When Breath Becomes Air (2): Quotes

The following are several quotes from When Breath Becomes Air that struck me:

The challenges of being a doctor
“In my life, had I ever made a decision harder than choosing between a French dip and a Reuben? How could I ever learn to make, and live with, [emphasis mine] such judgment calls? I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn’t enough; moral clarity was needed as well. Somehow, I had to believe, I would gain not only knowledge but wisdom, too.” (66)

“The reason doctors don’t give patients specific prognoses is not merely because they cannot. . . Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.” (134-5).

Speaking of all the deaths and traumas he’d witnessed, “At moments, the weight of it all became palpable. It was in the air, the stress and misery. Normally, you breathed it in, without noticing it. But some days, like a humid muggy day, it had a suffocating weight of its own. Some days, this is how it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down.” (78)

Finding Meaning 
“All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escort them into the world, and then back out. Seeing the body as matter and mechanism is the flip side to easing the most profound human suffering. By the same token, the most profound human suffering becomes a mere pedagogical tool.” (49-50)

“The questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context.” (70) . .. every operation on the brain is, by necessity, a manipulation of the substance of ourselves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. . . Because the brain mediates our experiences 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?” (71)

“I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death. I had thought that a life spent in the space between the two would grant me not merely a stage for compassionate action but an elevation of my own being: getting as far away from petty materialism, from self-important trivia, getting right there, to the heart of the matter, to truly life-and-death decisions and struggles . . . surely a kind of transcendence would be found there? But in residency, something else was gradually unfolding. In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun. I was not yet with patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it. Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinging to the same raft, caught in the same tide.” (81-2)
I expect every profession has its areas where we all stand too close to the light.

“Amid the tragedies and failures, I feared I was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient. Technical excellence was not enough. As a resident, my highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness.” (86).

When he discovers the stage-four cancer, he notes “One chapter of my life seemed to have ended; perhaps the whole book was closing. Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany- a piercing burst of light, illuminating What Really Matters – and more like someone had just firebombed the path forward.” (120)

On faith: “Although I had been raised in a devout Christian family, where prayer and Scripture readings were a nightly ritual, I, like most scientific types, came to believe in the possibility of a material conception of reality, an ultimately scientific worldview that would grant a complete metaphysics, minus outmoded concepts like souls, God, and bearded white men in robes. I spent a great deal of my twenties trying to build a frame for such an endeavor. The problem, however, eventually became evident: to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning – to consider a world that is self-evidently not the world we live in. That’s not to say that if you believe in meaning, you must also believe in God. It is to say, though, that if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn’t have any.” (168-9)
“Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” (170)

Words to his daughter at the end of the book: “When you come to one of the many moments in life where you must give 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 and more but rests, satisfied. In this time, right now, that is an enormous thing.” (199)

This illustrates how sometimes it is not our best efforts that bring joy, but simply who we are.

Other Quotes
“As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know. It’s like falling in love or having a kid. You don’t appreciate the mounds of paperwork that come along with it, or the little things. When you get an IV placed, for example, you can actually taste the salt when they start infusing it.” (140)

“It was the relational side of humans – i.e., “human relationahlity”- that undergirded meaning. Yet somehow, this process existed in brains and bodies, subject to their own physiologic imperatives, prone to breaking and failing. 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.” (39)

After the suicidal death of a colleague, a friend, he notes how they “had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of life. We had assumed an onerous yoke, that of mortal responsibility. Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” (115-6)

Lab Girl by Hope Jahren (2017)

It is a strange book, but when I really appreciated for its honesty and its hope. It was also helpful for me for understanding the experience of those at the university who are in the sciences, especially females and those without tenure.

I'm not sure what to make of the interspersed chapters on plant biology. They were fascinating, although it felt a bit like it got in the way of the story I wanted to hear more about, even as much as Jahren's telling us of the biology of trees is as much a part of her story as all the (mis)adventures that she had. As she puts it: “People are like plants: they grow toward the light. I chose science because science gave me what I needed – a home as defined in the most literal sense: a safe place to be.” (18)

What this is a story of: “there’s still no journal where I can tell the story of how my science is done with both the heart and the hands.” (20) Where I can tell of all the non-successes that obviously don’t make it into journals. “I have become proficient at producing a rare species of prose capable of distilling ten years of work by five people into six published pages, written in a language that very few people can read and that no one ever speaks. This writing relates the details of my work with the precision of a laser scalpel, but its streamlined beauty is a type of artifice, a size-zero mannequin designed to showcase the glory of a dress that would be much less perfect on a real person.” (20)

What does it say about academia (science)?
"Next time you meet a science professor, ask her if she ever worries that her findings might be wrong. If she worries that she chose an impossible problem to study, or that she overlooked some important evidence along the way. If she worries that one of the many roads not taken was perhaps the road to the right answer that she’s still looking for. Ask a science professor what she worries about. It won’t take long. She’ll look you in the eye and say one word: “Money.” " 124-125

