Paul Kalanithi’s “When Breath Becomes Air”

Synopsis: At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor making a living treating the dying, and the next he was a patient struggling to live. Just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air, which features a Foreword by Dr. Abraham Verghese and an Epilogue by Kalanithi’s wife, Lucy, chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a young neurosurgeon at Stanford, guiding patients toward a deeper understanding of death and illness, and finally into a patient and a new father to a baby girl, confronting his own mortality.

What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.

Outlook: I admit, I had a personal investment in this book.  When I say I have a personal investment, it is because I had the honour and privilege of being by my father’s death-bed as he passed from leukemia.  Seeing the things I had seen, I wanted to know how Paul and his family dealt with the same thing.  A killing blow from cancer.  I wanted to see in the mind of someone who was not only a patient, but a doctor.  How would someone with terminal cancer react, when knowing the science behind their disease? What I found out through reading Paul’s book, is that like you and I, they are human.

When Breath Becomes Air summarizes Paul’s entire life.  From early child hood, to university, to interning, to his wife Lucy, and finally diagnosis and death.  I found it odd, but powerful, to hold once again someones entire life in my hand.  Moreover, the life of a neurosurgeon and one that was no longer with us.

Before becoming an MD, Paul received his Masters in English Literature from Stanford.  But deep in the back of his mind, he couldn’t stop thinking about death.  He was fascinated by it, almost becoming obsessed.  It was during this realization he decided to go back to school, to become a doctor.  While attending medical school, it was neurology that pulled him in.  What better way to learn about life and death, than immersing yourself into the human psyche.

Paul’s book was unfinished at the time of his death, but through his writing you can see that he simply had said everything that needed to be said, and the time he had left was going to be spent with his family.  Specifically, spending the last bit of strength he had, holding his newborn daughter, Cady.

It’s interesting how doctors always say “think positive” as being strong-willed goes against everything science says.  If the tests say it’s time, then it should be time.  Why do people who say “Nope, not today!” live longer? Could Paul have gotten more time if he didn’t spend his whole life being fascinated by death? Subconsciously, maybe he felt this was the best way he could experience it.  To truly know death, one must die.  I believe this is only part of it.  When Paul looked at his scans, it is clear to see that he would not survive.  No matter how positive you think.  When cancer has spread to the whole body and brain, it all comes down to time. 

Eventually, Paul was so weak and his fingers so exposed from the medications and chemo, that he wore gloves to keep writing.  He got his English Lit degree to become a writer, and in the final year of his life that is exactly what he became.

The memoir finishes with an epilogue from Lucy.  A doctor herself, and also a fantastic writer.  She has a marvellous way with words, painting a sharp picture in your mind of her love for Paul, and Paul’s love for his family.


Susannah Cahalan’s “Brain On Fire”

Synopsis: When twenty-four-year-old Susannah Cahalan woke up alone in a hospital room, strapped to her bed and unable to move or speak, she had no memory of how she’d gotten there. Days earlier, she had been on the threshold of a new, adult life: at the beginning of her first serious relationship and a promising career at a major New York newspaper. Now she was labeled violent, psychotic, a flight risk. What happened?

In a swift and breathtaking narrative, Cahalan tells the astonishing true story of her descent into madness, her family’s inspiring faith in her, and the lifesaving diagnosis that nearly didn’t happen.

Outlook: Susannah’s story is one of triumph, but getting there was difficult, frustrating, and exhausting.  As a reader of her tale, I truly felt the pain her and her family went through over the course of the year.  Yes, her 30 days were in hospital, but there was symptoms leading up to her admission as well as post treatment.

It is so unfortunate how much is still unknown in the medical field, but even more disheartening is how little doctors can, or want, to do about it.  There is so much politics involved in hospital administration, and most of it comes down to cutting costs across the board.  Ever been to your GP and you discuss a problem you have had for a year or more, and he gives you an Rx for 10-30 days? GP’s here in Canada are only allowed by law to see X number of patients a day, to keep their billables from going into the $220,000/year range.  As a result, no GP can take longer than 5-10 minutes per patient and they leave by 2:00PM.

The only way Ms. Cahalan received proper treatment (she wrote about this in her book) was because the insurance provider she is with at the Post was great, and what couldn’t be covered her parents paid out-of-pocket.  Cahalan says in order to save her life, the bills were a bit above $1,000,000 USD.  Politics aside, let’s look at the book.

Cahalan was initially diagnosed as a schizophrenic / alcoholic by her GP and hospital staff at the psychiatric facility she was sent to.  Her symptoms were that of a mental patient, and since scans came up negative they said it [schizophrenia] was induced from alcohol withdrawal (Cahalan drank 1 to 2 glasses of wine a night with dinner, light years from alcoholism.)

