This book was recommended by one of top oncologist of Tata Medical Centre, Kolkata to me 2016. As it usually happens, someone borrowed the book to never return it again and I too, let it go. I again purchased the book recently and gave a patient reading. Its Phenomenal. You enter into the Paul's world from first page itself and get immersed as you procced further. For someone who is not a professional writer and whose its a debut book (sadly, his last too), the flow, emotions and words are so much intertwined that its like a music, a poetry.
The book is divided formally into 2 parts, first part titled "In Perfect health I Begin" and the second one titled "Cease Not till Death". There is a concluding part written by his wife Dr. Lucy Kalanithi which was added after death of Dr. Kalanithi.
As in my previous blogs I have reviewed Being Mortal by Dr. Atul Gawande which has dealt with the subject of mortality in detail. He has also reviewed this book as "Rattling, Heartbreaking and ultimately Beautiful, the too young Dr. Kalanithi's memoir is proof that the dying are the ones who have the most to teach us about life.". Another book which I remembered while reading was OUTLIVE as it has dealt with the core subject of Cancer in-depth and its author Dr. Peter Attia identifies cancer as one of the horseman disease in todays' world.
Dr. Kalanithi, a second generation immigrant from India born to a parents who migrated from India, intended to pursue a career in literature. Hoewver, the destiny guided him to the neurosurgery in Stanford and he ultimately aimed for neurosurgeon-neuroscientist with own lab. It is said that life is what it happens when we are busy making other plans, same happened with Dr. Kalanithi.
The book is dotted with several couplets from T.S. Elliot's poetry, verses from Bible, references from classics. In the first part the author flashbacks his childhood and memories with his family, his reading fixations, his craveing for English literature. Infact he was accepted for Masters in English literature at Stanford, he wrties, "I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion. A word meant something only between people , and life's meaning, its virtue, had something to do with the depth of the relationships we form. It was the relational aspect of humans- human relationality- that undergirded meaning. Yet somehow, this process existed in brains and bodies, subject to their own physiologic imperatives, prone to breaking and failing. There must be a way, I thought, that the language of life as experienced- of passion, of hunger, of love-bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats."
On his anatomy class he writes "Cadavers reverse the polarity. The mannequins you pretend are real; the cadavers you pretend are fake." He adds "Humans are organsims, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation."
One interesting addition to vocabulary happened when he mentioned that in olden times patient was referred to the one who endures hardship without compliant.
Adding a positive aspect to his training as a doctor he mentions, "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. Those burdens are what make medicine holy and wholly impossible: in taking up another's cross, one must sometimes get crushed by its weight."
Emphasising that for a neurosurgeon or for that matter any specialist branch of medicine there was no scope of error as one is dealing with someone's life, he writes, "The pain of failure has led me to understand that technical excellence was a moral requirement. Good intentions were not enough, not when so much depended on my skills, when the difference between tragedy and triumph was defined by one or two millimeters."
The second part solely deals with the final encounter with the disease. How he and his wife Lucy lived his last moments, his dilemma over planning a baby and support system. The will power of the author and his jijivisha (a hindi word whose exact English translation I could not relate to) can be fanthomed from the fact that in order to have a purpose in life, he again joined surgery and attened Operations regularly. His prophetic statement "Death may be a one-time event, but living with terminal illness is a process. Grand illnesses are supposed to be life clarifying."
On limitation of science and academic and role of God in today's world and in his personal life, he quotes, "Science may provide the most useful way to organise emperical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love , hate, beauty, envy, honor, weakness, striving, suffering, virtue."
The author's explanation of his bonding and sense of purpose when he held his daughter Cady is relatable for someone with kids. They give a meaning to life, a sense of extenstion of our personality, joy and completeness. On his last days in hospital surrounded by family, he writes "Everyone succumbs to finitude. I suspect I am not the only one who reaches this pulperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder towards the goals of life, flattens out into a perpetual present. Money, status all the vanities the preacher of Ecclesiates described hold so little interest: a chasing after wind, indeed. "
The last stage of the cancer didn't give oppurtunity to the author to complete the book and Dr. Lucy Kalanithi has written it as epilogue. I must say that she has an equal command over the words, she has summed up brilliantly and beautifully. The cancer was so brutal and unyeilding that it didn't gave time to Paul. He prefered not to be intubated and live in vegitative state by artifical life support system and died in presence of his loving family.
His memorable contribution to the humankind in form his first hand experience is perhaps one of its kind creation. Its not a fiction, its not a third person story, its not a biography but a real life happening real time is what makes this book unique.
He is merged in air yet he is with us. Died on March 9, 2015, He became immemorable.
