I’ve been fascinated with complicated surgeries and the surgeons who are capable of doing them since I was a kid — especially neurosurgeons, cardiovascular surgeons and transplant surgeons. I scour the internet for videos of brain surgery with some regularity. I enjoy watching them for the same reason I enjoy watching a symphony or a world-class violinist. There is a certain elegance there. The margin for error is extremely slim. Perfection is demanded. The really great surgeons and musicians are capable of pulling it off artfully and with a grace and precision rarely seen amongst our species. I’ve also always had this strong awareness of my own death. It’s with me everywhere I go and in everything I do. I always imagined these people — these surgeons who see so much life and so much death — probably understood it better than most of us ever will.
I was driving to the gym one morning when a story on NPR had caught my attention. They were interviewing a woman called Lucy, the widow of a young neurosurgeon who had died of metastatic lung cancer. The neurosurgeon, Dr. Paul Kalanithi, had finished a short memoir, When Breath Becomes Air about his life and the process of dying. Lucy, a doctor herself, was promoting the book. I was instantly moved by what I heard — how she discussed touring in support of the book as a kind of catharsis and healing in its own way while also having to raise their baby on her own. He had died only eleven months before.
I read the book in a day. I didn’t set out to do that, but I was dedicated to it after the first page. I set aside the rest of my plans for the next few hours and consumed it. The thing that struck me first was that Paul had such a different upbringing than I had — loving, intelligent, supportive parents and family, thoroughly dedicated to his education, etc. — yet, I saw so much of myself in him as well. He too was also constantly preoccupied with mortality. He frequently referenced writers and books I was also enthusiastic about –Tolstoy’s The Death of Ivan Ilych, St. Augustine, Solzhenitsyn’s Cancer Ward, T.S. Eliot, Dr. Sherwin Nuland’s How We Die, Shakespeare. We both shared that driving urge to know where morality, biology, literature and philosophy intersect. That’s something I’ve constantly gone back to in my life. It’s at the center of all my creative work. Dr. Kalanithi took it to a whole other level with his career as a physician.
The more I read into the book, the more I felt like I was having a discussion with a very tired, very overworked friend. I kept wanting to reach out to him and maybe tell him to take it easy or something. Nevertheless, I deeply admired him and the life he had been living. Reading his account of the surgeries he performed, I thought to myself that if I ever needed brain surgery, I’d want to be in the hands of someone like him. This was obviously someone who loved what he did and was very, very good at it. This was also someone who had seen death many times in his short career and his accounts of these deaths left me with chills. He did everything right, no self-destructive behavior other than working himself too hard — then the cancer happened.
Paul was my age — 35 years old — when he was diagnosed with lung cancer. He wasn’t a smoker; it was just a thing that happened to him. He was just in the middle of things. He was just getting started — finishing up his residency, having some marital problems, dealing with the lives and deaths of his patients. Then the back pain came and soon, a cancer diagnosis. The cruel irony of it all wasn’t lost on me. Someone who truly wanted to understand death — who essentially dedicated his life to it — got to know it very well, in a way he was not expecting and didn’t want to. It hurt to read him tell the story of how it all unfolded.
Dr. Kalanithi showed me how to die. I spent the first half of the book getting to know and understand him. Then I spent the second half watching him deteriorate. He kept on working, performing surgeries and caring for his newborn daughter. Though he knew death would come soon, nobody could say when, so in the face of it, he kept on with life almost as usual. This is someone who had routinely sat down with patients to discuss the grim prognosis of what is essentially certain death. Something that needs to be dealt with with a kind of existential authenticity that only a rare and gifted individual like Dr. Kalanithi could do.
I sat there and read as the drugs and treatments wreaked havoc upon his body up to his demise. His widow, Lucy writes an account of his death in the epilogue. I found myself almost morbidly envious of it — surrounded by family, pumped with enough morphine to not feel it and finally going gently into the night. Of course I wasn’t truly envious. Tumors had begun to form up in his brain. The cancer had taken over aggressively. He was beginning to really suffer toward the end. When he finally did die, I felt myself feeling relieved that he could finally rest.
