How the book “When Breath Becomes Air” changed my practice

Behind every door in my clinic, is human suffering.  It hangs like a mist; I can see the living ghosts of my patients through it.

As an oncologist who treats primarily pancreatic cancer, many of my patients will be dead within a year of our first meeting.  I knew this would be the case when I chose my specialty. Pancreas cancer is one of the last frontiers in cancer therapeutics:  a disease for which we still have few effective treatments and for which the prognosis remains abysmal.  I have watched healthy, hopeful people crumble in the clutches of a beast so ravenous that it seems to eat them alive.

I chose to become a pancreatic cancer oncologist not in spite of the devastation it wreaks, but in some part because of it.  Standing alongside the dying is good work; something I have always been drawn to. There is so much that you do for a person, even when you cannot cure them.  I find solace in counseling, guiding and calming my patients.

Hope for future therapeutics also drew me to this disease.  There are many other illnesses that were once swift death sentences: pediatric acute lymphoblastic leukemia, metastatic melanoma, HIV.  One by one, through diligent and persistent science, these beasts have been knocked down to become curable or chronically manageable.  Patients who would previously have died within a few months now live long enough to worry about their cholesterol.  Children with deadly leukemia grow up to have children of their own.  We aren’t there yet for pancreatic cancer — the shadow people in my clinic are an attestation to how far we still must come — but someday we will be.

Despite my best intentions when I started practicing, standing under the hot glare of suffering and death caused a swift emotional drought.  Within a short time, I had become quite polished in talking gently about prognosis, symptom management and death, but with the emergence of those skills, my empathy had melted into its inferior cousin: sympathy.  An imperceptible film crept in between me and those slumped in the clinic chairs.  It’s normal, I thought.  After all, being in the room is like holding my breath underwater: If I stay too long, won’t I drown?

Then, on a plane ride home from an oncology conference, I opened When Breath Becomes Air.

Reading Paul Kalanathi’s book was to experience terminal cancer from the inside and the outside simultaneously.   Paul is one of us.  Even more so, he is us: I was wearing his hospital gown and his white coat at the same time.  Through this duality, Paul’s story gave me the most refreshing look into the other side of the cancer story.  It is the story of my patients, refracted and distilled in the experience of a colleague.

The insider’s look at the journey was jarring but revivifying.  With Paul’s words in my head, I could be more emotionally present for my patients; I could help them more effectively.  Against my expectations, the shift did not cause more emotional fatigue, but rather relieved it.

So thank you, Paul.  Thank you for writing so eruditely and poignantly about such a profound part of the human experience. Thank you for helping us understand what cancer can do and what it cannot take away; thank you for showing us the inside.

Kim A. Reiss is an oncologist.

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