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Why was I so authoritative in a surgeon’s coat but so meek in a patient’s gown? The truth was, I knew more about back pain than she did—half of my training as a neurosurgeon had involved disorders of the spine. But maybe a spondy was more likely. It did affect a significant percent of young adults— and cancer in the spine in your thirties?
When Breath Becomes Air PDF Book by Paul Kalanithi
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The odds of that couldn’t be more than one in ten thousand. Even if it were one hundred times more common than that, it’d still be less common than a spondy. Maybe I was just freaking myself out. The X-rays looked fine. We chalked the symptoms up to hard work and an aging body.
Scheduled a follow-up appointment, and I went back to finish my last case of the day. The weight loss slowed, and the back pain became tolerable. A healthy dose of ibuprofen got me through the day, and after all, there weren’t that many of these grueling, fourteen-hour days left.
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My journey from medical student to professor of neurosurgery was almost complete: after ten years of relentless training, I was determined to persevere for the next fifteen months, until residency ended. I had earned the respect of my seniors, won prestigious national awards, and was fielding job offers from several major universities.
My program director at Stanford had recently sat me down and said, “Paul, I think you’ll be the number one candidate for any job you apply for. Just as an FYI: we’ll be starting a faculty search for someone like you here. No promises, of course, but it’s something you should consider.”
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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. Then, a few weeks later, I began having bouts of severe chest pain. Had I bumped into something at work? Cracked a rib somehow?
Some nights, I’d wake up on soaked sheets, dripping sweat. My weight began dropping again, more rapidly now, from 175 to 145 pounds. I developed a persistent cough. Little doubt remained. One Saturday afternoon, Lucy and I were lying in the sun in Dolores Park in San Francisco, waiting to meet her sister. When Breath Becomes Air PDF Book
She glimpsed my phone screen, which displayed medical database search results: “frequency of cancers in thirty- to forty-year-olds.” Before leaving for New York, I snuck in a few medical appointments to rule out some common cancers in the young. (Testicular? No. Melanoma? No. Leukemia? No.) The neurosurgical service was busy, as always.
Thursday night slipped into Friday morning as I was caught in the operating room for thirty-six hours straight, in a series of deeply complex cases: giant aneurysms, intracerebral arterial bypasses, arteriovenous malformations. I breathed a silent thanks when the attending came in, allowing me a few minutes to ease my back against a wall.
The only time to get a chest X-ray was as I was leaving the hospital, on the way home before heading to the airport. I figured either I had cancer, in which case this might be the last time I would see my friends, or I didn’t, in which case there was no reason to cancel the trip. I rushed home to grab my bags. When Breath Becomes Air PDF Book
Lucy drove me to the airport and told me she had scheduled us into couples therapy. From the gate, I sent her a text message: “I wish you were here.” A few minutes later, the response came back: “I love you. I will be here when you get back.”
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… When Breath Becomes Air PDF Book
Of our many childhood mysteries, chief among them was not why our father decided to bring his family to the desert town of Kingman, Arizona, which we grew to cherish, but how he ever convinced my mother to join him there. They had eloped, in love, across the world, from southern India to New York City.
My mother was forced to confront an intractable mortal fear of snakes. Even the smallest, cutest, most harmless red racer would send her screaming into the house, where she’d lock the doors and arm herself with the nearest large, sharp implement—rake, cleaver, ax.
The snakes were a constant source of anxiety, but it was her children’s future that my mother feared for most of all. Before we moved, my older brother, Suman, had nearly completed high school in Westchester County, where elite colleges were the expectation. When Breath Becomes Air PDF Book
He was accepted to Stanford shortly after arriving in Kingman and left the house soon thereafter. But Kingman, we learned, was not Westchester. As my mother surveyed the Mohave County public school system, she became distraught. The U.S. census had recently identified Kingman as the least educated district in America.
The high school dropout rate was somewhere north of 30 percent. Few students went on to college, and certainly none to Harvard, my father’s standard of excellence. Looking for advice, my mother called her friends and relatives from wealthy East Coast suburbs and found some sympathetic.
Others gleeful that their children no longer had to compete with the suddenly education-starved Kalanithis. At night, she broke into tears, sobbing alone in her bed. My mother, afraid the impoverished school system would hobble her children, acquired, from somewhere, a “college prep reading list.” When Breath Becomes Air PDF Book Download
Trained in India to be a physiologist, married at twenty-three, and preoccupied with raising three kids in a country that was not her own, she had not read many of the books on the list herself. But she would make sure her kids were not deprived.