I was in tears and pretty much destroyed when I finally finished the book. The Bach violin concerto I had swirling on in the background added to the mood of the thing. The endless complexities of life and existence all caved in on me and became a blur. It was beautiful and devastating. His story is unique in that he was such a bright light, someone young and successful who regularly dealt with death, someone who dedicated his life to understanding death, who felt deeply called to what he was doing — taken away right in the middle of things. He got the news, processed it and got as ready for it as he could — something none of us want to even think about, let alone do. He faced down death bravely and Stoically, finishing up as much work as he could before the cancer took him. He left us with that beautiful book — something that will live on and help others to understand and come to terms with their own mortality.
The whole thing really affected me in a way I wasn’t quite ready for. I had to take a few days to process it all. For most of my life, I’ve had this overwhelming feeling that I’ve been lagging behind. It’s hard for me to truly relax or feel calm, yet I do catch myself wasting time frequently. I’ll spend two hours playing with the dogs, then another hour or so cooking, dancing in the living room, looking out the window and watching the cars go by. I really love staring out the window and spacing out like a zombie. The whole time I do that I’m constantly haunted by this feeling that time is slipping away from me — because it is. It really, really is and I’ll never get it back again. How dare I do that to myself? Yet I do.
There’s nothing wrong with wrestling with dogs or watching people in their cars or making a killer kale soup just for for the hell of it, but there are other things — bigger, grander things I had planned out for my life that evade me. Reading this account of Paul’s death did little to ameliorate that, it only drove it home to me even more. After all, what would I do if I were faced with the same situation he was? Searching myself, I could safely say I would be angry. I would be very, very angry with myself for wasting so much time.
We often hear of these horrible fatal diseases striking people in their prime and kind of brush them off as something that’s not really quite real. We tend to think of them as so far off and rare that they seem like almost a kind of fiction. And while cancer appears to be becoming more and more common and it is a terrible thing, as Paul says in the book: “Yes, all cancer patients are unlucky, but there’s cancer and then there’s CANCER, and you have to be really unlucky to have the latter.” These things are rare, but they do happen to real people who did everything right with their lives. Fate plays a large role and in this way, we’re all vulnerable. Our lives are all the product of chance and number.
I don’t think most of us will ever be able to accomplish all we set out to. There will always be some unfinished business, but it’s important that we do as much as we can so that when we finally do have to face down death, we can be relatively content and not have to come back as angry ghosts, terrorizing curious teenagers exploring abandoned factories. Statistics tell us that we will likely die old, we will know it’s coming and we will probably be on a lot of drugs at the very end. That’s a scene I’ve been playing out over and over in my head for a while now. We all know that day is coming. It’s so important that we be ready.
But now I have this new scene, this scene where I’m in Dr. Kalanithi’s situation and I think about what really matters to me in my life. It makes me want to work harder at what I love doing, forge strong and meaningful relationships that truly matter to me and let go of all the things that don’t serve me or cause me unnecessary grief. Material things lost any significance to me. Fame and status are like silly little distractions, hardly worth thinking about anymore. I ultimately read When Breath Becomes Air as a companion to Shelley’s sonnet, Ozymandias — especially these lines:
“Look on my works, ye Mighty, and
Nothing beside remains. Round the
Of that colossal wreck, boundless and
The lone and level sands stretch far
That sonnet kept repeating in my head as I read the book. I was amused to later discover a promotional trailer for the book which featured a reading of Ozymandias. As with the sonnet, I ultimately take When Breath Becomes Air as a warning. Our lives are ephemeral and can be taken away from us at any moment. It’s important that we take advantage of our time here. Unfortunately, so many of waste unbelievable amounts of time. I’m not sure if Dr. Kalanithi intended to or not, but before dying, he gave us a great gift — to prepare yourself for death, take advantage of your time here on this planet and never stop working toward what you love.