Recently I read a book written by Paul Lalanithi entitled “When Breath Becomes Air”.  Paul was finishing his residency in neurosurgery when he was diagnosed with terminal lung cancer.  He wrote this book to talk about his career in medicine and his thoughts about dying just as he was about to reap the fruits of his long years of medical training.  He ends his book talking about the impact his infant daughter has had on his life by saying, “There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.  The message is simple:  When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied.  In this time, right now, that is an enormous thing.”

What strikes me about this man’s words is that he did not come to the end of his life frustrated that he would never become a medical professor teaching others the art of neurosurgery.  He does not bash his head against the wall and yell, “No,no, this isn’t fair.  This isn’t right!!”  In his last days he is able to hold his infant daughter and observe her looking around with child like curiosity.  He is able to watch her play with her toys, look at him and laugh and make noises and all of this fills his heart with a joy that he has never felt in anything else he has done.  It is a gift that graces his heart and blesses his dying days.  And in this experience he finds a door in the wall of unfairness.

I thought about this moment as I sat with a patient last week.  She is in hospice care and knows her days are numbered.  She told me she is so depressed because she had wanted at least fifteen more years.  She will not see her precious granddaughter grow up.  She is going to miss so many things she had hoped to see and be a part of.  As she told me how she has been bashing her head against the wall of unfairness and getting more and more depressed as she recognizes the futility of her efforts, I thought about Paul Kalanithi’s words about his infant daughter.  I shared with this patient how he had found joy in all that she was and in all that she was becoming.

We sat in silence as she thought about how there might be a door in the wall that she was facing.  She thought about the idea that she was not only dying but she was still living and there were still things to see and take joy in.  Life is not only a realization of what we don’t have, it is also a realization of what we do have.  There are always moments of grace that can fill our hearts with immeasurable joy.

She and I have agreed that we will talk more about living fully.  We are going to explore where is the joy in her life?  What makes her smile?  What makes her heart swell with gratefulness?  It’s hard to say where this exploration will take us.  Who knows what joys will be found?  Who knows where the door in the wall is?  What we know is that it is there.

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