Draw­ing hope from the heart of suf­fer­ing

Cecil Whig - - OPINION - Michael Ger­son

— Hav­ing sat down to pro­duce a col­umn about the vice pres­i­den­tial de­bate, I found that any topic, even death from can­cer, was prefer­able. So I fin­ished read­ing a re­mark­able book on the sub­ject called “When


Breath Be­comes Air,” writ­ten by Dr. Paul Kalanithi and com­pleted by his wife, Lucy.

Along with Tom Brokaw’s re­cent, grace­ful re­flec­tions on his mul­ti­ple myeloma, Kalanithi’s mem­oir has given a first-per­son voice to can­cer. This re­view is late be­cause the book sat on my desk — re­ally rested within my Kin­dle — for months. As a can­cer sur­vivor (kid­ney), I had lit­tle in­ter­est in a maudlin voice from the grave.

Kalanithi’s ac­count is noth­ing of the sort. It is a vivid pic­ture of a driven and ac­com­plished pro­fes­sional — a neu­ro­sur­geon — on the verge of a bril­liant ca­reer, fac­ing a disease that hum­bles and then kills him. It is a sit­u­a­tion we some­times see from a dis­tance. It is a gift to be given an hon­est ac­count from in­side.

For can­cer sur­vivors, the book has the added weight and ur­gency of de­scrib­ing the road be­hind, and per­haps — we pray not and hope not — the road ahead. But it is, of course, the road trav­eled by ev­ery­one, in some form, even­tu­ally. “He who was liv­ing is now dead,” wrote T.S. Eliot (a source of in­spi­ra­tion for Kalanithi). “We who were liv­ing are now dy­ing/ With a lit­tle pa­tience.”

We meet the au­thor ap­ply­ing al­most su­per­hu­man en­ergy and in­tel­li­gence to­ward per­fec­tion in the most dif­fi­cult of the med­i­cal spe­cial­ties. Ev­ery can­cer death ends a world; the con­tin­u­a­tion of this par­tic­u­lar world would have in­volved the sav­ing of many other lives. Can­cer is first the lim­iter of hori­zons, lay­ing waste to plan­ning and am­bi­tion. Fol­low­ing his di­ag­no­sis of ad­vanced-stage lung can­cer at age 36, Kalanithi says, “My imag­ined fu­ture and my per­sonal iden­tity col­lapsed.”

The in­ter­est­ing thing is what we build on the ru­ins of our am­bi­tion. The chal­lenge seems es­pe­cially dif­fi­cult for a doc­tor, trained to as­sume, not re­nounce, con­trol. “In­stead of be­ing a pas­toral fig­ure aid­ing a life tran­si­tion, I found my­self a sheep, lost and con­fused,” the au­thor re­counts. When he fi­nally releases the di­rec­tion of his care to an­other doc­tor, it is the pre­view of an­other re- lease, the last and nec­es­sary one.

Given a year to live, we think we would fill it with climbed moun­tains, bal­loon rides and an arm-long bucket list. But one of the cru­el­ties of can­cer is that it can take away mo­ti­va­tion and plea­sure. “All of my joys were salted,” says Kalanithi. It is hard to set new goals when your days are con­sumed with sur­viv­ing, and when lift­ing a wa­ter glass re­quires both hands.

So what life lessons does the au­thor take from a disease that kills him? There is the pri­or­ity of fam­ily. The au­thor’s story of re­sis­tance can only be­gin when his wife, Lucy, says, “I will never leave you.” The cou­ple also makes the de­ci­sion to have a child, throw­ing new life in the face of death. While the prospect of an early part­ing be­tween fa­ther and (we later find) daugh­ter was ter­ri­ble, they con­cluded, “The eas­i­est death wasn’t nec­es­sar­ily the best.”

The au­thor deals gen­tly with spir­i­tual mat­ters. He is a sci­en­tist and a Chris­tian, which is not as rare as you’d imag­ine. He re­coils from the prospect of a uni­verse in which sci­en­tific knowl­edge is the only form of hu­man knowl­edge. “To make sci­ence the ar­biter of meta- physics,” the au­thor says, “is to ban­ish not only God from the world but also love, hate, mean­ing — to con­sider a world that is self-ev­i­dently not the world we live in.”

“When Breath Be­comes Air” clar­i­fies the im­por­tant dis­tinc­tion be­tween op­ti­mism and hope. The pos­i­tive think­ing of “We’ll beat this thing” can be use­ful, but it is not suf­fi­cient. Even­tu­ally we don’t beat death. The real courage comes in draw­ing hope from the heart of suf­fer­ing. And even if this fails, to find a kind of hope­less grace.

Kalanithi finds a way to die, not with dig­nity — be­cause can­cer sel­dom al­lows it, given the nausea, pain and weak­ness, and the emo­tional mess of de­nial, hope and de­s­pair — but with in­tegrity. He shows per­se­ver­ance and con­cern for those around him, un­til the mo­ment is right for hon­or­able sur­ren­der.

Kalanithi ends up leav­ing his in­fant daugh­ter be­fore her first birth­day. But he will be a pres­ence in her life, and in the lives of many oth­ers, as a model of pur­pose­ful liv­ing and of pur­pose­ful dy­ing. We need ex­am­ples of both.

Michael Ger­son is a syn­di­cated colum­nist. Con­tact him at michael­ger­son@wash­post. com.

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