When Breath Becomes Air

When Breath Becomes Air

“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 simply:

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.”   Paul Kalanithi, in a letter to his daughter.  Excerpt from When Breath Becomes Air

My brother passed away from pancreatic cancer last fall, and I didn’t feel quite ready for When Breath Becomes Air, a Stanford neurosurgery resident’s memoir about his cancer diagnosis. Also, in my work as a clinical librarian, I’d spent time supporting and rounding with clinical staff in neurology/neurosurgery. I had a special affection and respect for the brilliant, hard-working residents, who were about the same age as my sons. So to read about the death of a young resident from lung cancer….

But if you are a living, breathing person who likes to read memoir and nonfiction, and if you consider yourself an engaged participant in our death-denying culture, I would say When Breath Becomes Air is required reading.

One of my favorite authors, Ann Patchett, who owns a bookstore that practices the art of making personal recommendations to readers based on their interests, says, “This is one of the handful of books I consider to be a universal donor – I would recommend it to anyone, everyone.” 

On publication, When Breath Becomes Air shot to number 1 on the New York Times Nonfiction Bestseller List. So when I saw Paul Kalanithi’s memoir on our library’s “Most Wanted Book” shelf, I decided to grab it.

Paul Kalanithi set out to be a writer and then switched to medicine and neurosurgery, one of the most challenging and consuming of all clinical disciplines. He believed that a person’s brain determines his identity, which is inseparable from his values and sense of life’s meaning.

Finding meaning was all-important to Kalanithi. During his residency, Paul came to see it was his responsibility to do his best to give his patients the quality of life that would allow them to live according to their most precious values.

We need more doctors who have both the time and desire to get to know and serve their patients in this way, wouldn’t you say?

In his memoir, Kalanithi says the twin pursuits of caring for patients with brain illnesses and writing as a way to explore the meaning of life’s joys and traumas was his perfect calling.

It’s just that he hadn’t planned on doing the writing part until much later in his career. Many months after his diagnosis, when he could no longer work as a neurosurgeon, Paul chose to use his remaining time to write a memoir that, among other things, explores living and dying from the unique perspective of someone who is both a patient and healer.

He and his wife decided to have a child, too. Paul writes of becoming a father with great joy. It reminded me of last summer, when my brother (and our extended family) lived with end-of-life illness, even as we celebrated his daughter’s wedding.

As you can see from the memoir excerpt above, Paul was an extraordinary writer. Medical humanities literature, also known as narrative medicine, written by patients, doctors, nurses, and clinicians, is really coming into its own, and I think When Breath Becomes Air will become a classic.

Paul Kalanithi stands right alongside Anthony Verghese, Danielle Ofri, Sherwin B. Nuland, Tilda Shalof, Theresa Brown, Atul Gawande, Oliver Sachs, and others as one of the best. Really, his memoir is not to be missed.

“The fact of death is unsettling. Yet there is no other way to live.”  Paul Kalanithi

Below is the trailer for When Breath Becomes Air.

Have you read When Breath Becomes Air, and what did you think? Have you read another medical humanities or health related memoir, novel, or essay that you have especially liked? Please share your thoughts and recommendations in the comments.

 

The Cancer Survivor’s Garden Companion

Cancer Survivor's

The Cancer Survivor’s Garden Companion, by Jenny Peterson

 

“‘Don’t let cancer define you, Jenny.’ So how did I not let cancer define me? Not knowing anything better, I simply kept doing what I knew to do. And one of those things was gardening….I’m not going to lie –  I had many days when I did not feel like gardening. But I decided to change my approach and focus on small, doable tasks….little by little, my relationship with plants and my garden became the thing that turned me around – body, mind and spirit. No, it wasn’t easy. Nothing about cancer and cancer treatment is easy. But it was my reality, and I was determined to find some place where I could thrive and experience joy again.”