Progressively, she deteriorated.  Cahalan got so bad so quickly, that all signs pointed to a mental disorder.  In her book, she writes that much of her writing comes from expanding on her fathers journal during her ordeal.  To this day, most of it is still a blank.  A gap in time.

Brain On Fire contains detailed medical records and medical jargon about the authors diagnosis and treatment.  The staggering thing is, once recognized, how treatable it was.  All they [hospitals, staff, doctors] needed to do was show a bit of compassion, and go back to the drawing board.  It wasn’t until Dr. Najjar (an outside the box, real-life House neurologist) received her case, that Cahalan improved.

Over all, I found this book fascinating both from the view of the author and the doctors.  I also appreciated Cahalan throwing in all the medical talk, in turn keeping me from having to Google it.

All of this made me wonder, how many people are strapped to a bed right now, because of an undiagnosed (or misdiagnosed), treatable brain condition.  Nothing to do with being schizophrenic.

Elyn Saks’ “The Center Cannot Hold: My Journey Through Madness”

Synopsis: At the age of 8, Elyn  became obsessive over details, and began experiencing horrible nightmares.  She would walk home from school, having the houses on her left talk to her.  Tell her to do things.  She fought them for a while, but eventually told her mother.  Her family, and doctors, passed over it citing “an active imagination” but the truth was, Elyn was terrified and sick.

It wasn’t until she reached Oxford University that she began having episodes.  Incoherent ramblings to herself, and friends.  “We’ve got to case the joint. I don’t believe in joints. But they hold your body together.”

Saks’ episodes ranged from ramblings, to suicidal tendencies, to believing she was God.  Sometimes she was evil resurrected, and everyone was going to die.  Saks’ was never a violent person, these are just things she would say to people.

Things escalated until they could no longer be ignored, when Saks was found singing atop the Yale Law School.  She was taken to the ER, tied down, and was force-fed antipsychotics.  Later, she would be moved to a psychiatric ward where she was again tied up (only for short periods) but did have to remain for 5 months.

Saks describes her troubling, never-ending war with her delusions of reality, constant paranoia and living a life with schizophrenia.

Outlook: Saks’ introduction to her disease plays an important role.  Obviously, it sets up the dynamic for the rest of the book, but from an educational point of view – we see how young schizophrenia really begins.  Schizophrenia is also a deteriorative disease, which Saks talks about.  Similar to the mathematician John Nash (A Beautiful Mind), without treatment things only escalate.

Nash, became ill in the 50’s.  Possibly the worst time to be a schizophrenic as the treatment was in its infancy, and largely Freudian.  Without proper diagnosis, Nash eventually did start to hallucinate.

Saks did not get to this stage, at least, not at this time.  Throughout her novel she toys with the idea that she is not ill at all, as one could imagine.  Through trial and error, she learns some painful truths.

Saks knowledge of her time fighting back the demons is staggeringly accurate.  Although not funny, the things that come out of her mouth were so unique I couldn’t help but laugh aloud.  Not at her expense of course, just at the sheer lunacy of the sentences.

Saks tells her story exactly as she remembers it, and you get every nitty-gritty detail.

“The Center Cannot Hold” does have some slow points, in my opinion.  But the over all read is fascinating as we, the reader, get a first person perspective deep into the broken mind of a schizophrenic.

When my analyst said he was going to close his practice, I fell apart.  Again.  Thankfully, a concerned friend flew out to see me.  What he found was a human being living in complete disarray.  I hadn’t eaten or bathed in over a week, and sauntered around as a withered skeleton. – Elyn Saks

If any form of psychology is the least bit fascinating to you, or your simply curious about Elyn’s life, this is a great read.

From the Wiki: Elyn Saks is an Associate Dean and Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioural Sciences at the University of Southern California Gould Law School, an expert in mental health law and a MacArthur Foundation Fellowship winner.

Featured image courtesy of the University of Southern California

The Amazon Fairy

A little bird brought me some new bookage!  I’m in the process of reviewing all of my past reads (well, most) so here are 5 new ones that will be coming to A3 over the next couple months.

I’m excited to start Brain On Fire, as I know most of us WP readers have thought it was intriguing.  Its also a continuation from my psychology phase (I have 2 psych. reviews scheduled for next week).

What are you reading this week?

Brain On Fire —

When twenty-four-year-old Susannah Cahalan woke up alone in a hospital room, strapped to her bed and unable to move or speak, she had no memory of how she’d gotten there. Days earlier, she had been on the threshold of a new, adult life: at the beginning of her first serious relationship and a promising career at a major New York newspaper. Now she was labeled violent, psychotic, a flight risk. What happened?