She made me read 1984 when I was ten years old; I was scandalized by the sex, but it also instilled in me a deep love of, and care for, language. Endless books and authors followed, as we worked our way methodically down the list: The Count of Monte Cristo, Edgar Allan Poe.
Robinson Crusoe, Ivanhoe, Gogol, The Last of the Mohicans, Dickens, Twain, Austen, Billy Budd…By the time I was twelve, I was picking them out myself, and my brother Suman was sending me the books he had read in college: The Prince, Don Quixote, Candide, Le Morte D’Arthur, Beowulf, Thoreau, Sartre, Camus. Some left more of a mark than others. When Breath Becomes Air PDF Book Download
As graduation loomed, I had a nagging sense that there was still far too much unresolved for me, that I wasn’t done studying. I applied for a master’s in English literature at Stanford and was accepted into the program. 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. When Breath Becomes Air PDF Book Download
At Stanford, I had the good fortune to study with Richard Rorty, perhaps the greatest living philosopher of his day, and under his tutelage I began to see all disciplines as creating a vocabulary, a set of tools for understanding human life in a particular way. Great literary works provided their own sets of tools, compelling the reader to use that vocabulary.
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 I finished my thesis.
I could only conclude that Whitman had had no better luck than the rest of us at building a coherent “physiological-spiritual” vocabulary, but at least the ways in which he’d failed were illuminating. I was also increasingly certain that I had little desire to continue in literary studies. When Breath Becomes Air PDF Book Download
Whose main preoccupations had begun to strike me as overly political and averse to science. One of my thesis advisers remarked that finding a community for myself in the literary world would be difficult, because most English PhDs reacted to science, as he put it, “like apes to fire, with sheer terror.”
I wasn’t sure where my life was headed. My thesis—“Whitman and the Medicalization of Personality”—was well-received, but it was unorthodox, including as much history of psychiatry and neuroscience as literary criticism. It didn’t quite fit in an English department. I didn’t quite fit in an English department.
“I don’t know. What I do know—and I know you know these things, too —is that your life is about to—it already has changed. This is going to be a long haul, you understand? You have got to be there for each other, but you also have to get your rest when you need it. When Breath Becomes Air PDF Book Download
This kind of illness can either bring you together, or it can tear you apart. Now more than ever, you have to be there for each other. I don’t want either of you staying up all night at the bedside or never leaving the hospital. Okay?” He went on to describe the planned operation, the likely outcomes and possibilities.
What decisions needed to be made now, what decisions they should start thinking about but didn’t need to decide on immediately, and what sorts of decisions they should not worry about at all yet. By the end of the conversation, the family was not at ease, but they seemed able to face the future.
I had watched the parents’ faces—at first wan, dull, almost otherworldly—sharpen and focus. And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. When Breath Becomes Air PDF Book Free
In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise. Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation.
While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact.
In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. But in residency, something else was gradually unfolding. In the midst of this endless barrage of head injuries. When Breath Becomes Air PDF Book Free
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 patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it.
Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinging to the same raft, caught in the same tide. My fellow resident Jeff and I worked traumas together. When he called me down to the trauma bay because of a concurrent head injury, we were always in sync.
He’d assess the abdomen, then ask for my prognosis on a patient’s cognitive function. “Well, he could still be a senator,” I once replied, “but only from a small state.” Jeff laughed, and from that moment on, state population became our barometer for head-injury severity.When Breath Becomes Air PDF Book Free
“Is he a Wyoming or a California?” Jeff would ask, trying to determine how intensive his care plan should be. Or I’d say, “Jeff, I know his blood pressure is labile, but I gotta get him to the OR or he’s gonna go from Washington to Idaho—can you get him stabilized?”
In the cafeteria one day, as I was grabbing my typical lunch—a Diet Coke and an ice cream sandwich—my pager announced an incoming major trauma. I ran to the trauma bay, tucking my ice cream sandwich behind a computer just as the paramedics arrived, pushing the gurney, reciting the details: “Twenty-two-year-old male, motorcycle accident, forty miles per hour, possible brain coming out his nose…”