Reflections on “When Breath Becomes Air”

Drew Summers, M.D. Class of 2019

“And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.” – When Breath Becomes Air by Paul Kalanithi

My time at OHSU has changed my perspective on life. As a future orthopaedic surgeon with a passion to become a musculoskeletal oncologist, I will deal with cancer daily. My patients will die. Eventually all of my patients will die. One of the first things a person comments on when I tell them what I want to do with my career is how they couldn’t deal with death and not internalize it, doomed to become lost in a sea of sadness.

Perhaps I am suited for this because I think differently. There is beauty in everything, even in death. Obviously there is pain, loss, and fear, but there is also a unique opportunity to make the most out of every minute left. When one receives news that their time in this life has a known expiration date, things change. People actually live, some for the first time. I am not so glass-half-full that I won’t admit that not all patients have the mental fortitude or social support to do this. Nevertheless, I subscribe to the belief that everyone is capable of finding light, even in the darkest of dark.

It is what each of us chooses to do in the face of adversity that defines who we are. Our moral fabric and character are continually challenged by the inequity of life and a terminal cancer diagnoses is crushing blow for anyone but especially for those in the prime of their life. Through my experiences I have come to believe that everything happens for a reason. Whether you call it spirituality, a belief in a higher power, or fate is irrelevant. Just because a person has worked toward something does not guarantee the success or outcome they envisioned regardless of how relentlessly they strived for it. It is what we do with the life we are given that matters most.

We expect to get out of life what we put into it. We expect equality and fairness. We hope to find happiness. We expect raise our children and see them grow. We do not expect cancer in the young.

“Is it cancer?”

A little girl played while sitting on her mother’s lap, unaware of the hyperintense lesion in her leg. The mother was panicked, uncertain and fearful of her only daughter’s future, her voice cracked as she discussed the need for surgery with my attending. He was masterful in the way he assuaged her anxiety. As he spoke, I saw her terror fade and her posture relax. As the conversation continued, I could see her begin to trust him, and then something amazing happened. I saw her breathe, angst evaporating, and then she emotionally released her daughter to his care. A man she had just met. It was an incredible thing to witness, the bond being formed between a patient and their physician.

This trust that we are given is sacred, as an orthopaedic surgeon it allows us to intervene in the most invasive and decisive manner to save form, function, and even life.

To hold the limp body of a small child, someone’s little girl, to blink and see my son in my arms; I have no words. I have opened up a child. I have cut deep into someone else’s child. I have operated on an only child. She did not come into this world on a whim. Her parents prayed for her, they cried for her, they strived for her. A new future realized.

We made the cut, followed our approach, and exposed the mass. To see disease, to physically put my hands on it, and to remove it from this little girl was emotionally overwhelming. The mask was fogged with concentration and love for my patient.

We wait. Arms crossed, we wait. Small talk. We tower over our tiny patient.

The phone rings.

“Clear margins.”

I will soon have the skill and knowledge to resect disease, to alter outcomes, to be able to say to another human being, “you are cancer free.”

Families will come to me surrounded in darkness. I will wade into the darkness with them, hold their hands, and show them there is light still.

I didn’t immediately recognize the true gravity of what I had done in the operating room, nor did it come to me in the dressing room. I was sitting at a stoplight, when I realized that the greatest gift I could have been given in this life was the ability to heal a sick child, to return normalcy to families.

I called mine.

I joyfully wept as I explained to my mother that this gift – medicine, orthopaedic surgery, orthopaedic oncology – is everything I could hope to do with my life.

This quote resonates with me because of how hard I have worked to get to where I am, a decade in the making. Yet sacrifice and strife is not exclusive to the pursuit of medicine. Nor is it exclusive to other pursuits in other work. It is in everyday, in everything we do. Seeing patients’ lives, goals, and plans evaporate into thin air has strengthened me. I will live my life and work tirelessly to inspire other to do the same.

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2 responses to “Reflections on “When Breath Becomes Air”

  1. That is some powerful writing, Drew. You beautifully expressed the balance of fear and hope in each moment of life.

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