When Breath Becomes Air

When Breath Becomes Air by Paul Kalanithi Page B

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the past few days, did so again.
    “We can do details later,” she continued, “as I know this is a lot to absorb. Mostly, I just wanted to meet you all before our appointment Thursday. Is there anything I can do, or answer—besides survival curves—today?”
    “No,” I said, my mind reeling. “Thanks so much for stopping by. I really appreciate it.”

    “Here’s my card,” she said, “and there’s the clinic number. Feel free to call if anything comes up before we see you in two days.”
    My family and friends quickly wired through our network of medical colleagues to find out who the best lung cancer oncologists in the country were. Houston and New York had major cancer centers; was that where I should be treated? The logistics of moving or temporarily relocating or what have you—that could be sorted out later. The replies came back quickly, and more or less unanimously: Emma not only was one of the best—a world-renowned oncologist who served as the lung cancer expert on one of the major national cancer advisory boards—but she was also known to be compassionate, someone who knew when to push and when to hold back. I briefly wondered at the string of events that had sent me looping through the world, my residency determined by a computerized match process, only to end up assigned here, with a freak diagnosis, in the hands of one of the finest doctors to treat it.
    Having spent the better part of the week bedridden, with the cancer progressing, I had grown noticeably weaker. My body, and the identity tied to it, had radically changed. No longer was getting in and out of bed to go to the bathroom an automated subcortical motor program; it took effort and planning. The physical therapists left a list of items to ease my transition home: a cane, a modified toilet seat, foam blocks for leg support while resting. A bevy of new pain medications was prescribed. As I hobbled out of the hospital, I wondered how, just six days ago, I had spent nearly thirty-six straight hours in the operating room. Had I grown that much sicker in a week? Yes, in part. But I had also used a number of tricks and help from co-surgeons to get through those thirty-six hours—and, even so, I had suffered excruciating pain. Had the confirmation of my fears—in the CT scan, in the lab results, both showing not merely cancer but a body overwhelmed, nearing death—released me from the duty to serve, from my duty to patients, to neurosurgery, to the pursuit of goodness? Yes, I thought, and therein was the paradox: like a runner crossing the finish line only to collapse, without that duty to care for the ill pushing me forward, I became an invalid.

    Usually when I had a patient with a strange condition, I consulted the relevant specialist and spent time reading about it. This seemed no different, but as I started reading about chemo, which included a whole variety of agents, and a raft of more modern novel treatments that targeted specific mutations, the sheer number of questions I had prevented any useful directed study. (Alexander Pope: “A little learning is a dangerous thing; / Drink deep, or taste not the Pierian spring.”) Without appropriate medical experience, I couldn’t place myself in this new world of information, couldn’t find my spot on the Kaplan-Meier curve. I waited, expectantly, for my clinic visit.

    But mostly, I rested.
    I sat, staring at a photo of Lucy and me from medical school, dancing and laughing; it was so sad, those two, planning a life together, unaware, never suspecting their own fragility. My friend Laurie had had a fiancé when she’d died in a car accident—was this any crueler?
    My family engaged in a flurry of activity to transform my life from that of a doctor to that of a patient. We set up an account with a mail-order pharmacy, ordered a bed rail, and bought an ergonomic mattress to help alleviate the searing back pain. Our financial plan, which a few days before had banked on my income

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