Three Books On Living and Dying

I read Paul Kalanithi’s When Breath Becomes Air  this weekend. It is a great book; one worth owning, so you can refer back to it at moments of need.

I dog-eared several pages of my library copy, which I’ll share below. But, first, I want to mention to other books that are favorites by doctors.

First is The Man Who Mistook his Wife for a Hat, by Oliver Sacks.

This book shows shares stories from Sacks’ practice, working with people who have neurological conditions. His patients were men, women, children, old, young, from many countries and means.

He writes about their conditions with a combination of curiosity, wonder, and compassion. Ever the detective, he describes how each situation presented its unique challenge for diagnosing and often, though not always, treating.

Next is How We Die, by Sherwin Nuland. Using a series of stories as the set up for each chapter, Dr. Nuland describes the variety of ways that people die, from old age, to infectious disease, to massive trauma, by way of accident or intent (e.g., homicide and suicide), and other causes of death.

In each case, he transitions from a vivid, personal accounting of death from the perspective of the patient, to a scientific, clinical description of the chemical, biological, and physical forces that combine to bring about the end of life, from whatever triggering event(s) occurred.

But, far from cold-hearted, the book is an honest, comforting accounting of a subject that is too often avoided, even though it is a universality that every human being shares — from the richest to the poorest of us.

So, I recommend these three books to you, providing a trilogy of insight on humanity and death.

In closing, some of my favorite passages from When Breath Becomes Air.

[For brain surgery patients], “the question is not simply whether to live or die, but what kind of life is worth living. Would you trade your ability – or your mother’s – to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? …What makes life meaningful enough to go on living?”

= = =

“In that first year (of medical residency), I would glimpse my share of death…At moments, the weight of it all became palpable. It was in the air, the stress and misery. Normally, you breathed it in, without noticing it. But some days, like a humid, muggy day, it had a suffocating weight of its own. Some days, this is how it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down.”

= = =

“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 towards death — it’s something that happens to you and those around you….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.”

= = =

“There is only one thing to say [to your child(ren)], who is all future, overlapping briefly with you, whose life, barring the improbable, is all but past.

That message is simple.

When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.”

END