A shadow from my memory, you are as thin as the wisp of yellow hair curtaining your delicate head, a head so long and round it dominated that small and trembling body as your hand reached up and found mine. You took hold of my finger as you took hold of life, for one strong year, as though you would eke out every last drop of time this world had to give. I cried for you in my sleep, your spirit took refuge in a stitched and crooked animal I plucked from a rack at your funeral. I do not remember your mother or your father there. I do not remember my own. But I remember you, this cherub, a pearl tucked snugly into your earthbound bed— a lesson in death and remembrance. You, my wisdom.
I wrote this poem a few months ago in response to a Poets & Writers prompt from their newsletter The Time is Now. I don’t write much poetry, but every now and then it’s one form of creativity that allows me to discuss something that I don’t talk about very often in a way that’s healing. I also submitted it to a few places, but I don’t think it’s going to be accepted anywhere. I don’t say this to be negative or pessimistic. I’m actually at a place right now where it doesn’t bother me to be rejected. I received another rejection for the poem while I was walking into the bathroom at work last week, and it didn’t affect me at all. I braced myself for a moment to feel a twinge of disappointment, but nothing came of it. I realized it just didn’t bother me the way it used to, and then I wondered if I wasn’t simply unmoved by the publishing industry entirely. I know what I need to do to make a piece work, and I know what it feels like to read something I’ve written and know that’s everything I have to give to it. Especially when I read something months later and know I wouldn’t make any changes.
So, who is Hannah? She was my cousin, daughter to my aunt and uncle, my mother’s brother, and born with a severe case of Down’s syndrome. She was born when I was 5 and died when I was 6 of heart failure, from what I remember being told. I didn’t follow the prompt exactly, because when I started to write the poem this particular memory dominated its form, so I went with it. I decided to write about the first time I met her when my aunt and uncle brought her home from the hospital. I was standing beside her crib and offered a small finger in welcome. She then grasped it, rather tightly, and then tried to stick my finger in her mouth. My mom swatted my hand and told me not to let her do that, so reluctantly I pulled away. Other than sitting in a chair in the sunroom of her maternal grandparents’ home after the funeral, where someone rolled a cart of teddy bears in front of me so I could choose one to take home, I don’t remember anything else about her. I remember her clutching my finger and I remember selecting a teddy bear from the cart after her funeral. Regardless, she made an impression, being my first real loss. It was devastating, but I don’t remember crying about it until I was a bit older. But there were several occasions before then where I would accidentally leave that bear behind somewhere and then lose my shit about it. I even left her once at a hotel at the beach, and somehow someone managed to get it back to my parents for me.
Sometimes I wonder if her death is the reason why I’ve had some mild abandonment issues in the past, and being that I’ve never written about her this way before made me believe that in doing so I could be healing a piece of myself that has long needed a salve. To bring it out into the open is daunting, and I’m still not sure I’m completely comfortable with it. I’m going through a period where I don’t want to be a writer anymore because I don’t want just anyone to know these parts of me, and I’ve realized I don’t feel the need to be published in order to validate myself. Which is definitely not to say those who choose to publish are merely validating themselves, only publishing for me became solely about that, and now that I’ve been published that particular process of being a writer has lost its luster. Even May Sarton complained of publishing’s business aspects in her book, Journal of a Solitude. It’s not that I think it’s outdated, only that I’m not in a place right now where I want to be published in a traditional way. It’s okay for me to simply post something on my blog because of how simple the process is. And if this is the most I become as a writer I can honestly say, at this point in my life, I’m okay with it. Because I’m still trying to figure out what I want professionally, and I don’t want to mope about something that’s not happening for me when I’m not even trying to work for it because I don’t know if it’s what I want in the first place. I love writing. It really is a soothing, if not predominately frustrating, practice. But I don’t want to continue carrying around this idea that I need to be published in order to feel like a “real” writer.
Earlier this year, I spent a couple of days in Greenville, SC for work. While I was on my way into the office one morning, I glanced out the window and saw an old historic home boasting a local bookstore.
Before I left Greenville that evening, I decided to stop by for a self-directed tour and was not disappointed.
The bookstore was called Joe’s Place, and before I even stepped foot inside I was already well in love.
The historic character of the house has a charming, boutique-museum feel. Not only is Joe’s Place a curator of literature, but it hosts local art, crafts incredible coffee, and stocks wine from family-owned vineyards in the southeast.
According to their website, the bookstore is named after the owner, Mary’s, brother, Joe, who passed away in 1999, but who left behind him an infectious spirit that Mary translated into Joe’s Place.
It is truly the kind of bookstore one can easily, and willingly, get lost in. The space is designed a bit like a maze, as though to lure guests from room to room, and there are endless quirky details to catch your attention and leave you lingering in a single spot for inordinate amounts of time.
Because I make it a point to buy at least one book every time I visit an indie bookstore, I left Joe’s Place with a copy of Bryan E. Robinson’s Daily Writing Resilience.
Since one of my 2019 goals (really, my only 2019 goal at this point) is to visit more bookstores in the southeast, starting with my home state of South Carolina, I wanted to share this lovely literary business before heading into the new year. If you ever visit Greenville, absolutely do not leave until you’ve had a stroll through Joe’s.
Do you make New Year’s Resolutions? I can’t remember the last time I made one. Every year, I have vague ideas about what I’d like to do differently, but I never put anything concrete down into words because I don’t trust myself to see them through. I have project-specific commitment-phobia. I might stick with something for a few weeks, but struggle just as things are starting to pick up. I don’t lose interest so much as I lose faith in my abilities, completely selling myself on the idea that I’m “not good enough” to go after something I want, which is becoming a tired insecurity. I’m only “not good enough” when I don’t put forth a substantial effort. People tend to put more emphasis on being rather doing, when doing is what will determine your state of being.
And the worst thing you can do after deciding on a thing is to overthink it, as the plight of the overthinker is that it’s easier not to do something than to think about doing it and how you’re doing it and whether or not you’re doing it well or right. My cousin, Emily (pictured above), once said something to me that I still haven’t been able to accomplish but that is a resolution in itself: “Decide on what you’re going to do, but first decide on its consequences.” Bad planning is refusing to see potential obstacles. This past year has shown me just how easily I’ve let obstacles stand in my way. Yes, they can be debilitating, but they don’t have to overpower you.
For instance, I woke up this morning with every intention of going to the gym when I realized a sharp pain in my neck would not allow me to do so. But while I wouldn’t be physically capable of lifting weights over my head or even accomplishing some of my regular yoga poses later that night, I could walk the stairs in my office throughout the day. No, it’s not exactly circuit training, but it’s something I could do to counteract the obstacle. There have also been nights where I only managed ten minutes of yoga or just stretched in bed because I couldn’t work in a lengthy practice. Don’t focus on not getting something done to the level you originally planned, but on not letting the obstacle defeat you. Push back however hard you can, in whatever way you can.
One of the biggest challenges I face when creating new habits is consistency. I used to make it really hard on myself. I’d plan out these intense and intricate schedules and routines, and if I slipped somewhere it would nip away at my confidence, my level of dedication, my resolve. My mind would immediately jump to quitting because obviously I couldn’t hack the workload. But then I learned I wasn’t creating a workload, I was creating a habit, and if these habits felt like work then I would inevitably fail.
It’s not that forming good habits doesn’t take a certain amount of work. Of course it does. But it has to be manageable in a way that allows your growth process to develop naturally, so that you’re not forcing your body into a foreign practice. I honestly believe that my body was at war with me sometimes when I first started working out, because I didn’t properly prepare it for the level of sophistication I wanted it to achieve. The same goes for my writing practice or my yoga practice or even something as domestic as meal prepping. They say “baby steps” for a reason. You have to build knowledge around what you’re doing before you can move forward.
So, for 2019, instead of making a handful of resolutions, I’m going to focus on two things: pace and response. I know I want to reinvigorate practices in writing, yoga, training, and meal preparation, but they all have to be in service to one another and they all have to be manageable habits. I usually don’t discuss things I want to do with other people because I’m afraid they’ll ask me about it and I’ll have to tell them that I flaked, so then I end up keeping it to myself and I flake anyway. The great thing about being open with others, especially people who inhabit your daily life, is that by doing so you create a support system.
