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He became a physician instead, but one who always dreamed of coming back to literature in some form. A book, perhaps. One day. He thought he had time, and why not? And yet now time was the very thing he had so little of.
I FLIPPED THROUGH THE CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated.
neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.
“Do you think there’s any possibility that it’s something else?” “No,” I said.
About six months before, I had started losing weight and having ferocious back pain.
At age thirty-six, I had reached the mountaintop; I could see the Promised Land, from Gilead to Jericho to the Mediterranean Sea. I could see a nice catamaran on that sea that Lucy, our hypothetical children, and I would take out on weekends. I could see the tension in my back unwinding as my work schedule eased and life became more manageable. I could see myself finally becoming the husband I’d promised to be.
she wanted time to consider the state of our marriage.
Neurosurgical training, among the most rigorous and demanding of all medical specialties, had surely put a strain on our marriage.
Hadn’t we discussed this a dozen times? Didn’t she realize this was the worst possible time for her to blow things up? Didn’t she see that I had only one year left in residency, that I loved her, that we were so close to the life together we’d always wanted?
what if it’s not just residency? Do you really think things will be better when you’re an academic neurosurgery attending?”
I figured either I had cancer, in which case this might be the last time I would see my friends, or I didn’t, in which case there was no reason to cancel the trip.
A security guard approached. “Sir, you can’t lie down here.” “I’m sorry,” I said, gasping out the words. “Bad … back … spasms.” “You still can’t lie down here.” I’m sorry, but I’m dying from cancer. The words lingered on my tongue—but what if I wasn’t? Maybe this was just what people with back pain live with. I knew a lot about back pain—its anatomy, its physiology, the different words patients used to describe different kinds of pain—but I didn’t know what it felt like. Maybe that’s all this was. Maybe. Or maybe I didn’t want the jinx. Maybe I just didn’t want to say the word cancer out loud.
“Everything okay?” “Why don’t we grab some scotch and have a seat?” I said. In front of his fireplace, I said, “Mike, I think I have cancer. And not the good kind, either.” It was the first time I’d said it out loud. “Okay,” he said. “I take it this is not some elaborate practical joke?” “No.” He paused. “I don’t know exactly what to ask.” “Well, I suppose, first, I should say that I don’t know for a fact that I have cancer. I’m just pretty sure of it—a lot of the symptoms point that way. I’m going to go home tomorrow and sort it out. Hopefully, I’m wrong.”
My phone rang as I stepped off the plane. It was my primary care doctor, calling with the chest X-ray result: my lungs, instead of being clear, looked blurry, as if the camera aperture had been left open too long. The doctor said she wasn’t sure what that meant.
She likely knew what it meant. I knew.
I received the plastic arm bracelet all patients wear, put on the familiar light blue hospital gown, walked past the nurses I knew by name, and was checked in to a room—the same room where I had seen hundreds of patients over the years.
In this room, I had sat with patients and explained terminal diagnoses and complex operations; in this room, I had congratulated patients on being cured of a disease and seen their happiness at being returned to their lives; in this room, I had pronounced patients dead. I had sat in the chairs, washed my hands in the sink, scrawled instructions on the marker board, changed the calendar. I had even, in moments of utter exhaustion, longed to lie down in this bed and sleep. Now I lay there, wide awake. A young nurse, one I hadn’t met, poked her head in. “The doctor will be in soon.” And with
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heart wrenching
I was leaving this small Arizona town in a few weeks, and I felt less like someone preparing to climb a career ladder than a buzzing electron about to achieve escape velocity, flinging out into a strange and sparkling universe.
He had reached some compromise in his mind that fatherhood could be distilled; short, concentrated (but sincere) bursts of high intensity could equal … whatever it was that other fathers did. All I knew was, if that was the price of medicine, it was simply too high.
Of our many childhood mysteries, chief among them was not why our father decided to bring his family to the desert town of Kingman, Arizona, which we grew to cherish, but how he ever convinced my mother to join him there. They had eloped, in love, across the world, from southern India to New York City (he a Christian, she a Hindu, their marriage was condemned on both sides, and led to years of familial rifts—my mother’s mother never acknowledged my name, Paul, instead insisting I be called by my middle name, Sudhir) to Arizona, where my mother was forced to confront an intractable mortal fear
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The snakes were a constant source of anxiety, but it was her children’s future that my mother feared for most of all.
Suddenly there was a feeling in our high school that the two mountain ranges that bounded the town no longer defined the horizon: it was what lay beyond them.
what were our brains doing, otherwise? Though we had free will, we were also biological organisms—the brain was an organ, subject to all the laws of physics, too! Literature provided
a rich account of human meaning; the brain, then, was the machinery that somehow enabled it. It seemed like magic. That night, in my room, I opened up my red Stanford course catalog, which I had read through dozens of times, and grabbed a highlighter. In addition to all the literature classes I had marked, I began looking in biology and neuroscience as well.
What makes human life meaningful? I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.
But I couldn’t quite let go of the question: Where did biology, morality, literature, and philosophy intersect?
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.
Getting ready for medical school would take about a year of intense coursework, plus the application time, which added up
to another eighteen months.
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:
Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.
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.
Even working on the dead, with their faces covered, their names a mystery,
you find that their humanity pops up at you—in opening my cadaver’s stomach, I found two undigested morphine pills, meaning that he had died in pain, perhaps alone and fumbling with the cap of a pill bottle.
But by the time you’d skinned the limbs, sliced through inconvenient muscles, pulled out the lungs, cut open the heart, and removed a lobe of the liver, it was hard to recognize this pile of tissue as human.
Anatomy lab, in the end, becomes less a violation of the sacred and more something that interferes with happy hour, and that realization discomfits.
we were all silently apologizing to our cadavers, not because we sensed the transgressi...
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the most profound human suffering becomes a mere pedagogical tool.
I was a prophet returning from the mountaintop with news of a joyous new covenant!
Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?
In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun.
detailed statistics are for research halls, not hospital rooms.
it is important to be accurate, but you must always leave some room for hope.
The pain of failure had led me to understand that technical excellence was a moral requirement. Good intentions were not enough, not when so much depended on my skills, when the difference between tragedy and triumph was defined by one or two millimeters.
he had become a demon, summoned by one millimeter of damage.
Neurosurgery requires a commitment to one’s own excellence and a commitment to another’s identity.
