LIFE

Our Stretch With Time

About two strangers worlds apart, biding time

The name Paul Kalanithi may not exactly ring a bell. Maybe it does to a few, highly likely it won’t to many. He was a perfect stranger to me up until a few days ago.

It was an ungodly early trip to Penang airport to evade traffic, followed by an unexpected flight delay, that brought Kalanithi to me, in that order. A neurosurgical chief resident and neuroscientist, the Stanford graduate was introduced to me at a bookstore named WH Smith. It’s been said that the best place to meet a good man is at a bookstore. This was one, and I was lucky. Winner winner chicken dinner.

There I was, loitering at the international airport. A substantial breakfast had been consumed, restless feet activated, boredom creeping in. I had my doctorate notes with me (I never travel without them), but the last thing I wanted was to read about mediating effects of employee engagement. That’s how I’ve unwittingly repelled men since my program started a good five years ago.

The doctorate journey has been exciting, but also grueling and emotionally isolating, to the point I make it a personal rule not to discuss it with anyone outside the program. It’s like reciting TS Eliot or William Butler Yeats. Not everyone fancies you reading them the metaphorical complexities of The Second Coming when they’ve got TikTok, unless they’re in a coma sans the ability to throw a piece of furniture at the reader. “Recite that to me only when I’m dead,” I told a good friend who’s besotted with Yeats since our undergraduate days. “Better you read me Chaucer’s The Wife of Bath’s Tale. I prefer bawdy sauce with my roasted death.”

I’m at my last doctorate hurdle and it has been tough as hell. The closer I get to the end, the further the end seems to escape from me. From concepts to language, I doubt what I am contextually pounding circa 100,000 words is in English anymore. I needed a few more days of reprieve before my supervision meeting. So there I was, hoping to kill time purposefully, albeit differently, when his name caught my eyes.

To be exact, it was The New York Times’ blurb that did the preliminary introduction, “Finishing this book and then forgetting about it is simply not an option.” You had me at this Hello.

And that’s how I was acquainted with the brilliant neurosurgeon Dr. Paul Kalanithi. He had written a memoir, the length of a novella, about a man on a mission to save lives on the cusp of medical success only to discover he was dying from stage IV lung cancer. Sudden, severe, a silver bullet to the chest.

With his days numbered, his existential paradigm shifted. Sometimes for the better, sometimes for the worse. How do you say goodbye to your dreams and loved ones before your time?

Kalanithi reluctantly switched roles. Passion and ambition sailed him through medical school. Switched from scrubs to hospital gowns, now he was forced to walk in the toughest pair of shoes, those of a walking dead man. He was only thirty six.

“I received the plastic arm bracelet all patients wear, put on the familiar light blue hospital gown, walked past the nurses I knew by name, and was checked into a room — the same room where I had seen hundreds of patients over the years. In this room, I sat with patients and explained terminal diagnoses and complex operations; in this room, I had congratulated patients on being cured of a disease and seen their happiness at being returned to their lives; in this room, I had pronounced patients dead. I sat in the chairs, washed my hands in the sink, scrawled instructions on the marker board, changed the calendar. I had even, in moments of utter exhaustion, longed to lie down in this bed and sleep. Now I lay there, wide awake.” — Paul Kalanithi, Prologue, When Breath Becomes Air

I stood leaning against the glass wall with the sun warming my back, unfazed by the passing aircrafts coming and going on the tarmac behind me. Like being enraptured in a delicious conversation on a tantalizing first date, I held my new literary purchase gingerly in my hands, drinking one page after another. By the time the Prologue was over, I knew I had to commit to his memoir before I reached Kuala Lumpur. Or else, the suspense would kill me.

Kalanithi was the type of man who could easily win my attention. His writing pierced through my armor with all the allurements that fed my mind: science, literature, philosophy, poetry of death and dying without the maudlin. He was a gladiator, hell bent to ascend Everest despite knowing reaching the summit would be his death. In that sense, though the diagnoses felt unfair, he was unafraid. At his highs and lows, he asked, Why me? Why not me?

Kalanithi was adamant not to see himself lose at the casino of Life. The Arizona native was driven to win by leaving behind a written testimony of his reality, so others could seek strength swimming through the changing patterns of the tides. Setting aside anger and denial, he allowed kindness through the dark clouds and dotted CT scans. He was an atheist, but his illness made him reconsider the existence of a God he once knew as a child.

As I traversed through his thoughts I found we had much in common.

Kalanithi was not only a neuroscientist with a passion to solve the mysteries of the human brain, he began as a literature major. His love for prose and poetry possessed a magnetic pull that hooked my attention from his Prologue. “Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection.”

