The following Sunday morning, the temple was overflowing with people. We all looked on as the group of brightly robed monks surrounded the mandala and began to chant in low, guttural tones, their eyes closed and palms pressed together. I stood on my toes and craned my neck to glimpse the mandala, hoping to see it encased in glass.
Instead, I looked on in shock as one of the monks began to move a feathery brush over the mandala, swirling together the gold and the navy, the circles and the rectangles. He moved along the edges of the table, sweeping away his work just as methodically as he had placed grains of sand in the same space, transforming the mandala from pattern to pile. Hot tears filled my eyes, not only because the mandala was gone, but because the hands that had created it were content to let it go.
The Bhagavad Gita, which my father had read to me as a child, emphasizes that change is the law of the universe. The Vietnamese monk Thich Nhat Hanh reminds us that “impermanence does not necessarily lead to suffering. What makes us suffer is wanting things to be permanent when they are not.” Yet it was the sweeping away of a sand painting that helped me truly understand that change and impermanence are not just spiritual tenets but laws of nature — ones that I’d struggled against and had been taught to ignore throughout much of my medical training.
Just as I’d expected that the gorgeous mandala had been created in order to be preserved, I had also expected that my patient in her 30s should live to see her children graduate from college, that the marathon runner should have lived to run more races. I’d expected, partly as a result of my medical training, to change and control what wasn’t necessarily mine to change and control. How might I doctor my dying patients differently if I remembered that everything worldly — a painstakingly crafted mandala, a sky ablaze with color, our fragile human lives — is also temporary and subject to change?
Accepting that life is finite wouldn’t prevent me from drawing upon science to diagnose and treat disease, to use every tool available in medicine to alleviate suffering. But I wondered if it would make it easier for me to endure the inevitability of change and loss that both my patients and I would experience. Perhaps it could bring me solace to remember that just as my patients’ lives are temporary, so is their suffering.
I wiped my eyes as I looked upon the remaining heap of swirled sand, itself a thing of great beauty. The monks scooped teaspoons of sand into plastic bags, handing one to each of us. Through the bag, the sand felt both tough and soft, the bright blues and pinks particularly visible when I held it up to the light.
When I returned to the hospital the next day, I thought of the mandala as I sat with a breathless man my own age dying from lung cancer, and an agitated grandmother in the final stages of dementia. I would feel compassion for both of them, but I didn’t leave work that day consumed with grief, withdrawn and disengaged. By accepting my patients’ circumstances, rather than fixating on their inherent tragedy, I could focus instead on changing what I could: easing breathlessness and agitation, explaining hospice services to their despondent families.