When Breath Becomes Air(32)

“Right. And just remember, you’re doing great. You’re working again. You’ve got a baby on the way. You’re finding your values, and that’s not easy.”

Later that day one of the younger professors, a former resident and close friend, stopped me in the hallway.



“Hey,” she said. “There’s been a lot of discussion in faculty meetings about what to do with you.”

“What to do with me, how?”

“I think some professors are concerned about you graduating.”

Graduation from residency required two things: meeting a set of national and local requirements, which I’d already done, and the blessing of the faculty.

“What?” I said. “I don’t mean to sound cocky, but I’m a good surgeon, just as good as—”

“I know. I think they probably just want to see you performing the full load of a chief. It’s because they like you. Seriously.”

I realized it was true: For the past few months, I had been acting merely as a surgical technician. I had been using cancer as an excuse not to take full responsibility for my patients. On the other hand, it was a good excuse, damn it. But now I started coming in earlier, staying later, fully caring for the patients again, adding another four hours to a twelve-hour day. It put the patients back in the center of my mind at all times. The first two days I thought I would have to quit, battling waves of nausea, pain, and fatigue, retreating to an unused bed in down moments to sleep. But by the third day, I had begun to enjoy it again, despite the wreck of my body. Reconnecting with patients brought back the meaning of this work. I took antiemetics and nonsteroidal anti-inflammatory drugs (NSAIDs) between cases and just before rounds. I was suffering, but I was fully back. Instead of finding an unused bed, I started resting on the junior residents’ couch, supervising them on the care of my patients, lecturing as I rode a wave of back spasms. The more tortured my body became, the more I relished having done the work. At the end of the first week, I slept for forty hours straight.



But I was calling the shots:

“Hey, boss,” I said, “I was just reviewing cases for tomorrow, and I know the first case is booked interhemispheric, but I think it will be much safer and easier if we come parietal transcortical.”

“Really?” the attending said. “Let me look at the films….You know what? You’re right. Can you change the booking?”

The next day: “Hi, sir, it’s Paul. I just saw Mr. F and his family in the ICU—I think we’ll need to take him tomorrow for an ACDF. Okay if I book it? When are you free?”



And I was back to full speed in the OR:

“Nurse, can you page Dr. S? I’m going to be done with this case before he gets here.”

“I’ve got him on the phone. He says you can’t possibly be done yet.”

The attending came running in, out of breath, scrubbed, and peered through the microscope.

“I took a slightly acute angle to avoid the sinus,” I said, “but the whole tumor’s out.”

“You avoided the sinus?”

“Yes, sir.”

“You got it out in one piece?”

“Yes, sir, it’s on the table so you can have a look.”

“Looks good. Really good. When did you get to be so fast? Sorry I wasn’t here earlier.”

“No trouble.”

The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.



It struck me that I had traversed the five stages of grief—the “Denial → Anger → Bargaining → Depression → Acceptance” cliché—but I had done it all backward. On diagnosis, I’d been prepared for death. I’d even felt good about it. I’d accepted it. I’d been ready. Then I slumped into a depression, as it became clear that I might not be dying so soon after all, which is, of course, good news, but also confusing and strangely enervating. The rapidity of the cancer science, and the nature of the statistics, meant I might live another twelve months, or another 120. Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die—but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?



At some point, then, I began to do a little bargaining—or not exactly bargaining. More like: “God, I have read Job, and I don’t understand it, but if this is a test of faith, you now realize my faith is fairly weak, and probably leaving the spicy mustard off the pastrami sandwich would have also tested it? You didn’t have to go nuclear on me, you know…” Then, after the bargaining, came flashes of anger: “I work my whole life to get to this point, and then you give me cancer?”