Roy Exum: The Dead Man’s Lesson

  • Sunday, March 15, 2015
  • Roy Exum
Roy Exum
Roy Exum

There is a cute guy in Birmingham who is in an uphill fight with cancer. Sid Ortis is a big LSU fan – his parents are from Louisiana – and, when he finally came home after another tough surgery the other day, the entire neighborhood – house after house, street by street – was decked out in LSU purple-and-gold. The balloons and ribbons were almost as incredible as when the phone rang an hour or two later.

LSU football coach Les Miles didn’t just say hi-and-bye. No, sir, the coach and the young boy talked at length and before the conversation finally ended, Les asked the 15-year-old if he could pray with him.

And he did. The crux of their lengthy conversation? Coach Miles told young Sid that life is not measured by how long you live, but by how well you live it.

Ironically, another guy on the west coast just came to the same conclusion. Paul Kalanithi, a brilliant neurosurgeon who also obtained a master’s degree in English literature, wrote a story that appeared in the New York Times a while back entitled, “How Long Have I Got Left?”

Also a cancer patient, Kalanithi did exactly what he told hundreds of patients not to do. Rather than urging patients to avoid statistics and Kaplan-Meier graphs, the doctor-turned-patient was suddenly a statistics-driven researcher of his own disease. “As a doctor I learned … to be honest about the prognosis but to always leave some room for hope. Be vague but accurate; days to a few weeks, weeks to a few months, months to a few years …

“People react differently to hearing ‘Procedure Y has a 70 percent chance of survival’ and ‘Procedure Z has a 30 percent chance of death.’ Phrased that way people flock to Procedure Y, even though the numbers are the same.

“I would dissuade patients by telling them that five-year survival curves are five years out of date … but coming face-to-face with my mortality changed both nothing and everything. The fact of dead is unsettling but there is no other way to live,” he wrote.

“What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on their own. Getting too deep into statistics is like trying to quench thirst with salty water. The angst of facing mortality has no remedy in probability.

“I remember the moment when my overwhelming uneasiness yielded,” the doctor wrote. “Seven words from Samuel Beckett (that I read as an undergraduate) began to repeat in my head, and the seemingly impassable sea of uncertainty parted: ‘I can’t go on. I’ll go on.’ I took a step forward, repeating the phrase over and over: ‘I can’t go on. I’ll go on.’ And then, at some point, I was through.”

“I’m exactly eight months from my diagnosis,” he wrote in January, “and every morning at 5:30 my dead body awakes, and I think again to myself, ‘I can’t go on.’ A minute later, I’m in my scrubs, heading to the operating room, alive: ‘I’ll go on.’”

“Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire.”

Dr. Paul Kalanithi, the author of such prose, died last Monday holding on to one last wish.

He began, “I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.

“Yet one thing cannot be robbed of her futurity: my daughter, Cady. I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters — but what would they really say? I don’t know what this girl will be like when she is 15; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.

“That message is simple: When you come to one of the many moments in life when you must give an account of yourself, and provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”

Paul Kalanithi died at the age of 37. “I can’t go on. I’ll go on.”

royexum@aol.com

Dr. Paul Kalanithi holds his daughter Cady
Dr. Paul Kalanithi holds his daughter Cady
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