In a swift and breathtaking narrative, Cahalan tells the astonishing true story of her descent into madness, her family’s inspiring faith in her, and the lifesaving diagnosis that nearly didn’t happen.

You’re Not Sick, You’re Thirsty! Water: for Health, for Living, for Life —

Asthma, allergies, arthritis, hypertension, depression, headaches, diabetes, obesity, and MS. These are just some of the conditions and diseases that are caused by persistent dehydration. But there is a miracle solution that is readily available, all natural, and free: water.

My Stroke of Insight —

Jill Taylor was a 37-year-old Harvard-trained brain scientist when a blood vessel exploded in her brain. Through the eyes of a curious scientist, she watched her mind deteriorate whereby she could not walk, talk, read, write, or recall any of her life. Because of her understanding of the brain, her respect for the cells in her body, and an amazing mother, Jill completely recovered. In My Stroke of Insight, she shares her recommendations for recovery and the insight she gained into the unique functions of the two halves of her brain. When she lost the skills of her left brain, her consciousness shifted away from normal reality where she felt “at one with the universe.” Taylor helps others not only rebuild their brains from trauma, but helps those of us with normal brains better understand how we can consciously influence the neural circuitry underlying what we think, how we feel and how we react to life’s circumstances.

Outliers —

In this stunning new book, Malcolm Gladwell takes us on an intellectual journey through the world of “outliers”–the best and the brightest, the most famous and the most successful. He asks the question: what makes high-achievers different?

His answer is that we pay too much attention to what successful people are like, and too little attention to where they are from: that is, their culture, their family, their generation, and the idiosyncratic experiences of their upbringing. Along the way he explains the secrets of software billionaires, what it takes to be a great soccer player, why Asians are good at math, and what made the Beatles the greatest rock band.

The Man Without a Face: The Unlikely Rise of Vladamir Putin —

The Man Without a Face is the chilling account of how a low- level, small-minded KGB operative ascended to the Russian presidency and, in an astonishingly short time, destroyed years of progress and made his country once more a threat to her own people and to the world.

Handpicked as a successor by the “family” surrounding an ailing and increasingly unpopular Boris Yeltsin, Vladimir Putin seemed like a perfect choice for the oligarchy to shape according to its own designs. Suddenly the boy who had stood in the shadows, dreaming of ruling the world, was a public figure, and his popularity soared. Russia and an infatuated West were determined to see the progressive leader of their dreams, even as he seized control of media, sent political rivals and critics into exile or to the grave, and smashed the country’s fragile electoral system, concentrating power in the hands of his cronies.

Catherine Ryan Hyde’s “Ask Him Why”

Synopsis:  Ruth and Aubrey are just simple teens when their older brother, Joseph, ships off to the Iraq.  But when Joseph returns only 3 months later, with a dishonourable discharge, his family is put in a media crossfire.

We view the story from the perspective of Ruth, as she tries to get the secret out of her parents and Joseph.  She is beside herself that no one will talk about it, and feels the ramifications of Joseph’s actions are directly affecting young Aubrey.  Ruth has to be the grown up in her family, at a time when she is really too young to understand the politics of it all.

Joseph, thinking removing himself from the situation is the best option, goes into hiding.  Not only has his tarnished his family name, but his relationships are in shambles.

Ruth and Aubrey are determined to find him, and figure out the truth.

Outlook: This was my first book by Catherine Ryan Hyde, and I bought it based on ratings and the synopsis.  It was written in the biographical style I prefer (although the book is fiction) but it also had a slight thriller element to it.  At least, I was gripped by it at certain points.  I was captivated by the plot, and I just had to know what Joseph had done to deserve 333 pages of scrutiny.

Although we don’t find out till almost the end of the novel what Joseph has done, a long the way Ruth and rebellious Aubrey meet a man known as Hamish, who Joseph viewed a father figure.  The introduction of the Hamish character really pulls the story together, and the scene Hyde sets up around Hamish and his home makes for a great read.

However, there are times when the book is slow, and I could easily put it down and come back later, often doing just that.  Overall, I would recommend this book despite its slow middle, as the Hamish character is not to be missed.

Featured image courtesy of JP Solatorio

Kent Wayne’s “Echo” Volume 1

Synopsis (via Goodreads): In the late 21st century, humanity left Earth due to multiple resource shortcomings aggravated by an acceleration in climate change. They settled Echo, a planet that was nearly a carbon copy of Earth except for being devoid of all but the most basic life forms.

Fast forward 1200 years later. Echo has endured over a thousand years of dark age. Corporations and government merged early on, becoming the oppressive authority known as the Regime. Military and police merged into the Department of Enforcement, their only mission to crush the huge network of rebels known as the Dissidents.

