Before operating on a person’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end…Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight (Paul Kalanithi, When Breath Becomes Air, 98).
I woke in the night, anxious. I was hot, so I threw the covers off. Then I was cold, so I put them back on. I kept rolling over, trying to find a comfortable position, but my brain would have none of this sleeping thing. At 2:50, I turned my light on (thank goodness even though Gabe wakes up, he can usually fall back asleep), took a small book from the pile by the bed, and started to read.
I haven’t read in the middle of the night since I was a little girl in my parents’ home. I used to love the feeling of rebellion (who was I rebelling against? certainly not my parents, who didn’t care if I slept or read or wrote or dreamed — whatever consequences came from lack of sleep were mine and mine only), and the sense that I had found a book so good, so tantalizing, that I couldn’t sleep until it was over. My sister was a deep sleeper, also, so I never had to live with the guilt of a light in the night or the sound of pages turning.
It’s been harder to sleep through the night lately, and I’ve taken to reading or sometimes watching The Office. The soothing voices of Jim and Pam, the irritating voices of Michael and Angela, somehow these help me transcend the nighttime anxieties of why did I say that? what was I thinking? what will I do for work this summer? why am I not writing? why do I still stink at doing laundry in a timely fashion?
Reading also helps me let go of these thoughts, but instead of easing me into the comedy of a group of employees who never work, it often tricks me into thinking not about the daily worries of a relational human but into questions far beyond the capacity of a tired woman who must get up at 6:00AM.
It might have something to do with the books I’m choosing.
My uncle recommended it to me over dinner with the proper warning: “Be sure you have tissues.” I didn’t have any tissues at hand, but I thought: I have read many sad things. Sometimes I cry. Usually I don’t. So I read it anyway in the middle of the night, this tiny book with a title scary enough to make me wonder if I was being wise.
When Breath Becomes Air — at three in the morning, I read the words of a dying man (he reminds me we’re all dying but he more imminently than most). Paul Kalanithi, a neurosurgeon-in-training, a husband, a hardworking, depths-reaching, meaning-seeking 36-year-old is diagnosed with lung cancer, and suddenly, it seems the future he’d been working toward is completely altered.
Everyone succumbs to finitude…Most ambitions are either achieved or abandoned: either way, they belong to the past. The future, instead of the ladder towards the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after wind, indeed (198).
I felt a strange kinship with this man I would never meet. He was full of many loves, many gifts, and like me, he had studied English AND… although his AND was biology leading to medical school, not music. This foot-in-both-worlds accounts for his visceral descriptions of the brain, of the opened body, of tumors precisely removed with deft fingers. It also accounts for a question that he seemed to have wrestled with much of his life: “If the unexamined life is not worth living, is the unlived life worth examining?” (31). In college, this question leads him to take a job at a summer camp rather than an intern at a research center, and it isn’t the only time he will choose human relationship over his so-called “monastic, scholarly study of human meaning” (31).
I was reading because I felt anxious about something I could not name, and this reading led me into questions of meaning, truth, death and its inextricable connection with life. I knew he would die — my uncle had told me and I had read the “About the Author” to be sure — yet I kept thinking: maybe he won’t actually die — maybe they find a cure, maybe he dies, but years and years later, maybe my uncle was misjudging my ability to handle intensity.
And then he and his wife decide to have a baby. She is born. She lives eight months. And he dies. He dies in his hospital bed surrounded by family. He gives his unknowing daughter a last kiss, he takes a deep breath, his breath becomes air.
Neurosurgery requires a commitment to one’s own excellence and a commitment to another’s identity. The decision to operate at a all involves an appraisal of one’s own abilities, as well as a deep sense of who the patient is and what she holds dear (108).
Suddenly, I was holding this book with this ending that felt incomplete. His wife Lucy writes an epilogue — sweet, loving, rounding out Paul’s person with authenticity — and I wondered what it must have been like to be in love with a man who was dying and writing, writing and dying, and wanting a child with him even so you could have a daily reminder that he was real, you loved him, and he died.
I was reading to stop my worrying and I had replaced it with deep sadness. Death comes for everyone, of this I have been aware since I was 9 years old and my grandfather died despite my utter determination to pray him into life, and I still do not believe it.
I still think that somehow I will defy the ultimate leveler.
And in the same breath, death feels right around the corner, closer to me than I hope most 29-year-olds feel.
In some ways, I think the worries I have about living enough, doing enough, hurry hurry hurry, all stem from this belief that death really is close at hand, and I am unutterably lucky to have lived as long as I have.
Maybe it stems from my blood clot at 22, my reckoning with if this is the end, how do I want it to look?
Paul Kalanithi did what he had set out to do: he taught me how to die, and in so doing, really showed me how to live. As his wife Lucy wrote in the epilogue:
Paul’s decision to look death in the eye was a testament not just to who he was in the final hours of his life but who he had always been. For much of his life, Paul wondered about death — and whether he could face it with integrity. In the end, the answer was yes (225).
“To live is Christ, to die is gain” — even at my best, I find this hard to fully embody.
I closed the book, put it back on the floor, and wept into my pillow. I cried for Paul, for his dreams that had to die, for his wife and daughter, for his family and friends. I cried for myself, for the husband who slept next to me, who might leave this world at any moment like a puff of smoke. I cried for my grandma and her twenty years of living alone. I cried for my students who are just beginning to wrestle with these questions of meaning and truth, and I cried for any child I might have — for the sorrow that inevitably awaits her, the pain she will without doubt experience in this beautiful and terrifying world.
I was reading to forget my anxieties, and in a sense, I did. Instead of focusing on the minute, meaningless worries, I was forced to confront the root of fear and ask myself:
How do I want to die?
Then how do I need to live?