Lois Leveen, PhD is a Kienle Scholar in Medical Humanities at Penn State College of Medicine and the author of the novels Juliet’s Nurse and The Secrets of Mary Bowser. Her public humanities work focuses on how content and approaches from literary studies, history, the visual arts, and related fields can foster greater reflection for individuals and deeper bonds of community among practitioners, patients, and families. Contact her through humanitiesforhealth.org.
Lucy Kalanithi, widowed in her thirties by lung cancer, describes her neurosurgeon husband’s final year not as a period of dying but as a period of living:
By the time he had become too sick to continue working in the operating room, he was writing furiously about his struggles — as a physician, a lover of literature and a terminally ill patient — to continuously seek and live his values. Returning to writing kept him serving others and helped him to live well.
The result of this furious writing is Paul Kalanithi’s memoir, When Breath Becomes Air, a deeply moving literary work. As a record of how to cope with terminal illness and a document of how to accept suffering as part of what makes us human, the memoir does indeed serve its readers. In the coming years, it will likely become a favorite text for medical humanities courses and scholarship. But the greatest power of the book lies in what it tells us not only about Kalanithi’s slow demise from cancer, but about how his own dying contrasts with that of his close friend and fellow resident “Jeff” (like many memoirists, Kalanithi uses pseudonyms for nearly all of those he writes about), whose life ends suddenly, by suicide.
For all the emotional impact of Kalanithi’s memoir, what strikes me most about it is how little attention Jeff’s death gets from critics and readers. Both Paul Kalanithi and Jeff are highly skilled surgeons and caring human beings, yet as captivated as we are with the dramatic and rare death of a young physician from cancer, we seem unable to confront the equally awful reality of physicians dying from suicide. It may strike us as incomprehensible that a thirty-something non-smoker could suffer from advanced lung cancer, but when it comes to physician suicide, we are more willfully refusing to comprehend how wide spread the problem is.
To put it more bluntly, how can we expect physicians to care for and save us, unless we acknowledge how difficult it has become for them to care for and save themselves?
Answering that question can have important consequences for physicians, patients, and public health. Approximately 400 physicians die by suicide every year in the US. Thousands of others experience such intense burnout they leave the profession. Still more continue to practice, despite untreated depression or burnout. In The Hidden Dying of Doctors: What the Humanities Can Teach Medicine, and Why We All Need Medicine to Learn It, I argue that Kalanithi’s memoir—and medical humanities more broadly—can provide an important model for addressing these problems.
I have many friends who are healthcare practitioners, from ER doctors to infectious disease specialists, from hospital nurses to physicians serving indigent patients. Sometimes I feel a little ridiculous (or self-important) to suggest to them, or to anyone who deals with sickness and dying in their workplace that there can be something lifesaving about bringing literature, art, philosophy, and other humanities into their already busy professional training and careers. But the response I’ve gotten from physicians to The Hidden Dying of Doctors underscores how imperative this work is.