“To be a neurosurgeon? To teach? I didn’t know. But if I did not know what I wanted, I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician’s duty is not to stave off death or to return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.
Emma hadn’t given me back my old identity. She’d protected my ability to forge a new one. And, finally, I knew I would have to.”
Paul Kalanithi has always been torn with what to do with his life. Literature? Philosophy? Neurosurgery? In university he studied it all, and finally settled on becoming a neurosurgeon. He is intoxicated by the harsh confrontation of the job: death, meaning of life, and ultimately one’s identity. He wanted to know what really mattered in life. At the end of his residency, after years of working towards his goal, and before starting his job as a fully qualified surgeon, he develops metastatic lung cancer.
Suddenly, he is a neurosurgeon sitting on the other side of the doctor’s desk. He is the patient seeing his own oncologist. Take a look at the book cover and you will understand the situation he is in – between the patient and the doctor, the charts and percentages he has studied and faced with the reality that you can’t apply a chart to one person.
Becoming a patient isn’t easy, especially when one of your colleagues becomes your doctor. Emma, the oncologist taking Paul on as a patient, is one of my favourite characters. She is almost a mirror of what Paul might be like as a doctor.
“This is going to be a long haul, you understand? You have got to be there for each other, but you also have to get your rest when you need it. This kind of illness can either bring you together, or it can tear you apart. Now more than ever, you have to be there for each other. I don’t want either of you staying up all night at the bedside or never leaving the hospital. Okay?”
Even though written by a neurosurgeon, this book is not about the tumour in the brain. There are some scientific explanations, yes, but no more than the details anyone faced with an illness will know. We study it, we understand how it works and suddenly become experts in just this one case; Kalanithi is no different. He slowly gives up the responsibility of being a doctor, of explaining possible outcomes and prognosis, and focuses on being the patient, having to hand all other responsibilities over to his colleagues.
“‘You can stop neurosurgery if, say, you want to focus on something that matters more to you. But not because you are sick. You aren’t any sicker than you were a week ago.’
Once again, I had traversed the line from doctor to patient, from actor to acted upon, for subject to direct object.”
The focus of this book is on one person, Paul, who is defining (or redefining?) his life. It is not even about his family (although his wife of course was by his side, they took decisions together, and she wrote the epilogue to this book), but simply about understanding life, the ticking clock that it is, and about what to pursue in life.
Kalanithi was interesting in death, in understanding it, understanding the complex world of terminal illnesses and their patients. Guiding his patients and their families was the far more important part of his job.
“As a doctor, I had had some sense of what patients with life-changing illnesses faced – and it was exactly these moments I had wanted to explore with them. Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death?
What better way to understand it than to live it? But I’d had no idea how hard it would be.”
After chemotherapy, Kalanithi did his best to return to neurosurgery and finish his residency. Slowly, he took on his old work load again. “Why? Because I could. Because that’s who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.”
Rather than teaching about dying, Kalanithi teaches about living. “In his final months, he was singularly focused on finishing this book.” says his wife in the epilogue. “During the last year of his life, Paul wrote relentlessly, fueled by purpose, motivated by a ticking clock. This book carries the urgency of racing against time, of having important things to say.”
When working in the OR was no longer possible, Kalanithi focused on writing, because books and words had always been his passion. At the start of his book, he explains his love for the different areas – literature and science – and throughout the book he wrestles with which one to follow. My favourite quote, as a reader, comes from his description of books, because this book provides a new and interesting view on how to live.
“Books became my closest confidants, finely ground lenses providing new views to the world.”
When Breath Becomes Air, by Paul Kalanithi
First published January 2016