Monday, 8 May 2017

#7 A book published in the last year (2016)

When Breath Becomes Air – Paul Kalanithi

THE book that caught the year 2016 by storm would have to be Paul Kalanithi’s  chronicle on how he undergoes a painful transition from an exceptionally gifted neurosurgeon to that of a patient struggling to live. 

At the age of thirty-six, just as he was about to complete his training and residency as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV inoperable lung cancer which affects less than 2% of adults younger than 45. But, non-smoker, hiking enthusiast, young and brilliant Paul Kalanithi is diagnosed with it. 

“The lung cancer diagnosis was confirmed. My carefully planned and hardwon future no longer existed. Death, so familiar to me in my work, was now paying a personal visit….nothing about it seemed recognizable.” 

In the face of imminent mortality he begins to write down his life’s quest which is encompassed in this profound question - What makes life worth living in the face of death?

As he explains in his posthumously published memoir, he had been a literature enthusiast as a teenager and had even completed his Master’s from Stanford (he has degrees in biology, philosophy and history as well) when he realized that medicine was his true passion.  Though he felt literature did provide the best account for the life of the mind, neuroscience helped him practice it in life. Laying aside his ambition to become a writer, he had embarked on a path to put his exquisite knowledge and skill into helping people sustain lives. But it is indeed a testament for his lifelong love of literature and the power of words that, in the end he comes back to it for sustenance and meaning.

“Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection.”

His memoir has a profound impact on the lives of others, even after he has gone.
Paul Kalanithi has written the memoir in two parts, the first half taking us through his growing up and coming to terms with his choice of following a career in medicine like his Dad and elder brother, Suman. He writes honestly about what made him choose a profession that would entail nearly a decade’s worth of further study and research. He goes through his initial days of cadaver dissection, the enormity of the moral mission of medicine being what truly guides him. He takes us along through his first experiences as intern and then his residency as a neurosurgeon. 

He witnesses birth, death, miracles and life-altering decisions made by the doctors close at hand. He himself would be taking such decisions as he gains more experience. A very poignant scene during his initial days is when Mari, a fellow med student crying in the hallway since she had prayed that the patient had metastases( a sign of wide-spread cancer)  so that the complicated surgery in which she had to assist would be cancelled. She cannot bear the guilt of having wished something as devastating as that only because she had a spent a sleepless night and couldn’t stand a nine hour straight operation.

The ethical question of medicine is also never far away from his daily encounters with death. As he observes, a doctor needs to help his patients understand and guide them through the process. He/she has a heavy moral responsibility in preserving not just the health of the patient but also their identity. 

“Technical excellence was not enough. As a resident, my highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness.”

As a neurosurgeon he understood that many decisions will have to be taken by him knowing that he has to confront directly with meaning, identity and death. Technical excellence was a moral requirement for a doctor, but there was more to it than just that. For instance there is the case of a 22 year old who was brought in fatally injured in a bike accident, the best he could do would have left the boy in a vegetative state for the rest of his life. He chooses to let him die. Many cases like these are brought forward in his recollection of his time as a training neurosurgeon, but the irony is that the moment he was ready to start a new life, with his wife Lucy, nearing the end of his decade-long training – he had to learn, how to die.

As part two begins we are brought face-to-face with what has come to be his reality – he was diagnosed with lung cancer and it had already become quite severe. Being doctors, both he and his wife realize what this means – time would cease to make sense anymore. His future which looked bright (fellowships and job offers were pouring in) would all go unrealized.  They decide however to start the family they had been always planning to before he starts his treatment. This unrelenting belief that life continues despite you is what makes his story worth reading.
Paul Kalanithi, his wife Lucy and daughter Elizabeth "Cady"

After both medicines and chemotherapy fails, Paul Kalanithi has to relinquish his neurosurgeon duties – his last day at work is heart-breaking for us to read. He has settled in for an experimental therapy but he is sinking fast and spends as much time as possible with his new-born daughter Cady. “The fact of death is unsettling. Yet there is no other way to live.” Paul Kalanithi doesn’t finish his memoir. The afterword written by his wife Lucy Kalanithi informs us how he passed away on 9th March 2015 surrounded by all his family and closest friends.

His memoir was his attempt to find “a vocabulary with which to make sense of death”, and in doing so will make the readers question what gives meaning to their lives. What kind of life is worth living? His book published after his death has become a worldwide bestseller. His book is a memoir, chronicling his evolving relationship with medicine – first as a doctor and then as a patient. We also see his philosophical side in the way we are led to ask questions that each one of us can only find answers to.

This kind of writing, though was a first for me, apparently isn’t as uncommon as one would think There are other works by doctors and medical practitioners who contemplate the meaning of existence and value of life. The names I came across which I fully intend to read up are the following – Atul Gawande , Oliver Sacks, Jerome Groopman and Sherwin B. Nuland. 

Do read this opinion piece which Paul Kalanithi wrote for the New York Times titled How Long Have  I Got Left? – this had elicited a huge response at the time. It is also something that seems to have prompted him to continue to write as he went through his illness. And he did leave a significant amount of life lived in these pages. 

It is funny that people listen to you after you are dead. Why wait so long?  

No comments: