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When Breath Becomes Air: Life, Meaning and Mortality




By Laura Rathbone BA BSc MSc


Part one: a good life

Part two: a good death

"I could hear Emma's voice again: You have to figure out what's most important to you."

This is a book about dying. And in the dying, finding the meaning to a life well lived and a person well loved.


In the health care and medical field, the life road to success is well-travelled and the path beaten down by the feet of those who travelled before us. It can sometimes feel like once you've decided to dedicate yourself to serving the health needs of the society around you, you have stepped onto a full and busy pilgrimage towards some lofty goal.


Idealised, romanticised, and ultimately plagiarised.


Why plagiarised? Plagiarism is the act of taking someone else's idea as your own. There is a thoughtlessness to it. you don't need to have gone through the process of reflection and creation, you simply adopt it.


How many of us have really considered WHY we decided to come in to healthcare? I mean really, why did you not only choose to be the healthcare professional you are, but why do you keep choosing it?


"medical school sharpened my understanding of the relationship between meaning, life and death"

I think I appropriated my role in healthcare from my mother, inspired by my father. But also, because I thought it might make me a good person. If I dedicated my life to helping others, then surely I was selfless?


But something else happened as I developed into the clinician into I am today. I found a much deeper meaning in the work and how I looked at life. As a Physiotherapy student I nursed people in the local hospital, sat with them as they died, comforted their grieving family, restored to dignity the unwashed bodies of the frail, the elderly and the homeless. Becoming a clinician is not event, it's a process. And in the doing I found the point of it all.


To bear witness to and support the transformation within the person that goes through ill health. As a Physiotherapist, you might think that we don't dabble in identity and existential healthcare....but the longer I am a clinician, the more sure I am that this is exactly our landscape.


Paul Kalanithi goes through this process of realisation too as he journeys towards his goal to become.a respected neurosurgeon and to have a good death as he journeys with his own experience of cancer. His literary elegance and the depth of his experience are a real gift to those of us practicing in healthcare, and to any human that might at some point experience their own death.


"while all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of ourselves"

Kalanithi's experiences as a Doctor, student of medicine and literature, and ultimately as a patient help uncover the truth for him between the patient and the clinician - hope. For Kalanithi, medicine and clinical practice is a "commitment to one's own excellence and a commitment to another's identity". For him, the quiet practice of excellence allows us to hope for the patient that they can continue forging forwards as a human in the world, full of meaning and value despite the reality of illness and the ever present possibility of death.


"...the question is not simply whether to live or die but what kind of life is worth living?"

In part one of this book: In Perfect Health I Begin, Kalinithi reflects on how his work within medicine and neurosurgery brings him to questioning the meaning of a 'good life'. He takes us through his experiences with patients, grappling with the idea of not just keeping people alive, but of helping people turn towards their life - even if that means it is coming to an end.


I find it remarkable, that a life of seeking down into the beauty of the nervous system ultimately ends with a realisation that it is the whole person in their world and connected to their people that matters. This existentialist approach to understanding what it means to be a person and a person with pain and disability is a key journey that many of us on Pain Geeks will be able to relate to. And yet, as I read the book, there was a philosophical conflict for me, because Kalinithi appeals to a phenomenological approach but uses property-dualism to explain this. By that he considers the person's identity to be within the brain, and this is why he felt so connected to neurosurgery - because in his understanding - he was working directly with the person's sense of self.


Towards the end of the book, he concludes after much reflecting:

" ...the physician's duty is not to stave off death or return patients to their old lives but to take into our arms a patient and a family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence."

This speaks to my physio-core, because this is a model of rehabilitation. What do we do, we take the patient into our arms (sometimes literally!) and we work with them until they can stand back up and face, and make sense of their own existence. Often, that is through a temporary disability, like a broken leg, but it can also be coming to terms with an acquired or congenital permanent disability. We are working at the intersection of human and world.


How does he make sense of his life and his world, as an "ambassador for death" as he puts it? Literature.


"Literature not only illuminated another's experience, it provided, I believed, the richest material for moral reflection"

Kalinithi speaks to the Pain Geek in me when he advises us to sense make through reflection, creative expression and reading of the studies of life - poetry, philosophy, art and literature. I couldn't think of a more profound summer read for our community of deep-thinking and deep-caring clinicians.


And so I leave you with this final quote from this beautiful book, because I think it really encapsulates the philosophy of Pain Geeks as a community platform for sharing our knowledge and wisdom with working in the field of pain:

"Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete."

Thank you for reading

Laura :-)



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