November 13, 2020
Thoreau said “Read the best books first, you might not a chance to read them all.” Picture a white-haired gentleman sitting in a overstuffed, dark leather chair in his huge library. Books are arranged from floor to ceiling and book cases along the walls are crammed with them. Piles of them are arranged around an old man sitting in an over-stuffed chair and reading a single book. If a picture is worth a thousand words, this one hits the mark. I think I had better read good books first because I am running out of time.
Paul Kalanithi’s autobiography, When Breath Becomes Air is just such a book. Paul was a neurosurgeon who died of an aggressive lung cancer at the age of thirty-six. When he was a middle-schooler, his mother gave him great classics to read from Ivanhoe through Dickens. One after another he sailed through the adventures, romances, simple stories and awesome writing skills of great authors. Along the way he became fascinated with the connection of mind and brain. As Paul matured he decided that his life’s quest would be to study the physical basis of thought.
A word about Kalanithi’s unusual title. When Breath Becomes Air was inspired by Baron Brooke’s Fulke Greville, a collection of short, introspective poems from a British author whose life spanned the seventeenth to the eighteenth century (1650s to 1730s]:
Celica 83
“You that seek what life is in death,
Now find it in air that once was breath.
New names unknown, old names gone:
Till time ends bodies, but souls none.
Reader! Then make time while ye be
But steps to your eternity.”
So, the title of this book “When Breath Become Air,” is the moment of death or the ambiance of death itself.
One of the questions that interested Paul the most was what is the meaning of life. He was fascinated by the power of the human mind to reflect deeply on issues, to investigate the infinite number of places in the human mind and wander around in one or another seeking what was walled in. But, he also was intrigued by the human brain, the material organ which he felt generated all these great ideas.
As an aside, as I read Paul’s book I began to wonder whether the mechanism might be the other way around: Does the mind inform the brain first? But then what of the electronic probes which can stimulate tiny areas of the brain and elicit, for example, a feeling of intense sadness or a spasm of giddiness. Memory, a function of the mind, can be affected or even lost when the brain is damaged. Just think of the relentless progression of dementia in Alzheimer’s patients. A more fundamental issue are we sure that the physical brain issue does issue forth a non-material thing such as an idea? What about a complex of ideas? Is thought nothing more than activity in a nerve complex? Or is the conscious, subconscious and unconscious of Jung a separate reality informing the brain and the central nervous system?
Is it true that the brain is machinery that somehow enables the mind, even produces it? I still wonder whether thought, emotions, and whatever else that is immaterial about us could have other sources, physical or immaterial. Take the theory of structural Integration”a therapy devised by Ida Rolff. In “Rolffing,” a therapist uses force and pressure from her thumbs to trap muscles and break fascia which may release strong and significant memories. The person whose facial muscles give her the face of a rigid, unpleasant appearing individual becomes suddenly aware of demeaning methods of behavior training that were employed by her parents as they raised her. And she relates that she sees and hears her father saying to her that she’s a nobody, and ugly and useless besides. The repressed memory is released when the muscles are manipulated. So, where is that memory? Can a set of tiny muscles around a mouth release a recollection? Or, is the brain simply remembering what those muscles signify?
I have a memory of my grandmother bathing my feet and drying them while reciting a nursery rhyme as she dried each toe. But I never remembered that experience except when a therapist Roffled the muscles in my toes. I am sure this memory was released by the novel experience of the therapist working on my toes. I am also convinced that this memory was from my infancy. I could not have called up this memory because I did not have access to it until the therapist squeezed my toes like my grandmother used to do. I was unaware of that memory until far from my brain some kind of reservoir retained this memory. Or, did the stimulation of the squeezing of the muscles simply bring that memory to consciousness in my brain. Or, are the sensory nerves of my toes simply an extension of the brain itself so that “brain” in it’s ability to reflect upon itself could just as easily be located in my toes as in my head? (See next pg.)