“As hard as I worked, I just couldn’t get ahead. Showers became a biweekly ritual. My breakfast and lunch were reduced to a couple of cans of Ensure from the cases that I kept under my desk. . . I passed the workday biting my nails with ferocity. None of the single guys that I met could understand why I worked all of the time, and nobody wanted to listen to me talk about plants for hours, anyway. Everything about my life looked pretty well messed up compared with how adulthood had always been advertised to me.” (130)

What does it say about being female in academia?She struggled with fitting in as a female, with being accepted and getting enough funding. Despite being someone who won some prominent awards (and was on the tenure track at 26 already!), funding was clearly a problem for at least ten years. She speaks about being taken advantage of by another lab in the building; of being yelled at during a conference presentation, of receiving weird and clearly mean feedback on paper/grant submissions, and being utterly ignored socially at conferences by the senior scientists in her field.

“I didn’t know if I was crying because I was nobody’s wife or mother – or because I felt like nobody’s daughter – or because of the beauty of that single perfect line on the readout. I had worked and waited for this day. In solving this mystery I had also proved something, at least to myself, and I finally knew what real research would feel like. But as satisfying as it was, it still stands out as one of the loneliest moments of my life. On some deep level, the realization that I could do good science was accompanied by the knowledge that I had formally and terminally missed my chance to become like any of the women that I had ever known. In the years to come, I would create a new sort of normal for myself within my own laboratory. I would have a brother close than any of my siblings, someone I could call any hour of the day or night. . . I would nurture a new generation of students, / some of whom were just hungry for attention, and a very few who would live up to the potential that I saw in them.” Jahren, Hope. Lab Girl (p. 71-2).

What does it say about mental illness?

"Tiny but determined, I navigated the confusing and unstable path of being what you are while knowing that it’s more than people want to see." 16

The honesty is a bit disconcerting, as we hear more than we might want to know. For instance, she describes full-blown mania: “You don’t fear life and you don’t fear death. You don’t fear anything. There is no sadness and there is no grief. You feel your sub-conscious formulating the answers to all the collective miserable searching that man has ever done. You have indisputable proof of God and the creation of the universe. You are the one for whom the world has waited. And you will give it all back; you will pour out all you know and then wallow knee-deep in thick viscous love, love, love.” (145)

What does it say about religion?“My lab is a place where my guilt over what I haven’t done is supplanted by all the things that I am getting done. . . My lab is a place where I can be the child that I still am. . . . My laboratory is like a church because it is where I figure out what I believe. The machines drone a gathering hymn as I enter. I know whom I’ll probably see, and I know how they’ll probably act. I know there’ll be silence; I know there’ll be music, a time to greet my friends, and a time to leave others to their contemplation. There are rituals that I follow, some I understand and some I don’t. . . And, just like church, because I grew up in it, it is not something from which I can ever really walk away.” (19)

What does it say about friendship?Her relationship with Bill makes me think of Spiritual Friendship (see book by Wesley Hill and website) and the deep goodness of this strange family-like relationship. She describes her friendship in the following way: “He is strong where I am weak, and so together we make one complete person, each of us gaining half of what we need from the world and the other half from each other. I inwardly vowed to do whatever it took to raise more salary for him and to keep us going. . . Within two separate but adjacent rooms, we tuned two radios to different stations and went back to our work, having once again reassured each other that we are not alone.” (25-26).

After an accident with glass that left splinters of glass all over the lab – and didn’t harm her only because at that moment she’d been fiddling with the radio (as if this isn’t God’s providence!), Hope’s anxiety arises as she sits outside biting her hands. Bill is present, and he notes that he had a dog who used to bite her hands. Hope acknowledges that it’s gross, as she is also flooded with shame. Bill’s response was “no, she was a great dog. When you have a dog that good, you let it do whatever it wants.’

Other quotes that I appreciated: 

“Science didn’t talk about books that had been written to analyze other books that had originally been written as retellings of ancient books; it talked about what was happening now and of a future that might yet be.” (18)

“At its peak, sweet corn grows a whole inch every single day and as the layers of husk shift slightly to accommodate this expansion, you can hear it as a low continuous rustle if you stand inside the rows of a cornfield on a perfectly still day. As we dug in our garden, I listened to the lazy buzzing of bees as they staggered drunkenly from flower to flower, the petty, sniping chirps of the cardinals remarking upon our bird feeder, the scraping or our trowels through the dirt, and the authoritative whistle of the factory, blown each day at noon.” (14)

“Time has changed me, my perception of my tree, and my perception of my tree’s perception of itself. Science has taught me that everything is more complicated than we first assume, and that being able to derive happiness from discovery is a recipe for a beautiful life. It has also convinced me that carefully writing everything down is the only real defense we have against forgetting something important that once was and is no more, including the spruce tree that should have outlived me but did not.” (29)

