Prologue
I’m sorry, but I’m dying from cancer.
“I need you,” I whispered.
“I will never leave you,” she said. And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.
Part 1: In Perfect Health I Begin
Fatherhood is about time and attention.
Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P .S., by Jeremy Leven
T. S. Eliot’s The Waste Land resonated profoundly, relating meaninglessness and isolation, and the desperate quest for human connection.
Nabokov, for his awareness of how our suffering can make us callous to the obvious suffering of another.
Conrad, for his hypertuned sense of how miscommunication between people can so profoundly impact their lives.
If the unexamined life was not worth living, was the unlived life worth examining?
The day sky would spread wide and high, until the first ray of the sun made an appearance. The morning commuters began to animate the distant South Lake Tahoe roads. But craning your head back, you could see the day’s blue darken halfway across the sky, and to the west, the night remained yet unconquered—pitch-black, stars in full glimmer, the full moon still pinned in the sky. To the east, the full light of day beamed toward you; to the west, night reigned with no hint of surrender. No philosopher can explain the sublime better than this, standing between day and night. It was as if this were the moment God said, “Let there be light!” Y ou could not help but feel your specklike existence against the immensity of the mountain, the earth, the universe, and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur.
I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.
Moral speculation was puny compared to moral action.
How We Die by Shep Nuland #book
“Most mothers with stillborns still have to go through labor and deliver. Can you imagine? At least these guys had a chance.”
This is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job—not a calling.
“Always eat with your left hand. You’ve got to learn to be ambidextrous.”
It is important to be accurate, but you must always leave some room for hope.
One of the early meanings of patient, after all, is “one who endures hardship without complaint.”
Patients, when hearing the news, mostly remain mute.
Whether out of dignity or shock, silence usually reigns, and so holding a patient’s hand becomes the mode of communication.
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.
Neurosurgery requires a commitment to one’s own excellence and a commitment to another’s identity. The decision to operate at all involves an appraisal of one’s own abilities, as well as a deep sense of who the patient is and what she holds dear.
Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it’s something that happens to you and those around you.
Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.
Part 2: Cease Not till Death
Alexander Pope: “A little learning is a dangerous thing; / Drink deep, or taste not the Pierian spring.”
The fact of death is unsettling. Yet there is no other way to live.
Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving.
After so many years of living with death, I’d come to understand that the easiest death wasn’t necessarily the best. We talked it over. Our families gave their blessing. We decided to have a child. We would carry on living, instead of dying.
That morning, I made a decision: I would push myself to return to the OR. Why? Because I could. Because that’s who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.
Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.
Y ou have to figure out what’ s most important to you.
The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.
The main message of Jesus, I believed, is that mercy trumps justice every time.
The basic message of original sin isn’t “Feel guilty all the time.” Maybe it is more along these lines: “We all have a notion of what it means to be good, and we can’t live up to it all the time.” Maybe that’s what the message of the New Testament is, after all. Even if you have a notion as well defined as Leviticus, you can’t live that way. It’s not just impossible, it’s insane.
Struggle toward the capital-T Truth, but recognize that the task is impossible—or that if a correct answer is possible, verification certainly is impossible.
In the end, it cannot be doubted that each of us can see only a part of the picture.
Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.
“One sows and another reaps.” I sent you to reap what you have not worked for; others have done the work, and you are sharing the fruits of their work.
When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.
Epilogue
“We shall rise insensibly, and reach the tops of the everlasting hills, where the winds are cool and the sight is glorious.”
It can be as uncomfortable as it is peaceful, both communal and lonely—like death, like grief—but there is beauty in all of it, and I think this is good and right.
“Bereavement is not the truncation of married love,” C. S. Lewis wrote, “but one of its regular phases—like the honeymoon. What we want is to live our marriage well and faithfully through that phase too.” Caring for our daughter, nurturing relationships with family, publishing this book, pursuing meaningful work, visiting Paul’s grave, grieving and honoring him, persisting…my love goes on—lives on—in a way I’d never expected.
“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
“When someone dies, people tend to say great things about him. Please know that all the wonderful things people are saying now about your dad are true. He really was that good and that brave.”
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