Ideally, the people you open up with about these things will encourage you in your aspirations, but you also shouldn’t strive to make everyone happy. Of course, sacrificing your time to develop these practices for someone in need will be your call. You certainly don’t want to risk neglecting anyone you care about. And sometimes inviting someone who is in an emotional rut to partake in, say, a yoga class with you (or offering to do something within their interests) can not only be a way to sustain your own practices but to also be there for someone who needs you. You don’t want to be so strict with yourself that you develop no tolerance for leniency. Special circumstances are allowed.
What I try to avoid, though, is treating everything like a special circumstance. Sometimes, we come dangerously close to using non-urgent situations as an excuse not to do something. In that case, you are not sustaining a lifestyle, belief system, or habit, but saying that you never took yourself seriously in the first place. This is only negative because you lose your integrity this way. It’s like telling yourself, yet again, that you’re “not good enough” or worth putting in an effort for. If you don’t want to live the kind of life you’ve created for yourself, just remember to consider the consequences of disabling that life before you decide to change it. Will you be okay with that reality? I never was. 2018 taught me what I need in my life in order to thrive. It taught me what my weaknesses are. Most importantly, it taught me how to resolve them.
How do you design a life? I’ve been obsessed by this question lately, wondering exactly what it is I have to do or not do so that my mind can rest, so that I’m satisfied. On the one hand, people will tell you not to let yourself become complacent, but then when you’re not content with your circumstances that’s bad too. I feel sucked dry creatively. For years now, I haven’t been able to find a peaceful rhythm in my writing. My life has grown quiet, stagnant. I don’t mind the quietness exactly. Actually, I prefer it. But the stagnancy can be so anxiety-inducing as to become unbearable. I find myself creating projects I know I won’t stick with because I’m looking for a distraction from the things I want to do, but of which I feel impotent.
Saturday morning I stood at the stove cooking breakfast in silence. Usually, I put on a podcast or an audiobook, but I didn’t have the mental energy to follow along with anything. As I worked, I pained over the problem of my failing creative life. Why couldn’t I write? What was this block? Where had my spirit gone? When I was done, I placed the dirtied frying pan and spatula into the sink and a question sprang into my mind as audibly as if someone had been standing behind me. What interests you? it said. I stared down into the sink, at the plates stacked atop each other, several wine glasses circling them in tribute to a life just as neglected and chaotic. These dishes, I thought, these dishes interest me.
But every time I sit down to write I am haunted by the thought that no one will find what I have to say very worthwhile. It is the same agony I’ve picked at now for years, like a fiery scab. Last night, I was sitting up in bed playing a word game with my mom on my phone, and I had a thought that cracked the thin veneer of apathy I’ve been knitting together for the past year: “God may as well let you die, you’re not doing anything.” What shocked me was not how cruel it had sounded, but how fervently I believed it. I don’t consider myself to be a suicidal person, but the hatred I felt at my own mind was piercing. But then I wondered, how am I to know any better? We are not raised in this world to be kind, we are raised in this world to survive. When a horse is lame, for instance, or a dog has gone mad, you might issue a mercy killing. In that moment, I had failed myself completely, because I thought it would be easier to give up, to be put out of my misery.
I don’t write any of this lightly, but I don’t write it gravely either. I still have a sense of myself that is bright with future and longing. However, I don’t want to skirt past my weaknesses. I believe that in exposing vulnerability we build knowledge and authority—knowledge and authority for others to use as stepping stones, that is, not to dominate or belittle. It does not escape me that perhaps I struggle to write anything solid because I haven’t been completely honest with myself, so that when I write it is like a child who says what they think they’re supposed to say rather than what they truly believe or know. And maybe that’s the problem. I’ve distanced myself from God for reasons I’m not even entirely conscious of, and in so doing have robbed myself of any chance at growth.
I jump to him because he is the source of every ailment and happiness. If he created good, he also created the possibility for evil, and so I’ve come to understand that it is not my responsibility to prevent suffering but to design a life that behaves as an antidote to it. I will continue to be knocked down, but I certainly don’t have to stay there, and yet, I don’t have to push myself back up either. Usually, we have to sit with our suffering to build strength, and everybody sits differently. Writing is my antidote, writing is what I do when I sit and suffer. So many times I have built myself back up this way, and so many times I have fallen back down again, and so many times I have crouched in pain as though there is nothing I can do to help myself, until I realize that there is.
