Impermanence and Suffering

First there was Dr. Abraham Verghese. More than two decades ago, when I read his memoir that intertwined his personal life and his professional life treating HIV and AIDS patients in the boondocks of rural Tennessee, I was blown away that a physician with origins in India could engage in such awesome writing.

Then came Atul Gawande.

"And the muttering grew to a grumbling; And the grumbling grew to a mighty rumbling." Now, it seems like there are Indian-American physician-authors everywhere I turn. Fantastic!

One of the latest additions to this long list is Sunita Puri, who is "a palliative care doctor at the University of Southern California."

Palliative care. It takes a brave soul to get into that field of medicine.

She wrote about that aspect too: "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."  She writes there:

One of my attending physicians noticed that I’d become more withdrawn, less punctual and occasionally distracted. “This is difficult work,” she told me gently, reminding me that I’d need to care for myself in order to care for my patients. I tried massages, therapy, hiking and meditating under the shade of Marin County redwoods. But when my sadness grew stronger, I longed for a place where I might find community among others searching for support.

In that awesome piece of writing, Puri describes a group of Buddhist monks creating the mandala and then methodically sweeping away their creation.

[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.

In an interview with NPR, timed with the release of her book, Puri emphasizes that doctors, heroes they are, "are not good at knowing what to do when we can't fix a problem."  Puri says:

In my medical training, there were so much focus on the technical and scientific aspects. But as I was learning those things, I was not also learning how to talk with someone who has a serious diagnosis. How do you explain to them how their life might change? How do you ask, if this is not something that we can cure, "What would be really important to you in the time that you have?" And this language was not given to me in medical training.

I am so thankful that people like Sunita Puri are out there working on this important aspect of life, in which death is certain.  As she says, dying a good death is a part of living a good life.