“Wouldn’t It Be Great?” A Perspective on Pain

Paul Kalanithi was a husband and neurosurgery resident at Stanford when he began to experience a dire combination of symptoms: a cough, fevers, back pain, and unexpected weight loss. Quick tests confirmed that he had metastatic lung cancer, which would eventually prove fatal.

Paul’s wrote about his journey with lung cancer in a book called When Breath Becomes Air. I read it some years ago and often think about what it says about our shared experiences life, death, and mortality. Shortly after he finished the book in 2015, Paul passed away. He is survived by his wife, Dr. Lucy Kalanithi, and his newborn daughter.

Recently, I read an interview published on the fifth anniversary of Paul’s passing (which is worth a read) which revealed something new about the Kalanithis: it wasn’t until after the diagnosis that they decided to have a child. At first glance, that seems like an strange choice. Now that Paul and Lucy know that Paul will be dead within 1-2 years, they choose to have a child together. There is an important lesson in the details of that decision.

Interviewer: In all of that intensity [of a cancer diagnosis], how did you decide to have a child?

Dr. (Lucy) Kalanithi: It seemed pretty crazy to do that. Paul was more sure than I was that he wanted to have a child. I said, “It’s going to make it really hard. You’re really sick. I worry that having to face dying and having a new baby who you need to say goodbye to is going to make it really hard. What do you think about that?” He said, “Wouldn’t it be great if it did make it really hard?” It was such a lovely statement of what our lives are about. Sometimes you cannot have joy without risking pain.

I love Paul’s perspective on pain. “Wouldn’t it be great if it did make it really hard?”

Pain is a fascinating subject. Our instinctive response to pain is to avoid it all costs. We hide things from others to avoid the pain of being separated from our social groups. We put off difficult conversations that need to happen to avoid the pain of dealing with interpersonal conflict. We attempt to ignore our problems by numbing our emotions through distraction, vice, or even success. We hope that with just enough numbing, we can avoid pain.

And in our frantic attempts to escape the inevitable, we learn that we can never get enough of what we don’t really need. The numbness wears off and we realize we have merely postponed dealing with the root cause of our discomfort.

Paul’s perspective teaches a lesson that needs constant relearning: Our purpose in life is not to avoid pain and discomfort. Our purpose is to find those things that are worth our pain and discomfort. Learning to be ok with ourselves, building healthy relationships, investing in others’ well-being, saving money for the future, crossing a finish line, or dealing with our demons — these things open us up to pain, but they are worth that cost. Paul and Lucy knew this. They ignored the instinct to avoid pain. Paul had a perspective that would bring him joy in his final months: “Wouldn’t it be great if it did make it really hard?” They made a choice to pursue something that would be worth the pain that it would cost.

At 2:11am on July 4, 2014, Lucy gave birth to Elizabeth Acadia, whom they nicknamed Cady. In the last paragraphs of his autobiography, Paul gives us a taste of the coupling of pain and joy that he experienced as a father, watching his own life end while Cady’s life was beginning.

Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.

Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire…

I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters—but what would they say? I don’t know what this girl will be like when she is fifteen; I don’t even know if she’ll take to the nickname we’ve given her. 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.

That message is simple:

When you come to one of the many moments in life when 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.

Our purpose in life is not to avoid pain and discomfort. Our purpose is to find those things that are worth our pain and discomfort. And then once we find them, to pursue them with all we have, purchasing with our pain a life of meaning and “a joy that does not hunger for more and more, but rests, satisfied.”

The Right Now Paradox

Time is a funny thing.

Or maybe it’s the way we think about time and make choices around time that are strange. Tomato, tomahto.

For example, sometimes we think there is plenty of time to put off that due-in-a-few-days task. We watch the show, stay up later than we should, and say to ourselves “I’ve got time.” We tell ourselves that Right Now isn’t critical.

At other times, we think there is no time to accomplish our long-term career goals. Any failure now means certain career death and life is surely over. Right Now is all that matters.

Sometimes, these mindsets hit at the same time, which is something I call the Right Now Paradox, where we think the current moment simultaneously isn’t all that critical but is all that matters. When these hit together, the compounded stress often leads to even more procrastination.

The solution to the first pitfall is to learn how to manage ourselves emotionally. And when we need to relax, it’s better to take a deep breath and a screen-free break than to numb our emotions with mindless distractions. In short, minimize the shiny distractions and maximize the leisure activities that have a higher value or more relaxing affect: take a walk outside, read a book, message an old friend you’ve been meaning to talk to.

The solution to the second is to keep a healthy perspective when failure strikes. Look at Lincoln, Morgan Freeman, Thomas Edison, Michael Jordan–all men who are famous for things that happened long after they had attempted many other ventures. Remember that failure is a stepping stone to success in most circumstances, and that success doesn’t have to come early to be impressive.

In sum, if you need a break, take a break that is high-value. If you’re feeling stressed about a potential failure, remember that failure is a key ingredient in the recipe for success. Right now IS critical, but you’ve got enough time to try and fail.

Maya Angelou on Complaining

I get a weekly newsletter from James Clear, author of Atomic Habits, which lives up to its claim of being the “most wisdom per word of any newsletter on the web.” (If you’re interested in seeing his latest, you can scroll to the bottom click here

A recent quotation from the newsletter was good enough to go into my notes review system (which I should talk about sometime), and popped up this evening during my review.

