After sobbing wretchedly through the last chapter and the epilogue of “When Breath Becomes Air,” I sat for a while in silence, trying to absorb the weight of this incredible person’s life. As an aspiring physician-scientist who can’t stop turning over unanswerable questions, his words resonated with me.
But there was one thing I couldn’t get over: the fact that at every crossroads, he chose a grueling career that demanded everything – his time, his sleep, his health, his hours with the people he loved. Part of me understands that neurosurgery is his identity, the thing that makes him feel most himself. But part of me just doesn’t understand how someone could choose, again and again, to spend their finite life witnessing other people live theirs?
So, I’ve been having a conversation with him in my head. It goes something like this:
*****
Paul: What do you want to pursue? You also seem to relish turning over moral, philosophical, and biological dilemmas in your mind. Is neurosurgery on your list of careers?
Me: If careers were the only thing in life, yes. I think I’d choose what you chose. But gosh, I don’t think I’m that selfless.
Paul: What do you mean? Is work-life balance holding you back?
Me: Sort of. As a neurosurgeon, you sit at the nexus of what it means to be human. You don’t just keep bodies alive. You make decisions hinged upon factors like quality of life and identity. A family receives the worst news of their lives, and you have to help them absorb a brain cancer diagnosis and decide whether they can live with the version of their mother who exists on the other side of a possibly personality-altering operation. There’s no specialty more philosophically loaded.
But that work costs so much. To do it well, you almost take on your patients’ lives as your own. It seems like the neurosurgeon’s own life is put on hold. Your own evenings, your own dinner table, your own hours next to someone you love.
You got to wrestle with the deepest questions about being human by bearing witness to other people’s lives. But what about learning by living your own?
Paul: It was my calling.
Me: Yes…and that line in your book stuck with me, because it made me understand how rare and brave it is to actually answer a calling when you hear it.
Paul: But?
Me: But I think about the choice differently. And I want to push back on you a little, if you’ll let me.
You wrote that life’s meaning lies somewhere in our relationships with other people. You cherished the memories of you and your friends embarking on adventurous escapades and having long, late-night conversations. You took a college summer to be a prep chef instead of interning in a lab, because you wanted to live a rich life. You wrote so tenderly about your wife and your daughter.
And then you chose a career that asks you to be elsewhere. Almost all the time.
That’s the contradiction I keep circling back to. You said the answer was in human relationships, and then you chose the work that would let you witness more of them but inhabit fewer of them. So I have to ask. After you were diagnosed, was there any part of you that wished you’d taken a different path?
Paul: It’s a valid question. Here are my thoughts.
You’re framing it as a trade where living life is on one side and witnessing it is on the other. When I stood at the operating table with someone’s brain in my hands, I wasn’t away from my life. These patients and these moments helped me understand what I had to lose. Because of them, I cherished my wife and my friends more than ever in the time that I did spend with them.
You imagine life as a finite room, and a calling like mine asks you to give up too much space. But for me, the room got bigger the more I put into it.
Me: Maybe. Maybe it’s not a zero-sum exchange the way I keep imagining. But my room still feels finite. Every hour I spend working is an hour I’m not laughing with my friends into the night or making dumplings with my parents in the winter. And I think I’d grieve those moments if I traded them for the OR.
So maybe the question isn’t whether your path was right. Maybe it’s whether it’s the right one for me.
Paul: That’s a fair distinction. A calling isn’t a moral standard. It’s just a particular shape of life that fits a particular person. Mine fit me. It doesn’t have to fit you.
Me: Can I ask you one more thing?
Paul: Go ahead.
Me: In your last chapters, you struggled with the question “Who am I now?” When you could no longer operate, you had to figure out what was left of you without the “surgeon”. I wonder if that means, at the end, the thing that matters most is identity? Not relationships or memories, but the answer to who you were?
Paul: I think you’re separating things that aren’t actually separate. My relationships were a part of my identity. When I realized my end was coming sooner than expected, I just had to figure out which relationships – with people and with intellectual interests – I wanted to invest more of my time in. Becoming a father didn’t feel like a deviation from neurosurgery. It was my value of ‘wanting to matter’ taking on a different form. Writing when I couldn’t stand up for long surgeries was just my value of ‘wanting to create and solve’ taking on a different form.
I asked “Who am I?” because I needed to know what I could still do with the limited time I had left.
Me: I see. Thank you, Paul. You’re such a strong person.
*****
I notice that my imagined Paul gave me the answer I wanted to hear, which is that he didn’t have to trade anything away. But the real Paul didn’t always sound that resolved.
I don’t think I’ll ever be able to resolve this. My imagined Paul makes a case I can’t quite refute and can’t quite adopt. But I suppose that’s the beauty of life. There are billions of ways to live it.
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