Monday, March 6, 2023

A Memoir About Death

Environmental & Science Education, STEM, Education, Literacy, Science & Society

Science educator Rodger Bybee has had a long and productive career, making many important contributions to K-12 science education. I think it fair to say that literacy in science must contribute to the ability of students to deal with the daily issues and problems they will experience as citizens. One of his papers dealt with the issues and problems of lifestyle, lifespace and lifetime.

I thought of one of these, lifetime, e.g., life cycle - birth, aging, death, health, when I read Dr. Paul Kalanithi's "When Breath Becomes Air" (Random House) about coming face-to-face with his own mortality. At the time of his diagnosis at age 36 with stage IV lung cancer he was in the last year of his long-in-hours-and stress neurosurgery residency.
I recommend this book rather than review it but I do describe it.

In the time Kalinithi had remaining - less than a year, he had written two essays, one before starting the book, the other while writing the book. The former was a New York Times Op-Ed in 2014 that went viral; the other during the writing of the book, an essay included in a Stanford Medicine issue on time.

Kalinithi was not given much time to write the book and the completed manuscript was left on his computer to be published two months following his death.

Two essays that inform and provide bookends to the book are stunning, a foreword by Dr. Abraham Verghese, a well-known physician and writer. He said that Kalinithi's "prose was unforgettable." His wife, Dr. Lucy Kalinithi, wrote an honest epilogue as his wife, also as a mother of their child who was conceived and born during his final year of life, as a physician and as a frank witness to his death--the real life of a component of  Bybee's "lifetime," when it ends through  disease and of living with death and included, I think, in Bybee's description.  This book is likely to be of help when death catches us.

The book's humanity is caught in a sentence Lucy Kalanithi wrote in the acknowledgements. "Thank you to Abraham Verghese for a forward that would have thrilled Paul (my only objection being that what Dr. Verghese judged to be a 'prophet's beard' was really an 'I-don't-have-time-to-shave' beard!)."

Kalinithi begins with a prologue of events upon hearing and following the cancer diagnosis. The first part, "In perfect health I begin" includes his "certainty that I would never be a doctor" and describes his childhood, college at Stanford - degrees in English literature and human biology, followed by a master's in English literature to be followed by a degree in the history and philosophy of science and medicine (Cambridge, U. K.) where he learned he wanted "direct personal experience" if he was to "pursue a serious biological philosophy." The only route was medicine so he went to Yale for medical school where he met Lucy, had a course with Dr. Sherwin Nuland (both events were life changing) which made him realize his study of medicine was "to bear witness to the twinned mysteries of death, its experiential and biological manifestations : at once deeply personal and utterly impersonal."

The prologue includes his ideas about god, religion, free will (he was a determinist), etc., based on the adduced evidence, leaving you to think of how those ideas might have changed with more evidence as he further developed in his career and thought and read more about them as he grew older.

It was in medical school that he had his first experiences with birth and death, combined in one event. Here, through that dual event, he provides a thorough discussion of obstetrics and gynecology and then his full residency experience at Stanford (neurosurgery) with Lucy headed to UCSF for her residency in internal medicine.  He describes students making up their minds on which residency to pursue and notes that few of them chose a residency based on medicine as a calling rather than a career.

During this time he realized that his "highest ideal was not saving lives---everyone dies eventually---but guiding a patient or family to an understanding of death or illness," with a thick section of case examples. He observes that "neurosurgery requires a commitment to one's own excellence and a commitment to another's identity." He also "resolved to treat all paperwork as patients, and not vice versa."

"The (neurosurgeon's) secret," Kalanithi writes "is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet 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."

"Cease Not Till Death" is the final part of the book and is about his cancer, temporary stable periods when he was able to return to practice, how his reading habits changed and why, when he knew he would never be in the OR schedule for neurosurgery again, with more tests and treatment to follow, the birth of his daughter Cady, short for Arcadia, the "double-edged" days when relapse brings him closer to death.

This section concludes with a letter to Cady. Kalinithi decided he would leave a simple message for this infant "who is all future, overlapping briefly with me. whose life, barring the improbable, is all but past."  I found it diamantine. Filled with meaning and love for her.

The book's title takes its name from this epigraph by Baron Brooke Fulke Greville's (Caelica 83). "You that seek what life is in death, / Now find it air that once was breath. / New names unknown, old names gone: / Till time end bodies, but souls none. / Reader! then make time while you be, / But steps to your eternity." 

We meet Greville early in the book.

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