Death seems the only desirable sequel for a career like this; but Death is only a launching into the region of the strange Untried; it is but the first salutation to the possibilities of the immense Remote, the Wild, the Watery, the Unshored; therefore, to the death-longing eyes of such men, who still have left in them some interior compunctions against suicide, does the all-contributed and all-receptive ocean alluringly spread forth his whole plain of unimaginable, taking terrors, and wonderful, new-life adventures; and from the hearts of infinite Pacifics, the thousand mermaids sing to them- “Come hither, broken-hearted; here is another life without the guilt of intermediate death; here are wonders supernatural, without dying for them. Come hither! bury thyself in a life which, to your now equally abhorred and abhorring, landed world, is more oblivious than death. dome hither! put up thy grave-stone, too, within the churchyard, and come hither, till we marry thee!”" –Herman Melville Moby Dick
in time of all sweet things beyond whatever mind may comprehend, remember seek (forgetting find) and in a mystery to be (when time from time shall set us free) forgetting me, remember me –E. E. Cummings
Mysteriously, Wonderfully, I bid Farewell to what Goes, I Greet what Comes; for what comes cannot be denied, and what goes cannot be detained. —Chuang-Tzu The Complete Works of Zhuangzi Burton Watson translation
All
life is lived in the shadow of its own finitude, of which we are always
aware — an awareness we systematically blunt through the daily
distraction of living. But when this finitude is made acutely imminent,
one suddenly collides with awareness so acute that it leaves no choice
but to fill the shadow with as much light as a human being can generate —
the sort of inner illumination we call meaning: the meaning of life.
That tumultuous turning point is what neurosurgeon Paul Kalanithi chronicles in When Breath Becomes Air (public library)
— his piercing memoir of being diagnosed with terminal cancer at the
peak of a career bursting with potential and a life exploding with
aliveness. Partway between Montaigne and Oliver Sacks,
Kalanithi weaves together philosophical reflections on his personal
journey with stories of his patients to illuminate the only thing we
have in common — our mortality — and how it spurs all of us, in ways
both minute and monumental, to pursue a life of meaning.
What emerges is an uncommonly insightful, sincere, and sobering
revelation of how much our sense of self is tied up with our sense of
potential and possibility — the selves we would like to become, those we
work tirelessly toward becoming. Who are we, then, and what remains of
“us” when that possibility is suddenly snipped?
Paul Kalanithi in 2014 (Photograph: Norbert von der Groeben/Stanford Hospital and Clinics)
At age thirty-six, I had reached the mountaintop; I could
see the Promised Land, from Gilead to Jericho to the Mediterranean Sea.
I could see a nice catamaran on that sea that Lucy, our hypothetical
children, and I would take out on weekends. I could see the tension in
my back unwinding as my work schedule eased and life became more
manageable. I could see myself finally becoming the husband I’d promised
to be.
And then the unthinkable happens. He recounts one of the first
incidents in which his former identity and his future fate collided with
jarring violence:
My back stiffened terribly during the flight, and by the
time I made it to Grand Central to catch a train to my friends’ place
upstate, my body was rippling with pain. Over the past few months, I’d
had back spasms of varying ferocity, from simple ignorable pain, to pain
that made me forsake speech to grind my teeth, to pain so severe I
curled up on the floor, screaming. This pain was toward the more severe
end of the spectrum. I lay down on a hard bench in the waiting area,
feeling my back muscles contort, breathing to control the pain — the
ibuprofen wasn’t touching this — and naming each muscle as it spasmed to
stave off tears: erector spinae, rhomboid, latissimus, piriformis… A security guard approached. “Sir, you can’t lie down here.” “I’m sorry,” I said, gasping out the words. “Bad … back … spasms.” “You still can’t lie down here.” […] I pulled myself up and hobbled to the platform.
Like the book itself, the anecdote speaks to something larger and far
more powerful than the particular story — in this case, our cultural
attitude toward what we consider the failings of our bodies: pain and,
in the ultimate extreme, death. We try to dictate the terms on which
these perceived failings may occur; to make them conform to wished-for
realities; to subvert them by will and witless denial. All this we do
because, at bottom, we deem them impermissible — in ourselves and in
each other.
Punctuating Kalanithi’s story are vignettes of those small yet
enormous moments in which destinies pivot and the elaborate universe of
priorities we’ve spent a lifetime constructing combusts into stardust.
