Not the End

 

This is not the end. Or even the beginning of the end. This is just the end of the beginning. - Paul Kalanithi

I have two cancer books next to each other on my reading stack — by Paul Kalanithi and Nina Riggs. More on this later.

Paul Kalanithi died in 2015 at age 37. He was diagnosed twenty-two months earlier with EGFR lung cancer. First line chemo worked for a time and he went into remission, resumed his work as a skilled brain surgeon, until the cancer began growing again and no treatment existed a decade ago that could stop it. There are options today because of ongoing cancer research.

The first half of his book When Breath Becomes Air describes Kalanithi’s intense training to become a neurosurgeon. Near the end of his training, he realized that he had been focused so much on learning the delicate complexities of brain surgery, and being perfect in every step, that he had lost sight of the patient — what the patient worries about going into surgery and how the family suffers alongside. He began to take more time to listen to patients to find out what they valued about life and help them choose the option that offered them more of this. He noted that having empathy for his patients made him a better doctor, and that doing so had emotional costs and rewards. His fiancé Lucy, who was also in training to become a doctor, had more natural empathy. One day she was studying the wavy lines of sample EKGs from actual cases when she identified a fatal arrhythmia and began to cry because she knew that this patient had died.

The second half of the book details his struggles with cancer, the bouts of chemotherapy and remission when he was able to return to doing surgery. As he continued his lifelong search for the meaning of life, he had numerous insights: doctors meet patients where life and their identity intersect. Science does not address emotions like hope, fear, love, hate, and beauty. It’s faith that deals with matters of sacrifice, redemption, and forgiveness and gives life meaning. Science only provides medical details. When his drugs stopped working and he became deathly ill, he wrote that he didn’t need more medical facts to guide him forward, he needed words. His book references more than sixty novelists, philosophers, and classical works of literature that inspired him.

One example, from Michel de Montaigne – “he who should teach men to die would at the same time teach them to live.”

I loved learning about the mindset and rigors that one goes through to become a doctor, the details of how it feels to go through chemo, the struggle to hold on to hope before the closure of a terminal diagnosis begins. Being an English major and premed for several years, I love both the literary references that spark his search for meaning, and the medical details that get into the grit of life and death. I also like his honesty: that he, as a doctor, put off getting treatment, that he lost sight of patients and their emotions as he pushed to do the technical side of medicine perfectly, and that he didn’t tell Lucy he was worried he had cancer. When you are in a committed relationship, you need to share whatever you are worried about because you are in this together, and cancer should be at the top of your oh-did-I-tell-you-about? list.

Paul hoped that if he wrote his book well enough, then readers would get a sense of how it feels to have a terminal cancer so that if their time came, they would be familiar with walking in cancer’s shoes. I think he also wrote for doctors – to remind them to stay human. With one in three of us getting some kind of cancer during our lifetime, reading about the experiences of others who have cancer, and learning what brought their life meaning, helps us endure.

Paul noted that we flourish only in community with others, because each of us has insights that others need to hear.

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Now back to my opening note. After Paul died, Lucy read Nina Riggs’s essay in “Modern Love” in the New York Times about her terminal breast cancer when she was consumed with needing to buy the right couch for her family to remember her by. Lucy wrote to her, regular correspondence began, and Lucy read Nina’s manuscript about her cancer that would become her book The Bright Hour. Nina would tell her husband John to lean on Lucy after her death to help him grieve, write her eulogy, etc., and this interaction became a love relationship. As much as cancer sets us aside, it also unites us.