Thursday, December 1, 2016

When Breath Becomes Air: Finding Purpose While Dying

Patient: one who endures hardship without complaint.
I know about cancer. My parents died of it.

Mom had psoriatic arthritis and psoriasis that had been controlled by Methotrexate, allowing her a better quality of life during her last years. But she always feared an dependent old age, unable to take care of herself.
She had been a lifelong smoker until the birth of my son when she decided to give it up. It turned out to be easier than she ever imagined.

She was fifty-seven, recovering from a broken knee, when she convinced her doctor that her excruciating back pain was not normal. A CAT scan revealed cancer spread through her body, in her lungs, pancreas, brain, and bones. She had weeks or months.

After her first chemo she came home and called all her friends and relatives, calming chatting and telling them the news. She instructed me on the value of her Depression glass collection and what jewelry was 'good'.

She wondered if I remembered my grandparents who had died before I was three, hoping that our two-and-a-half-year-old son would remember his doting grandmother. It was her only regret, for she had given up hope of ever having a grandchild and had found joy as a grandmother.

Two weeks later she was in the hospital, choosing morphine over pain, leaving behind a weeping family and devastated husband.

Fast forward sixteen years. My father had found a girlfriend and was enjoying life when his Non-Hodgkins lymphoma came out of remission. Whereas Mom accepted the news, Dad was determined to fight the cancer. I stayed at the hospital with him during the day, and my brother came after work. He held on for ten weeks before the oncologists allowed his removal to Hospice. Dad was 78. My brother and I were now all that was left.

I have uncles and a grandfather who died in their early fifties. It is hard to lose someone 'before their time'. I feel for my cousins whose dads passed when they were young adults. What is harder to accept is when death comes to people under forty, or thirty, or even as children.

"I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful?"

Paul Kalanithi was driven to understand the most basic question of life: What makes life meaningful? What kind of life is worth living? Can a life cut short, on the cusp of reaching its potential, still hold meaning? He studied medicine, biology, philosophy, literature, and poetry searching for understanding. He attended Medical school to "bear witness to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal." He realized that physicians must understand their craft intellectually but also morally.

Had I been more religious in my youth, I might have become a pastor, for it was the pastoral role I'd sought.

At age 36, soon to graduate and begin his career as a neurosurgeon and planning to start a family, Paul was diagnosed with terminal cancer.

        "And with that, the future I had imagined, the one just about to be realized, the culmination of             decades of striving, evaporated."

The cancer could be managed, held off, for an uncertain length of time. As a doctor Paul understood his case, the options and the probability of their effects. He was also now a patient, needing to make sense of his options and potential, finding what would give meaning to his time left on earth.

I began to view the world through two perspectives; I was starting to see death as both doctor and patient.

His love for language, writing, literature, and deep medical and scientific knowledge allowed Paul to express and probe his experience as a dying cancer patient, leaving behind this memoir.

Paul tells us about his patients and what they taught him, and about being a patient and what he learned. We hear about the rigorous and crushing work of residency and how a slight touch with a scalpel can be irrevocable. As a cancer patient, he had to decide how to live--oriented towards life or death--and whether to have a child he won't live to see grow up.

...even if I'm dying, until I actually die, I am still living.
Paul did not live to finish his memoir. The moving epilogue is written by his wife. The Forward by Abraham Verghese warns us, "Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words...Listen to Paul. In the silences between his words, listen to what you have to say back. Therein lies the message."

When Breath Becomes Air
Paul Kalanithi
Random House
Published January 2016
$25 hard cover
ISBN: 9780812988406

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