In those moments, there is a violent slamming shut of chapters we had
naïvely thought would go on and on, leading to Happily Ever After and
yet somehow not really ending there, for the endings we imagine for
ourselves aren’t really endings. An ending is devastating and
unsatisfying in its finitude, and the endings we imagine for ourselves
are permanent states of ongoing, infinite satisfaction. Kalanithi recounts one such moment of enormous smallness as he finds
himself a patient at the very hospital where he works as a neurosurgeon,
awaiting the news of his dismal prognosis:
A young nurse, one I hadn’t met, poked her head in. “The doctor will be in soon.” And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.
As a young man, Kalanithi bridged the lifelong love of reading
instilled in him by his mother’s passion for literature with a sudden
fascination with neuroscience — all thanks to a mediocre 500-page novel
that, despite its questionable literary quality, posited an idea that
turned his worldview upside down. He recounts how he found himself at
the mesmerizing intersection of the life of the mind and the life of the
brain:
The throwaway assumption that the mind was simply the
operation of the brain [was] an idea that struck me with force; it
startled my naïve understanding of the world. Of course, it must be true
— what were our brains doing, otherwise? Though we had free will, we
were also biological organisms — the brain was an organ, subject to all
the laws of physics, too! Literature provided a rich account of human
meaning; the brain, then, was the machinery that somehow enabled it. It
seemed like magic. That night, in my room, I opened up my red Stanford
course catalog, which I had read through dozens of times, and grabbed a
highlighter. In addition to all the literature classes I had marked, I
began looking in biology and neuroscience as well. A few years later, I hadn’t thought much more about a career but had
nearly completed degrees in English literature and human biology. I was
driven less by achievement than by trying to understand, in earnest:
What makes human life meaningful? I still felt literature provided the
best account of the life of the mind, while neuroscience laid down the
most elegant rules of the brain. Meaning, while a slippery concept,
seemed inextricable from human relationships and moral values…
Literature not only illuminated another’s experience, it provided, I
believed, the richest material for moral reflection. My brief forays
into the formal ethics of analytic philosophy felt dry as a bone,
missing the messiness and weight of real human life.
Kalanithi reflects on his decision to continue his education with a master’s degree in English literature:
I had come to see language as an almost supernatural
force, existing between people, bringing our brains, shielded in
centimeter-thick skulls, into communion. A word meant something only
between people, and life’s meaning, its virtue, had something to do with
the depth of the relationships we form. It was the relational aspect of
humans — i.e., “human relationality” — that undergirded meaning. Yet
somehow, this process existed in brains and bodies, subject to their own
physiologic imperatives, prone to breaking and failing. There must be a
way, I thought, that the language of life as experienced — of passion,
of hunger, of love — bore some relationship, however convoluted, to the
language of neurons, digestive tracts, and heartbeats. […] For my thesis, I studied the work of Walt Whitman, a poet who, a
century before, was possessed by the same questions that haunted me, who
wanted to find a way to understand and describe what he termed “the
Physiological-Spiritual Man.”
As his friends pursued careers in the arts, Kalanithi remained
animated by the seemingly quixotic quest to locate the intersection of
literature, biology, philosophy, and morality, and to mine it for the
raw material of meaning in human life. Eventually, several of his
professors suggested that a degree in the history and philosophy of
science might come closest to his inquiry, so he applied to the program
in Cambridge and set off for the English countryside. He recounts:
I found myself increasingly often arguing that direct
experience of life-and-death questions was essential to generating
substantial moral opinions about them. Words began to feel as weightless
as the breath that carried them. Stepping back, I realized that I was
merely confirming what I already knew: I wanted that direct experience.
It was only in practicing medicine that I could pursue a serious
biological philosophy. Moral speculation was puny compared to moral
action. I finished my degree and headed back to the States. I was going
to Yale for medical school.
It was on the wings of this incisive idealism that Kalanithi soared
through his life as a neurosurgeon, and it was on them that he rose to
his death. He writes:
I had spent so much time studying literature at Stanford
and the history of medicine at Cambridge, in an attempt to better
understand the particularities of death, only to come away feeling like
they were still unknowable to me… Such things could be known only
face-to-face. I was pursuing medicine to bear witness to the twinned
mysteries of death, its experiential and biological manifestations: at
once deeply personal and utterly impersonal.