In speaking of her time visiting the psych ward (while she was working for a hospital pharmacy. “The first time that I entered through the double-locked doors of the psych ward I was terrified, believing for no real reason that such places harbored evil souls ready to assault me at any moment. But once inside I found it to be the slowest-moving place on Earth, and I saw that these patients were unique only in that time had stopped inside their wounds, which were seemingly never to heal. The pain was so thick and palpable in the psych ward that a visitor could breathe it like the heavy humidity of summer air, and I soon realized that the challenge would not be to defend myself from patients, but to defend myself against my own increasing indifference toward them.” (49)

Us Versus Us by Andrew Marin (2016)

According to the research given in Us Versus Us, 86% of people who identify as LGBTQ+ were raised in a faith community (from ages 0-18). That means that the discussion of what to do about homosexuality isn't a fight between us - folks in the church who are anti-homosexual - and them - those people, outside of the church, with their gay agenda. Instead, it ought to be a conversation between who are a lot more alike than we often recognize, especially when it comes to faith.

As Andrew notes, "Marin gives a detailed discussion about how the LGBTQ+ movement is not simply a movement outside of the church. Members of our churches right now are wrestling with this issue in their own lives, particularly high school students in youth groups.
The book is based upon a research study done by the Marin Foundation, and the book is broken up into six chapters, each one based on a striking statistic found from the survey, such as '76% of LGBTQ+ people are open to returning to their religious communities and its practices.' The 2006 study was done with over 1,712 usable surveys of people all across the United States, and it contains multiple open-ended questions to allow for full responses. Most important to this survey, the responses were all anonymous, allowing for honesty without reprimand. Marin also notes how 96% of LGBTQ+ have prayed to God to stop their homosexual desires."

Spirituality in the Mother Zone by Trudelle Thomas (2005)

In Spirituality in the Mother Zone Thomas expresses the complicated reality of becoming a mom, including how hard it is to be honest about it:

"While it's acceptable to talk about the intense love of new motherhood, mothers are often reluctant to mention the 'darker' emotions that are often just as powerful. They may complain, even joke, about outward difficulties like hours of labor, sore episiotomy stitches, and sleepless nights, but few will speak candidly of the confusion, rage, and grief that may come with the territory of new motherhood and last far longer.
No religious initiation is any more intense than the deprivations new mothers face: interrupted sleep; seeing your once orderly home strewn with receiving blankets and dirty dishes; the vigilance of trying to understand a baby's unfamiliar cries; often not being able to eat, dress, shower, or even use the bathroom at will [for me it was not being able to go to sleep when I wanted or needed]; suddenly having to learn all the practical skills of breastfeeding, dressing, bathing, and attending to the medical needs of a helpless human being.
Even amidst the joys, it is a painful time of surrendering to a new way of life, of being stripped of the familiar." (page 33)

While I only got about halfway into the book, I found it encouraging and honest. It helped me better to understand my own complicated feelings of becoming a mother, the anxiety, joys, and helplessness.

On living by Kerry Egan (2016)

Kerry Egan, in her book On living, provides the following description for her work as a chaplain:

"Every one of us will go through things that destroy our inner compass and pull meaning out from under us. Everyone who does not die young will go through some sort of spiritual crisis, where we have lost our sense of what is right and wrong, possible and impossible, real and not real. Never underestimate how frightening, angering, confusing, devastating it is to be in that place. Making meaning of what is meaningless is hard work. Soul-searching is painful. This process of making or finding meaning at the end of life is what the chaplain facilitates. The chaplain doesn't do the work. The patient does. The chaplain isn't wrestling with the events of a life that doesn't match up with everything you were taught was true, but she won't turn away in fear, either. She won't try to give you pat answers to get you to stop talking about pain, or shut you down with platitudes that make her feel better but do nothing to resolve the confusion and yearning you feel. A chaplain is not the one laboring to make meaning, but she's been with other people who have. She knows what tends to be helpful and what doesn't. She might ask questions you would never have considered, or that help you remember other times you survived something hard and other ways you made sense of what seemed senseless. She can reframe the story, and can offer a different interpretation to consider, accept, or reject. She can remind you of the larger story of your life, or the wisdom of your faith tradition. She can hold open a space of prayer or meditation or reflection when you don't have the energy or strength to keep the walls from collapsing. She will not leave you. And maybe most important: She knows the work can be done. She knows you can do it and not crumble into dust. . . . . 

But the fact remains that before a chaplain gets to that place with a patient - the place where the patient can share into a deep hole of meaninglessness, or even leap right into it and wrestle down in the lonely existential muck until a ladder of sorts begins to appear - and somehow, somehow, in ways I still can't fully explain, a ladder always does appear - before all that, the chaplain has to create a sacred space, and to do that, she has to offer her loving presence first."               - Kerry Egan, On living, pages 18-20

Some of my work with Campus Edge is like this - a creating of sacred space to re-find meaning. Yet, too often I feel like I am trying to check off a list of things that need to be done instead of being present with others, expectant that God is working in that moment. The challenge is that many of the moments in my work are not momentous, and it is harder to remember that in the ordinary moments God is not any less present and working.

Part of this appeared earlier on my personal blog.