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risee-and-grind-blog1 · 6 years

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“Be ready. Be seated. See what courage sounds like. See how brave It is to reveal yourself this way. But above all, see what it is like to still live, to profoundly influence the lives of others after you are gone, but your words… Listen to Paul. In the silence between his words, listen to what you have to say back. Therein lies his message. I got it. I hope you experience it too. Let me not stand between you and Paul.”

Indeed, when breath becomes air was a touching and memorable read, urging us to search directly for what we buried deep in our heart all this time. Given that all organisms will eventually experience death, what makes their life worth living? To what extent could someone live a meaningful and fulfilling life with the knowledge that it will one day all be lost in oblivion? Paul’s book was indeed a blessing and gift to us all—as we journey with him through his triumphs and losses, we found ourselves increasingly searching for, grappling at who we are and what that means. What our lives are worth. How to live our lives to the fullest despite all the various restraints we might have. As we all mourn his death, no one can deny that his was a life filled with meaning, with striving, with bravery and acceptance, and this spurred me to, too, look within at who I was, what I wanted to do in life, and wherein I found my purpose and meaning. When breath becomes air; a book with a title as lyrical and melodic that echoed many of Paul’s quiet and reflective words in the essay deeply and profoundly impacted me in more ways than one, one obvious one being that his words helped to reflect some of the emotions I felt but could not quite spell out, another one where his masterful linguistic ability allowed me to see the world through his lenses, even if it was as a vestige.

“Getting ready for medical school would take about a year of intense coursework, plus the application time, which added up to another eighteen months. It would mean letting my friends go to New York, to continue deepening those relationships, without me. It would mean setting aside literature. But it would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what made human life meaningful, even in the face of death and decay.”

Even at the beginning of the novel, I was deeply moved and motivated by Paul’s words and the reflection of his younger self. Here, I saw a guy, who, despite being heavily invested in his friendships, was able to let go of them for a pursuit of something he did not yet of full knowledge of. This, to me, was the embodiment of a youth’s courage and striving, how he able to jump out of their zone of comfort to a world of the unknown in a search for a purpose and on the things that meant so much to him. While I cannot be sure whether this that particularly went against my careful, risk-adverse upbringing merely difference in culture; whether his encounter was a prosaic or at least accepted one in America, it still made me marvel at the sheer courage and fortitude that went into the decision. Deeming it reckless was not entirely right; this was not an act of thoughtless courage, but nonetheless, the capacity to take such big a risk for chance made me rethink of many past actions (how many times have I turned down or away from something because of the risks involved, or because I felt unprepared) and hopefully will serve a role when I make future ones. Hopefully, I too will find the strength in me to take the path less travelled, to manoeuvre myself away from a path I’ve endlessly strived for if the need comes to be.

“I spent the next year in the English countryside, where I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them.”

There’s so much truth in this, and this frankness and honesty is a rare find from mere textbooks or even in the life of academics. Whilst studying philosophy or famous quotes of world-renowned people could offer room for moral reflection, it cannot compare to the vastness of the real-world experience, where a brief encounter with death oftentimes leaves us breathless. After all, there is only so much we can learn from viewing the world through others’ lenses, and our feet might not fit when we try to step into their shoes. Our own experience, however, allows for all of that and more. It offers an undiluted range of emotions and thoughts that fill us, shape us and change us.

“Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feeling: from revulsion, exhilaration, nausea, frustration and awe to, as time passes, the mere tedium of academic exercise… Cadaver dissection epitomizes, for many, the transformation of the sombre, respectful student to the callous, arrogant doctor.”

The message here is rather clear: the slow dilution of feelings as one gets constant exposure to the human body after dissection, where the humanity of the cadaver gets slowly dissected with each cut and opening. It also serves as a warning for any aspiring student to stay solemn throughout the procedure, to continue comprehending the enormity of each action and the sacrifice of the donor even as features slowly disappear as students get muted by the procedure. It is a reminder to everyone that, no matter whether this was the first, tenth or hundredth cadaver, in the hands of the medical student lies a real person, with the full spectrum of feelings and all of their lives’ experience. Their eyes saw every moment left awake; their hands have held another in a passionate embraces, have held the palm of another; their feet have brought them miles and miles, have run in on the grasslands, have carried them day to day to work. Before any one of us have gone through their lives and experienced every moment, it will serve us well to remind ourselves to stay respectful at the person that now lay in front of the students, to embrace his humanity and life behind the now-soulless eyes. Feelings of detachments, I’ve read, can be also said as a defensive mechanism for these students to prevent them from collapsing under the enormity of it all, but I feel that this should have been a defining question when students choose their area of specialisation. Could they look at the now lifeless body and see the soul, the consciousness that now occupied it? Could they comprehend that and not break down from seeing the passing of a human life up close? And most of all, would they still see the patient after five or ten years? Or would these faces get replaced by the mere human anatomy due to a doctor’s jadedness? While this book serves as a gift for everyone, I believe it an especially precious one for those with keen interest to pursue medicine, allowing them a glimpse into the world and urging reflection and deep pondering before they took the plunge.

