Dr. Paul Kalanithi spent his final days writing his memoir When Breath Becomes Air (2016), a work that exhibits his lifelong preoccupation with death and what makes life worth living. It too is the product of what he chose to do after malignant tumors had suddenly spread across his body and cut his life shorter than prognosticated.
A literature major who was unsatisfied with the distance that literature has from real life, and believing that “direct experience of life-and-death questions was essential to generating substantial moral opinions about them,” Kalanithi set aside his plans of further literary studies to pursue a career in medicine. He recalls:
I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise.
He even adds, “Moral speculation was puny compared to moral action.”
He then plunged into the field of neurosurgery, a “work in the crucible of identity.” After all, brain traumas and surgeries can and usually do alter one’s personality, behavior, and physical ability. Consequently, such significant changes end one’s life as he knows it, and usher more grueling days for him and presumably more heartbreaking ones for his family and friends.
Here Kalanithi emphasizes that quality of life cannot be simply detached from questions on life and death. That perhaps there lies our ability for meaning making, because it allows us to live in the way we see fit. If it’s taken away when we are paralyzed, for example, some of us would rather not live at all.
Would you trade your ability—or your mother’s—to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? How much neurologic suffering would you let your child endure before saying that death is preferable?
Kalanithi asked such questions to the loved ones of his patients in order for him to identify what the patient values the most, where he finds meaning in, and whether or not an operation should be done if the patient is at a high risk of losing what he holds dear.
One can argue that Kalanithi’s perspective is rather pessimistic, as it shuns the possibility, the hope, that a scientific breakthrough would occur in a person’s lifetime and better ameliorate his condition, or that the person would be resilient enough to live a different kind of life and derive happiness, if not meaning, in it. Shouldn’t one stay hopeful so long as there’s life? What of defying the odds one is condemned with, the way Sisyphus has? One must imagine Sisyphus happy, yes?
Yet another can retort that Kalanithi’s perspective is more realistic and influenced by his empathy toward his patients and his closeness with suffering and death.
Kalanithi took the more difficult path: When he himself turned from doctor to lung cancer patient, he and his wife decided to have a child together through IVF before his treatment began. “If human relationality formed the bedrock of meaning,” he muses, “it seemed to us that rearing children added another dimension to that meaning. I knew a child would bring joy to the whole family.”
Nine months later, a fragile and disabled Kalanithi welcomed his daughter into the world. It wouldn’t be long until the cancer would spread rapidly so that he would struggle to breathe and would need a breathing support system to do the breathing for him. Although he eventually opted for comfort care as he was dying, Kalanithi knew what brought meaning into his life, went after it, and braved on as far as his cancer would allow:
Feeling her weight in one arm, and gripping Lucy’s hand with the other, the possibilities of life emanated before us. The cancer cells in my body would still be dying, or they’d start growing again. Looking out over the expanse ahead I saw not an empty wasteland but something simpler: a blank page on which I would go on.
The Myth of Sisyphus and Other Essays, Albert Camus. Knopf. 1983. Book.