When Death Becomes Air, or Some Thoughts on Doctors and Dying

I am not a doctor by any means. A few weeks ago, my sister Mallory sent me a paper she had written about an interesting patient case and I spent more time trying to pronounce the diagnosis, symptoms, and medicines than actually editing. I do, however, run quite often and have developed a habit of listening to books on Audible while running. When you’re sick of listening to the same pump-up music for weeks on end, reading while running is a good alternative.

The last book I finished is the best-selling When Breath Becomes Air by Paul Kalanithi. It’s a memoir of sorts about a budding brain surgeon who is diagnosed with lung cancer. The book begins with the diagnosis and how Kalanithi’s relationship with his wife is affected. Later in the book, he admits that having cancer may have saved his marriage. Kalanithi and his wife Lucy decide to have a child even though they know his time is limited. Kalanithi left the book incomplete- he began writing it the year he died, and as his wife notes in the epilogue, the book is a testament to the life he left incomplete.

Earlier this year I wrote a post after reading Being Mortal by Atul Gawande, a text that argues we, doctors and patients, do not prepare adequately for “the end.” Aging, Gawande says, is a somewhat new phenomenon, and one with which we in the United States and perhaps elsewhere have not learned to develop a relationship until it is too late. I remember while reading Being Mortal that there is a deep connection doctors and chaplains have, even though our day to day job descriptions look wildly different. We both are placed in charge of holding someone’s life in our hands. Overwhelmingly, it is not an individual’s life, but their family and friends, the people that mean something in their lives. We perform our work with a strong commitment to journeying with the patients and people we encounter when they trust us. The best of us worry about our patients and our care-seekers long after we’ve left work for the day.

death becomes air.jpg
PC: Pablo Garcia Saldana

 

My sister Mallory is about to begin her fourth year in medical school. This weekend, she flew from Philadelphia to Los Angeles (home) and today will drive up to Fresno, California to begin yet another rotation. She has moved her living space at least three times in the past year and begun a new rotation in a new hospital every six weeks. When Kalanithi describes his medical student days- excruciatingly long hours, candy bars for lunch, dropping on the floor from exhaustion upon returning home after his wife had gone to sleep- I found myself nodding while jogging along the river. “Sounds like Mallory,” I thought to myself. I wondered how in the world medical students do it. But they do, and they transform lives every day.

Not every day, doctors are reminded that doctors also fall ill. My mom texted me on Friday. “That surgeon that Mallory really admires has 15 months.” “That surgeon” is a legend. My mom tasked me with “send her some words of I don’t know what.” I certainly didn’t know what. Chaplain rules: 1) don’t evade a painful subject. 2) Practice empathy 3) Ask what they need (and mean it!).

“Mom told me about the surgeon at Drexel. Sorry to hear about him, that’s awful. Do you need anything?” I sucked in a breath.

“No thanks, it’s definitely a bummer. All the residents are crying and my other attending is a mess. Just a reminder that we are all human and that life is short,” she sent back.

Such prophetic words from a medical student! I wiped away a few tears. She was right. As a chaplain and a sister, I wished my care in that moment could be more than a “you’re right” reply.

Doctors and especially brain surgeons often live under the stereotype that they are mathematical, cold, even unhuman. They see the body as a puzzle to put back together or a circuit with a loose wire. In hearing the stories from Mallory, sometimes this seems true. But also true is the care surgeons hold for their patients, the deep affect that success or failure has on them because the lives they hold in their hands matter. When doctors themselves fall ill, when they are diagnosed with terminal cancer, they too must make decisions with the people they love. I find solace in Mallory’s early recognition of this, mourning the deep sorrow she feels for her mentor’s life cut short. Inevitably, she will be reminded of this too often as a brain surgeon. But with hope, I know she will do her best to do what I strive as a chaplain: to hold her patients close to her heart and do her best to serve them.

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