Literature is the distillation of a people’s soul, an unpacking of their ideals; a space where the (mis)fortunes of life are fleshed out and preserved. What happens then, when medical doctors — whose vocation is the clinical sustenance of life — become
writers? Does the value of life become clearer? Does death become more comprehensible?
I have just read a book that answers those last two questions with a definitive “yes”. It is a small book, a one-day read, about death. Or, more accurately, about dying — young.
At the age of 36, Paul Kalanithi was diagnosed with stage four lung cancer. He died 22 months later, in March 2015. Within that time, he completed residency requirements, graduated as a neurosurgeon, fathered a baby girl and wrote his memoirs.
His story, When Breath Becomes Air (Random House, 2016), bears evidence of a man who spent many years immersed in Literature. His first degree combined English Literature and Biology. His Masters thesis examined “(Walt) Whitman and the
Medicalisation of Personality”.
You know that Kalanithi is not a Kenyan when, reflecting on his degree choices, he says, “I was driven less by achievement than by trying to understand … what makes human life meaningful?” Yet here we are in Kenya, accumulating every kind of
certificate from one year to the next just so that we can bag the next job or nail another promotion!
Some will argue that in an African country that is still struggling to contain malaria, jiggers, hunger and illiteracy, the intellectual search for the value of human life is a luxury that Kenya(ns) cannot afford. Maybe. But all these degrees we are churning out of
our universities urgently need to translate into something more than jobs.
I read Kalanithi immediately after In the Footsteps of my Father (2015), the autobiography of Joseph Amolo Oluoch, one of Kenya’s oldest physicians. Inevitably, I started comparing the American migrant’s ethos of belonging to the politics of post-colonial identity.
Kalanithi was the son of a medical practitioner. So is Aluoch. Both of them were born many kilometres away from their ancestral homes — Joseph Aluoch in Nairobi, Paul Kalanithi in New York.
In a thoroughly predictable opening chapter — almost as if he had to pay heed to a binding oath taken by his generation — Aluoch displays a concern with ethnic ancestry that does not worry Kalanithi. Indeed, it isn’t until many pages into his story that
Kalanithi describes himself simply as a “second-generation Indian”. Beyond observing that his father was Christian and his mother Hindu, Kalanithi never bothers to trace his Indian roots or to justify his Americanness.
Aluoch draws many contrasts between the elegances of city childhood and the harshness of life in rural Gem. By contrast, Kalanithi looks for sameness. He finds functional similarities between urban legends and the “country facts” of rural Arizona where his
family moved to when he was 10 years old. City folk spin urban legends to intimidate upcountry folk. Similarly, the function of “country facts” is to “confuse city folk and amuse the locals”.
Kalanithi underwent medical training in a totally different time and place from Aluoch, but there is still some value in comparing their philosophy of medicine. Actually, Aluoch’s unpacking of learning medicine is not too dissimilar to that of Japheth K. Mati as
he tells it in Healers to Physicians (2014).
Mati entered Makerere University’s medical school in 1960 and became the second Kenyan African to qualify as an obstetrician gynaecologist. Aluoch and Mati give vivid histories of medical training in East Africa, beginning in 1897 under Dr Albert Cook,
and they trace diseases such as TB and HIV/AIDS.
GRAPHIC HISTORIES OF MEDICAL PRACTICES
Kalanithi paints graphic histories of medical practices like dissection and of medical terms like “cadaver” and “patient”. He argues that dissection engenders “a legion of feelings: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the
mere tedium of an academic exercise… (it) epitomises … the transformation of the somber, respectful student into the callous, arrogant doctor.”
Alouch and Mati never come anywhere near making you smell and touch their immersion into the routines and rituals of learning how to practice medicine in the way Kalanithi does. Aside from being victims of the unimaginative structure that governs Kenyan
(auto)biographies, they come from a generation and a culture that excels in weaving silences around emotions. They focus on the structure of their training, on racial politics of the day and on their teachers.
They speak of academic triumphs and professional accolades but they hardly allow you to peep into the trajectory of their frailties. Aluoch’s philosophy of medicine is labouriously stretched out in the second half of his book.
Like Mati, Aluoch opts for an academic’s approach of argument and counter-argument to unpack his worldview. You come away feeling like you have just read a PhD thesis, rather than shared in a life! And yet, there were so many literary tools available to
humanize individual cases memorably for the lessons that seem to be summed up in Aluoch’s conclusion that, “the body is the only true healing mechanism and all drugs do is to clear the way and help the body heal itself”.
Kalanithi only talks about his income when he observes that it would have increased six-fold once he completed residency but both Aluoch and Mati are candid about how much they earned, upon qualifying.
Thanks to racism, Mati walked all over Nairobi with a colleague looking for a bank that would accept their first cheques for Sh600 each. Aluoch started at Sh900 per month. He took a loan for Sh12,000, bought “a swanky new Volkswagen registration
number KLG 960”.
Aluoch shares the intricacies of servicing mortgages and the fortunes of navigating private practice on a “peanuts” pension, never mind that after he had formally resigned from public service in 1986, he quietly pocketed a salary for a full year because he
“needed the money”.
Ultimately, all three doctors, directly or indirectly, ponder the question, “If the weight of mortality does not get lighter, does it at least get more familiar?”
In ancient Greece, Apollo was the god of both medicine and poetry and as far back as St. Luke in the first century, to John Keats, Anton Chekov, Nawal el Saadawi and our own Yusuf Dawood, the (f)act of physicians becoming writers is not new.
Last year, South Africa’s Mtutuzeli Nyoka, an ENT surgeon, published Deliberate Concealment, the story of his time as President of Cricket SA (2008-2011). This is not Nyoka’s first plunge into writing, but writing is a call that he answered fairly late in his
life. He was 45 years old when he published his first novel, I Speak to the Silent (2004). He followed it up in 2013 with A Hill of Fools.
Like Kalanithi, Nyoka studies the critical experiences that transform a person’s identity or, perhaps, personality. As with Kalanithi, Nyoka’s prose is breath-taking. His phrases are pure poetry; his sentences are musical, producing a rhythm that you want to
tap your feet to in a solo dance. But behind this soothing dance, Nyoka is always deeply disruptive on the subject of heroism and what it really means for one to occupy the moral high ground in a society.
There isn’t a better place to discern the values of a society, its politics of belonging and the events that have shaped the thinking of a generation, than life writing. Aluoch poses some urgent questions about the pedagogy of parenting, teaching and medical
practice in Kenya with a strong dose of humour that enhances readability. Mati notes big social changes and outlines the impact of corruption and bad politics on our healthcare systems.
Paul Kalanithi’s brave memoir exceeds time and place. It asks (and answers) the big questions about human existence by peeling over and getting under his own aspirations, desires, failures and his life’s work. Kalanithi found moral clarity, especially over his
role as a neurosurgeon. “Before operating on a patient’s brain, I realised, I must first understand his mind, his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end.”
His words are reminiscent of the brutally material philosophy of life offered by Ezeulu, the chief priest in Chinua Achebe’s Arrow of God. When he prays for his age-mate Akuebue, Ezeulu says, “may you live and all your people … But life alone is not
enough. May we have the things with which to live it well. For there is a kind of slow and weary life which is worse than death”. Because he saw the truth of this view of life not as years, but as quality, Paul Kalanithi confronted his personal experience of
terminal illness with absolute clarity about the value of death.
Dr Nyairo is a Cultural Analyst – [email protected]