From time to time, I like to take a break from literary fiction and literary nonfiction at Books Can Save a Life to feature a slow living book that gets me out of my head and inspires me to enjoy the moment. I especially love the unique gardening books published by St. Lynn’s Press, so I was thrilled when they sent me a review copy of The Cancer Survivor’s Garden Companion.

This book is especially meaningful to me because over a year ago my brother was diagnosed with pancreatic cancer. Sadly, my brother passed away in the fall.  As I thumbed through the pages of  The Cancer Survivor’s Garden Companion, I wished Jenny Peterson‘s book had been available earlier. It would have been a wonderful gift for my brother and his family. From now on, The Cancer Survivor’s Garden Companion will be part of any care package I might give to friends and loved ones with health challenges.

Jenny’s book is filled with simple and enjoyable gardening activities to restore body, mind, and spirit, especially during treatment. I thought about my brother’s small backyard garden, which was a bit neglected after his diagnosis, and how this book might have inspired him to continue enjoying manageable tasks on his tiny plot of tomatoes and eggplants.

One of my fondest memories of that difficult time was the afternoon we decided to make jam from the two old crab apple trees and the grapevines in my brother’s backyard. Joe and my sister-in-law had never picked or eaten the tiny crab apples, and we had no idea how the jam would turn out. We had fun all afternoon picking, cooking, and then tasting the deep purple and ruby colored jams, which turned out delicious.

Four jars of homemade jam

Jam made from the crab apple trees in my brother’s backyard.

 

 

Jenny Peterson is so right about the restorative powers of gardens and nature, because that afternoon my brother really enjoyed sorting and de-stemming the crab apples, the aroma of fruit cooking over the stove, and tasting the still-warm jam. I think he appreciated the little miracle of new and unexpected late-summer bounty from his backyard.

Wellness + Mindfulness + Gardening

Jenny Peterson, a writer and landscape designer with degrees in psychology and theology, is also a survivor of breast cancer and skin cancer. She wrote The Cancer Survivor’s Garden Companion not as a how-to gardening book, but “to encourage people who are diagnosed with cancer, going through cancer treatment, healing from cancer or living with cancer to view their gardens, plants and outdoor spaces as resources in creating the healthiest and most balanced life possible. Life can be difficult, but it can also be profoundly beautiful, and our gardens are the best teachers of this.”

So, you don’t have to be an experienced gardener, or even a gardener at all, to enjoy and benefit immensely from The Cancer Survivor’s Garden Companion. The activities, each centered around body, mind, or spirit, can be scaled up or scaled down, depending on needs and energy levels.

“Survivor Spotlights” feature gardening tips from individuals who have had a cancer diagnosis.

Jenny Peterson talks about her own physical, mental, emotional, and spiritual challenges during radiation, chemotherapy, and other treatments, and how she turned to her garden as both a haven and good medicine. She genuinely understands the rigors of cancer treatment and is deeply empathetic, warm, and encouraging.

CancerContents

The Garden That Heals: Body + Mind + Spirit

Her suggestions for restorative and healing garden activities include:

  • Gardening for cardio exercise, strength and flexibility, strong bones, circulation & boosting the immune system
  • Ideas for building a yoga deck garden
  • Beneficial fruits, vegetables and herbs for nourishment and strength during treatment, including aromatherapy and herbal remedies
  • Garden design, problem solving, and nature photography to relax the mind and keep it sharp
  • Sharing the garden with friends and family by hosting seed and plant sharing parties, social hours, and other events
  • Garden-themed music to enjoy
  • Prayer, meditation, and mindful movement, including labyrinths, suggested mantras, garden altars, and tea ceremonies

There is an appendix with suggested books (fiction and nonfiction), excellent health information sites, and sources for garden tools and clothing.

CancerWabiSabi

I love the Japanese words wabi sabi and have read other books on this fascinating topic, including Wabi Sabi for Writers  by Richard R. Powell.

 

I love these other books published by St. Lynn’s Press, too:

Slow Flowers, by Debra Prinzing

Windowsill Art, by Nancy Ross Hugo

The Herb Lover’s Spa Book, by Sue Goetz

If you have a personal story of gardening, illness and health, please share. I’d love to hear about your own gardening book favorites, too.

