Death is universal. The finest doctor in the world can often take no action to alter the trajectory of a sick patient. And so, often, the role of a doctor is to bear witness to death, to guide a patient on their journey towards the end of their life. In this, a good doctor can make all the difference in the world. They can guide a patient through the last legs of their journey by forecasting milestones ahead and serving as a guide who the patient knows will not abandon them.
To serve in this role is one of the great privileges of our profession. But it also has a great clarifying role for us personally. Witnessing how quickly one can lose everything makes us hyper-aware of our own mortality and quickly places priorities into perspective. If I go to work and see a young patient die during the day, it’s challenging for me to muster up anger at a neighbor for playing music too loudly or at a pen that went through the laundry in my pocket.
Paul Kalanithi’s book When Breath Becomes Air is a reflection of a young neurosurgeon for whom the odds of fate fell against. Diagnosed with a metastatic lung cancer in his 30’s, he is left to grapple with the meaning of his life when his story is forced to a conclusion where he thought it was half complete.
I never directly met Paul, but our paths crossed in and out at Stanford, with a few mutual mentors and friends. From his beautiful writing, I get the sense that he was an earnest man, a gifted man, and someone committed to living life, not abstracting it. His book is a testament to that. When faced with an insurmountable road block, he turned it into a monument. He created a child with his wife, and made something beautiful to share with us all, his feelings as conveyed through his book.
Survivor’s guilt is threefold. The first is feeling sorry for person who was lost. The second is wishing there were more we could have done. And the third is the fear that we have been given the gift of life and are not making the most of it, especially in comparison to what the departed could have accomplished. The third feeling I get when I read Paul’s words. It’s the same gush of sadness I feel when a Freddie Mercury song comes over the radio, or I hear the last speech before MLK was assassinated. What could have been if only…