But facing these twinned mysteries as a participant rather than an
observer upended his most basic beliefs. He reflects on his conflicted
mental state midway through his treatment as the tumors shrink and the
cancer is momentarily under control:
No one asked about my plans, which was a relief, since I
had none. While I could now walk without a cane, a paralytic uncertainty
loomed: Who would I be, going forward, and for how long? Invalid,
scientist, teacher? Bioethicist? Neurosurgeon once again…? Stay-at-home
dad? Writer? Who could, or should, I be? As a doctor, I had had some
sense of what patients with life-changing illnesses faced — and it was
exactly these moments I had wanted to explore with them. Shouldn’t
terminal illness, then, be the perfect gift to that young man who had
wanted to understand death? What better way to understand it than to
live it? But I’d had no idea how hard it would be, how much terrain I
would have to explore, map, settle. I’d always imagined the doctor’s
work as something like connecting two pieces of railroad track, allowing
a smooth journey for the patient. I hadn’t expected the prospect of
facing my own mortality to be so disorienting, so dislocating. I thought
back to my younger self, who might’ve wanted to “forge in the smithy of
my soul the uncreated conscience of my race”; looking into my own soul,
I found the tools too brittle, the fire too weak, to forge even my own
conscience.
It was literature that brought me back to life during
this time. The monolithic uncertainty of my future was deadening;
everywhere I turned, the shadow of death obscured the meaning of any
action. I remember the moment when my overwhelming unease yielded, when
that seemingly impassable sea of uncertainty parted. I woke up in pain,
facing another day — no project beyond breakfast seemed tenable. I can’t go on,
I thought, and immediately, its antiphon responded, completing Samuel
Beckett’s seven words, words I had learned long ago as an undergraduate:
I’ll go on. I got out of bed and took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” That morning, I made a decision: I would push myself to return to the
OR. Why? Because I could. Because that’s who I was. Because I would
have to learn to live in a different way, seeing death as an imposing
itinerant visitor but knowing that even if I’m dying, until I actually
die, I am still living.
As he nears the end, Kalanithi comes closer and closer to the vital
substance of living, stripped of the conceits, delusions, and false
refuges with which we hedge ourselves against our own impermanence. He reflects:
Everyone succumbs to finitude. I suspect I am not the
only one who reaches this pluperfect state. Most ambitions are either
achieved or abandoned; either way, they belong to the past. The future,
instead of the ladder toward 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.
With an eye to his baby daughter — parenthood was a deliberate choice
he and his wife, Lucy, made in the wake of the diagnosis — he considers
what message he would give to this brand new being, blessed and
burdened with her own infinite potential for an inherently finite life:
There is perhaps only one thing to say to this infant,
who is all future, overlapping briefly with me, whose life, barring the
improbable, is all but past. That message is simple: When you come to one of the many moments in 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.
Kalanithi died in March of 2015, leaving behind When Breath Becomes Air
— a ledger of precisely such enormity and a rare masterwork of duality
in which the tragedy of death isn’t subverted or diluted but coexists,
every bit as real, with the triumph of aliveness as the highest human
potentiality. –By Maria Popova
Never between the branches has the sky burned with such brilliance, as if it were offering all of its light to me, to say – what? what urgent mystery strains at that transparent mouth? No leaf, no rustle . . . It's in winter, in cold emptiness and silence, that the air suddenly arches itself like this into infinity, and glitters. This evening, far from here, a friend is entering his death, he knows it, he walks under bare trees alone, perhaps for the last time. So much love, so much struggle, spent and worn thin. But when he looks up, suddenly the sky is arrayed in this same vertiginous clarity. –Jean Joubert Denise Levertov translation In The Gift of Tongues
When the white fog burns off, the abyss of everlasting light is revealed. The last cobwebs of fog in the black fir trees are flakes of white ash in the world's hearth.
Cold of the sea is counterpart to this great fire. Plunging out of the burning cold of ocean we enter an ocean of intense noon. Sacred salt sparkles on our bodies.
After mist has wrapped us again in fine wool, may the taste of salt recall to us the great depths about us.
We die containing a richness of lovers and tribes, tastes we have swallowed, bodies we have plunged into and swum up as if rivers of wisdom, characters we have climbed into as if trees, fears we have hidden in as if caves.
If the slayer thinks he kills and the slayed thinks he dies, both are wrong. The eternal in man cannot kill. The eternal in man cannot die. –The Upanishads
