An uglier reality – F.S. Aijazuddin


WE die from the moment we are born. Yet, Death is the one constant companion whose presence we refuse to acknowledge, and whom we are unprepared to meet when it calls.

Recently, US physicians have published books that are informative in their intent, inspirational in their effect. They deserve to be read by everyone who takes life for granted and treats death with insouciance.

Dr Siddartha Mukherjee’s book The Emperor of All Maladies: A Biography of Cancer (2010) propelled cancer into popularity. It won him a Pulitzer Prize. The book has been described as a “lucid and eloquent chronicle of a disease humans have lived with — and perished from — for more than five thousand years”.

Dr Mukherjee’s second major work The Gene: An Intimate History (2016) traces the history of the gene and genetic research, from Aristotle to 21st-century scientists who have mapped the human genome. It should be a manual for those who advocate cousin-marriages.


Our leaders are denied the dignity of such departures.

His fellow oncologist Dr Azra Raza is a living asset Pakistan lost to America. She is incisive in her approach to medical research and steeped in Urdu poetry. “I have not faced an intellectual issue or question in my life which Ghalib has not addressed directly or indirectly in his magnificent Diwan.” Her book The First Cell: and the Human Costs of Pursuing Cancer to the Last (2019) derides the traditional approach to cancer. “Treating cancer as one disease is like treating Africa as one country.”

She asks why, despite research, there has been so little improvement in treatment. Her mission is “identification and eradication of transformed cancerous cells at their inception, before they have had a chance to organise into a bona fide malignant, incurable disease.” Her case studies include a touching account of her patient Omar Azfar, a talented economist who died painfully, cruelly of cancer at the age of 40.

Certainly, the most arresting of such books is Dr Paul Kalanithi’s memoir When Breath Becomes Air (2016). Kalanithi, a brilliant neurosurgeon, died at the age of 37 of lung cancer in March 2015. He studied English literature, then medicine, and intended to spend the rest of his years healing and writing. In 2013, diagnosed with terminal cancer, he told his best friend: “The good news is that I’ve already outlived two Brontes, Keats, and Stephen Crane. The bad news is that I haven’t written anything.”

In the 22 months before his death, he wrote When Breath Becomes Air. It is a brief book, as was his life. He describes how he copes with his traumatic transition from being a doctor to becoming a patient and then an un-breathing cadaver, as lifeless as the ones upon which he learned his trade.

Dr Kalanithi resigned to the inescapable: “Most ambitions,” he wrote, “are either achieved or abandoned: either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present […] My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit.”

Handling terminally ill patients and helping their families through the painful transition, he says with precise humanity: “When there’s no place for the scalpel, words are the surgeon’s only tool.” But even sympathy like medicine needs to be administered in controlled doses: “A tureen of tragedy was best allotted by the spoonful.”

Within a week, Dr Kalanithi found himself converted from being a tireless surgeon who could operate for 36 hours continuously into a supine patient who had to muster enough energy to get out of bed each morning. For a careerist who had lived by ordered priorities, Dr Kalanithi chafed at the inability of his attending physicians to give him a clear timetable for his remaining life: “…if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me 19 years, I’d be back to treating diseases.”

Bedridden, Dr Kalanithi describes, with searing truth, the callousness of visiting specialists who gathered around his bed only to disagree. Despite their well-meant ministrations, Paul Kalanithi died on March 9, 2015. In his last moments, he told his wife Lucy, in a “voice soft and unwavering. ‘I’m ready.’ Ready he meant, to remove the breathing support, to start morphine, to die”.

Our leaders are denied the dignity of such departures. Ayub Khan died in oblivion; Yayha Khan died reviled; Z.A. Bhutto died on the scaffold; Ziaul Haq died in a mid-air explosion; and Benazir Bhutto was assassinated. Pervez Musharraf, Nawaz Sharif, and Asif Zardari share the ignominy of a slow death by accountability.

Death puts their current political percussions into perspective.

The writer is an author and historian.

Published in Dawn, December 12th, 2019