An Extraordinary Life

“Death, be not proud, though some have called thee

Mighty and dreadful, for thou art not so”—John Donne

On a Sunday in January, 2014, I opened the New York Times Opinion section and stumbled upon one of the most unusual essays I had ever read.  It was written by Dr. Paul Kalanithi, who at the time was a 36 year old neurosurgery resident at Stanford who had been battling metastatic lung cancer for eight months.  Here is a link to the essay, entitled “How Long Have I Got Left?”– http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html?_r=0    The author’s point was one well understood by cancer patients everywhere—if the doctors could not tell him whether he had a month, or a year, or ten years, how could he possibly determine what his priorities should be and how best to live his life?  Should he finish his residency?  Should he write a book?  Should he have a child?  In his worst moments he wrote that he fell back on his first love—literature.  In the last sentence of Samuel Beckett’s The Unnamable, Kalanithi found a mantra to live by: “I can’t go on.  I’ll go on.”

As it turned out, he did not have long.  Despite the optimistic and sometimes humorous tone of the essay, Dr. Paul Kalanithi died of his lung cancer 14 months later.  But not without first doing ALL of the things he mentioned in the essay.  He finished his neurosurgery residency as chief resident. He repaired a fractured marriage.  He had a child.  And to our great benefit, he wrote a book called “When Breath Becomes Air” published posthumously in January of this year—a book which despite my oft stated incredible reluctance to read anything I know will make me cry, I grabbed off the shelf the minute I spotted it in a local bookstore.   I was not disappointed, and yes, I cried.

The courage of cancer patients, and of all patients facing life threatening disease astounds and inspires me.  Many go through grueling and exhausting treatments and manage to put one foot in front of the other—they “can’t go on…they go on.”   Paul Kalanithi not only went on…he wrote about his experience in a book that will stand not only as a cancer memoir, but as a profound piece of writing.  When faced with dying, he chose life by completing his training, by having a child, by believing every day that he still had much to offer.  In an essay for Stanford Medicine he wrote words for his infant daughter which were included in his book: “When you come to one of the many moments in life when 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.”

I hope you get a chance to read his book.  Even if it makes you cry.

You Know You’re at a Plastic Surgery Meeting When…

My friend Dawn and I recently attended an evening meeting of the Houston Society of Plastic Surgeons.  Since we were invited guests, and not plastic surgeons, we didn’t stop on the way into the lovely formal dining room to pick up our name badges because the organizers had not made them for us.  On the way out, however, we both noticed clear plastic perfectly formed oval objects sitting on the table, looking for all the world like crystal paper weights.  I picked one up and it slithered out of my hand, slippery as a water balloon.  It was then that I realized that the beautiful paper weight was indeed, a silicone breast implant made by the company that sponsored the dinner.  After all, what do you expect when you attend a gathering of the plastic surgery clan?

I have learned in medicine to expect the unexpected.  The reason that I got in my car and drove 970 miles from Santa Fe to Houston was that my father, now nearly 91 years old and an emeritus Professor of Plastic Surgery at Baylor College of Medicine, had been asked to give several lectures as a visiting Professor for the residents and fellows in training.  Several is a bit of an understatement.  He was actually asked to give five separate talks, including three on consecutive days at 6:30 am, because as we know, surgeons start their days early.  After assuring Dad that I would not be getting up to attend ANY 6:30 am lectures, I set out for Houston in the midst of some of the worst rainstorms and flooding seen in that town in over thirty years.  Dad has had to curtail his practice over the last few years due to significant health issues, and when he came down with a bad cold days before the trip, I tried to no avail to convince him to stay home.  He of course wouldn’t hear of it.

His assignment for the evening lecture last Thursday night was to talk about his surgical missions overseas to repair cleft lips and palates, other birth defects, and contractures due to severe burns and other injuries. Especially since he retired from active practice, he has participated in several trips a year with Surgicorps International, traveling to Guatamala, India, Bhutan, Viet Nam, Zambia and other countries to attempt to give a normal appearance, and thus a normal life, to those unfortunate enough to require his services.  Devoted parents travel great distances to wait all day for their children to be evaluated, and once the schedule is set, surgeries proceed for the next 7 to 10 days, twelve hours a day, until the work is done.  Dad methodically showed the construction of each trip, from soliciting donations, to transporting equipment, to evaluating prospective patients, to post-operative care. At the end of his talk, he showed a blurry photograph of a 43 year old man who had lived his entire life with a severe facial deformity.  He told us that when the patient woke up in the recovery room, the first thing he asked for was a mirror.  When he saw his own face, swollen from surgery, but yet distinguishable as a normal human face, this patient burst into tears.  As my father told the story, everyone in the room did the same.

Plastic surgeons often get a bad rap.  In our youth driven, appearance conscious world, it is all too easy to make jokes about their bread and butter cosmetic work—the breast implants, the face-lifts, the nose jobs, and the botox.  At dinner last Thursday night, my friend and I, and the residents in the room, were privileged to catch a glimpse of what these talented surgeons can do to change the life of a child, and that child’s family and future.  The residents in the room are lucky—in a few years they too will have the skills to give the gift of a normal appearance and normal function.  As for me, well, I think it’s time to get back to work treating cancer patients.