I just read Paul Kalanithi’s ‘when breath becomes air’. Some had told me that it was inherently depressing. What is joyous about death? Especially when it is about death that is imminent, untimely and destroys a life full of promise?
Yet we are all potential Kalanithis. May be I should say were? He was thirty six when he died. He was seven years younger than me. Yet, as he has said in his book, inspite of having worked for about ten years and having almost completed a six year residency in Neurosurgery putting in a mind numbing fifiteen to sixteen hours a day, He was just acquiring potential. Potential for a future he would never live to see.
He had become adept at saving lives. He was already a Surgeon in practice- a good, effective and conscientious one. He had hardly one year left to finish a residency of seven years. Yet, after having been diagnosed with terminal, disseminated cancer, with no hope of recovery, he came back to work part time. That was all he could do.
Yet, his trainers decide that he has to assume full responsibility if he is to get his licence. He goes back to his fourteen hour days. He screams inwardly in pain, as he does one life saving surgery after another, his own cranium supported by a spine studded with radiolucent spots of cancer. The disease eats him alive, as he fought to fight disease in others. As he was trained to do. As he was told to do.
He completes his Residency, but he never goes for his graduation. He is in the hospital, dying.
His marriage to Lucy, whom he had met during Medical School, is on the verge of collapse, when he starts the book. His cancer was yet to reveal itself.
“In actual fact, my terminal diagnosis saves our marriage” He says. He makes it clear in the book that it was the rigours of his work that has put the strain on the marriage.
It is inspiring stuff, I agree. The language is beautiful. The courage one can imbibe, if one is to face his own mortality, as all of us will have to do, sooner, or later.
Still, I cannot shake off an unnamed uneasiness. What I would like to discuss is not the looming mortality and the death of Paul Kalanithi, which is the central theme of the book and which makes it so poignant.
Should it be necessary to be a super human to do Medicine? Despite the glorification of Neurosurgery in this book and in popular parlance, let us face it. Every speciality in Medicine is important. Many physicians save more lives than any Surgeon, due to their skill, swift decision making and their abiding desire to do good for their patients.
That is the key. There are relatively normal human beings who want to do good by doing Medicine. Superman can do just about anything. But will he be empathetic enough? Will he be able to sustain a lifetime of serving humanity despite the lure of money, prestige and short cuts? Will agonising setbacks break him or strengthen him?
Worse still, will he be able to confront, and accept, his own limitations?
What about “her’? More women are in Medicine now. Should everyone be superwoman?
Should all doctors be celibate, so that the “Calling” is not disturbed? Should all doctors go childless to optimise the dedication to the calling?
This may be sacrilegious to say. But I have to say this. I don’t think Medicine is a ‘calling’ like a religious calling. We are not priests. The public doesn’t think or treat us like we are high priests of a magnificent omnipotent religion. Or they shouldn’t.
The public, the authorities, the legal system and the hospital owners don’t think so. They think that it is a job. An important job, yes. A job requiring skill, training, courage and kindness- yes. Above all, a job that mandates a conscience. But a job nevertheless.
Excessive attempts to make it extra difficult produces Physicians who are highly driven to survive and beat the system in triumph. Then would they celebrate by basking in money and prestige, for which they may employ methods dubious as well as legitimate?
Should our politicians, civil servants, engineers, teachers and scientists be any less in dedication, sincerity and effectiveness?
We can argue that we need absolutely extra ordinary people who do have super powers to perform our ‘Calling’. Come on, we need more Neurosurgeons than that.