During my nearly twenty six years of practicing medicine, I have been with so many people in their last moments of life. Death is an unavoidable part of my work as an oncologist, where caring for patients involves both treatment plans designed to put cancer into remission, and others that are intended to make the inevitable as uncomplicated and pain-free as possible. To save a life is a wonderful, joyous thing, but there is much worth considering in the lives that are lost too, and we can honor those who die by trying to find some meaning from the very end of their lives.
I have found that in terminal cancer cases, death is the moment when people are finally able to find a moment of calm. It struck me the very first time when, as an intern, I counted a man’s pulse beats as they slowed and finally stopped. The moment when it ended looked peaceful, but only because I arrived with death—not before. In facing our mortality for the first time that night, it was clear that there was nothing to fear in the last breath, even if I couldn’t know what happened after it was gone. To die is easy. What comes before is the hard part—the pain, the loss of dignity, the looming unknown. Death’s beforemath, as you might call it, is where our humanity is laid bare. For a doctor, what happens just before death presents the challenge of combining the scientific with philosophical. For in the moments before death—moments that can, in some cases, be drawn out for years—the knowledge I have as an oncologist converges with more philosophical concerns and questions about the meaning of life and existence. Each person’s approach to the end of life is as unique as they are, and each person’s journey contains unexpected lessons.
In that space between life and death, my profession thrives. In that space, I realize the meaning of my, and our existence.
The Long Tale of Tears and Smiles takes that space as its subjects, telling stories not only of patients whom I have cared for but of how their lives and my own—and the triumphs and losses found in both—are reflected in one and another. The very narrative-driven case studies are interwoven with my memories from my childhood in Syria, reflections on my brother’s untimely death in a car accident, and my experiences as a young immigrant medical student, as an intern, as a fellow, as a specialist, and as a wife and a mother.
There comes a time when my home country is ravaged by a civil war. I live the irony of devoting my time to studying cancer, and to follow the invention of new drugs to help my patients fight against it. Yet I see on the television innocent people, dying every day in groups as a result of indiscriminate war weapons; and I am incapable of helping even one of them. The ache in my heart for all these people becomes overwhelming, and I find myself tempted to retreat, to move from the center of life to the edges so that I could breathe. But when I do, I start losing the fire, the energy source of my bustling soul; and I run back and linger, as close as possible to where our journey ends, but our hopes continue.
More than anything, The Long Tale of Tears and Smiles is the story of that place called hope.