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STORIES INTERRUPTED

9/8/2016

25 Comments

 
Picture
​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.”
​

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
.”
25 Comments
Malathi Swaminathan
9/9/2016 12:49:08 am

Very moving!!

Sir, sad the Stanford Palliative Care has not included essays. They have come up with a solicitation honoring the author. The flyer says, stories less than 1500 words or poems less than 50 words, theme being patients of chronic or "life limiting illness" caregivers be sent before Nov, 2016. You write poems with ease, give all these descriptive essays and travelogue; story(ies) from you is a possibility. Given that you are such humane carer, healer the theme too is doable. So one from you for the Stanford's, please?

Reply
ragu
9/9/2016 01:10:21 am

Sure Malathi!

Reply
Chanda Bhide
9/9/2016 01:57:30 am

Well written review Ragu. Very moving.Have read excerpts of Kalanithi's book in a magazine a few months ago. Don't have the mental energy to go through his journey...
Too close to what Ajit and I went through for so many years.

Reply
Malathi Swaminathan
9/9/2016 02:14:04 am

Wonderful Sir!

Reply
Preethi Vaman link
9/9/2016 06:39:47 am

Beautiful review Sir. I loved the book though it was painful and somewhat scary. As doctors we often view death objectively and so to suddenly turn tables n be at the receiving end needs a lot of maturity which I do not know whether I am capable of!!

Reply
ragu
9/9/2016 07:41:09 am

Thanks Preethi! It is moments like this we discover the power of healing within and outside of ourselves!

Reply
Chitra
9/9/2016 06:44:42 am

Beautiful Sir

Reply
Ragu
9/9/2016 07:42:02 am

Thanks Chitra. It is a good companion to read along with Atul Gawande's Being Mortal

Reply
K P Raman link
9/9/2016 07:50:13 am

Beautiful review
I liked it
I could identify myself with him because I as you know went through near death twice in my life
First kidney transplant in 1995
Second transplant and CABG in 2015
I had terrible fear that I would die during 2015 ordeal but escaped
Going through all these gives new meaning to life
I feel in my heart how Kalanithi would have felt
Any one can read my story in my website www.alhayathospital.com

Reply
ragu
9/9/2016 09:16:30 am

True Raman. It's only in those moments of our own fragility we discover new meanings in life...

Reply
Naheed Azmathulla
9/9/2016 08:52:24 am

I understand that a story can possess complex and multidimensional nuances when told from the point of view of a patient coping with a terminal illness, while having the mind of  a surgeon. When a reweiw of such a story is given by a mind that has studied and understood human minds for years gives this very story a whole new perspective...a story retold  and yet leaves one eager to know more...Dr Raguram  this is such an insightful review. ..I am intrigued and will certainly read the book!

Reply
ragu
9/9/2016 09:17:15 am

Thanks for your perceptive reflections...do catch up with the book!

Reply
Ravi Shankar Rao
9/9/2016 09:01:22 am

We are all trained as medical practitioners to use our empiricism and logic to arrive at clinical judgements. But when one is faced with 'meaningless' situations as with Kalanithi one finds that these methods are of limited use. They do not answer the 'real' problem because they are not equipped to. That is when one becomes intuitive to connect with the angst. That is where one comes closer to the absolute truth and Kalanithi reaches that moment in the paragraph when he 'talks' to his daughter. He is not cured but we are seeing signs of his healing! Poignant.

Reply
ragu
9/9/2016 09:23:26 am

Absolutely true Ravi!

Reply
Prathap Tharyan
9/9/2016 05:22:17 pm

Both the books you referred to should be required reading for health specialists. The concept of a "Good death" is not one that figures in medical curricula, yet the omission is why books like these two are so necessary, poignant, terrifying, and ultimately calming. They enable us to comprehend the limits of what the life-force can achieve, and how all departures from life are tragic, but just as Lucy reflects on Paul, the lives need not be remembered as tragedies.
Thanks for that erudite and meaningful review.

Reply
ragu
9/9/2016 06:51:48 pm

The need to pay attention to 'good death' is all the more important in this era of privatization of medical care, where there is so much emphasis on maintaining life at any cost.

Reply
Vijayakrishnan
9/9/2016 08:00:29 pm

Dear Ragu,
very well written; I wish we could interact more, for my benefit, of course. Each human being's reaction to waiting for death is unique, this is a given. But after reading your piece I feel that it is better to achieve the state the author finally accomplishes than the one I felt after my operation when I felt neither regret nor worry merely saying "my bags are packed and ready for the journey any time."

Reply
ragu
9/9/2016 08:14:26 pm

True Viji! Do drop in when you are around here....sometime!

Reply
Raji Sheth
9/26/2016 12:56:03 am

Doctor, very lucid and articulate musings. Enjoyed reading your write-up and the opportunity to think through this concept! Thank you!

Raji

Reply
Vidya link
10/2/2016 09:00:23 am

Really moving. These lines have left me pondering over my own personal losses ...
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.

Reply
Dr T M Raghuram
4/9/2017 10:19:27 am

Dear Ragu,
I just finished reading When Breath becomes Air and immediately rushed to re read your wonderful review of Paul's unforgettable book. I feel every medical practitioner should read this book which is a first hand treatise on life and death and a doctor's role which bridges both.

Reply
Ragu
4/9/2017 08:51:04 pm

Thanks Raghu!

Reply
Bala
7/11/2020 12:20:20 am

Not only did this book bring tears to my eyes, it also taught me to be more empathetic towards my patients and clients. A must read for MH providers! Appreciate your review, Sir 🙏🏾

Reply
Manju R
7/11/2020 01:47:06 pm

So poignantly captured Sir!
Dr. Kalanithi graceful life surely showed us how to create a eulogy resume!

Reply
Diana M
7/11/2020 03:32:22 pm

Eloquent and moving review!

Paul Kalanithi’s book Is a tear jerker and is a powerful account of his short but impactful journey.
It also brought to mind Randy Pausch’s “Last
Lecture.....”
You dear Sir, have reviewed Kalanithi’s book with as much flair, empathy and poignancy!

I am grateful for the gifts you share with the world, to make it a better place.
Always remember you as a brilliant, unassuming, creme de la creme of a teacher and a larger than life personality!
Tons of respect!

Reply



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    Dr Raguram

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