“You that seek what life is in death,
Now find it air that once was breath,
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! Then make time, while you be,
But steps to your eternity.”
– Baron Brooke Fulke Greville, “Caelica 83”
I cried Sunday morning as I sat by my fire pit. It was all I could do to keep from sobbing as I read the last pages of When Breath Becomes Air by Paul Kalanithi, MD. I often had to stop mid-page to gather myself together before I could continue to read.
At the age of 36, on the verge of completing a decade’s worth of training as a neurosurgeon and neuroscientist, Paul Kalanithi was diagnosed with stage IV lung cancer. When Breath Becomes Air is his story of his transformation from a medical student, seeking to answer the question of what makes a virtuous and meaningful life, into a neurosurgeon, seeking to understand more deeply that critical place of human identity, and finally into a patient and new father confronting his own mortality.
He died in March 2015 while working on this book, leaving behind a wife and 8-month-old daughter. The tragedy of his premature death was heart-wrenching to read. However, the words he wrote in those final months of his life are an unforgettable, life-offering reflection on the challenge of facing death and the sacred relationship between doctor and patient. In his dying, he had much to teach about life, powerful lessons all too easy to forget in the busyness that is the life of a physician.
Early in the book, he writes about his struggles during the arduous first years of neurosurgical residency. He realized he was becoming inured to the suffering and death that was now commonplace. Paul feared losing sight of the sacred relationship between doctor and patient. He realized that saving lives – everyone dies eventually – was not his highest ideal, rather guiding a patient or family to an understanding of death or illness. He wrote, “When there’s no place for the scalpel, words are the surgeon’s only tool.” I know this to be true, as well. I have seen much death and suffering in my years of medicine and the medical missions I lead throughout the world. When all else has failed – medical/surgical treatment, experimental protocols, last-ditch holistic therapies – what can one do? Our scalpel, our medical treatment, become the words we choose and the way we say them. The right words said with caring, compassion, a loving touch can be healing in ways we cannot imagine. But words said otherwise can be as wounding as the cut made by the sharpest of scalpels.
He felt doctors had a duty to learn, “What made that particular patient’s life worth living or, if not, to allow the peace of death. Such power required deep responsibility. Yet most lives are lived with passivity toward death.” As I read those words, I was reminded of the last scene in the movie Braveheart where the main character, William Wallace, played by Mel Gibson, knowing his execution was imminent, said, “All men die, but few men truly live.”
Paul found himself facing his own mortality while trying to understand what made his life worth living. In the end, it was his daughter that made life worth fighting for. His wife asked him, “What are you afraid or sad about?” He answered, “Leaving you.” He knew a child would bring joy to their family, and he could not bear to see his wife childless after he died. His wife was concerned that saying goodbye to his child would make his death more painful. He answered, “Wouldn’t it be great if it did?” They both felt life was not about avoiding suffering. They would carry on living instead of dying. They would not allow themselves to “miss the dance.”
He understood that life was precious and what made it so was not money, prestige, titles, or material things. He called these vanities that hold so little interest: a chasing after wind. He came to understand that we are all “but steps to your eternity,” yet few of us stop long enough from our busyness to comprehend that.
We all need to be reminded of this. We have been given a precious gift – the gift of making a difference in the lives of others, a gift of living a life that counts. We have the great privilege of the sacred trust between physician and patient. In seeking those things that truly are important, may we find life not death, breath not air as we remember we all are “but steps to your eternity.”
Andy Lamb is an internal medicine physician. He can be reached at Bugle Notes.
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