Last Reviewed on February 6, 2020, by eNotes Editorial. Word Count: 1336
Six weeks after starting treatment, Paul undergoes another CT scan. The cancer appears stable, and his spine is healing. Furthermore, he can walk without a cane again. The following day, Emma says Paul is improving enough that they will only have to meet every six weeks and can begin discussing the future, though this is a subject that fills Paul with angst. At a meeting with fellow Stanford neurosurgery graduates, Paul feels envious that the others present can still look forward to a successful future that will likely never be his. No one asks him his plans, which is a blessing, as he has none. Paul begins reading books on mortality, from cancer patients’ memoirs to Tolstoy’s The Death of Ivan Ilyich, and the process is crucial in inspiring him to return to his surgery career. He feels that even if he is dying, he must continue to live his life—and return to his calling—as best he can.
For the next six weeks, Paul alters his physical therapy program so that he will be strong enough to return to the operating room. His next CT scan shows his tumor shrinking even more. Emma gives him further grounds for cautious optimism: another patient on the Tarceva pill has been living seven years since his diagnosis. He might have another decade or so to live. For Paul, this is further justification for returning to his work as a neurosurgeon.
Paul informs his program director of his intentions, and the director welcomes him back with enthusiasm. Paul only requests that a fellow resident be in the operating room should anything go wrong. Paul’s first surgery since his diagnosis is a temporal lobectomy. Initially, everything goes well, but then Paul suddenly has tunnel vision, forcing him to leave the rest of the procedure to the other resident. Though this near-fainting spell does not deter Paul from work and his next few operations go better, Paul does not find surgery as enjoyable as he used to and comes home exhausted every night. Paul also learns that a surgeon-scientist position he has long coveted at Stanford has just been filled. Even though the workload would be too much for him in his condition, he still mourns the lost opportunity.
The two shining spots during this period are Lucy, who is in her first trimester of pregnancy, and Paul’s stable condition. Though he does not know how long he has to live, he feels that he must continue on as though he were going to live a long time if he is to enjoy the time he has left fully.
Nine months following Paul’s diagnosis, he is more exhausted than ever, often too tired to eat after work. He has also developed a chronic cough. Nevertheless, he works hard, even going to Wisconsin for a job interview. The offer is attractive: a large salary, a neuroscience laboratory, flexible hours, tenure, a clinic, job opportunities for Lucy, and a gorgeous location in which to live and work. However, Paul declines the offer. Should he have a relapse, Lucy and their newborn child will have no family to go to for support.
Paul has an epiphany: he cannot regain his former life or pursue his former dreams of medical superstardom. Once again, he is unsure of how to proceed. He realizes that Emma’s talk of his future has nothing to do with resurrecting his pre-cancer existence:
Emma hadn’t given me back my old identity. She’d protected my ability to forge a new one. And, finally, I knew I would have to.
While attending a Lenten service with his family, Paul reflects on his changing views of religion. Though raised Christian, he was an atheist throughout college, turned off by literalist readings of Scripture and intrigued by a rational, materialist vision of the universe. However, Paul has come to find that disbelief in God makes life seem cold and without meaning. As someone who sees life as inherently...
(The entire section contains 1336 words.)
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