The Lesson of Impermanence

A chance encounter with a sand painting helped me learn how to doctor patients I knew I would lose.

As a palliative care doctor, I spend much of my time face-to-face with pain and suffering, debilitating disease and death. When I began my training, I thought I was comfortable with the idea of mortality, and with the notion that fighting death at all costs wasn’t the sole purpose of medicine. But I hadn’t expected that the type of medicine I’d chosen to practice would require a strength and perspective that medical training hadn’t offered.

It was a chance encounter with a sand painting that helped me learn how to doctor patients I knew I would lose.

At the time, I was in the middle of my yearlong fellowship in hospice and palliative medicine, seeing patients at a county hospital in San Jose. I’d immersed myself in learning how to treat patients living with serious illnesses: end-stage heart failure, widespread cancer and devastating strokes. I’d learned how to help families anticipate what dying looks like. It had become second nature to talk openly with patients about the severity of their diseases, and to ask them how we might work together to maximize joy, meaning and comfort in their waning lives.

I hoped that projecting an acceptance of death and comfort with it might soothe my patients and their families. But I had grown progressively more anxious, and occasionally despondent. I didn’t understand why death had come for a 35-year-old mother of three with a rare and aggressive cancer, or why a marathon runner was dying after a sudden heart attack when he’d been a marathon runner...