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 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 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?” 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.
From “When Breath Becomes Air,” by Paul Kalanithi
A formidable book written by a gifted neurosurgeon whose life meaning changed when cancer hit him. It went from learning the most advanced surgical techniques to treat patients to teaching us how to die. His book contained many tips and profound thoughts. This paragraph shows the author’s humanity, “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?”
We do not discuss death enough despite being a daily reality. In my book “Afterlife Tracks,” I tried to understand what dying might feel, “I figured that dying had to feel like diving into the cold waters on a sunny beach. You slowly waded farther and farther into the sea, and the water got higher and higher until it reached your groin, where the sensation sent shivers through your entire body. Then you jumped into the water, and everything turned fresh and comfortable, and there was no more cold.”