“As graduation neared and we sat down, in a Yale tradition, to re-write our commencement oath—… several students argued for the removal of language insisting that we place our patients’ interests above our own. (The rest of us didn’t allow this discussion to stay for long. The words stayed. This kind of egotism struck me as antithetical to medicine and, it should be noted, entirely reasonable. Indeed, this is how 99% of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you would find a job—not a calling.) ”

The constant exposure to death and the dying has an undeniable impact on muting the emotions of once-ambitious medical students; the idealism of their med school application essays tempered or lost. This scares me— the majority, if not all of these students went in with heart filled to the brim with caring, compassion, love. Nonetheless, I believe that there is a difference between loving with an open heart and loving others before yourself. Being a doctor requires us to be the letter. I’m still searching and trying to comprehend which category I belong in, but I pray so hard—for the sake of both these future doctors and their patients—that no one will enter the profession without truly knowing the extent of their love. A true doctor’s capacity to love should be infinite, if not barely finite. Selflessness should be the basic requirement for doctors; it is what will carry them through gruelling hours, tiring days, it is what allows them to view patients as individuals with hopes and fears instead of just an obstacle between them and a break. With all things considered, medicine is not an ideal career by the conventional benchmarks, simply because—as Paul so aptly phrased—it is not meant to be a career. It is a calling. Definitely, it guarantees those in the profession a lifetime of meaning and purpose, but doctors have to be prepared to give up so many things along the way: their free time, normal schedules, short hours, relatively relaxing work experience. Does your love for humanity trump the high costs? I, for one, am still trying to find out myself.

“As a resident, my highest ideal was not saving lives — everyone dies eventually — but guiding a patient or family to an understanding of the death of illness. When a patient comes in with a fatal head bleed, that first conversation with a neurosurgeon may forever colour how the family remembers the death, from a peaceful letting go to an open sore of regret. When there’s no place for a scalpel, words are the surgeon’s only tool.”

Many people perceive the doctor’s job as merely entailing the operating of surgeries or the stitching of wounds for the patients, but Paul has shown us once and again that it goes so much deeper and more complex than that. More than just the technicalities and scientific aspects, the surgeon I required to heal and mend the souls of those living: helping them come to terms with the loss of a loved one, allowing them to reconcile with themselves and be at peace; to let go. Alas, this is more easily said than done: even seasoned psychologists may take a long time to help families heal and come to terms with themselves after tragedy strikes — what of doctors who are racing against time to help these family reach acceptance? It has always seemed such a wondrous feat in my eyes. Ergo, more than the impressive feats of doctors saving lives in cases where chances of survival are nearly nil, what draws me to medicine is the gentle brushes the doctor works at the remaining souls; the attempt to bring the broken pieces of their hearts back together. When the difference reaped from the utterance of a single word made all the difference, surgeons have to be more precise and delicate than ever. While the process might be different from technical surgeries, the brevity needed is the same. Here, in the space where the sciences and humanities align, is where the true practice of medicine lies.

“Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what made medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”

The burden on the operating surgeon’s shoulder is one that many cannot even begin to fathom. In scenarios whereby the patient is unable to choose their path, they are the ones tasked with the often burdensome job of making the call: should this patient live? Or will the devastation be so great and possible salvation of him/her be so insignificant that it will be a mercy to just let him/her go? With emotional family members and loved one often too blinded by the person that once was to accurately imagine the one who will surface after the surgery and therefore at risk of biased judgements, the decision has to be up to the doctor. Which will be the path that — if not eliminate — reduces suffering? Where should they draw the line between the lives to safe and forgo? And how do they live, having the consequences of their decisions weighing down on them every day? Those placed in major decision-making roles surely understand the weight behind their every action: the difficulties, the struggles. And how much higher can the stakes be than that between life and death? Indeed, I cannot help but echo Paul’s sentiments that these burdens shape medicine into something that is both sacred and unimaginable; something I fear but yet just can’t turn away from.

