American - Writer | April 1, 1977 - March 9, 2015
Time for me is double-edged: every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence - and eventually, death. Perhaps later than I think, but certainly sooner than I desire.
Paul Kalanithi
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When there's no place for the scalpel, words are the surgeon's only tool.
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The diagnosis was immediate: Masses matting the lungs and deforming the spine. Cancer. In my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to see if surgery offered any hope. I'd scribble in the chart 'Widely metastatic disease - no role for surgery,' and move on. But this scan was different: It was my own.
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I have sat with countless patients and families to discuss grim prognoses: It's one of the most important jobs physicians have. It's easier when the patient is 94, in the last stages of dementia, and has a severe brain bleed. For young people like me - I am 36 - given a diagnosis of cancer, there aren't many words.
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Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnosis, I knew that someday I would die, but I didn't know when. But now I knew it acutely.
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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.
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Science may provide the most useful way to organize empirical, 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.
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Science is based on reproducibility and manufactured objectivity. As strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable.
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During my sojourn in ironclad atheism, the primary arsenal leveled against Christianity had been its failure on empirical grounds. Surely, enlightened reason offered a more coherent cosmos. Surely, Occam's razor cut the faithful free from blind faith. There is no proof of God; therefore, it is unreasonable to believe in God.
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What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find on her own... the angst of facing mortality has no remedy in probability.
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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.
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I had spent so much time studying literature at Stanford and the history of medicine at Cambridge in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me.
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