I have no problem understanding that a series of electrical impulses surged through my sensory nerves back through the cranial nerves to wherever in the brain memorial impulses are interpreted for my consciousness. But all this is fascinating: to think that the brain is extended down to tiny muscles as part of the system or simply that there is another source of memory outside of it.
(I also can’t forget the writhing woman with eyes closed anguishing as she related her experience of undergoing five abortions. I don’t remember whether her anguish was because she was in pain during those procedures or whether she had remorse about being responsible for the lives plucked from her or whether she regretted that she had no children as she entered late maturity. But the memories were released during a Rolfing session. I don’t remember where in the cycle of rolfing treatments her revelation occurred)
Ida Rolf and her system of Structural Integration lives!
(Paul uses a few words whose meaning is new to me: “idyll” (p.30) (pronounced like “idol”)= a perfect time usually evocative of rustic themes/ “a happy or enjoyable experience or scene.” “to burke” — to strangle or suffocate secretly in order to obtain cadavers to sell to med schools.( p. 46) “burke him! originally meant to suffocate but later became any kind of cover-up. “that realization discomfits” (p. 49) — the feeling of dejection that came over him as he began to lose the sense of the dignity of the person he dissected. His cadaver no longer elicited in him a sense of the sacred. “Polymath” (p. 72) someone who can work with and through scientific, emotional or spiritual aspects of a single experience or just some one who knows much in many subjects –he or she of universal knowledge. “Hypothalamus” –a region of the forebrain below the thalamus which coordinates both the autonomic nervous system and the activity of the pituitary, controlling body temperature, thirst, hunger, and other homeostatic systems, and involved in sleep and emotional activity.
p. 75 — Paul describes how furiously working on a crashing patient, his pager goes off with requests for sleeping meds, or attn to a change in a patients condition. How do you do two or more things at once: Think fast, don’t worry about perfect solutions, just attend quickly to one or the other and move on with more deliberation to the urgent case. A triage of busyness.
p. 86 “A truculent vet(eran)– a guy quick to argue or fight defiantly. “dehiscent” — a wound pod, fruit that breaks open because it is corrupting, over-mature inside so it breaks its seam or simply pops the skin.
“talus” – The sloping rock debris at the base of a cliff (Tay-lus)
(p. 44) “He was caught unawares.” “Unawares” is an adverb, and holdover from old English and it is correct. BUT, “He walked down the corridor unaware of the banana peal in wait for his foot” because it’s an adjective.
p. 49 or so. “bathos” triteness, sentimentalism. An instance of the commonplace in the midst of the extraordinary. A film that squats in its bathos. (sic, mine)
Back to Paul Kalanithi: What is the meaning of life which for him also involves what is the meaning of death? What makes human life meaningful? (p. 30). Wanna find out? Then experience life, not just read about it. Go live on a mountaintop in Costa Rica not just read about the geography. Actually hear and see Howler Monkeys growling loudly in the tops of the jungle trees on a misty morning and how eerie it is; experience the swirling upheaval of the warm Pacific wind as it swoops up to meet the heavy cool air of the mountains, a maelstrom of grey clouds dancing to sort it all out as the sun is setting in he Pacific. How dramatic it is.
P.88 “Had I been more religious in my youth, I might have become a pastor, for it was the pastoral role that I sought.” He is talking about his calling to lead his patients thru whatever dx or sickness that they were experiencing and not just applying curative medicine.
For me: Each parishioner who suffers is a chance to forge a covenant with a burdened disciple, a compatriot. Those who reveal their sins in all their evil, their weaknesses that to them are intolerable, the doubts about the existence of God or rather as one of Flannery’s characters says (Tarwater in The Violent Bare It Away) speaking of the God he feels has yet to act in his life: “God hasn’t noticed me yet.” All the self-revelation of the confessional the bitterness, the anger, the embarrassment, the confusion, the hurting of loving someone whom you can’t seem to help, all this as a pastor I’m supposed to help heal and lead them through. It’s “active listening” but with direction sought or received from the Holy Spirit. How do I reveal the path –not to the other side, but to the waiting Jesus. (Can I do this for them when I make only small steps toward Our Lord myself?)
