Our first pregnancy erupted on us unexpectedly, with a stabbing pain in my wife’s belly, and ended with her on the surgical table, as much dead as alive, and half the blood of her body gone. We were barely in time when we reached the hospital—in any previous age the ectopic pregnancy would have killed her a few hours after the first hint of distress. My grandmother, whom we lived with at the time, just nodded when I filled her in on what had happened at the hospital. She was from a much earlier age that knew about the risks in a way that we have forgotten today. Her college friend, a healthy woman, young and full of promise, simply dropped dead one day from the same condition.

Our second pregnancy, several years later, came in the shadow of that lost day and night. For months as my wife grew bigger, I waited for the other shoe to drop, for the pregnancy to turn suddenly from a joy into a malignancy. Yet we reached the appointed day for our son’s birth with no serious issues, and I let my guard down to enjoy this new beginning. And then, it all went wrong. Hour by hour, he just could not pass through the birth canal. My wife, who’d asked not to be drugged and was now in such peril that she could not be given medicine, descended into agony. I could do nothing. Finally, the emergency truly upon us, they cut her open and retrieved him. Even as I held my son for the first time, my wife continued to spiral away from us, and I thought of the Indian mother who died 2,500 years ago in similar circumstances. They could not sew the slice they’d made—as the doctor put it, my wife’s flesh had become like raw hamburger meat. Blood gushed from her over the maternity bed onto the floor. Once again she was taken to surgery, beyond my reach and vision. Her mother and I waited through the long night. In the morning, my wife lived.

I was beginning to sense what the Buddha meant by the suffering of birth, but still, we are always good at fooling ourselves. Once more the bitter fear began to lose its sharp flavor and we decided to add to our family. When we learned that she was pregnant, we told everyone in the family. The pregnancy was a main theme of Christmas that year, as my wife handed out coupons to everyone redeemable for a new grandchild/niece/nephew/and so on in the coming year. And then after New Year’s, the doctor told us that the baby had died in the womb. Day after day, my wife bled the remains of dead hope and love, while I waited. We had to call all the family again and tell them.

I feared telling my parents that they would not have a new grandchild after all, in part because it reminded me of something that happened in my junior year in college. A close friend of mine received a call that her mother had had a stroke and was dying—I was with her when the phone rang. Her father was already long dead. We gathered a friend with a car and set out for the hospital in driving rain. In the darkness of the night and the storm, we were unable to proceed past the Bronx; defeated, we returned mutely to campus. The next day her mother died and it fell to me to tell a mutual friend who had no idea what was going on. As I tried to explain that our friend’s mother had died, a giggle escaped. I laughed so much as I choked the revelation out that my friend didn’t believe me—she thought I was joking. But it wasn’t laughter of delight. It was the laugh of pure tension seeking any release, no matter how inappropriate, in the face of that which should not be, but is. It was involuntary; it was the same as crying; it was still wrong. I did not laugh when I told my parents that our baby was dead, but until I spoke, I wondered if I would. I wondered if they would even believe me as I struggled to say the worst thing I had ever said.

And so, in my own way, I have come into perfect agreement with the Buddha. He said that birth, old age, sickness, and death are the four fundamental realms of suffering. The last three are easily assented to, and I have seen each of them up close in my life. But it is harder for people in America to acknowledge that birth too is suffering. I only came to agree after seeing for myself that pregnancy, gestation, and birth are so dangerous and beyond our control. It was something I never wanted to learn. But we have little choice in the lessons we receive, and less right to demand exemption from the pain that countless past have experienced.

So now when my wife came to me to tell me she was pregnant once more, I smiled, hugged her, and thought, “Who will it be this time? Will she die? Will the baby?” Thus even the announcement of new life can become a source of suffering, long before the child ever joins us to feel cold, hunger, and confusion.

This is the world in which I say the nembutsu, the cry of entrusting to power-beyond-self that is the central practice of Shin Buddhism. It is a world like that night in the Bronx many years ago—daily I peer out through dark windows into blinding curtains of rain, knowing that soon, very soon, we will probably have to turn back. In this world, we often cannot reach our loved ones in time. In this world, what we love dies as we stand helpless, and what we hope for fades unborn. And yet, too, in this world, we may face death time and again and say, “Not yet, not yet.” Our terrible pains may bring forth love and happiness. Birth is suffering and, often, joy inexhaustible. To say otherwise would also be a lie.

The Buddha named his son “Fetter.” So too, my son’s birth ties me to this world of pain and joy in a way that nothing else possibly can. His struggles to be born, his simple happinesses and angers, his fingers around mine, all bring forth the nembutsu, day by day. What choice do I have? I haven’t died yet, and life continues to deliver blessings to blunt its pains. I cannot shave my head or wear a robe. I cannot stop the bleeding or pass through the storm. I cannot stop laughing when it is wrong, nor when it is so right. All I can do is say, “Namu Amida Butsu”—the nembutsu—in the rain and in the sunshine.

In Shin Buddhism, we call death “birth” because it is emergence from the womb of this world into the ultimate reality. And so we come full circle. My future “birth” someday will be a source of suffering for others, even as it ends my own. That’s how it works. Namu Amida Butsu as your mother dies; Namu Amida Butsu as your son is born; Namu Amida Butsu from birth to birth and all the death in between.