What genetic tests tell us about our health

Chromosome 4

Genome Management Information System, Oak Ridge National Laboratory

I am what I do with the beautiful information that has flowed through millions of years through billions of organisms and has, now, finally been entrusted to me.    Lone Frank

Genetic tests for consumers now cost as little as $99.

Send in a sample of your DNA (usually a swab of saliva) and you’ll be notified of the results by mail, email, or online. (In some states, such as New York, genetic tests must be requested by a physician.)

Science journalist Lone Frank purchased a genetic test kit and sent in her sample of saliva. In My Beautiful Genome, she describes going online and finding out her risk for Alzheimer’s, glaucoma, asthma, gallstones, arteriosclerosis, and other conditions.

Breast cancer is Lone’s number one concern; her mother and maternal grandmother died relatively young from it. At first, she’s relieved, because the test says she has a 7.7 percent risk for breast cancer, lower than a woman’s average risk of 12%.

But when Lone interviews the founder of the genetic testing company, he advises her to get a BRCA gene test because of her family history. Mutations in these genes can mean up to an 80% risk for breast cancer.

When Lone tries to get a BRCA test, she’s turned down, because the testers want evidence of breast cancer in her family going back one more generation, and Lone doesn’t have that information. Nonetheless, she manages to convince them to give her the test.

I’ll permit myself one spoiler and tell you Lone doesn’t have the BRCA genes. She’s tremendously relieved, of course – between that and her lower-than-average 7.7 % risk, maybe the genetic roll-of-the-dice is in her favor.

Not so fast.

The genetic counselor tells Lone that, because both her mother and grandmother died of breast cancer, there could be another risk factor at play – a genetic anomaly for breast cancer that hasn’t been discovered yet.

Let’s say another genetic risk factor for breast cancer comes to light and Lone has it. That would mean her risk rating would increase from 7.7% to something much higher.

The risk ratings from consumer genetic testing are based on limited information, because there is so much we don’t know yet about the human genome and disease. As more of the human genome is decoded, people’s risk ratings change.

The fact of the matter is, every human has over 20,000 genes, and consumer genetic tests examine only a handful of them.

So, just how useful are these tests?

I asked my general practitioner, an excellent physician, what he thinks of direct-to-consumer genetic tests. He’s not enthusiastic.  They yield information that’s incomplete, possibly inaccurate, and worrying. He believes specific genetic tests for specific conditions – the kind of test you’d obtain after a discussion with your health care provider – can be useful, but only if you’re prepared to act on the information. A woman may get a BRCA test, for example, with the intention of having a double mastectomy if the results are not in her favor.

I’m not going to be asking him to request a genetic profile for me anytime soon. When I first began reading My Beautiful Genome, I considered it, but I’m not convinced I’ll learn anything useful, I’ll wonder about accuracy and, depending on the results, I’ll probably worry.

There are lots of other drawbacks, too, which Lone discusses in her book. But she gives equal time to the potential benefits of genetic testing, and writes about what is being done on the cutting edge. Some of what she has to say sounds like science fiction, but it’s really happening.

Lone Frank wants very much to know her own genome; I’ve decided to postpone exploring my own DNA for health reasons until more is known. If and when I do, I’d want to discuss the results with a genetic counselor or other qualified expert.

Still, I’m excited about the prospect of someday knowing something about my own genetic code. I hope that day isn’t too far away.

And if I ever have the opportunity to participate in a research study about the genetics of something I care about – schizophrenia, for example – I’d volunteer in a heartbeat.

Would you choose to explore your DNA with a genetic test? Have you already been tested? What do you think of consumer genetic tests? Please share your thoughts in the comments below.

Would I have my DNA analyzed for ancestry? That’s another story. In my next and last post about My Beautiful Genome, I’ll write about what Lone learned about her genetic roots.

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