When Breath Becomes Air(10)

Some of my closest friends from college were headed to New York City to pursue a life in the arts—some in comedy, others in journalism and television—and I briefly considered joining them and starting anew. But I couldn’t quite let go of the question: Where did biology, morality, literature, and philosophy intersect? Walking home from a football game one afternoon, the autumn breeze blowing, I let my mind wander. Augustine’s voice in the garden commanded, “Take up and read,” but the voice I heard commanded the opposite: “Set aside the books and practice medicine.” Suddenly, it all seemed obvious. Although—or perhaps because—my father, my uncle, and my elder brother were all doctors, medicine had never occurred to me as a serious possibility. But hadn’t Whitman himself written that only the physician could truly understand “the Physiological-Spiritual Man”?

The next day, I consulted a premed adviser to figure out the logistics. Getting ready for medical school would take about a year of intense coursework, plus the application time, which added up to another eighteen months. It would mean letting my friends go to New York, to continue deepening those relationships, without me. It would mean setting aside literature. But it would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.



I began working through the necessary premedical courses, loading up on chemistry and physics. Reluctant to take a part-time job—it would slow my studies—but unable to afford Palo Alto rent, I found an open window in an empty dormitory and climbed in. After a few weeks of squatting, I was discovered by the caretaker—who happened to be a friend. She provided a key to the room and some useful warnings, like when the high school girls’ cheerleading camps would be coming through. Thinking it wise to avoid becoming a registered sex offender, I’d pack a tent, some books and granola, and head up to Tahoe until it was safe to return.

Because the med school application cycle takes eighteen months, I had a free year once my classes were over. Several professors had suggested I pursue a degree in the history and philosophy of science and medicine before deciding to leave academia for good. So I applied for, and was accepted into, the HPS program at Cambridge. I spent the next year in classrooms in the English countryside, where I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them. Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action. I finished my degree and headed back to the States. I was going to Yale for medical school.

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You would think that the first time you cut up a dead person, you’d feel a bit funny about it. Strangely, though, everything feels normal. The bright lights, stainless steel tables, and bow-tied professors lend an air of propriety. Even so, that first cut, running from the nape of the neck down to the small of the back, is unforgettable. The scalpel is so sharp it doesn’t so much cut the skin as unzip it, revealing the hidden and forbidden sinew beneath, and despite your preparation, you are caught unawares, ashamed and excited. Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feelings: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the mere tedium of academic exercise. Everything teeters between pathos and bathos: here you are, violating society’s most fundamental taboos, and yet formaldehyde is a powerful appetite stimulant, so you also crave a burrito. Eventually, as you complete your assignments by dissecting the median nerve, sawing the pelvis in half, and slicing open the heart, the bathos supersedes: the sacred violation takes on the character of your average college class, replete with pedants, class clowns, and the rest. Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.



The enormity of the moral mission of medicine lent my early days of med school a severe gravity. The first day, before we got to the cadavers, was CPR training, my second time doing it. The first time, back in college, had been farcical, unserious, everyone laughing: the terribly acted videos and limbless plastic mannequins couldn’t have been more artificial. But now the lurking possibility that we would have to employ these skills someday animated everything. As I repeatedly slammed my palm into the chest of a tiny plastic child, I couldn’t help but hear, along with my fellow students’ jokes, real ribs cracking.



Cadavers reverse the polarity. The mannequins you pretend are real; the cadavers you pretend are fake. But that first day, you just can’t. When I faced my cadaver, slightly blue and bloated, his total deadness and total humanness were undeniable. The knowledge that in four months I would be bisecting this man’s head with a hacksaw seemed unconscionable.

Yet there are anatomy professors. And the advice they gave us was to take one good look at our cadaver’s face and then leave it covered; it makes the work easier. Just as we prepared, with deep breaths and earnest looks, to unwrap our cadaver’s head, a surgeon stopped by to chat, leaning with his elbows on the corpse’s face. Pointing out various marks and scars on the naked torso, he reconstructed the patient’s history. This scar is from an inguinal hernia operation, this one a carotid endarterectomy; these marks here indicate scratching, possibly jaundice, high bilirubin; he probably died of pancreatic cancer, though no scar for that—killed him too quick. Meanwhile, I could not help but stare at the shifting elbows that, with each medical hypothesis and vocabulary lesson, rolled over this covered head. I thought: Prosopagnosia is a neurological disorder wherein one loses the ability to see faces. Pretty soon I would have it, hacksaw in hand.