My point is that it’s okay to be wounded, it’s okay to need time, but don’t let yourself believe you are beyond hope, without tools, undeserving of compassion, especially your own. Christian teachings love to make us feel that we’re unworthy of God. But God is who made us, and “in his image,” after all. If we are not worthy of him, then what is?
Guilt is productive only as far as it connects us to our humility, but beyond that it is crippling and serves no one, a passive emotion that leads only to self-pity. There are things that are your fault and there are things of which you are innocent, and sopping guilt hinders our ability to deal with either. It did not occur to me until now that I struggle to write because I feel guilty about something, and until I figure out what that is and why that is–in essence, until I write my way into this discovery, until I acknowledge that writing is how I deal with this, how to heal myself–then my suffering will be wasteful, useless pain.
“Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.”
–Abraham Verghese, When Breath Becomes Air
Paul Kalanithi’s When Breath Becomes Air had been on my radar since its posthumous publication in 2016. A reader of the lifestyle blog, Cup of Jo, for many years, I knew bits and pieces of the Kalanithi’s story, Paul’s struggle with lung cancer, and the Pulitzer Prize nominated memoir that followed his death several years ago. Finally, in Birmingham, AL attending a training program for work, I bought my very own copy of his book.
The afternoon of my arrival, I decided to stroll downtown Homewood to avoid staying cooped up in my hotel room for my entire stay, and found Little Professor Book Center completely by accident. I’d walked into a boutique across the street initially, and when I left with a pair of earrings to gift to my cousin for her upcoming birthday, I looked up and saw the word “books,” which settled the question of my next destination. After much browsing and deliberation, I eventually left with Paul’s memoir, not knowing exactly what I would be getting myself into when I finally decided to read it seven months later.
I cannot say what exactly drew me to read this book when I pulled it from its perch on my bookshelf a couple of weeks ago. Perhaps my grandfather’s own battle with cancer steered my wandering hand as it lingered over the staggered spines of my books. Perhaps I was feeling lonely and craved the conversational tone of the memoir. Perhaps it was both of these things. What I can say is that no book has affected me quite as intensely and emotionally as Kalanithi’s in a very long time.
If you’re not already familiar with Paul’s story, he was diagnosed with lung cancer in May of 2013 at the age of 36. This is also where he introduces himself at the beginning of the book, sitting on a hospital bed with his wife, Lucy, as they grapple with their oncoming reality. However, in order for us to ascertain exactly how poignant his diagnosis is to him as a person, Kalanithi takes us back to his formative years, the years that led him on his path to neuroscience and neurosurgery.
As a child, his mother, fearing for the quality of his education in Kingman, AZ, where “the high school dropout rate was somewhere north of 30 percent,” instilled in him a love for literature by unearthing a college prep reading list from some unknown location and giving it to her son as literary guidance. At only ten years old, she had him read George Orwell’s 1984, which he wrote, “instilled in me a deep love of, and care for, language.” It was this book, in fact, that sent him on a reading frenzy, in which “books became [his] closest confidants, finely ground lenses providing new views of the world.” However, it was a former girlfriend’s suggestion to read Satan: His Psychotherapy and Cure by the Unfortunate Dr. Kassler, J.S.P.S. by Jeremy Leven that got Kalanithi thinking differently about the relationship between the brain and the mind. “Literature provided a rich account of human meaning;” he writes, “the brain, then, was the machinery that somehow enabled it.”
Throughout his years at Standford, Kalanithi would work toward “a deeper understanding of a life of the mind.” He completed degrees in both English literature and human biology, and in his senior year of college, applied for a master’s in English literature to continue his work of marrying the literary with the molecular: “There must be a way, I thought, that the language of life as experienced—of passion, of hunger, of love—bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats.” But even after completing his thesis, he felt that an English department could only take him so far in a specific direction. He needed to be free to plunder all directions, most notably the ones that allowed him to locate the intersection of biology, morality, literature, and philosophy. So he found himself applying for med school following a stint at Cambridge to study the history of medicine.
Studying medicine provided Kalanithi an access to reality that literature had failed to offer. When I was studying English in college at the University of South Carolina, one of my favorite professors wrote to me in an email that it’s almost better for writers to study something other than literature and writing if they can catch themselves before it’s too late. The marriage of a person’s proclivity for language with their chosen speciality can breed astounding insights into the human condition, and Kalanithi’s writing is nothing if not a testimony to that very notion. “Reading books and answering multiple-choice questions bore little resemblance to taking action, with its concomitant responsibility,” he writes. If his literary years allowed him to cultivate ideologies, his years studying medicine would “allow [him] a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.”
