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Two Good Books on Death and Dying

Posted in Reviews - of books, mostly by EloiSVM42 on January 5, 2017

When Breath Becomes Air

By Paul Kalanithi (mostly)

It was first said (circa 1665-68) by Francois de la Rochefoucauld that “Neither the sun nor death can be looked at directly.” Well, two fine writers have taken a crack at it recently, from very different viewpoints, and with very different styles, but each with credible results.

Consider the credentials of this 36-year-old writer: BA and MA in English Literature from Stanford; M-Phil (Master of Philosophy) in History of Science and Medicine, from Cambridge; Graduate, cum laude, from Yale Medical School; Senior Resident at Stanford Medical School. Would you consider this man capable of writing a meaningful book about clinical death? I certainly would.

Oh, and he has one more qualification: 14 days before becoming a Professor of Neuroscience at Stanford, he was observing a scan of a patient with Stage-4 lung cancer (read terminal). About which he writes, “This scan was different; it was my own.”

Such was the fate of Paul Kalanithi, a man of extraordinary intelligence with a sky’s- the-limit career before him, whose life hanged in an instant and whose death was foretold and near. His life – its length, scope and purpose had to be re-considered.

Paul planned to write a book, someday, after a distinguished career in medicine. Now the 30 or more years between his imminent graduation and far-in-the future plans are gone. He skips far ahead to book writing, but first he has cancer to deal with as best as is possible. (Note: I use Paul’s first name in this review because with all he revealed about himself to me in this book, it feels only right.)

Paul takes us through the details of his consultations, tests, treatments and results. Others have done similar recording and reporting before, though few have such professional insight or writing skills. And he adds something more. Common or rare among surgeons, I don’t know, but Paul gave a lot of thought to what it means and takes to lead a meaningful life. Ultimately, Paul came to a rather common conclusion – friends and family – which he calls, being a scientist/philosopher, “relationality.” But his thinking processes, intertwined with the events of his medical adventure, make meaningful reading.

Among the first decisions: his wife Lucy and he decided to have a baby, via in vitro fertilization, which is by now, we must infer, was all he was up to, to create a for comfort for Lucy when he is gone, and for himself if he lives long enough.

Thereafter, Paul’s life is simply a matter of living it out and recording it for us. When treatments permit, he works as long as he can as a surgeon – and then spends his remaining time with his wife, and, yes, with his new baby daughter, Elizabeth Acadia (Cady). Paul died with eight-month old Cady in his arms.
Paul did not live quite long enough to complete this book. Lucy added the finishing touches. We do not know how much of the book is truly his. Lucy wrote the Epilogue for sure, and her style seems a lot like Paul’s, which obscures the issue a bit. However, the vast bulk of the work is clearly Paul’s. The literary references and allusions are those of a Master of English Literature.

Caelica 83: You that seek what life is in death
By Baron Brooke Fulke Grenville

You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! then make time, while you be,
But steps to your eternity.

You should read this book, but there is a caveat. The New York Times reviewer wrote that “Finishing this book and then forgetting about it is simply not an option,” and I think he’s right.

Old Age: A Beginners Guide

By Michael Kinsley

Having heaped all that praise on When Breath Becomes Air, you may be surprised to read that I saved my favorite of the two books for last. Michael Kinsley is one of my very favorite writers, almost an idol to me, actually. His thinking is insightful, even on subjects you might think have been completely well worn. What’s more, his work, regardless of topic, is humorous.

Kinsley’s short book is as poignant as Paul’s; more insightful about death in some ways; definitely more practical about the meaningful life and how to live it; plus it is wicked funny, in both meanings of the term, which makes death a little easier to look at directly, but leaves no doubt about its ultimate result.

Kinsley approaches his subject from the point of view of the Baby Boomer generation (those born between 1946 and 1964), to which he belongs, and which is rounding the turn and beginning the home stretch to the finish. He assures his contemporaries that, “the best medical research indicates that eventually you’re going to be dead.”

Boomers are characterized by being especially ambitious and competitive, but while Kinsley thinks Boomers get a bad rap, he also acknowledges that there is some truth to this, particularly when compared to the sacrifices made by the previous, “Greatest Generation,” which won World War II and saved the world.

Kinsley admits being a classic Boomer, but with one rare difference: he contracted Parkinson’s disease at 43. This is much, much earlier than the disease generally presents. He has been fortunate in that his symptoms have been mild for much of this time, and even today are not as typically inhibiting. As he observes about Parkinson’s, “like its victims, it tends to move slowly.” Fortunate as Kinsley has been in this regard, still he has been dealing with this reminder of his mortality directly for around 25 years.

It turns out that Parkinson’s doesn’t kill that many people, though it did kill my father. Most people who get it do so later in life and usually die of something else before Parkinson’s gets them. But the diagnosis, Kinsley writes, “…is a pretty valuable warning shot from the Grim Reaper.”

This is not the case, Kinsley reminds his fellow Boomers, for old age. As for that, “We don’t need any tests. We can give you that diagnosis right now. You’ve got it, it’s progressive and (unlike Parkinson’s) it’s invariably fatal.”

Kinsley discusses the pros and cons of a number of ways to measure the value of lives in the competitive spirit of Boomers: material success (The one who dies with the most toys wins); longevity; cognition; finally settling on reputation, though only of a certain kind. (He has some fascinating ideas about reputation versus fame and celebrity.)

Fortunately, Kinsley tells us how to do this. If you want a good reputation, he says, “be good. And you better get started now, because after your dead, it’s too late.”

Kinsley even has an idea that would let the entire Baby Boom generation pass on with a good reputation, almost as good as that of the “Greatest Generation.” His proposal: pay off the national debt…about $17 trillion dollars. This will take a big sacrifice – not as big as getting shot and killed in your youth – but still huge. It will require a lot of contribution from every Boomer. It will require soaking the one percent pretty good. It will require (all but) eliminating the inheritance tax, something I’ve always advocated.

But, hey, paying off the debt would lift an enormous drag on our economy, and on the prospects of all those yet to come, and who by definition had nothing to do with creating it. Though I’m not technically a Baby Boomer – I was born a few years too early – I’m willing to chip in. How about you, young-uns?

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