I’ve interned myself here in a room where the light can barely sneak through the blinds. If any ultraviolet rays reach my face, it will only intensify the present pain. I just finished another session of Photodynamic Therapy, a procedure to prevent cancerous growths. You submit your face to a blue light for 16 minutes, and the effects are worse than a really bad burn on a San Diego beach.
This is, of course, why I am going through this process, counterintuitive as it is, for I spent too many days on the shores of Pacific Beach and too many hours, in my youth, on the courts of Grossmont College. It’s not that we managed things with sunscreen—we were too vain and ignorant to think about such things. We actually used oils to magnify the exposure, and then we complimented one another for having such dark tans and looking so healthy. Looking back, it was all utterly mindless.
It is fine being holed up. There are papers to grade and emails to attend to. And then there is some time for reading, so I am just finishing When Breath Becomes Air. The magazine, The Week, listed it as one of the year’s best nonfiction books. This is not an overstatement. From the beginning, the book has drawn me in such that I lose all sense of my surroundings and my pain. The author, Paul Kalanithi, is a 36-year old neurosurgical resident dying of stage 4 lung cancer, so you know how the book ends. But he takes you on his journey, from youth through medical school, and through residency.
As one writer put it, Kalanithi grows his soul as his body wastes away. In the end, you find yourself struck with the way he articulates his understanding of both life and death. There is a depth to his faith that, I think, only comes when one is dying. He ultimately moves from unbelief to belief, for he recognizes that making science a final arbiter of metaphysics is to banish not only God, but love and hate, as well as all meaning.
Some books bore—others tire you, and you work through them just to hurry and get to the end. As much I enjoyed a The General vs. The President, MacArthur’s egoistic ways left me fatigued. But then there are those books, like a good movie, that you don’t want to end. This one will, because cancer is having its way in Kalanithi’s body. Nonetheless you stay on this trek with Kalanithi, for he occasionally stops you in your tracks and asks piercing questions like–If the unexamined life is not worth living, is the unlived life worth examining?
Part of a physician’s preparation includes working with cadavers. It’s a medical rite of passage. Meticulous care is given to understanding how the body functions and how it dies. But Kalanithi is aware of what working with cadavers can do. You can lose a certain reverence for creation. Out of the lab and into the hospital room, long days and endless hours can also take their toll on the soul. If one is not careful, one can become preoccupied with formalism, focused on the rote treatment of disease, and miss the larger human significance.
The more I read, the more I keep reflecting on ministry. We in seminary often talk about the calling, the sacrifice that comes with giving yourself to serving God. And there is a price. But for many of us, the costs of becoming physicians of the soul pale in comparison to the costs of becoming a physician of the body. For most who prepare for medicine, there is an unforgiving call to perfection. There has to be. Everything is on the line. Those who begin residency soon learn you can’t be sloppy and you can’t be slow. And I ask, should it be any different for those of us committed to things eternal? Shouldn’t there be a similar call to excellence? We are dealing with decisions that will determine the course of one’s eternal state.
I stop at points and ask myself–shouldn’t we take more time to understand how a life works? Shouldn’t we submit ourselves to a similar rigor? Souls are on the line. Ironically, seminary education is looking for ways to stay afloat, cut requirements and reduce costs. There are an increasing number of cheap “theological” degrees out there. More and more schools are offering theological degrees where all the courses are online. Imagine if your neurosurgeon bragged about the fact he did all of his education through distance learning. Would you want to be under his/her care? No thanks.
At graduation, students in medical school sign an oath. Part of it says that their patients must always come before themselves. We should expect a similar oath signing at graduation—that our parishioners’ interests come before our own. This is what separates a calling from a job. And just as a physician is devoted to sustaining life, we must be absolutely devoted to keeping one’s faith alive.
It’s towards the latter part of the book that Kalanithi talks about death. He goes further than almost any author I have read on the subject. He is well acquainted with mortality, for everyday he works with dying patients. And then he too is struck with a terminal illness. During his treatments, his cancer occasionally retreats, but it still casts long shadows. Eventually death wins. As he notes, all organisms, whether goldfish or grandchild, die.
Strangely, most lives are lived with passivity towards death. To any notion we can escape the physical laws, this book dismantles it. Entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation. If there is any benefit of terminal illness, it’s that it helps you to sort out what really matters.
I’m finished now, and I am rethinking some things like how I use my time (and what is real pain). Kalanithi invested most of his years preparing for a practice he never experienced. His carefully planned and hard-won future was lost. How we must seize our moments! As unsettling as it is to think about our mortality, there is no other way to live.