What makes a meaningful life in the wake of inevitable, if not immediate, death becomes Kalanithi’s specialty. This is the concern, he believes, from which good doctors are made. And the neurosurgeon, further still, “work[s] in the crucible of identity.” As he surmises:
“Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?”
This question becomes the basis on which Kalanithi stakes his claim in the world of medicine, neurosurgery being the most attractive field of study for its “direct confrontation with meaning, identity, and death.” And, of course, when he returns to Stanford for his residency, neurosurgery is the superior speciality, and neurosurgeons the elite of the hospital. But Kalanithi grazes over this with a few paragraphs before, one by one, leaning into the cases that molded him, not just as a neurosurgeon, but as a physician. And while he confronts falling prey to moments of fatigue and impatience, blockading his ability to connect with his patients at their most vulnerable, it is through this struggle to remain human in the wake of their illnesses that drove him in his practice. “Openness to human relationality,” he writes, “does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.”
Perhaps the most illustrative quote of this image he held as being the ideal doctor: “Had I been more religious in my youth, I might have become a pastor, for it was the pastoral role I’d sought.”
In a specialization that prides itself on perfection, the place of failure on and off the operating table was notably agonizing to Kalanithi. But that he gleaned one of the most poignant passages in the book from these experiences is a testimony in itself to the kind of doctor he was becoming:
“Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness.
Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking another’s cross, one must sometimes get crushed by the weight.”
This passage is especially gratifying during the second installment of the book in which the narrative surrounds his diagnosis. He is struck by this sudden lack of life his future self was once able to enjoy. But as is common when the word CANCER appears in the headline of one’s life, the ways in which that life must stop being lived are prominent in the mind of the cancer stricken. So Kalanithi is surprised when his own doctor opens the discussion for him to continue his life as he lived it before. He can go back to work, he can have children. “The fact of death is unsettling,” he writes, “yet there is no other way to live.”
So live he does. He and his wife, Lucy, visit a sperm bank, and in time he goes back to work. Pain wracks his days, not just physically but mentally, as he comes to terms with the unknowable time left to him and his family. But keeping his life moving in a forward direction consumes him. “Maybe,” he writes, “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.”
Just before his graduation, Kalanithi flies to Wisconsin for a job interview. Though he loses a professorship at Stanford, the chairman of this department, unnamed, excites him with possibilities. They know the time he has left is uncertain, and still they woo him with compelling offerings that make Kalanithi think it just may work, this life he’s been working so hard for, even in the face of his imminent demise. But then the reality of the situation hits him as he and the chairman are overlooking a frozen lake after dinner one night. “It was like a fantasy,” he says. There was no reasonable solution in which his dreams and goals reached fruition. In realizing this, he spends a lot of time wondering what he should do, where his focus should lie, what his values are, as his oncologist steadfastly reminds him. Who does he want to be now? In all of this searching, he comes to realize:
“…the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”
Kalanithi’s life continues in waves of physical chaos and stabilization. So he focuses on keeping his body strong. When his daughter is born, he finds in her “a blank page on which [he] could go on.” From here, he shifts his narrative from past to present. In her, he sees only future, and so he spends the remaining chapter in a kind of ode to her becoming. The reader may feel anxious, anticipating what is to happen. But even as his words near their end, as that final paragraph looms over an empty margin, Kalanithi, ever the physician, is there to ease our pain over a death that isn’t even ours with a message not intended for us, yet prescribing the very practice we should all make a habit of while there’s still time for ourselves and our loved ones. “That message is simple,” he writes:
“When you come to one of the many moments in life where you must give an account of yourself, 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.”
Through this book, Kalanithi became a steward for death, a philosopher on meaningful living, and a testimony to how a person dies manifesting in the quality of his life. For Kalanithi is not remembered by his cancer, but the substance of what his cancer brought out of him. As his wife, Lucy, gorgeously writes in the epilogue: “Writing the book was a chance for this courageous seer to be a sayer, to teach us to face death with integrity.” And thus, our lives, which are certainly better for having read his story.