29 July 2019
When I first finished this book, I was ready to award it only 3 stars.
I had absolutely loved Part 1. Everything Paul talked about enthralled me. His love for literature, his constant philosophical questioning as to what made life meaningful, his insights into the paradoxes of studying life to understand it vs experiencing it and building the relationships that gave it meaning, and his drive and fascination with biology and specifically neurology. He felt so alive in Part 1 as I read, his drive, his yearning to master this thing called life, his success mindset, I loved him. I felt so sad that he was dead and that I would never get to meet him. What a loss to the world. And it seemed so horribly unfair that a man who did so much to save the lives of others, should be deprived of life himself. Horribly unfair. Was that how we got rewarded in life for good deeds?
I gave myself a break before Part 2. A breather because I knew it was going to get heavy. Paul hadn't survived despite the upbeat voice of Part I. He had died. Others had warned me this was a book that would leave me in torrents of tears, so I gave myself some time to prepare for the emotional upheaval and brace myself.
Yet during that break, something nagged at me. A small voice at the back of my head told me something didn't sit quite right. Paul seemed too brilliant from the first part. Was that how he really was? Maybe he was saying some of things that so impressed me, because they came to light after he knew he was facing death. Maybe he was making himself sound better than he was...?
I made the mistake of googling the book so I could read some more about him. It was odd, I wasn't ready to face Part 2 yet, but I still wanted to stay connected to Paul and the book, so I found myself reading about him and his wife on the internet.
I discovered they'd had a baby! That shocked me. Why would he have a child when he knew he wasn't going to be around to bring it up?
And I read about his wife finding new love a couple of years after his death. Ironically, with a widower whose dead wife had also written and had a memoir published about her impending death.
I know it's totally wrong of me to feel this and judge, but I felt cross with her. I was still at the part in the book where Paul was alive, and here she was already with someone else. I lost love for her and my opinion of her became a little jaded. (I know, totally dumb and unfair. What can I say...)
When I finally got back to Part 2 then, I was already in lower spirits, but not because I knew Paul was going to die. Because I felt lost and didn't understand the decisions that he or his wife were making. I started to feel cross with him for having a baby when we wouldn't be there for her as she grew up. And when he returned to work full gusto after the first successful treatment, I was beyond flabbergasted. How could he do that. Knowing how ill he'd been? In fact, worse, how could he ignore all the pain that was returning and just use painkillers to mask it and go on? Why? Why would he do that? Why would anyone do that?
In my vanity and arrogance, I was so mad with Paul. He'd had a chance to live and he'd thrown it away in my opinion. He'd gone back to a job that had killed him. That's what it felt like for me.
And that oncologist! Why did she keep pushing him back to such a stressful unhealthy job?! There was no way in the world that a personality like Paul was going to go back to it part-time. A return to it was always going to almost certainly put critical strain on his body.
And emulating her question, he kept asking several times in the book, what do you value? What gives your life meaning?
Except, he never explicitly answered. In my arrogance, I judged the meaning of his actions and assumed that they revealed what gave him meaning: his job, achievement, becoming a high-flying consultant who was respected and adored by all.
I thought he was selfish. His marriage was on the rocks before his diagnosis, precisely because they weren't spending time together (my assumption) and there he was, having been given another chance, and he returned to the same crazy lifestyle. He valued success. He didn't value relationships or other people.
That was my original opinion. Harsh, judgmental and assuming.
It took a whole evening of discussion at Bookclub to really unlock this book and Paul Kalanithi's last days for me, and turn my opinion completely around. One of the members asked repeatedly, why did we think Paul wrote the book?
We didn't come to a common consensus right away. I felt he had wanted to leave a legacy. For selfish reasons. But others thought that the book was a way of him coming to terms with what was happening to him.
I now think that this is true, the book did give him opportunity to try to make some sense of his life and his impending early death. I think that anyone facing an early demise would find themselves trying to understand what was the point of it all.
I think he did also want to leave a legacy, but not truly for selfish reasons. Literature was a passion of his and he had always wanted to write. It was a dream, an ambition and he wanted to fulfil it before he died. There's even something noble in this. To leave something of value behind for others so that they might benefit from his sorrow and suffering.
When we noted that Paul never explicitly answered what he valued and what made his life meaningful, we considered that maybe he didn't actually know the answer to that question. And there was a searching for it in the book as he wrote it to some extent.
Someone noted that he'd repeatedly asked and needed to know, how long did he have? Because how long he had would impact how he chose to spend his remaining time. Did he have time to finish his training and graduate? Or was it less? If it was less, he would write his book. The same dilemma appeared again and again.
And he noted finally at one stage, the irony of his position. Before his diagnosis, he hadn't known how long he'd got left. And after, he hadn't known how long he'd got left.
