position that fit my interests exactly, for a neurosurgeon-neuroscientist focused on techniques of neural modulation. One of my junior residents came up to me and said, “I just heard from the bosses—if they hire you, you’re going to be my faculty mentor!”
“Shhhh,” I said. “Don’t jinx it.”
It felt to me as if the individual strands of biology, morality, life, and death were finally beginning to weave themselves into, if not a perfect moral system, a coherent worldview and a sense of my place in it. Doctors in highly charged fields met patients at inflected moments, the most authentic moments, where life and identity were under threat; their duty included learning what made that particular patient’s life worth living, and planning to save those things if possible—or to allow the peace of death if not. Such power required deep responsibility, sharing in guilt and recrimination.
I was at a conference in San Diego when my phone rang. My co-resident, Victoria.
“Paul?”
Something was wrong. My stomach tightened.
“What’s up?” I said.
Silence.
“Vic?”
“It’s Jeff. He killed himself.”
“What?”
Jeff was finishing his surgical fellowship in the Midwest, and we were both so punishingly busy…we’d lost touch. I tried to recall our last conversation and couldn’t.
“He, uh—he apparently had a difficult complication, and his patient died. Last night he climbed onto the roof of a building and jumped off. I don’t really know anything else.”
I searched for a question to bring understanding. None was forthcoming. I could only imagine the overwhelming guilt, like a tidal wave, that had lifted him up and off that building.
I wished, desperately, that I could’ve been walking with him out the door of the hospital that evening. I wished we could’ve commiserated as we used to. I wished I could have told Jeff what I had come to understand about life, and our chosen way of life, if only to hear his wise, clever counsel. 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. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility . 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 II
Cease Not till Death
If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live.
—Michel de Montaigne, “That to Study Philosophy Is to Learn to Die”
L YING NEXT TO L UCY in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician—my identity—no longer mattered. With the cancer having invaded multiple organ systems, the diagnosis was clear. The room was quiet. Lucy told me she loved me. “I don’t want to die,” I said. I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately. We started calling family members. At some point, Victoria came by the room, and we discussed the scan and the likely future treatments. When she brought up the logistics of returning to residency, I stopped her.
“Victoria,” I said, “I’m never coming back to this hospital as a doctor. Don’t you think?”
One chapter of my life seemed to have ended; perhaps the whole
“Shhhh,” I said. “Don’t jinx it.”
It felt to me as if the individual strands of biology, morality, life, and death were finally beginning to weave themselves into, if not a perfect moral system, a coherent worldview and a sense of my place in it. Doctors in highly charged fields met patients at inflected moments, the most authentic moments, where life and identity were under threat; their duty included learning what made that particular patient’s life worth living, and planning to save those things if possible—or to allow the peace of death if not. Such power required deep responsibility, sharing in guilt and recrimination.
I was at a conference in San Diego when my phone rang. My co-resident, Victoria.
“Paul?”
Something was wrong. My stomach tightened.
“What’s up?” I said.
Silence.
“Vic?”
“It’s Jeff. He killed himself.”
“What?”
Jeff was finishing his surgical fellowship in the Midwest, and we were both so punishingly busy…we’d lost touch. I tried to recall our last conversation and couldn’t.
“He, uh—he apparently had a difficult complication, and his patient died. Last night he climbed onto the roof of a building and jumped off. I don’t really know anything else.”
I searched for a question to bring understanding. None was forthcoming. I could only imagine the overwhelming guilt, like a tidal wave, that had lifted him up and off that building.
I wished, desperately, that I could’ve been walking with him out the door of the hospital that evening. I wished we could’ve commiserated as we used to. I wished I could have told Jeff what I had come to understand about life, and our chosen way of life, if only to hear his wise, clever counsel. 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. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility . 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 II
Cease Not till Death
If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live.
—Michel de Montaigne, “That to Study Philosophy Is to Learn to Die”
L YING NEXT TO L UCY in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician—my identity—no longer mattered. With the cancer having invaded multiple organ systems, the diagnosis was clear. The room was quiet. Lucy told me she loved me. “I don’t want to die,” I said. I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately. We started calling family members. At some point, Victoria came by the room, and we discussed the scan and the likely future treatments. When she brought up the logistics of returning to residency, I stopped her.
“Victoria,” I said, “I’m never coming back to this hospital as a doctor. Don’t you think?”
One chapter of my life seemed to have ended; perhaps the whole
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