Vocation interrupted

Among the varieties of physicians -- internists, anesthesiologists, dermatologists, etc. -- surgeons have the reputation for being a bit brutish. After all, for all the high tech wizardry of modern medicine, their craft includes cutting into human bodies, drilling holes in skulls, setting screws into bones and so on. That work does not seem to commonly induce empathy. So one does not expect to encounter a surgeon, even one who works on brains, writing reflections like this:

I don't think I ever spent a minute of any day wondering why I did this work or whether it was worth it. The call to protect life -- and not merely life but another's identity; it is perhaps not too much to say another's soul -- was obvious in its sacredness.

Before operating on a patient's brain, I realized, I must first understand his mind: his identity, his values, what make his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible; in taking up another's cross, one must sometimes get crushed by the weight.

Dr. Paul Kalanithi was a 36 year old neurosurgeon who was just graduating from ten years of medical and specialist training and residencies when he was diagnosed with stage IV lung cancer. He didn't have the option of learning gradually what that meant; he knew immediately his chances of survival were very poor. One day he was on the threshold of a brilliant and absorbing vocation; the next he was a patient, dependent on what others could do for him as he struggled for life and purpose.

When Breath Becomes Air is his memoir of a youth in the desert in Kingman, Arizona; of sampling literature and neurobiology at Stanford; and of his choice to leave the study of literature and philosophic abstraction:

Words began to feel as weightless as the breath that carried them. Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action.

Kalanithi died in March 2015. During his two years fighting the cancer, he finished his neurosurgery residency, fathered a daughter, strengthened his family ties, and wrote this book. His life had been about trying to figure out what it all meant; so is his account of his own road to death.

This is a beautiful little book, full of gems, of lapidary descriptions of moments of experience. I read it first by ear, but ended up buying a hard copy: I needed to be able to lend it to friends. I don't do that often.