My friends helped me to realise that Paul was a man that was really struggling even though he doesn't express it in emotional terms through his writing. What a horrible position to find yourself in. You've got cancer, you're definitely going to die. What do you do with your remaining days? What would you do?
For Paul, it made sense if he had more time to go back to work and complete the training he had invested virtually his whole life in. He was so close to the finish line. So close. It made sense to just go back and finish it and maybe even reclaim the future he had worked so hard and relentlessly to attain.
When the returning cancer started to make itself known through the excruciating back pains he started to experience again, he dumbed it down, ignored it, buried his head in the sand a little, or more accurately perhaps, stayed laser-focused on his goal. You don't become a neurosurgeon by being swayed or distracted by obstacles when they appear. That was not his way, and I can only assume that he was helpless to change this in himself.
I realised that for all the good that Paul Kalanithi did for others, how many lives he saved and how many people he redirected on the road back to health and self-care, ultimately he did not do the same for himself.
Did he realise this? That he had failed in his own self-care? He makes a point midway through Part 1 how some students had rallied to try and change the Hippocratic Oath equivalent that they were to swear to in the US, caveating that they should not put their own welfare behind their patients. Of course this was meant in a different context, but the irony strikes me hard in the face. I wish fervently that Paul Kalanithi had cared more about his own health and well-being, maybe then, maybe, he might even be here still to save more lives and see his wife smile and his little girl grow up.
Of course death comes to us all. It is our final master. The curtain that gives our performance meaning ultimately. And yet what I learnt from this book is that having Focus without Balance is a fatal mistake. Fatal to all projects, but in this case it feels like it may have been a key factor that claimed a life.
If Paul had not been so single-mindedly driven, would he have spotted those shadows in the scans before they became irreversible? Would he have chosen to make better choices about his hours (punishing 5am starts and such late finishes it was all he could do to collapse), about the food that he ate (a quick lunch of an ice-cream sandwich and coke was never going to be conducive to promoting good health in the body), about the emotions that he felt (there was such a desperate need/requirement to perform unreasonably consistently at an exceptionally high level for him)...
I feel so sad for Paul now. This was a man who struggled desperately to do the right thing in the only way he was taught to and the only way he knew how. But he was not rewarded for it ultimately.
I think now, that what Paul maybe valued most of all, was maybe trifold - relationships in conjunction with giving value to others and achievement. When he returned to neurosurgery and he was only doing the surgeries, he had said that the job had started to feel empty and he’d stopped enjoying it. And that it was only when he returned to consulting with patients that it became meaningful again.
And at the very end of the book, his final letter to his daughter, he tells her that when she questions if her life has had meaning, to know that she gave a dying man joy such that all his desires were sated. Finally in death, he had stopped the chasing that had been set up in his childhood and persisted in this crazy world we live in permeating a job that he loved and had tremendous value. Finally he found value and found himself being valued by a child who was till a baby and asked nothing of him other than to love and adore him and be loved and adored back in return. No chasing, nothing about his past or his future, all she wanted and needed from him was his attention now, here, in the present.
I've realised that this book was actually his real gift to his daughter. In it she can learn everything that her father was, what he stood for and believed in, what he loved and what he struggled with. Within the pages if she looks closely enough, she will find a guiding compass as to what kind of questions to ask yourself in life so you can be proactive in making your life meaningful and valuable.
For me, Paul and our bookclub members have given me an immeasurable gift. I have realised that like Paul, I myself need to more actively prioritise my health. Maybe that is why I was so mad with Paul, because he did what I do myself so regularly. Sacrifice longevity for quick wins in the scheme of things.
And perhaps equally importantly, I've recalled that none of us know how long we have truly. And that if we live our life without prioritising what's really the most important thing in the world for us, regardless of how long we have left, then we can only win ultimately. We must find a way to balance the scenario where we might live for several decades more and yet today might be our last day too.
I think this is actually possible and achievable. But it requires us to stop and take a step back every now and then, so that we look deeply into how we our lives now. And consider what it would be like if everything was to phase out to black in the next moments, as death stole us away. What would be the urgent need in these final moments?
Paul's sweet wife, Lucy, says in the afterword that Paul's hope was that the book might prompt readers to walk in his shoes a moment and feel what it's like to facing a difficulty such as his, before stepping out of them again. It's definitely done this for me. What a tremendous profound gift.
I don't know what the book might have been if Paul had had an opportunity to complete it. But I feel that paradoxically, not achieving completion was his greatest achievement of all. He perfectly demonstrates the future that awaits us all, and gives a profoundly valuable opportunity to breathe more life into our remaining days and years as a result.