the Western contingent to cancel a clinic journey, she told me, Nepali doctors, nurses and dentists went without them and saw almost 600 patients. ‘It’s not my project anymore,’ she said.

I asked her about her legacy.

‘I don’t think about it,’ she said. ‘It’ll be apparent after I’m dead, if I have any legacy at all. I haven’t tried to build one. I’ve just tried to serve and live my life as deeply and intensely as possible. I’ve taken a lot of risks and have benefitted from not holding back. I’ve made a 1,008 mistakes. I’m very straightforward, sometimes blunt, some people think fierce, and people’s feelings have been hurt by me, because I give direct feedback. I’ve never been interested in being popular. What I care about are people at the margins, like women, people of colour, queer people, and whether they have an opportunity and are not subject to the vagaries of a racist sexist culture.’ Then she repeated an injunction she had posted publicly: ‘Do not cooperate. Do not believe them. Do not get used to this. Keep your focus. Stand your ground.’

Her place and home is Upaya, a verdant, high-desert glen. She has spent decades rewilding it, protecting the face of the mountain, planting trees. ‘That’s part of my legacy,’ she said. ‘Maybe Upaya will die, but the trees will grow. Maybe the people doing service in the world will forget what their inspiration was, but they’re out there serving.’ And so is she. The voice from her near-death experience – ‘You’re not done with your work yet’ – is ever present.