Kalanithi was a brilliant young man who, from a very young age, was interested in understanding life and death.
Intellectually, death interested him more. Academically, he pursued the meaning of death and dying through literature, philosophy, scientific research, and medicine. He was also Catholic.
I don't think I'm giving anything away that isn't already clear at the outset if I tell you that at age 36, he is diagnosed with terminal cancer, which he acknowledges is ironic, and something of an opportunity; but the reality of living with cancer was not a trip he would have taken (if he had had a choice) if he knew where it would take him.
What resonated for me, among other things, was how the author and his colleagues dealt with the constant presence of death in the life of the hospital. And not just death, but also other, almost equally grim medical outcomes.
Clearly, this guy, Kalanithi, with a Masters in Literature and Ph.D. in philosophy and MD in medicine and whatever to be a neurosurgeon and neuroscientist...This guy, who won every accolade in his path, had everything I would want in someone who was operating on my brain. But even so, mistakes happen. Death happens. It happens, and it happens, and it happens.
Sometimes, I think about Nineteenth Century mothers, how they managed to survive the loss of so many babies. All those little headstones at the family grave. It happened all the time. And I think, probably some of those moms went mad. But many of them (I haven't researched this, obviously; this is pure conjecture on my part) probably survived, emotionally, because death was so much a part of life back then.
I think they thought about death differently from contemporary Americans. I think they may have had more acceptance of death as something beyond their absolute influence. And I think that their belief that their lives and the lives of their loved ones were in God's hands would have been a comfort. And I don't think they ever imagined that they had as much control over life and death as we now imagine we do.
Even though contemporary culture retains countless threads of religious sentiment and influence, I think that most privileged and educated people believe that we have a lot of control over matters of life and death. We take care of our health; or if we don't, and we get sick, we become quickly motivated to take control over our health. We believe that it is a contract: If we take care of ourselves, we will live long healthy lives.
In his book, Kalanithi notes how people with cancer are expected to fight and beat it, as though survival were a matter of attitude. This puts great pressure on patients to undergo extreme therapies that can be torturous, unpromising, and dominate the time they have left.
The cultural imperative to fight cancer, to control our biological destiny, to be stronger than terminal illness, and never give up our sense of autonomy...is probably a very recent kind of thinking, quite different from a Nineteenth Century (or earlier) world view.
And yet, the people of the Nineteenth Century still managed to invent the lightbulb. The shadow of death overhanging all did not create an atmosphere of despair, or rob the world of ambition. Nor did people stop trying to develop remedies for pain and illness.
I'll tell you why this represents an epiphany for me. I have been running a long streak of bad luck with regard to the animals in my care. And I realized, after reading this book, that some of the anguish I've been experiencing in coping with the potential loss of several pets has stemmed from my overwhelming sense of custodianship and responsibility.
I felt that if one of my animals died, it was my fault. After all, I take care of them. I read the books and articles. I make the decisions about their medical care...So, everything that went wrong was my fault. It didn't matter what it was, or how it happened...My anguish has stemmed from this burden of responsibility (a mistaken sense of my control over life and death) and a corresponding anguish over the potential to fail catastrophically.
People have died in my family: grandparents, my father, uncles, friends, pets....And still, somehow, I forgot that death is beyond my control.
I say that I believe in God, but do I forget that I am not God?
Do I forget that death happens?
It happens with or without me. It's supposed to happen--for everyone, for every living thing.
Of course, it is hubris to imagine otherwise. Shake your head at me. I deserve it. But remember: My only experience of this God complex has taken the form of a consuming anguish that I have experienced in the shadow of grief. It's a terrible and lonely feeling that can only compound my sadness.
So that was my epiphany: Death happens. I'm not God.
The cat is sick. I love this cat, but she's got recurring pancreatitis, and she's probably going to die. It's hard for the vet to accept; she thinks that subcutaneous fluids or an enema might make a difference. But I've seen this cat pull out of it before, and it was always because of the Prednisone. This time, the Prednisone isn't working. She's not eating, and she's not getting any better. And I think she's going to die.
I love her, and I'm going to miss her. But I no longer feel the anguish that I felt when I thought it was my fault if I couldn't save her.
We are like God, but we are not God. And in the absence of any real sense of God, which is most of our culture today, we sometimes find that we have no one to blame but ourselves for the presence of death in life.
The cat is watching me from across the room. She is wary that I might make her take another pill, so she's keeping her distance. And she's not asking me to save her. She just wants to be where can she see me when she opens her eyes.