“Sister, there are people who went to sleep all over the world last night, poor and rich and white and black, but they will never wake again. Sister, those who expected to rise did not, their beds became their cooling boards, and their blankets became their winding sheets. And those dead folks would give anything, anything at all for just five minutes of this… So you watch yourself about complaining, Sister. What you’re supposed to do when you don’t like a thing is change it. If you can’t change it, change the way you think about it. Don’t complain.”

Maya Angelou in Wouldn’t Take Nothing for My Journey Now

Summary: time is precious, so don’t spend it complaining. If you don’t like something, change what you can about it, or change your mind.

I’m starting to see a pattern in my posts — a lot is about time figuring out how to get the right perspective around it in order to get the most out of it.

I’m ok with that.

We’re All Someone’s Crazy Relative

I’ve been reading a lot about beliefs and about how our minds work, and I’ve wanted to write something about it for a long time. I’m fascinated by the difference between disagreement that is healthy and constructive, and disagreement that is toxic and destructive. I’ve been putting it off, subconsciously thinking I had to wait until I knew everything before I wrote anything. I could then write the perfect article, chock full of footnoted links to research. It would answer every question and explore every nuance.

Could I do that without writing a thousand-page textbook? No, there is too much. So I’ll take the Inigo Montoya Approach and sum up. There are some fascinating ideas from evolutionary history and psychology that explain a lot of the animosity surrounding disagreement in today’s conversations about healthcare, politics, and religion. The source material is a blend of Harari’s Sapiens, Haidt’s Righteous Mind, Kahneman’s Thinking Fast and Slow, and Mark McRaney’s entertaining and insightful podcast You Are Not So Smart.

To begin, Harari says there are three reasons why homo sapiens have been very successful since first showing up 200,000 years ago: 

  1. Homo sapiens learned to harness fire to cook food, which increased our caloric intake and resulted in significant brain growth.
  2. Larger brains led to the development of language, including the ability to tell stories and produce fiction. 
  3. We began to use language, stories, and fiction to coordinate tasks and operate in groups, creating tribes, communities, and eventually cities. 

Those three evolutionary ideas lead to some fascinating psychological results. 

One, our beliefs aren’t built on pure rationality. Our survival historically depended on maintaining group status, not accuracy. As a result our views have more to do with group dynamics than a dispassionate search for truth. When faced with a new idea, our group-centered minds ask, “How will this affect my group standing?” You’ve seen this in action if you’ve ever seen someone base a political opinion on whether or not it came from their party’s leader, as opposed to the merits of policy itself. We instinctively align ourselves with our group.

Two, our evolutionary wiring causes us to trust people like us. Shared traits (skin color, political ideology, country of origin, socioeconomic standing) lead to increased trust. Dissimilarity decreases instinctive trust. These tendencies come from the deeper preprogrammed parts of our minds. While they can be overwritten with conscious reasoning, conscious rationality is not the default tool we use to evaluate new ideas. Trusting people who are different requires work, and our efficiency-focused brains don’t do that automatically. 

Three, we are unable to independently verify all of the things that we know. Due to a vast information surplus of things we could pay attention to, we filter and accept messages from people we trust. Our brains prioritize efficiency over accuracy. For example, I haven’t produced the necessary observations that show the earth is round or that it moves around the sun. I trust the scientific community when it tells me these are settled issues. Nearly everything you and I “know” is borrowed from someone we trust. 

Four, stories are more powerful than facts. The first narrative we hear from a trusted source (someone like us) is likely the one that we will use to decide whether we accept or reject the other facts that come to our attention. In fact, exposure to factual information that goes against our narratives causes us to dig in to our viewpoint even more. Contradictory evidence strengthens opposing conclusions, which is both fascinating and disappointing if you’ve ever tried to change someone’s mind. 

These four points go a long way in explaining why good people disagree about important issues. Our beliefs are more often based on identity, on maintaining group status, and on who we trust as opposed to a dispassionate factual examination. 

It doesn’t mean our beliefs are pre-determined. These are all tendencies we can overcome, with effort.

It does mean that arriving at The Truth (or some approximation to it) involves acknowledging that we have these tendencies and navigating them. 

It should also give us pause about how we arrive at our own conclusions. Do we believe something because it feels right, in spite of any contradictory evidence? Which sources do we believe? And why do we believe them? Is it just because they’re like us? Are they from the same political party or religion? Do they write for a news organization we trust? Or have we done some conscious and rational examination of the evidence presented, putting in the extra work of looking up alternative viewpoints? 

Finally, it means we should be “slow to speak, slow to wrath” (James 1:19) when we run into those who have come to different conclusions than we have. It’s natural to conclude that your crazy relative with different or weird or conspiratorial beliefs has been brainwashed or is evil. It’s completely natural, but also wildly ineffective if you hope to engage in anything approximating intelligent disagreement.

Idiocy and malice are not the sole sources of disagreement. More often than not, we have all arrived at different conclusions as a result of evolutionary tendencies that lead us to adopt the differing narratives we use to make sense of the world. To an extent, we are all someone’s “crazy relative.” Recognizing the psychological processes we all follow to reach conclusions can steer the conversation away from heated animosity and toward examining the underlying and unspoken narratives that cause most differences of belief.