By Tasaduq Hussain Mir, MD, FAAFP
It has been almost a year now since I read the powerful book, “When Breath Becomes Air,” a neurosurgical scholar’s account of his losing battle with cancer. Dr. Paul Kalanithi died at a very young age of 36 due to lung cancer that had spread from his lungs to his brain.
“When Breath Becomes Air” is about a journey toward an imminent death. This book is a doctor’s account as a patient and the reciprocal relationship between him and his doctor. It is about an uncomfortable sense of vulnerability when it comes to physicians being on the other side of the table as patients. It is also about our gratitude for what we have in our hands and how to reconcile with what is beyond our reach. It is about our appreciation for each and every blessing that comes our way without us realizing it.
After finishing this book I had more questions than answers as to why we keep on doing what we do and what we feel is important. From the day we enter medical school, we physicians spend a lot of time away from our family. There never seems to be an end, as this separation can get worse during residency than when we are full physicians. Physicians are faced with the responsibility to help patients stay healthy and alive, but that can come at the cost of neglecting their own need to truly live if we are not careful.
I did my residency training in Minnesota while my wife and son were in Denton, Texas. When I was a resident, I looked to research for guidance on how to do long-distance parenting in the medical field. To my surprise, I could not find much, so I started to figure out how to survive residency while being a long-distance dad and husband. My personal research interests were influenced by this barrier, as I even started a project to study long-distance parenting and assess its effects on resident physicians. My idea was to study different aspects of long-distance parenting and come up with suggestions and recommendations for resident physicians doing long-distance parenting, guidance I was unable to attain through my literature searches. I did some work on this topic and also had some data to work on. Although I still think that there is a need to work on this area, I have not actively pursued this after moving back to Texas.
Doing residency in itself is very challenging and when you do it without your family being around you it can be a daunting task. During my residency days, I would spend my time in the hospital and clinic seeing patients and counseling them about the benefits of a healthy lifestyle. At night I would try to figure out how to stay human in residency and remain connected with my family from afar. I have missed anniversaries with my wife and my children’s birthdays. There were days when I wanted to see them, but I could not make it happen with the demanding residency training schedule.
After coming back from a long day at the hospital or clinic, I would often stick to my computer on Skype video chatting with my wife and son. Video chatting was a life saver. My weekends and vacation time were crucial to my survival. I would book airline tickets far in advance to save money. In the compressed weekend time, I would fly to my family on Friday evening and be back in Minnesota on Sunday night, ready to see my patients early on Monday. During residency I had very little time to spend with my family and I missed key stages of my family members’ lives. I was not able to be part of a parent-student meeting, I hardly made it to my son’s soccer practice and games, and I knew none of my children’s teachers.
Weeks, months, and years passed and I successfully finished residency. This would not have been possible without the support of my family; my fellow co-residents; all my faculty, especially my program director Dr. Patricia Adam; and my advisor, Dr. Timothy Ramer.
Although residency was hard and challenging, every bit of it was worth doing. I was able to learn and develop necessary knowledge and skills that I would need as a physician and also educate my patients about the benefits of living a healthy life. Spending time with my patients was the most beautiful thing. Educating my patients about the benefits of living a healthy life gave me an opportunity to reflect on how I can improve my own life; and stay connected with my family and friends despite my busy schedule at work.
Going back to the book, “When Breath Becomes Air,” the questions I ask myself are these: what will we do if we are told that we have two, three or at the most five more years to live? Will we continue doing what we are doing on a routine basis or will we take a break from our crazy schedules and assess our lives? Will we continue to work like machines that start early in the morning on a set schedule and are turned off at a scheduled time? Are we still going to ignore our family and loved ones and keep thinking about how we are going to achieve more and more success no matter the cost?
When death is imminent, we give more value to time, even seconds matter. We try to spend as much time as possible with our loved ones, trying to capture moments for eternity. We know that all of us are going to die one day, so why is it then that we show no urgency or respect for time? Why is it then that we continue to work like machines and ignore our loved ones? Why is it that we have no time for our kids, even for the special moments that we know are never going to return?
This book has taught me so many things. It taught me that even though what happens to us sometimes can be tragic, death is a not a tragedy but a journey towards eternity. It taught me to value time and be there for loved ones while we are here, as we are not going to be here forever.
This life lesson has shaped me as who I am. When I was doing long distance parenting as a resident physician, I had no time to go with my son for his soccer practice or games. Now I make it a point that I will go to each and every soccer practice and cheer for him during his soccer games. During residency I did not know any of his teachers. Now I know all of them and have met most of them. Yes, being a physician with busy practice can be very hard, but if one plans things in advance (which I do now) one can enjoy all the beautiful things that this world and life has to offer. There are simple things that one can do to be able to spend time with his/her family and friends. Some of the things I do are:
- Email hygiene: Addressing urgent email from home, and leaving the rest to address during office hours.
- Finishing work, like clinic notes, in clinic and not bringing it home.
- Planning my vacations ahead of time.
- Marking important dates like birthdays, anniversaries etc. on Google Calendar.
- While my son is doing soccer practice, I take that opportunity to stay healthy by exercising.
- I'm a part of a wellness initiative at my residency program that helps our residents and faculty understand that wellness can prevent burnout.
- I regularly give a talk on “Burnout and Wellness” to medical students, to make them aware of burnout and the importance of wellness.
To conclude, let us try to respect and value time, and be there for our loved ones before something tragic happens. Let us live our life the way it should be, sharing love and spreading peace. Let us live our life to its fullest and then embrace death with peace and dignity.
As I continue my own journey in trying to find out more ways to live a happy and joyous life, I keep the beautiful quote by Rachel Naomi Remen in mind:
Life rushes us along and few people are strong enough to stop on their own. Most often, something unforeseen stops us and it is only then we have the time to take a seat at life’s kitchen table.
- Kalanithi P. When Breath Becomes Air. New York, NY: Random House, 2016.