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We held each other tightly, like young lovers.
She was upset because I’d promised her one life, and given her another.
Maybe a good night’s sleep and a few cocktails would help us reconnect a bit
and decompress the pressure cooker of our marriage.
while I read a book called Death and Philosophy. I used to laugh at the incongruities of that moment: a twenty-year-old amid the splendor of trees, lake, mountains, the chirping of birds mixed with the squeal of happy four-year-olds, his nose buried in a small black book about death.
And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.
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,
of familial rifts—my mother’s mother never acknowledged my name, Paul, instead insisting I be called by my middle name, Sudhir)
from somewhere, a “college prep reading list.” Trained in India to be a physiologist, married at twenty-three, and preoccupied with raising three kids in a country that was not her own, she had not read many of the books on the list herself.
She made me read 1984 when I was ten years old;
Brave New World founded my nascent moral philosophy and became the subject of my college admissions essay, in which I argued that happiness was not the point of life. Hamlet bore me a thousand times through the usual adolescent crises.
After I was caught returning at dawn from one such late-night escapade, my worried mother
thoroughly interrogated me regarding every drug teenagers take, never suspecting that the most intoxicating thing I’d experienced, by far, was the volume of romantic poetry she’d handed me the previous week.
However, it did make the throwaway assumption that the mind was simply the
operation of the brain, an idea that struck me with force; it startled my naïve understanding of the world.
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.
T. S. Eliot’s The Waste Land resonated profoundly, relating meaninglessness and isolation, and the desperate quest for human connection.
Other authors resonated as well. Nabokov, for his awareness of how our suffering can make us callous to the obvious suffering of another. Conrad, for his hypertuned sense of how miscommunication between people can so profoundly impact their
And then we would sit and watch as the first hint of sunlight, a light tinge of day blue, would leak out of the eastern horizon, slowly erasing the stars.
There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.
A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form.
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.
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.
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.
Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private.
Early on, when I made a long, quick cut through my donor’s diaphragm in order to ease finding the splenic artery, our proctor was both livid and horrified. Not because I had destroyed an important structure or misunderstood a key concept or ruined a future dissection but because I had seemed so cavalier about it. The look on his face, his inability to vocalize his sadness, taught me more about medicine than any lecture I would ever attend. When I explained that another anatomy professor had told me to make the cut, our proctor’s sadness turned to rage, and suddenly red-faced professors were
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The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating to asystole, and they could bring you to tears.
How We Die, had come out when I was in high school but made it into my hands only in medical school.
Nuland remembered Sir Thomas Browne’s Religio Medici: “With what strife and pains we come into the world we know not, but ’tis commonly no easy matter to get out of it.”
“Let no man put asunder what God has joined,” the attending said. “At least, no more than temporarily. I like to leave things the way I found them—let’s sew it back up.”
Birth astride of a grave, the light gleams an instant, then it’s night once more.”
Which is worse, being born too early or waiting too long to deliver?” “Judgment call.” What a call to make.
Maybe life is merely an “instant,” too brief to consider.
In the fourth year of medical school, I watched as, one by one, many of my classmates elected to specialize in less demanding areas (radiology or dermatology, for example) and applied for their residencies. Puzzled by this, I gathered data from several elite medical schools and saw that the trends were the same: by the end of medical school, most students tended to focus on “lifestyle” specialties—those with more humane hours, higher salaries, and lower pressures
While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact.
What makes life meaningful enough to go on living?
With that kind of head injury, we all murmured in agreement, death was to be preferred.
“Well, I guess I learned one thing: if I’m ever feeling down about my work, I can always talk to a neurosurgeon to cheer myself up.”
Science, I had come to learn, is as political, competitive, and fierce a career as you can find, full of the temptation to find easy paths.
meant for V. He paused. “Paul,” he said, “do you think my life has meaning? Did I make the right choices?” It was stunning: even someone I considered a moral exemplar had these questions in the face of mortality.
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.
When tumors or malformations abut these language areas, the surgeon takes numerous precautions, ordering a host of different scans, a detailed neuropsychological examination. Critically, however, the surgery is performed with the patient awake and talking. Once the brain is exposed, but before the tumor excision, the surgeon uses a hand-held ball-tip electrode to deliver electrical current to stun a small area of the cortex while the patient performs various verbal tasks: naming objects, reciting the alphabet, and so on. When the electrode sends current into a critical piece of cortex, it
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Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it’s something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life.
Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.
The room was quiet. Lucy told me she loved me. “I don’t want to die,” I said. I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately.
My brother Jeevan had arrived at my bedside. “You’ve accomplished so much,” he said. “You know that, don’t you?” I sighed. He meant well, but the words rang hollow. My life had been building potential, potential that would now go unrealized.
confirmed. My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here
I sat, staring at a photo of Lucy and me from medical school, dancing and laughing; it was so sad, those two, planning a life together, unaware, never suspecting their own fragility. My friend Laurie had had a fiancé when she’d died in a car accident—was this any crueler?
I immediately felt a kinship. This was exactly how I approached neurosurgery: have a plan A, B, and C at all times. “With chemo, our main decision will be carboplatin versus cisplatin.
The fact of death is unsettling. Yet there is no other way to live.
