“In that first year, I would glimpse my share of death. I sometimes saw it while peeking around corners, other times while feeling embarrassed to be caught in the same room.”
~ excerpt from Paul Kalanithi’s When Breath Becomes Air
In his last year of training to become a neurosurgeon, Dr. Paul Kalanithi is diagnosed with metastatic lung cancer. The foreword and afterword are not written by the author, and both let us know that the work is published in 2016 after his death. The memoir begins with the challenge of facing his own mortality, but flashes backwards through an inspired life that led him to study literature, consciousness, neuroscience, and eventually enter medical school.
I can barely imagine the intense grief of sitting on the precipice to a promising career, about to complete the grueling training, after many sacrifices, ready to soar, and suddenly having your wings broken by the diagnosis of cancer at age 35.
“You that seek what life is in death,
~ Baron Brooke Fulke Greville
Now find it air that once was breath.”
As a doctor today, I’ve been to the precipice at the end of residency training, but I made it off the cliff. Paul Kalanithi makes me realize just how blessed my life has been. His memoir carried me through the dual emotional spaces of becoming a doctor and the challenge of being a patient.
He describes the hours and hours dedicated to perfecting his skill as a neurosurgeon, a space where just a few millimeters can make a difference between life and death, or even worse, between living a life and living as a vegetable. Some things, perhaps, are worse than death.
In one scene, he describes the operation to insert a deep brain stimulator in a patient with Parkinson’s. A portion of the skull is removed. Through his description, I can even smell the operating room. The electrode is inserted while the patient is awake so that responses can be monitored. The hand tremor appears better, when suddenly the patient says, “I feel… overwhelmingly sad.” The current is turned off and the patient feels better. They adjust the settings, turn on the current. “…so sad. Just dark…” The electrode is removed and replaced two millimeters to the right. The patient’s tremor improves, and this time feels ok.
While I have not performed neurosurgery, I can identify with the demand for technical precision in the practice of medicine. The immense weight and pressure of holding a life in your hands, as well as the gratification of a job well done and a life saved.
While I have also not experienced brain surgery, I can identify with the patient’s sadness. Since my mother passed away a few months ago, I just have days where it feels like that electrode has been inserted. There are some moments that I’m just so sad. I sit with it. I have no surgeon to pull out the electrode, but sometimes I have a friend to call. Or the early days when someone sent a card; I would read it and feel less alone. Before my mother died, I somehow knew that mental truth that perhaps half the people in the world have lost their mothers. Yet now, I am so acutely aware of the emotional truth that so many others know this particular pain of losing a mother. The current on this sadness electrode comes is waves, but time has dampened the current. Memories of my mother are a now a mix of joy and pain. Day by day, joy is a little easier to access. The surgeon is repositioning the electrode.
Paul Kalanithi’s book is powerful and evocative, a memoir and a lyrical meditation that will bring you into a deeper appreciation of your own mortality and the beauty of this journey called life.
Check out the book
- When Breath Becomes Air by Paul Kalanithi (2016)
