The Ultimate Question: What Matters In A World Where Nothing Lasts?

What death, sandcastles, and a dying patient taught me about what actually matters

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Rachael was young when I met her at my surgery clinic. Married in her thirties with two small children, her diagnosis of breast cancer was especially heartbreaking. Yet, she maintained a positive attitude through pre-operative chemotherapy, surgery, and a second round of post-operative chemo.

She did remarkably well, returning to her life and even having a third child. Everything seemed to go smoothly with no signs of her disease coming back. But breast cancer at such a young age is always aggressive, and we all knew it was only a matter of time. When the cancer returned, I was disappointed but not surprised.

More surgery and chemotherapy followed, along with radiation. She again lost her hair and felt miserable much of the time, but she kept a brave front and tried to make life as normal as possible for her children for as long as she could.

It was more than eight years after she first walked into my office when she died in a hospital bed, struggling to get enough oxygen from lungs filled with cancer.

By then, I had seen many patients succumb to their diseases, but Rachael’s passing hit me especially hard. Her youth, the children left without a mother, and her determination to make the best of it made it especially hard to see her go.

But more than losing someone I cared about, her passing brought up an existential crisis as I confronted the fact that no matter how skillful I am, ultimately, all my patients will die. Does that mean my life’s work is meaningless?

The Wrong Question

I was asking the question too narrowly. If doctors measured their work by its ability to prevent death, then every physician would be a failure. Every physician’s work would be futile. Every human endeavor is doomed.

No one will live forever, so healing isn’t about defeating mortality. Healing is about changing the quality of time that remains.

I ultimately realized that my work matters, not because I prevent death, but because I change what someone’s life feels like while they are living.

I gave Rachael a few more years with her family. Time that she and they treasured because the specter of finitude hung over them. The fact that time was limited didn’t make it less valuable; it made it sacred.

And Racheal made the most of those years.

Sandcastles and The Meaning of Life

When my children were in grade school, we took them to the Caribbean. My fondest memory of that trip was a day at the beach, building sandcastles. This was their first time, and once I showed them how to fill a bucket with sand and turn it over to make a tower, they were hooked.

The four of us built an elaborate structure of towers, walls, and a moat, culminating in a driftwood drawbridge. As they built, the children narrated stories about who lived in each part of the castle and what they did. It was a wonderful day of exploration, cooperative play, and imagination.

Then the tide came in, and when it went out, our fantastical fortress was gone, replaced by flat beach sand. No sign we had been there remained. Does that mean we wasted the day?

Although the sandcastle did not last, the memories and feelings from that day live on. I’m smiling now just thinking about our day in the sun. My children may not remember the event as clearly as I do, but the feeling of love and camaraderie stuck with them, even if the memory faded.

So, although our sandcastle didn’t last, that doesn’t mean the experience was meaningless. It was the experience that made that day meaningful, not the result.

Of Pyramids and Purpose

We often mistake meaning for legacy, assuming that creating something enduring gives it significance. However, legacy is inherently fragile. No structure can last forever; of the seven wonders of the ancient world, only the Pyramid of Giza remains. Yet, even it is an incomplete success: designed to safeguard the pharaoh’s remains and treasures, it was looted and its treasures stolen. The once-shining white limestone casing stones were removed and reused in Cairo’s mosques and buildings, illustrating the impermanence of even the grandest achievements.

The Great Pyramid failed in its quest for permanence; it was robbed, defaced, and its purpose nullified. If a civilization obsessed with eternity cannot create something that endures, what chance do we have?

If we are to find meaning, we must seek it in something beyond legacy.

Meaning is About Aliveness

We don’t create meaning by crafting something permanent. We create it by paying attention, caring, and showing up with intention.

That day on the beach, my children and I were fully invested in their endeavor. I was there with them, not just physically. I was engaged, attentive, alert, and alive. That is what made the experience meaningful, not the durability of what we created, but how alive we felt while making it.

We often misunderstand meaning by thinking it must last forever. Instead, it’s the fleeting nature of our experiences that gives them value. That day on the beach is gone for good, just like the sandcastle. That’s what makes the memory so precious.

Impermanence Wakes Us Up.

Rachael succumbed to her illness, but she lived during the time I cared for her. The moments she shared with her family were not insignificant because they were fleeting; they were invaluable because they were limited.

Even simple things like making pancakes for her family felt meaningful to her. The certainty that there was a finite number of pancakes in her future meant she cherished every opportunity. She was alive and invested in each brunch as an event, not a chore.

The impermanence did not make her life less meaningful; it made it more so.

Impermanence lends gravity to the moments of our lives by removing the comforting lie that there will always be more time. When moments are limited, they demand our presence. The ordinary becomes charged: a meal becomes an occasion, a conversation an offering, a quiet afternoon something to inhabit rather than rush through.

Finitude sharpens attention. Without it, life dissolves into postponement; with it, each moment stands forward and asks to be lived. What woke Rachael up to her life was not hope for more time but the knowledge that time was fleeting.

Final Thoughts

Because nothing lasts, everything matters, not in some grand, historical way, but in the only manner that meaning ever appears: moment by moment, through lived experience. The value of our lives isn’t measured by what outlives us, but by how completely we live the time we’re given.

Rachael’s life mattered not because it defied death, but because she lived it with care, attention, and love until the end. The sandcastle mattered not because it endured, but because we were there, alive and together, while it stood.

Meaning isn’t something we secure against time; it’s something we engage with despite it. Once we stop demanding permanence from life, we are finally free to see what has always been true: this fragile, fleeting moment is enough.