Kalanithi charted his health condition and expounded his dilemmas with as much human observation as possible. In between rapid weight loss, wrecking back pain and deepening fatigue, he discussed TS Eliot’s The Waste Land, Sir Thomas Browne’s Religio Medici, and Walt Whitman’s work which inspired his thesis on “the Physiological-Spiritual Man.”

Why me? Why not me? These questions changed tone as Kalanithi came to accept his impending death. We see a man not defeated, but resolved, by his life’s work.

“It was not a simple evil however. All of medicine trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escort them into the world, and then back out. Seeing the body as matter and mechanism is the flip side to easing the most profound human suffering.” — Paul Kalanithi, When Breath Becomes Air

Kalanithi’s fascination with neuroscience was forged as he noted with sensitivity the doctor-patient dynamics. Dealing with the brain he felt he was gifted with a moral responsibility to ensure the patient’s identity was not altered, diminished or locked-in. Even the slightest, careless hand control can cause an injury to the brain that’s life-altering with permanent consequences. Some unresolved condition could lead to disintegration of behavior and unnecessary death. He reasoned, “I was compelled by neurosurgery, with its unforgiving call to perfection.”

Brain surgery has the impact of any major life event. The questions Kalanithi faced at critical junctures were not simply whether to live or die but what kind of life is worth living. Would you trade your ability to talk for a few extra months of mute life? What makes life meaningful enough to go on living? These are not the kind of questions I ask myself in the course of my career. Is that a blessing, or a deficit?

Kalanithi was drawn to the quest of meaning. It wasn’t just the meaning from his work examining the human brain but the healing of our soul. His early fascination with medicine was to create a bridge that links scientific healing with spiritual healing.

“Throughout college, my monastic, scholarly study of human meaning would conflict with my urge to forge and strengthen the human relationships that formed that meaning. If the unexamined life was not worth living, was the unlived life worth examining?”

As his condition worsened, Kalanithi achieved a series of epiphanies. Being a surgeon taught him to be a hero, the rescuer, the sorcerer, the problem-solver. What happens when you’re on the other end of the spectrum? What happens when there is no solution to your problem? What happens when you’ve exhausted all there is to find the cure? Here, Kalanithi realized that even as a successful brain surgeon, he was not well-versed with the magnitude of being a patient:

“I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun. I was not yet with the patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it.” — Paul Kalanithi, When Breath Becomes Air

Kalanithi raised an important question for us: If you could see the graph of your life and how little time is left to live, what would you change and pursue that’s truly meaningful? It wasn’t exactly his original thought, but one he borrowed from Samuel Beckett:

“One day, is that not enough for you, one day he went dumb, one day I went blind, one day we’ll go deaf, one day we were born, one day we shall die, the same day, the same second, is that not enough for you? They give birth astride of a grave, the light gleams an instant, then it’s night once more.” — Samuel Beckett, Waiting for Godot

I didn’t realize how time flew between us.

My delayed flight offered me gratis time to absorb myself in Kalanithi’s short life’s journey. He fought for his life against cancer for 22 months. Dr. Paul Kalanithi died on Monday, 9th March 2015, two days after my birthday. I tried to recall what I did in 2015. What were my struggles then? What did I achieve that year?

I recall struggling with my depression and battling a demon named alcohol. I was in the bowels of my madness. I recall the darkness I was in, the days that stretched for miles and the mornings I couldn’t get out of bed.

Yet here I am.

I outlived Dr. Paul Kalanithi. I thought of the friends I outlived, loved ones I buried. I looked at my doctorate notes and out towards the scheduled aircraft that arrived. As Hellish as my doctorate may be, I’ve fought my way out of my tunnel of despair to be where I am today. Friends teased saying PhD refers to “Permanent Head Damage.” Interestingly, it was pursuing my doctorate that gave me a new lease on life: a reason to rebuild myself better, cleaner and stronger. Every death is a reminder of a life to be lived.

Has it been easy? No. Would I do it all over again? Yes. In a heartbeat.

There are days I question, why am I still here? If they say “the good die young” what does that make me?

Looking out into beautiful sunsets, up towards glistening naked full moons, and witnessing exploding bursts of colorful horizons at different times and places, I used to ask Why me? If the good die young, am I unworthy to leave, or blessed to live? What’s the meaning and blessing of allowing me the privileges of this world?

Looks like I still have time to make the best of myself. I may not be a prolific neurosurgeon, but I think I can work my way around helping others within my capacity. In the thoughts of Dr. Paul Kalanithi, even when staring into the eyes of death, Why not me?