Bridging the gap between medicine and literature [Texte coup de coeur]

par Tian Ren Chu

In his profound and inspiring memoir When Breath Becomes Air, the late neurosurgeon Paul Kalanithi shares his reflections on the relationship between science and religious faith. As a young adult, Kalanithi rejected Christianity in favour of a more rigorous, scientific view of reality. However, he realizes later on in his journey that science and faith do not have to be at odds — instead, each realm addresses questions that the other is ill-equipped to answer: “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.”

Kalanithi's educational profile is quite unique among physicians. Puzzled by the question of what makes human life meaningful, he first pursued a bachelor and Master's degree in Literature, at Stanford University. Literature, he thought, with its collection of individual stories, would have the best chance at elucidating complex questions about identity, relationships, meaning. This dive into the humanities convinced Kalanithi that life's meaning ultimately lies in relationships — the connections we form with one another, or with the non-human world. However, what enables us to build these relationships must lie somewhere in our brain's biological wiring. In his quest to understand how neuroscience and literature intersect, Kalanithi then turned towards medicine. Medicine would put him on the front line, where he would not only approach meaning from an academic perspective, but actually learn to help others live meaningfully in the face of decay and death. 

Paul Kalanithi's insightful reflections helped me understand and spell out my own motives for pursuing medicine. As a medical student who deeply cares about literature, Kalanithi's memoir is a beacon to me. It reminds and reassures me that medicine is intimately connected with the humanities — that in-between the rigorous science and technological procedures, there is also space for human connection and for individual stories to be shared. 

From high school to college, English Literature was always my favourite subject at school; I especially loved group discussions about whatever book we were reading, although I was usually too shy to share my own thoughts. Once in a while, our teacher (or a classmate) would deliver an unusually insightful piece of analysis, and those moments almost felt like an epiphany. Biology, chemistry, and physics were very interesting classes as well — they helped me understand how the material world around me functions: how genetic traits are passed on, why iron tends to oxidize while gold doesn't, what forces keep the Earth rotating around the Sun... However, there are many questions that the scientific method is unfit to answer. Science can tell us how to live longer and healthier, but it cannot provide meaning and purpose to our life. 

Like Kalanithi, I am drawn to the wisdom that books and stories enclose. Unlike science, stories are inevitably based on a writer's personal, subjective view of the world and therefore cannot yield "objective" knowledge. However, they do provide a unique window into the human condition. By reading about other people's stories, we come to realize that the fears, uncertainties, and loneliness we face are actually shared by so many others. When we are going through difficult times, books can comfort us with the knowledge that other people (real and fictional) have also been there before, and have survived to share the bit of wisdom they acquired along the way. We also realize that other people are not so different from us — at the end of the day, most of us are searching for the pretty much the same things in life. In a way, stories make us feel a little less alone. 

Of course, books aren't the only vehicle for stories (as a bookworm, I might be cheering for my own team a bit). Movies, Netflix series and video games often have complex plotlines as well. However, books do offer an unequalled portal into other people's minds. In movies, we get to know the characters through dialogue and through their actions, but rarely do we have access to unspoken, private thoughts. A good novel, instead, not only puts us in someone else's shoes but pulls us into their mind, and for a while, that other person's thoughts almost become our own. Thus, reading can help us see things from new and different perspectives, and thereby help us cultivate empathy. After reading When Breath Becomes Air, I think I was able to understand just a little bit better what end-of-life must be like for someone who's only thirty-eight and just had a baby daughter.  

In medicine, stories are essential. Amid a daily routine overloaded with tests, procedures, and administrative work, communication between patient and physician is sometimes cut down to what's necessary for diagnosis purposes. Yet this doctor-patient dialogue is where the human aspect of medicine lies. Taking the time to truly listen to the stories that patients tell about their illness is a way of acknowledging that their suffering matters. It can offer them comfort during what might be one of the most stressful times of their lives. Furthermore, this communication process can reveal information that is crucial for deciding on the best treatment plan. Oftentimes, there isn't just one single treatment for a given disorder, especially when the illness is more complex and severe. In these cases, an appropriate intervention must take into account a patient's unique situation: their health condition and medical history, but also their beliefs, values, and the things that matter most to them. As famous neurologist Oliver Sacks wrote in his memoir, "One cannot abstract an ailment or its treatment from the whole pattern, the context, the economy of someone's life." Dr. Sacks is often remembered for the humanism he brought into his medical practice, and for the numerous case studies he published. In those clinical tales, he always spoke of his patients as unique and fascinating individuals whose stories are worth being told. 

In the future, when I'll get to work with patients, I hope to follow in the footsteps of  Dr. Kalanithi, Dr. Sacks, and the many other physicians who have paved the way for a more humanistic approach to medicine. Until then, I'll just try my best to set aside some time to enjoy a good book after a long day of studying. 

Left: Dr. Paul Kalanithi with his wife, Dr. Lucy Kalanithi, and their baby daughter, Cady.
Right: Physician and writer Oliver Sacks, sitting in his office in New York City, where he spent most of his career.  

Sources of original pictures:

https://www.npr.org/sections/health-shots/2016/02/12/466189316/inside-a-doctors-mind-at-the-end-of-his-life;

https://www.theguardian.com/books/2017/mar/26/bill-hayes-insomniac-city-my-life-with-oliver-sacks-new-york

References

Kalanithi, Paul. When Breath Becomes Air. First edition. New York: Random House, 2016.

Sacks, Oliver. On the Move: A Life. New York: Vintage Books, 2016. 

Thumbnail picture source:

https://lauraloveslife.files.wordpress.com/2011/05/tumblr_ll7hekod071qaxbtdo1_500_thumb.

*Texte en anglais selon les règles du concours. Les textes du Pouls sont habituellement en français.