When Breath Becomes Air(33)

And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.

—

I was operating until late at night or into the early morning, fixated on graduation, my diagnosis nine months in the past. My body was taking a beating. I was too tired to eat when I got home. I had been slowly upping the dose of Tylenol and NSAIDs and antiemetics. I had developed a persistent cough, presumably caused by scarring from the dead tumor in my lungs. I only had to keep up this relentless pace for a couple more months, I told myself, and then I would graduate from residency and settle into the comparatively calmer role of a professor.



In February, I flew to Wisconsin for a job interview. They were offering everything I wanted: millions of dollars to start a neuroscience lab, head of my own clinical service, flexibility if I needed it for my health, a tenure-track professorship, appealing job options for Lucy, high salary, beautiful scenery, idyllic town, the perfect boss. “I understand about your health, and you probably have a strong connection with your oncologist,” the department chairman told me. “So if you want to keep your care there, we can fly you back and forth—though we do have a top-notch cancer center here, if you want to explore it. Is there anything else I can do to make this job more attractive?”

I thought about what Emma had told me. I had gone from being unable to believe I could be a surgeon to being one, a transformation that carried the force of religious conversion. She had always kept this part of my identity in mind, even when I couldn’t. She had done what I had challenged myself to do as a doctor years earlier: accepted mortal responsibility for my soul and returned me to a point where I could return to myself. I had attained the heights of the neurosurgical trainee, set to become not only a neurosurgeon but a surgeon-scientist. Every trainee aspires to this goal; almost none make it.



That night, the chairman was driving me back to my hotel after dinner. He stopped the car and pulled over. “Let me show you something,” he said. We got out and stood in front of the hospital, looking over a frozen lake, its far edge luminous with specks of light leaking from faculty houses. “In summer, you can swim or sail to work. In winter, you can ski or ice-skate.”

It was like a fantasy. And in that moment, it hit me: it was a fantasy. We could never move to Wisconsin. What if I had a serious relapse in two years? Lucy would be isolated, stripped of her friends and family, alone, caring for a dying husband and new child. As furiously as I had tried to resist it, I realized that cancer had changed the calculus. For the last several months, I had striven with every ounce to restore my life to its precancer trajectory, trying to deny cancer any purchase on my life. As desperately as I now wanted to feel triumphant, instead I felt the claws of the crab holding me back. The curse of cancer created a strange and strained existence, challenging me to be neither blind to, nor bound by, death’s approach. Even when the cancer was in retreat, it cast long shadows.



When I’d first lost the professorship at Stanford, I’d consoled myself with the idea that running a lab made sense only on a twenty-year time scale. Now I saw that this was, in fact, true. Freud started his career as a successful neuroscientist. When he realized neuroscience would need at least a century to catch up with his true ambition of understanding the mind, he set aside his microscope. I think I felt something similar. Transforming neurosurgery through my research was a gamble whose odds had been made too long by my diagnosis; the lab wasn’t the place I wanted to plunk the remainder of my chips.

I could hear Emma’s voice again: You have to figure out what’s most important to you.

If I no longer sought to fly on the highest trajectory of neurosurgeon and neuroscientist, what did I want?

To be a father?



To be a neurosurgeon?

To teach?

I didn’t know. But if I did not know what I wanted, I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.

My own hubris as a surgeon stood naked to me now: as much as I focused on my responsibility and power over patients’ lives, it was at best a temporary responsibility, a fleeting power. Once an acute crisis has been resolved, the patient awakened, extubated, and then discharged, the patient and family go on living—and things are never quite the same. A physician’s words can ease the mind, just as the neurosurgeon’s scalpel can ease a disease of the brain. Yet their uncertainties and morbidities, whether emotional or physical, remain to be grappled with.

Emma hadn’t given me back my old identity. She’d protected my ability to forge a new one. And, finally, I knew I would have to.

—



On a crystalline spring morning on the third Sunday of Lent, Lucy and I went to church with my parents, who had flown in from Arizona for a weekend visit. We sat together in a long wooden pew, and my mother struck up a conversation with the family sitting next to us, first complimenting the mother on her baby daughter’s eyes, then quickly moving on to matters of greater substance, her skills as a listener, confidante, and connector fully evident. During the pastor’s Scripture reading, I suddenly found myself chuckling. It featured a frustrated Jesus whose metaphorical language receives literal interpretation from his followers: