"I was neither angry nor scared. It simply was. It was a fact about the world, like the distance from the sun to the earth."
- When Breath Becomes Air, Dr. Paul Kalanithi
Death is everywhere. The mere concept is enough to frighten us to sleeplessness. The fear. The mourning. The pain. And it's certain in this Earthly realm in which we find ourselves.
One day, we wake up. Born.
When is that? Is it at birth? Who remembers being born? We have only gauzy whisps of vision into our own pasts. We don't have a visceral internal knowledge of where we came from. It's like we all woke up on a moving train, when we were in kindergarten.
Yes, our parents show us the baby pictures. They are convinced they were around when we were born, and we had a whole childhood before we began forming memories. But we know better. We know it, the way we know this chair upon which I sit while writing this. The way we know the keyboard. The way we know the music we like.
There was no "here" before us. As much as older people assure us there were cars and lines at grocery stores long before we existed - we are certain this universe sprung into existence with the big bang of our emergence. Because everything else is as real as fiction. We actually need a sort of religious faith to form the belief in the past. And there is no difference in our experience between the religion of "before we were born" and any other religious formulation developed by our species. There's a gulf of nothingness between "knowing" and "faith." When it comes to "before-we-were-born" and "after-we-die" it's all faith.
Is it any surprise, then, that we fear death? Even though each of us is guaranteed one, we approach non-existence in this 4-D space with horror. Because we know in our hearts there was nothing before us and so there must be nothing after. No joy. No pain. No hope. All we have is faith in what we have been told. And faith is rickety. Minds can be changed by either fact or miracles. The faith of our birth is not necessarily the faith of our death.
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I recently heard Norm Macdonald paraphrase Vladimir Nabokov. (Yes, I know. Looking to a comedian for philosophical advice is probably dumb. But maybe there is relevance in just listening to each other.) The concept is this - Nabokov's character sees a picture of his parents and his siblings on vacation at a lake. The character is told that this picture was taken before he was born. And he doesn't look upon that photo with horror. He didn't exist when that picture was taken, and someday he will no longer exist. Yet one of those concepts is simply fact and the other, terrifying.
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"The angst of facing mortality has no remedy in probability."
I read the book twice. The first time was three years ago. I read the entire thing while sitting at the Toyota dealership in Flagstaff waiting for my truck to be serviced. My body had not yet been fully assaulted by cancer, and the chemical battle oncology fought in blood and bones had not yet been conceived.
I read it as a naturally aging person who would inevitably live a long and healthy life. Disease was not in my mind. What happened to Dr. Kalanithi was a sad story I was reading. It was not my future. It was not guidance. It was an interesting well-written story.
Yet, the capital-T Truth was that my DNA was defective and causing my bone marrow to produce distorted white blood cells at a prodigeous rate. It just hadn't caught up with me to the point I actually believed it was there.
Yes, I had cancer in common with Dr. Kalanithi, but his was aggressive, non-treatable, and terminal. My cancer was statistically not terminal, and I felt that my positivity was keeping it in check.
Then it was another day. Most people will remember 2021 for the capital-P Pandemic. (I got COVID twice. Maybe I'll write about that horror later. It left me with scarred lungs and an altered brain.) I remember it for the lymph node removal surgery that confirmed my leukemia was officially a problem, and that chemotherapy had to be started or something bad would happen.
Now, after a year of chemically-induced misery and near intubation due to COVID pneumonia - I decided I wanted to re-read the Doctor's end of life journey. Maybe I was searching for some sort of guide to know what was next for me.
But reading about something is not the experience of something. Dr. Kalanithi realizes this - that as a doctor he was close to people experiencing terminal illnesses - but being terminally ill was very different.
I found this to be a physical fact of my own life. Setting foot on the South Pole of the planet was nothing like reading about it, or seeing the pictures. Being there for my children's births is nothing like being told about a father's experience of childbirth. Going through chemo is not like reading about it, or even watching your own relatives go through it.
But all of that is ok. This is the way we grow in our lives. We are given to imagination as a survival skill. We can imagine going through chemo, and deciding that things would have to be worse than we have ever experienced to actually consent to endure that. As much as we care to we can design our own internal stories to help us understand it.
What is missing from our internal musings is the way gravity works when you have cancer. Once you are diagnosed and something must be done, gravity stops working. You repeatedly fall through to the center of the earth. You learn you are now officially mortal. Fragile. And you exist at the very limit of human medical understanding. Aside from the statistics - which the docs never want to quote, but with which they religiously govern their practice - nobody actually knows with rock-solid certainty what will happen to you -- you, the sick person. You, the data point on the chart.
You are now in a realm of quantum uncertainty. You are an unwilling participant in humanity's science experiment. You can know your WBC with accuracy. Our machines measure that. But science won't predict if your liver will recover from the cancer or the chemicals. You can't know for certain your strength will return. If the fog will clear from your mind. If you'll ever get back your sense of taste, or if you will ever ride a bike again.
You can ask. And the oncological answer is a sympathetic look from your doctor, and then his nearly imperceptable shrug.
And this is a thing people experience. It simply is.
