If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live.
—Michel de Montaigne, “That to Study Philosophy Is to Learn to Die”
LYING NEXT TO LUCY in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician—my identity—no longer mattered. With the cancer having invaded multiple organ systems, the diagnosis was clear. The room was quiet. Lucy told me she loved me. “I don’t want to die,” I said. I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately. We started calling family members. At some point, Victoria came by the room, and we discussed the scan and the likely future treatments. When she brought up the logistics of returning to residency, I stopped her.
“Victoria,” I said, “I’m never coming back to this hospital as a doctor. Don’t you think?”
One chapter of my life seemed to have ended; perhaps the whole book was closing. Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany—a piercing burst of light, illuminating What Really Matters—and more like someone had just firebombed the path forward. Now I would have to work around it.
My brother Jeevan had arrived at my bedside. “You’ve accomplished so much,” he said. “You know that, don’t you?”
I sighed. He meant well, but the words rang hollow. My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced. The lung cancer diagnosis was confirmed. My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.
The sun was setting. I would be discharged the next morning. An oncology appointment was set for later in the week, but the nurse told me my oncologist was going to drop by that night, before leaving to pick up her kids. Her name was Emma Hayward, and she wanted to say hello before the initial office visit. I knew Emma a little—I had treated some of her patients before—but we had never spoken beyond passing professional courtesies. My parents and brothers were scattered about the room, not saying much, while Lucy sat by the bed, holding my hand. The door opened and in she walked, her white coat showing the wear of a long day but her smile fresh. Trailing behind her were her fellow and a resident. Emma was only a few years older than I, her hair long and dark, but as is common to all those who spend time with death, streaked with gray. She pulled up a chair.
“Hi, my name is Emma,” she said. “I’m sorry to have to be so brief today, but I wanted to come by and introduce myself.”
We shook hands, my arm entangled in the IV line.
“Thanks for stopping by,” I said. “I know you have kids to pick up. This is my family.” She nodded hello at Lucy, at my brothers and parents.
“I’m sorry this is happening to you,” she said. “To all of you. There will be a lot of time to talk in a couple days. I went ahead and had the lab start running some tests on your tumor sample, which will help guide therapy. Treatment may be chemotherapy or not, depending on the tests.”
Eighteen months earlier, I’d been in the hospital with appendicitis. Then I’d been treated not as a patient but as a colleague, almost like a consultant on my own case. I expected the same here. “I know now’s not the time,” I proceeded, “but I will want to talk about the Kaplan-Meier survival curves.”
“No,” she said. “Absolutely not.”
A brief silence. How dare she? I thought. This is how doctors—doctors like me—understand prognostication. I have a right to know.
“We can talk about therapies later,” she said. “We can talk about your going back to work, too, if that’s what you’d like to do. The traditional chemotherapy combination—cisplatin, pemetrexed, possibly with Avastin, too—has a high rate of peripheral neuropathy, so we’d probably switch the cisplatin for carboplatin, which will protect your nerves better, since you’re a surgeon.”
Go back to work? What is she talking about? Is she delusional? Or am I dead wrong about my prognosis? And how can we talk about any of this without a realistic estimate of survival? The ground, having already buckled and roiled over the past few days, did so again.
“We can do details later,” she continued, “as I know this is a lot to absorb. Mostly, I just wanted to meet you all before our appointment Thursday. Is there anything I can do, or answer—besides survival curves—today?”
“No,” I said, my mind reeling. “Thanks so much for stopping by. I really appreciate it.”
“Here’s my card,” she said, “and there’s the clinic number. Feel free to call if anything comes up before we see you in two days.”
My family and friends quickly wired through our network of medical colleagues to find out who the best lung cancer oncologists in the country were. Houston and New York had major cancer centers; was that where I should be treated? The logistics of moving or temporarily relocating or what have you—that could be sorted out later. The replies came back quickly, and more or less unanimously: Emma not only was one of the best—a world-renowned oncologist who served as the lung cancer expert on one of the major national cancer advisory boards—but she was also known to be compassionate, someone who knew when to push and when to hold back. I briefly wondered at the string of events that had sent me looping through the world, my residency determined by a computerized match process, only to end up assigned here, with a freak diagnosis, in the hands of one of the finest doctors to treat it.
Having spent the better part of the week bedridden, with the cancer progressing, I had grown noticeably weaker. My body, and the identity tied to it, had radically changed. No longer was getting in and out of bed to go to the bathroom an automated subcortical motor program; it took effort and planning. The physical therapists left a list of items to ease my transition home: a cane, a modified toilet seat, foam blocks for leg support while resting. A bevy of new pain medications was prescribed. As I hobbled out of the hospital, I wondered how, just six days ago, I had spent nearly thirty-six straight hours in the operating room. Had I grown that much sicker in a week? Yes, in part. But I had also used a number of tricks and help from co-surgeons to get through those thirty-six hours—and, even so, I had suffered excruciating pain. Had the confirmation of my fears—in the CT scan, in the lab results, both showing not merely cancer but a body overwhelmed, nearing death—released me from the duty to serve, from my duty to patients, to neurosurgery, to the pursuit of goodness? Yes, I thought, and therein was the paradox: like a runner crossing the finish line only to collapse, without that duty to care for the ill pushing me forward, I became an invalid.