STORIES INTERRUPTED

​I am not a great aficionado of the opera. It was late afternoon and the sky was overcast with rain clouds threatening a heavy downpour. I was randomly browsing the internet and by sheer chance came across a recording of Four Last Songs of Richard Strauss rendered by Elisabeth Schwarzkopf (https://youtu.be/Cs0vSC9DUhU). It was achingly beautiful. The second song was especially moving, though I couldn’t understand the lyrics. A brief search revealed that it was based on a poem September by Herman Hesse. The English translation reads:

The garden mourns,
Cool rain sinks into the flowers.
The summer shivers
quietly to its end.
Leaves fall down one by one, golden,
from the high acacia.
The summer smiles suprisedly and dimly
towards the dying garden dream.
He stands for a long time at the roses,
Longing for a rest.
Slowly he closes
his big tired eyes.

These lines resonated deeply within, as I had just finished reading Paul Kalanithi’s ‘When Breath Becomes Air’. It is not a book easily forgotten…

I have rarely read the first paragraph of a book as poignant as this one:
“I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own”.
Kalanithi weaves the story of his early childhood, journey into the medical world and his encounter with life threatening illness with poetic flair. It is a short book but its story and message will stay with you long after you flip the last page.

‘When Breath Becomes Air’ is a story about what happens when a doctor becomes a patient, but it’s so much more than that. It is a philosophical and literary exegesis of what a life which is cut short looks like, from the viewpoint of a man who no longer has a long-term plan, because the future is not promised to him. It becomes a rigorous meditation on what death means in our death-averse society. Kalanithi narrates his experiences that are incredibly hard to talk about and in doing so, he teaches us much about finding what truly matters in the face of the invincible. In his quest for meaning, he avidly reads books about death – Tolstoy,  Solzhenitsyn, Montaigne, anything by anyone who had ever written about mortality’.  He was, he writes, “searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again.” And he finds seven words by Samuel Beckett to sum up the paradox of his condition, its perfect balance of despair and hope: “I can’t go on. I’ll go on.”

With an abiding love of literature and medicine, Kalanithi was constantly searching for the meaning in life. He epitomizes what Walt Whitman called the physiological-spiritual man. It is a heart wrenching and moving account of a riveting journey from being a young brilliant neuro- surgeon/scientist to a patient confronting the end of his life.

It is also a moving meditation on mortality much like Atul Gawande’s ‘On Being Mortal’. His first instinct on discovering he has cancer is to focus on survival curves as he wants to know how long he will live. But he finds that averages and probabilities, while useful to a doctor in deciding between treatments, have little meaning for a patient. “What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find on her own … the angst of facing mortality has no remedy in probability.” As a doctor, Kalanithi has worked hard to keep mortality at a distance: As a cancer patient with a terminal prognosis "coming in such close contact with my own mortality had changed both nothing and everything. … The fact of death is unsettling. Yet there is no other way to live."

Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. He recounts everything with a poetically inclined honesty: the fears, sorrows and joys of his work as a neurosurgeon, his love of literature and the daily struggle of existence with a terminal illness.

Tears welled up in my eyes when I read the last paragraph of the book where Kalanithi writes a heart-wrenching farewell to his eight-month-old baby daughter, Cady, to whom the book is dedicated: “When you come to one of the many moments of your life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.”

Inevitably, at many times in our lives we have to traverse the valley of adversities. During these travels in demanding terrains, there is often a sudden awareness about the fragility of human existence. In his Heiligenstadt Testament, Beethoven provides us with a glimpse of this anguish: “with joy I hasten to meet death. -- If it comes before I have had the chance to develop all my artistic capacities, it will still be coming too soon despite my harsh fate, and I should probably wish it later -- yet even so I should be happy, for would it not free me from a state of endless suffering? -- Come when thou wilt, I shall meet thee bravely. -- Farewell and do not wholly forget me when I am dead; I deserve this from you.”
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I would like to close with his wife Lucy’s reflection in the epilogue of the book: “The earth is quickly turned over by worms, the processes of nature marching on, reminding me of what Paul saw and what I now carry deep in my bones too: the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this. What happened to Paul was tragic, but he was not a tragedy.”