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I worked for Intel back in the days of Andy Grove and the late list. At the age of 27 I was hired as a 2nd level manager. They expected me to be an expert. I was shown my office and given a computer login. They showed me the org chart. Told me who my reports were and where they sat. And then they left me.
My boss said, "We have a saying around here. It's YOYO. Have you ever heard that?"
"Nope."
"It means, 'You're on your own.' And there's a small modification. Some people say YOYOMF."
When I asked my oncologist about my symptoms, and when they would abate, he gave me vague probabilities.
Then I knew that what I learned at Intel was not to simply survive managerial difficulty, it was a living truth.
Kalanithi says, "What patients seek is not scientific knowledge that doctors hide, but existential reality each person must find on his own."
In as theraputic a way possible, my oncologist gave me the same message as my first boss at Intel.
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Kalanithi claims Christianity as his religion. Says, "...the basic reality of human life stands compellingly against blind determinism." But then, "We are all reasonable people -- revelation is not good enough. Even if God spoke to us we'd discount it as delusional."
There is probably a God. But our human "reason" dictates that hearing directly from God is a symptom of sickness. So, there is probably a God, but we'd prefer he just stay out of our doings down here in Earth dirt. It's better for our collective psyche that God remains a non-physical construction of human culture.
"No system of thought can contain the fullness of human experience."
It was science and a practitioner of science that diagnosed my cancer. I didn't feel sick in any way. I had no clue.
There were blood tests and later DNA sequencing that pinpointed my ailment with atomic precision down to the individual defective gene.
I did not go to a holy man for the diagnosis nor treatment. I trusted in science. I sat in the comfy recliner with the IV needle in my arm and a bag overhead dripping poisons into my veins not due to any spiritual notion, but rather, because the sum and total of human scientific endevour dictated that was the proper course of action with the goal of prolonging my life. Two-hundred years ago the sum and total of human science would have dictated the application of leeches, or bathing in bovine urine.
Even today, spiritual healers might suggest Reiki energy manipulation. And I know people who perform this - and I did not go to them for help. I discounted that as possible delusional behavior. I went straight to science, and stuck with science.
Yet, I consider myself a spiritual person. I believe in God and the gravely misunderstood Jesus Christ. I also believe in the reality of Vishnu and Shiva. The ascension of the Buddah.
What my experience suggests to me is that "God" can be construed as being indifferent to my mortality. My suffering. My inevitable death. As I pointed out in a piece I wrote here on E2 years ago - the message of the crucifixion of Christ is not as I was taught by those earnest Dominican sisters, that "Christ died for our sins," but rather - What do you expect? Even God didn't survive here. Your fate is confirmed by your birth. But be joyous. Only the living can die, and as he demonstrated even death is survivable.
It's as if God is saying to me, "Ok, so you were born. You went to school. You bought Mother's day gifts for mom and traveled around the globe. You had three children, caught a lot of colds, sometimes the flu. You learned to drive a stick shift. And, oh yeah, someday you'll die. Let me know how it goes."
I don't feel this experience of being a senior-citizen with an incurable disease has in any way made me more spiritual. Rather, it has had me throw in my lot with science. And I don't feel belief in the scientific method excludes in any way my belief in unseen power and the truth of the soul, or visa versa. I have had people say, close people, say, "How can you believe in OOBEs and non-physical entities and the conclusions of science at the same time?" And I say that, to me, it's like comparing the physical reality of my boot size and the ecstatic joy I felt hiking the Grand Canyon in broken-in footwear. I've got friends from my more spiritual experiences who discount me when I suggest that perpetual motion machines are an utter waste of human effort. Thermodynamics does not allow it. If thermodymanics was a waste of time, none of our machinery would work. Not one thing.
The hierarchical division between these two ideas is a fabrication. One does not prove or disprove the other. We humans devised both of them because we needed to figure out what the hell we were doing here. And over the eons the two aspects drifted apart until some people felt more fulfilled by one than the other.
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God or heaven not withstanding, as I move forward through whatever remains of my life, my goal is to proceed with the highest degree of integrity.
"As long as you are dying, you're still alive."
That's kind of an existential concept - if "this" is all there is upon which you should be concerned as a possessor of life, then what makes the most sense for the individual is to proceed with with the highest degree of integrity he can muster All we can do is behave as well as we can. Paul Kalanithi may have felt the same way. His actions at the end of his life certainly display that to me.
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Of course, good people laud the dead. The cliche' is to say, "He fought so bravely. He was a hero." We do that because every time someone dies it reminds us we're ending up there too.
But as that comic Norm Macdonald said, who as we now know was dying of cancer at the time, "People always say, he lost his battle with cancer. Well doesn't that make him a loser? The way I see it, when you die of cancer, the cancer dies, too. So it's a draw."
That's what I'm aiming for. A good death that results in a draw.
I hope I can do it.
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EDIT: Hey just because this book review may be kind of bleak, I offer the data that as of 3 months ago I was in total remission and I expect decades of living ahead. Who knows exactly what entropy will dole out to me. But I am not currently in any danger of escaping mortality in a statistically abbreviated timeframe.
EDIT#2: Oops, I said I would someday write about having COVID the 2nd time and getting pneumonia and almost landing in the hospital for respiratory failure. And now I see I already did. Memory isn't so great these days, but improving.