As a major bestseller published a couple of years ago, Paul Kalanithi’s When Breath Becomes Air probably needs little introduction – but just in case: it’s a powerful memoir about a top neurosurgeon in his mid-30s coming to terms with terminal cancer (the book was published posthumously and has an afterword from his widow, Lucy Kalanithi).
One of the passages that I found most affecting was a segment where Paul weighs what he should do, not quite knowing whether he has months or years to live:
The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out…
It struck me that I had traversed the five stages of grief – the ‘Denial -> Anger -> Bargaining -> Depression -> Acceptance’ cliché – but I had done it backward. On diagnosis, I’d been prepared for death. I’d even felt good about it. I’d accepted it. I’d been ready. Then I slumped into a depression, as it became clear that I might not be dying so soon after all…
The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with my family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: what was I supposed to do with that day?
At some point, then, I began to do a little bargaining…then, after the bargaining came flashes of anger…
And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.
This seems to me to capture succinctly some key facets of the human experience. It seems like we all (or at least those of us lucky enough to be young-ish and without a terminal illness) have to traverse the line between death being probably a long way away and the knowledge that death or disease could strike at any point in time. We have to acknowledge that the rug could be pulled out at any point in time whilst simultaneously believing that it’s nailed to the floorboards. Or, to put it another way, we have to build for a future we can reasonably expect whilst ensuring that our day-to-day life is lived well and meaningfully.
So on the one hand we have to plan for the future: our careers, our families, our ambitions, our homes, etc. Kalanithi had spent the majority of his adult life training to be a neurosurgeon. He had been motivated to devote this time because he reasonably foresaw a career that would be measured in decades. Although most of us probably don’t reach the pinnacle of achievement in our chosen careers in quite the same way that Paul Kalanithi did, nonetheless, the impetus is recognisable for all of us. We are ambitious, we are striving, we have goals we want to achieve that require some kind of sacrifice – in terms of time and effort spent doing things that aren’t immediately rewarding but which have a longer term payoff.
On the other hand we all face the possibility that things could change drastically, that our future horizons could shrink and we’ll have to ask ourselves: ‘have I used my time well?’ Kalanithi was in a reasonably good position to answer this – as a neurosurgeon he routinely saved and improved lives. I don’t really have any regrets about my life so far, but I’m not sure I could so surely point to what I’ve achieved in quite the same way Paul Kalanithi could. I suspect I’m not the only one.
It’s not that working towards a future outcome isn’t meaningful or worthwhile – it’s more that focussing purely on the future at the expense of the present is almost as bad as the opposite (carpe diem). It feels like the things we do on a day-to-day basis should strike a balance between longer-term striving (certainty in a reasonable future) and valuing the anonymous and often unglamorous seconds, minutes and hours that life is made of.
What does this mean in practical terms? I think it lies in knowing the different answers to the question ‘what should I do with my time?’ assuming the amount of time is measured in decades, years or months. What if you live to be 90? What if you have five more years? What if you have five more months? We can’t really experience what it’s like to actually face the latter questions until they become a reality, but the thought experiment isn’t just a trite exercise, it helps us think about the difference in what is important given different levels of urgency.
Kalanithi’s answers to these questions are a good guide. With three months left, spending time with those we love becomes important. With a year left, we tackle the passion projects (in Paul’s case, the book he always wanted to write) that we put on the back burner because we’re always too busy with something else. Both of these answers are important, whether or not we think we have decades of time rather than years or months.
