When breath becomes air

Look around, look around,

how lucky we are to be alive right now

-Hamilton, Lin-Manuel Miranda

I often think about life and death.

It’s easy to be reminded that every moment on this planet is fleeting when you work in a hospital. Children take their first gasps in the same place where others breathe their last. Perhaps the only other profession, or vocation really, where you see both life and death in the same day would be a religious role, be it a priest, or an imam, or a Rabbi, or whatever else in between.

I just finished When Breath Becomes Air by Paul Kalanithi. If you have heard about him in the last year, you would recall that he is the neurosurgeon who passed away from lung cancer, despite never smoking. The first time I ever heard about him was through his sister-in-law’s blog, Cup of Jo. I remember reading her news about her dear brother-in-law, a man so loved, a man so kind and strong, and feeling this sadness.

I read his essays, I read the one his wife wrote. And now, I’ve read his book while on the plane, flying back home for the weekend. It was an easy read, the medical terms that he used all familiar to me. I enjoyed imagining what his voice would have sounded like. I read his story about how choosing medicine was not a childhood dream, his love of literature and English resonated with me. His favourite poem, The Wasteland by T.S.Elliot, is one of my favourites. He was a man who fell in love with the human mind first and sought to learn more about it, in a more tangible form in neuroscience.

And I felt a kinship with him.

When he wrote about his fears, when he spoke about how he went through the stages of grief backwards, my heart ached for him. I cannot imagine how paralysing it must be to be placed in such a difficult situation, where everything you know, everything that you strived for had to be placed on the backburner because you needed to relearn how to sit, how to walk, how to move as you previously did.

Dr Kalanithi passed away before he could complete his book. The epilogue was written by his wife, and if you don’t shed a tear while reading that, I fear for your soul. The book is unfinished, and it does feel that way, but in a way, that is how it is intended to be. I like to think that there was no true way for that book to end, because for as long as he was alive, Dr Kalanithi would have had more to share, he would have had more advice to give, more experiences to draw from to help educate his readers. I don’t think there could have been a way for it to have ended with a certain finality because that’s not always how life works, especially when it comes to the death of someone so young.

I think of life and death every time someone gets pushed through the Emergency Room doors. I think of life and death every time I watch a child being born. I think of life and death when a patient goes in for surgery.

I think about how final every day can be, and how some days are the end for someone on this planet. One of our classes last week was on human errors, and part of it was watching this reenactment of Eastern Airlines Flight 401. This was to do with the downing of a plane due to the fixation of the pilots on an issue related to landing and caused them to be unaware that their autopilot had stopped working. The video was based on the recordings of the black box. It ends with them realising that they were closer to the ground than anticipated, and with the crash. As much as this was a lesson in human error, I cannot help but imagine how it must have felt like to listen to their last words, to listen to their errors in judgement, and to hear them be suddenly cut off when the plane crashed to the ground.

Life is so quick, it is often too fast for us to grasp. And I wish we appreciated it more.

I wish I did.

I grew up with this weird feeling that I would die young, and silly as it is, I always imagine the worst possible situation (crashing in a terrible accident, being electrocuted to death, somehow dying of a fatal disease). That flight of fantasy always ends with me thinking about how many regrets I would leave behind.

but then, those moments pass and I go back to being too complacent with my existence, and the existence of others.

I don’t know what I’m getting at. I just know that it’s good to stop and think of how quickly things can take a bad turn and how much we can lose, whom we can lose.

There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.

-Paul Kalanithi

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