Over half the planet is covered by decaying cityscapes and the elite live high above, removed and remote from the greater populace on the moon-city of Ascension. Hope lies in one man, a former Enforcer named Atriya. But before he can break the cycle of darkness and ignorance on Echo, he has to do it within himself.

Outlook:  Wayne instantly had me by the opening chapters.  His novel is fast paced, well written, and I know exactly where he is coming from with his characters.

Speaking in generalities, the stereotype is accurate for males where being a “military super soldier, delta force, black water private security bad ass” is the best job in the world.  Politics aside, that is.

We are immediately dropped into the world of Echo, where Atriya begins another day of hard training.  Seeing as this is the future, and humanity requires the best of the best, would-be soldiers are put through gruelling tasks.  Pushing their physical capabilities passed natural limits, often requiring a “little help”.  Gear, is what I’m saying.  A bunch of super elite roid pigs with guns!

I often sat back in my chair, saying “Jesus…” or “Savage!” aloud, reading Wayne’s words regarding “Crew” training.  Those who fail, are beaten severely by successful Crew graduates.  All sanctioned and A OK’d by top brass.  Being a Crew member was considered a great honour.  Each member of the “Elevated Risk” team had to go through extreme mental and physical training, and it only got worse and more life threatening with every advancement.  Wraiths, for example, were barely human anymore.  The training killed thousands.  In order to beat the Dissidents, only the best would do.

We learn about futuristic weaponry, ballistics, and mechanical suits.  Physical enhancements are the norm, showing the populace that a Crew member has entered the room – and is not to be messed with.

The world of Echo is complex and vast.  Wayne leaves most of the imagery up to the reader, which for me I enjoyed as I could picture his scenes, creatures, and armaments any way I liked.

We learn about the type of person Atriya strives to be, including his doubts and fears.  He wants to be more than Crew, and is willing to die to prove it.

Volume 1 ends on a cliffhanger, as one could imagine.

Volume 1 focuses on plot, character, and scene development.  Leading us into the fray for Volumes 2, 3, and 4.

Science fiction is my favourite movie genre, but one of my least favourite when it comes to novels.  But, seeing as Wayne is a fellow WordPress writer, for $1 I would get hours of entertainment and could support a buddy.  Because of that reason, this review is a bit bias, however I did finish it and will continue to read future volumes.  If I don’t enjoy what I read, I always put the book down and move on, rarely going back to it.  So, that should tell you something.

Wayne’s work can be purchased from his site, and the beginning chapters of volumes 1 and 2 can be read for free:

Featured image courtesy of Kent Wayne

Chris Gardner’s “The Pursuit of Happyness”

Synopsis (via Goodreads): At the age of twenty, Milwaukee native Chris Gardner, just out of the Navy, arrived in San Francisco to pursue a promising career in medicine. Considered a prodigy in scientific research, he surprised everyone and himself by setting his sights on the competitive world of high finance. Yet no sooner had he landed an entry-level position at a prestigious firm than Gardner found himself caught in a web of incredibly challenging circumstances that left him as part of the city’s working homeless and with a toddler son. Motivated by the promise he made to himself as a fatherless child to never abandon his own children, the two spent almost a year moving among shelters, “HO-tels,” soup lines, and even sleeping in the public restroom of a subway station.

Never giving in to despair, Gardner made an astonishing transformation from being part of the city’s invisible poor to being a powerful player in its financial district.

Outlook: It’s no secret that most of the time, the book is better than the movie.  This is no exception.  Yes, they are two separate forms of entertainment, but you can’t take a 500 page novel and crush it into 2 hours.  In the film adaptation of “The Pursuit of Happyness”, it only covers the last portion of Gardner’s life.  Obviously, this is the portion that sells tickets.  The film was not about his life as a whole, but how he went from homeless with a toddler to his own investment firm, Gardner & Rich LLC.

Gardner’s journey takes us from his fatherless childhood, the men who tried to take on such role, an inspiring uncle and mother, his military career and finally the pursuit of Wall Street.

When I purchased this book, it was before I had read “Start Where You Are”. I wanted to see if the film “The Pursuit of Happyness” was really like the book, or was it Hollywood’s take on it.  Moreover, I wanted more detail, and to hear it from the man himself.

I was pleased to read that the book was about Gardner’s entire life, and not the final chapters of Wall Street success.  Gardner’s words inspired me, and was just another reason to pick up “Start Where You Are”.

About 70% of this book is Gardner’s struggles as a young man, military career, and finding himself.  The last portion is what we see in the film.

A terrific biography, from a humble and brilliant man.  Whenever I feel down, or am thinking “fuck this” I look to Gardner.

I’ve read this book twice, and I think it’s about time for another.