“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 millimetres.”

Another thing that continues to intrigue me about medicine: while the relentless pursuit of excellence in other professions is driven by avarice or monetary yields, that in medicine is backed by duty and moral obligation. The stakes are too damned high for anything less than perfection. As how Paul quaintly put it: the desire to serve and help others may be a necessity, but that alone does not meet the basic requirement for practising medicine. It is simply not enough. Precision, speed and accuracy are also necessities in the practice: how else are the doctors going to save the lives of patients? Here, erring surpasses a mere technical mistake, it is deemed a moral failure. Doctors are hence required to stay astute and sharp around the clock, to give their 100%, 100% of the time. Anything else? Simply not an option. The enormity of meticulousness and care are also highlighted here. They are attributes I can yet use to describe myself, but will have to should I even have a wisp of desire to pursue medicine.

“As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know.”

A short quote; yet one that reflects in earnest about the limitations of the doctor. As much as the speaker may believe that their empty assurances of “I know how you feel”, “I understand what you must be going through” bring solace and peace to the recipient, the truth is that no individual can truly understand the extent of pain someone else is going through. Even for two patients faced with the same illness, a multitude of variables makes the suffering unique for each — be it physical hurt or emotional turmoil. This is something everyone (myself included) will do well to remind ourselves. Let’s practice substituting these hollow words for more substantial, concrete ones that people can actually hold on to. Listen with empathy, with a mind open to understanding and not one already corrupted with assumptions about things we know little about. It is only through so that pain may be alleviated.

“People always ask me if it’s a calling, and my answer is always yes. You can’t see it as a job, because if it’s a job, it’s one of the worst jobs there is.”

Many around me have expressed interest to pursue the art of medicine, and it always results in a niggling thought at the back of my head (“Are they sincere and genuine in their said desire to help others? Or are they looking to reap certain benefits from the profession?”) Honestly, I’ve never really understood the thinking of those who are attempting to pursue medicine with a desire to ‘strike it rich’ or become a ‘winner in life’. For every aspiring student thinking of the money they might get is a doctor struggling to pay his/her massive student loans; for every hot-blooded youth desiring the honour the profession brings are a hundred doctors who are on a 24-hour duty shift, and another hundred who haven’t had a proper meal for days. Whilst becoming a doctor may guarantee a stable income and stroke one’s ego, when viewed objectively, the costs outweigh the benefits in many ways. Besides the debts doctors incur from merely finishing medical school and the late start to the workforce, doctors are often placed in difficult positions and have to face hefty consequences for even the most minor of slip-ups. Unreasonable, ungrateful patients are also another part of a doctor’s everyday life (not much space for pride and ego there, hmm?) All these are factors I’ve either came or realise or bought up to me by concerned family and friend. I’m acutely aware of all of these and more, but yet giving up the prospect of medicine just seemed unfathomable to me. No matter how hard I tried to convince myself otherwise, the thought of patients out there in need of medical attention or families in search for comfort and closure just makes medicine impossible to refuse, not to mention the overwhelming desire to help people; to impact and change the lives of others for the better in any way I can, no matter how small that change is. It’s in the other things too: the passion for human biology and the desire to understand the function (or malfunction) of our bodies, the intricacies of the systems that makes up us, the adrenaline rush when one is able to recognize symptoms and point it to a particular illness or disease (in which the diagnosis can hopefully save or at least prolong the patient’s life), the marvelling of this perfect fusion between the sciences and the humanities, and the sacredness of it all. How can I possibly give it all up, when every bone in my body tells me to pursue it? Not sure if this is deemed a calling, though. The word calling to me has always carried the undertone of something sweetly beckoning, seeming to suggest a possibility of choice. The force that compels me, however, is much more relentless and unyielding. For all the reasons and more, I cannot not pursue medicine. Yes, I do want it; but beyond that one is a voice that tells me I need to do it—for the lives I will impact along the way, for the desire to serve and bring relief and alleviate pain. With that, I too, say: I want to be a doctor.

#when breath becomes air #thoughts #musings

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