A very poignant read. The epilogue brought tears to my eyes. I enjoyed how Paul Kalanithi came to the conclusion that a life in medicine was his calling. He was sure at first that he would never follow in his family members' footsteps (he pointed out that he had associated medicine with absence- that of his father) and was keenly interested in literature and philosophy. I guess most of us had grappled with the same questions of life and its meaning, and by the same token death and its meaning/what lies beyond it at some point in time. I liked how he never relented in pursuing the truth by reading extensively and going through the academic route, driven by the hunger to understand rather than achieve (for the rest of us, our focus is sometimes misplaced on that elusive 'A'). On a walk one day, while contemplating the intersection of morality, philosophy, literature, biology, he had an epiphany and the rest was history.
What also stood out to me was when he was deciding on his residency. He noticed most of his peers electing to specialise in less demanding, "lifestyle specialties" (e.g. dermatology/radiology, according to Kalanithi) - those that offer a better work-life balance and higher salaries- seemingly forgetting/losing the idealism of their youths. Such choices are entirely reasonable as people sometimes grow weary and become disillusioned over time, or had a change in priorities. He added however, that when you find yourself considering pay, work environment, working hours, etc., you are choosing a job, not a calling. He chose neurosurgery in the end and I believe he would have been one of the best neurosurgeon/scientists (in terms of skills and compassion) had he had the chance to live beyond his 38 years.
He also pointed out that much of our decision-making process lies in how much time we have left. If we had 20 years vs. 3 months to live, what would we choose to do? He had a hard time deciding whether to continue his work as a neurosurgeon, become a writer, or spend time with his family because he only knew his time was limited, but by how long, nobody had a definite answer.
He admitted that at one point in his life, he became an atheist of sort since there is no empirical evidence for existence of God. He later concluded however, that to believe that since science cannot prove the existence of God, would by the same token, gives rise to the belief that there is no meaning in life, since science too cannot prove the existence of meaning. I wonder if the athesist believes in love, since nobody can prove its existence either but we all know it is there, just as we know there is hate, there is evil. If we could believe in the existence of evil, why couldnt we believe in the existence of a God? I could never really grasp how for e.g. a geneticist, a physician, or even a botanist, could study the wonders of the human genome/body/ a plant and not marvel at its intricacies and to subscribe to the belief that these are all created by CHANCE. By chance, we evolved into an organism that is capable of love, capable of creating beauty in the arts, music, capable of seeking meaning in its own existence. That reasoning is something my mind is unable to grapple with.
I was really upset by an incident Kalanithi had in the hospital, when his usual medication was not ordered. He spoke to the junior resident who was attending to him and explained that without the medication he would be experiencing excruciating pain soon but the resident couldnt care less. Ordering the medication would impose an inconvenience on him as he would have to call a senior to sign it off in the middle of the night. He asked if Kalanithi could wait till the next morning for his medication, by when he would be off-duty and the trouble could be passed on to the next unsuspecting person taking over his duties. Kalanithi said he saw in the resident's eyes that he was just a problem to be checked off and not a patient.
He also described how a peer had hoped that there were metastases in a patient so that she could escape a 9-hour surgical procedure. She later wept at having such thoughts. It is perhaps understandable to harbour such callous thoughts, as it is in our human nature, to put self above others. To suppress and overcome our innate selfish nature, requires effort and supernatural strength at times. We ought to applaud those who always put others' needs (especially those of strangers) above their own, such as those who toil daily in the healthcare setting.
The young think that they have all the time in the world. They make their 5 years' plan, 10 years' plan for that dream house, dream car, dream job...To them, tomorrow is a certainty. But they forgot that to death, age is just a number. No one escapes it, not even the young sometimes.
I believe that Kalanithi was able to face his impending death with bravado not only because he was used to facing death in his work, but because he was surrounded by love and the promise of eternity after this life has ended. The ending sometimes is just the beginning.
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