Ages ago, this book was on my to-read list for a long time before my brother borrowed it from his office's library and lent it to me.
These are some of my highlights from the book. The book is worth multiple readings in its entirety.
On the bigger questions of love, morality, ethics and so on...
"The ancient covenant is in pieces; man at least knows that he is alone in the unfeeling immensity of the universe, out of which he emerged only by chance." (Jacques Monod)
"Bereavement is not the truncation of married love, but one of its regular phases—like the honeymoon. What we want is to live our marriage well and faithfully through that phase too." (C S Lewis)
You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.
... virtue required moral, emotional, mental and physical excellence.
Surely intelligence wasn't enough; moral clarity was needed as well.
"With what strife and pains we come into the world we know not, but 'tis commonly no easy matter to get out of it." (Sir Thomas Browne)
If the unexamined life was not worth living, was the unlived life worth examining?
Moral speculation is puny compared to moral action.
His notes from his experiences as a neurosurgeon:
A physician's words can ease the mind, just as the neurosurgeon's scalpel can ease a disease of the brain. Yet their uncertainties and morbidities, whether emotional or physical, remain to be grappled with.
I had learned something, something not found in Hippocrates, Maimonides or Osler: the physician's duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.
As a doctor, I knew not to declare, "Cancer is a battle I'm going to win!" or ask "Why me?" (Answer: Why not me?).
What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find on her own. Getting too deeply into statistics is like trying to quench a thrist with salty water. The angst of facing mortality has no remedy in probability.
It occurred to me that my relationship with statistics changed as soon as I became one.
She would likely refuse surgery if I launched into a detached spiel detailing all the risks and possible complications. I could do so, document her refusal in the chart, consider my duty discharged, and move to the next text. Instead, with her permission, I gathered her family with her, and together we calmly talked throug the options. As we talked, I could see the enormousness of the choice she faced dwindle into a difficult but understandable decision. I had met her in a space where she was a person, instead of a problem to be solved. She chose surgery. The operation went smoothly. She went home two days later, and never seized again.
...several students argued for the removal of language insisting that we place our patients' interests above our own. (The rest of us didn't allow this discussion to continue for long. The words stayed. This kind of egotism struck me as antithetical to medicine and, it should be noted, entirely reasonable [...] But that's the point. Putting lifestyle first is how you find a job, not a calling.
What had not changed though was the heroic spirit of responsibility amid blood and failure. This struck me as the true image of a doctor.
In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.
Dealing with cancer:
"I don't know. What I do know — and I know you know these things, too — is that your life is about to — it already has changed. This is going to be a long haul, you understand? You have got to be there for each other, but you also have to get your rest when you need it. This kind of illness can either bring you together, or it can tear you apart. Now more than ever, you have to be there for each other. I don't want either of you staying up all night at the bedside or never leaving the hospital. Okay?"
Writing about falling in love with his wife:
empty at home, remembered falling in love in New Haven twelve years earlier, surprised right away by how well our bodies and limbs fit together, and thought of how ever since, we'd both slept best when entwined.
On writing, the need to write:
Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward.
His wife writes in the epilogue about Paul:
What happened to Paul was tragic but he was not a tragedy
About the weather at his grave:
...it can be as uncomfortable as it is peaceful, both communal and lonely — like death, like grief—but there is beauty in all of it, and I think this is good and right.
And so much more:
His journey thereafter was one of transformation — from one passionate vocation to another, from husband to father, and finally, of course, from life to death, the ultimate transformation that awaits us all.
The version of Paul I miss most, more even than the robust, dazzling version with whom I first fell in love, is the beautiful, focused man he was in his last year, the Paul who wrote this book — frail but never weak.
We each joked to close friends that the secret to saving a relationship is for one person to become terminally ill. Conversely, we knew that one trick to managing a terminal illness is to be deeply in love—to be vulnerable, kind, generous, grateful.