Suffering and Personal Identity

Suffering, death, and loss lay at the heart of a person’s connection to their sense of personal identity. It is in our most vulnerable moments that we come to know those things most dear to us; indeed, the people, possessions, and pursuits we are most afraid to lose come rushing to the surface when we confront the possibility of their actual–not merely fantasized, loss.

Paul Kalanithi in his excellent memoir, When Breath Becomes Air, relates his own pursuit of neurosurgical excellence through residency cut short by his stage IV lung cancer diagnosis as a building of potential, “potential that will now go unrealized” (120). Kalanithi reports that it is the duty of the neurosurgeon to learn what renders a patient’s life worth living, and either save those things or allow the peace of death if not (113). Kalanithi then interprets his own terminal diagnosis as a loss of his identity, by reader inference, as a loss of those things that makes his life worth living; things that for Kalanithti cannot be saved. He learns this truth first as clinician, then as patient. A dichotomy few of us experience, except by virtue of accepting the gifts offered in such a moving memoir as Dr. Kalanithi’s.

This difficult truth guides Abraham Verghese to pen in the forward to Kalanithi’s memoir, “See how brave it is to reveal yourself in this way” (xix).

 

Suffering is a gateway toward untold truths. An identifier to mark one as separate, as picked out, as an exemplar, not one of the norm, as statistically set apart and standardly deviated. That through suffering is the path to learn one’s identity, or to identify with oneself, and I am not sure which direction the causal arrow points in these cases. Whether to know oneself intimately is reveal one’s identity, and suffering facilitates this discovery. That suffering allows us to plumb the depths of our selves. Alternatively, that it may be the case that to identify oneself in a reflexive and self-realizing manner is to make ourselves vulnerable to suffering. That identifying with oneself, renders us vulnerable in an exceptional way that those who do not reveal themselves may be injured but may not suffer. That those who have not ventured to explore their inner lives are somehow less vulnerable to the suffering that leads to beauty, not merely death and loss.

If we are to make sense of suffering, we first must make sense of our selves, and regardless of what suffering may lie ahead, we are better to heed this invitation to know oneself. Even if it makes one more vulnerable. Vulnerability is the ticket to beauty.

 

Many have said, “Adam, you are an inspiration,” and I think, “how brave it is to reveal oneself in this way.” We are each of us inspirational when we seek to know ourselves and to reveal ourselves.

I wonder, do I suffer? Do I know my true self? Do I know what makes my life worth living?

On the operating table when we (surgeons and I) decided to end the resection with residual tumor remaining in the margins of my surgical cavity, “especially anteriorly,” reads the operation notes, the decision was made for engagement with my children, not wanting to risk permanent left-sided paralysis, but instead, risking more expedient recurrence and death for the sake of running and chasing after my kids.

I am struck that my disease will reveal my mortality. A woman, a mother, in an online discussion forum, reports the final year of her son’s life following his GBM diagnosis, “I thought we would have more time,” she relates. It is his rapid decline that is most frightening to me. He was 32. He said, “I don’t feel like I have cancer.” (I have spoken these words.) Yet from a bad scan in October showing progression, he is in hospice by December, dead by January. All of this within one year of his diagnosis. His standard of care therapy mirroring my own. GBM leads to death; whether in six months or sixty, this is the unknown.

Let these narratives serve as further invitations to identify your own pursuits, that should you have to chose, should your doctors, should your loved ones, that your identity makes obvious to the world what they are.

 

Should we all be brave enough to reveal ourselves in this way.

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