For me: I as a pastor must risk forming human connections. If I avoid them, if I am sure that I am better than them, that they are unworthy of my attention because I don’t like how they look, or talk, or dress, or that they are too demanding, or crude, or hateful, or if I don’t like the way they treat their children or husband or wife; or, if I feel too much of an attraction to them– I will not try to connect with that person.
For me: That connection is a bridge of trust that has to be instilled in parishioners by me because I am the person Our Lord has put in the path of the needy one. I have to decide when a person just needs my ear but also needs my tongue –and the wisdom to know the difference.
(p. 90) “disaster”– an unfavorable condition because the stars of the universe are misaligned for me. Or, worse when the star explodes. e.g The ultrasound of the heart shows a rapidly declining function which will end soon in death. This is a disaster for the patient. You can see the light go out in his eyes.
The best answer to continuing to face life in the midst of a disaster is to hear yourself come to this conclusion, the seven life-giving words of courage to the feeling “I can’t go on!”, is “I can’t go on. But, I will!” A form of Churchill’s 7 words for life “NEVER (X 5) GIVE UP!”
(p. 96) The seeker or the troubled shouldn’t be hit with theological reasoning or morality proscriptions on the first day. You meet people where they are at. You start slowly on the front steps of the church, carefully move into the foyer of the church, take them up the aisle and enter the apse only when you think they are ready for the revelation of the Eucharist, the mercy of the confessional, and the secret of Jesus within you.
(p. 125) “Without duty pushing me forward, I became an invalid.” { Jobs end, duty endures. I might not be able to work until the end of my days but duty will lead me on. The duty to hear the calling in every moment: the call to pray for the world; the call to be a disciple right now; the call to thanksgiving; the call to listen for His voice.}
(p.129) “Have a plan A, B, and C at all times.”
(p. 132)”I knew some day I would die, but I didn’t know when.”
(p. 143) ” The defining characteristic of the organism is striving.”
(p. 147) Shouldn’t terminal illness be the perfect gift for the young man who wanted to understand death?”
(p. 171) The main thing about the bible is that mercy trumps justice every time.”
(p. 151) “It’s not a job, it’s a sacred thing to help in intimate contact with another human being.”
Cardiogenic syncope — fainting — in the presence of fear, horror. The autonomic nervous system shuts down the heart: E.G> At a terrible accident where a car slams into an unyielding wall and six people are dead, crushed into one another or where another young man faints at the sound of the E.R. doctor clipping off the end of the mangled index finger of his buddy or the mature med student who faints at the dissection table in the presence of a “fresh leg” separated from the body. {The blood pressure drops as your heart for a few moments slows down, vasovagal syncope.} A condition affecting 3 % of men and a bit more with women. You lose consciousness for a brief time and then when you fall your heart rate returns to nl.)
(p.167) “In the doc’s purview” means from the doc’s point of view or from her perception or outlook. Although the scientific questions may be answered, the existential remain. E.G. “We know he has seizures because of this malformation in the frontal lobes.” a med answer to why he seizes. But ultimately why he seizes, why this condition has happened to him is an existential question which science cannot answer.
GRIEF — stages of: denial, anger, bargaining, depression, acceptance.
E.G. Paulito == How cd they choose anyone else? It makes me furious. I’m going to talk to him, maybe we can work this out. It hasn’t worked out and I am stuck with this. I have to move on. It also works in reverse: I accept my dx. It makes me sad. I’ve got to figure out how to manage this; what can I do? This is crap. Why me? It can’t be me. This can’t be true. (p. 193) “I needed the oracle to scry again.” The oracle is a seer who gazes into a reflective surface.
(p. IX) Introduction/dedication/ theme “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.” Baron Brooke Fulke Greville, “Caelica 83)
