All the while my grandmother sits quietly. Sometimes she lets out a struggling sound, trying to knock something lodged in her throat. I enter her room, exiting briefly my own hectic world, bearing witness. The scene is not nearly so dramatic as I make it out to be (most of my time is spent answering typical grandmother questions), but there is a heaviness which at times feels confusing. It feels most vivid when I step back from the conversation, survey the room, and look at my grandmother. I see that her own eyes are wandering as well—but where? They are probing, vague, moving from wall to table-top picture frame in mechanistic fashion.
I wonder what it must be like. She has not walked for some weeks now, and all her meals are taken in the bedroom. What does life feel like to her? I imagine it is a constant state of waiting—but waiting for what? I’m scared to ask. Instead I continue in the mundane-yet-heavy moment, both perplexed and at peace as I sit there with her. She was once like me, perhaps, but not anymore. Our lives are different now. Perhaps that is why I am so confused.
What is a life?
That is a difficult question to answer, mostly because it is so vague. A life in what sense? Perhaps the biological, where life could be defined in terms of genetic codes, energy consumption, or the maintenance of one’s internal milieu against nature’s demand for equilibrium. (“Equilibrium is death,” my college physiology professor once told me.) Or perhaps the philosophical, or theological, where one might turn to existentialism, or religion, to define a life. Or is it simpler than that? One could understand life as a list of sorts—a catalog of accomplishments and experiences accrued over the years. Or maybe a narrative, a stream-of-consciousness progression which blurs the discreetness of catalogs and lists.
Long before taking on the question itself, then, we see its complexities. We are not asking whether a life has meaning, or what value to place on human lives. Those are important questions, too, but they are secondary. Before you even arrive at them, you find yourself stuck at stage one: What is a life?
I can’t speak for anyone else, but I’m not sure I had ever asked this question throughout my first 23 years of life. I had asked a wide range of secondary questions—questions about purpose, meaning, and whatever else I could assault with my amateur philosophizing—but I had never asked that one. I had never defined the term through which everything else would be filtered.
That changed with my grandmother’s stroke.
It would probably be useful to clarify how, exactly, I thought about life prior to grandma’s stroke. By the time I graduated from college, I had shifted from a nominal Christian faith to a deep conviction that my life was, in some complicated sense, tied to an inherent value imbued by a loving God. Certain narratives and assumptions run alongside any worldview, and mine were relatively clear. For instance: my worth, my value, and my identity were unchanging and unalterable. There was an established reference point by which I was deemed worthy of love. My life, at least in this view, was defined by through a relationship, an identity.
One might think this worldview would have a straightforward effect on my thoughts and behaviors. And in many ways, that is true. I would like to believe I am kinder, more generous, more joyful, because I see life in this way. But no worldview operates in a vacuum. Each person exists within a certain culture, a certain set of values and norms which impact the definition of a life.
So in addition to my central definition, I have others. Growing up in Silicon Valley, for instance, I absorbed certain ideas about life taught not by any one person, but by a larger culture. There was the narrative of excellence—that life progresses as a smooth and logical series of successes, which in turn produce joy and meaning, so long as one is willing to work for them. And foundational to this narrative was an implicit assumption: that one’s value is somehow tied to merit. Individuals could alter their valuations of you, your sister, your cousin, based on what you, or they, had or had not accomplished. Life, in this sense, is indeed a list: what Paul Kalanithi, writing to his infant daughter as he died from Stage-IV lung cancer, referred to as “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.”
Obviously, this is not the exclusive—or primary, secondary, even tertiary—way in which people in Silicon Valley might view their lives. My intention here is not some sharp cultural criticism. Rather, my point is actually illuminated by the humanism and acceptance preached by this hectic, achievement-driven region. It is highlighted by the vague tension I feel in trying to reconcile my culture’s desire for equality, for a common humanity, with that same culture’s demand for the extraordinary.
When I look at myself as a child of Silicon Valley, I find that I operate not on one exclusive value system, but a complicated blend of narratives and suppositions about my life. And this brings us to the question at hand. For there is no greater complication, no stranger tension, than when my interlocking worldviews take their seats and discuss, “What is a life?”
I never quite understood my grandmother. Born in Latvia before World War II, she was a quiet and unfrightening woman in a strange and startling world. Though I have heard the stories several times, my knowledge of her life is spotty and scattered. I do not know what she was like as a student, and I have absolutely no knowledge of her particular vocational skills. But I do know something which is perhaps more important: I know a great deal about what she loved.
Ruta Petriceks, from what I can piece together, has always been a gracious woman. Old photos of her, even those from younger days, remind one of an old-world European matriarch: she was warm and welcoming. It is odd, then, to imagine her in the second World War, trying to escape Europe through Germany; what pulsing fear she must have felt, bunkering down as allied forces firebombed the city of Dresden. Even more incongruent are those familial memories of her in Venezuela, raising a Latvian family in the South American country where her husband was a forester. How had the winds of change altered—or toughened—my grandmother’s thick Latvian skin? How had her idea of life, and the good life, changed with them? These were fascinating questions to me.
And they took on a new meaning as I returned to my grandmother’s assisted living facility week after week, checking in regularly after her stroke in October of 2018. My thoughts were rather here-and-now in the first few visits, concerned mostly with grandma’s quality of life. I would think about her priorities, her plans for the end. But as the weeks progressed, my grandmother’s condition slowly stabilized. Yes, she was back on hospice; but her stroke seemed more like a rather heavy straw on a still-standing camel. She ate more easily; she spoke more clearly; and, like a prisoner awaking to a new cell, she began to look around her room with a wistful, searching gaze.
I knew what that gaze meant. “Are you alright?” I asked, my voice rising to fortissimo, trying to register in her aged ears. “Is there anything you want to do?”
She considered my question for a moment. Or, as I began to suspect, her neurons were still trudging along, running my message through the higher processing systems like lethargic students in morning gym class. Whatever the reason, her response was a long time coming. But finally it came. She raised up her right arm (her left was still weakened by the stroke) and pointed her index and middle fingers down towards the bed. The two fingers began fiddling past one another like legs. “Walk,” she said, in a tired and thick accent.
“Ah,” I said, “well th—”
“—And piano,” she continued, all five fingers now gliding effortlessly like pistons in a well-oiled engine. “Walking, and piano.”
The vague sadness which I had felt after my grandmother’s stroke was now magnified. This is exactly what we fear about illness: that it will threaten what we love, that it will take away those simple, yet definitive features of our lives. To walk and to play the piano: for a diabetic, 89-year-old woman with hearing problems and weak kidneys, these were portals to the world. They were concrete ways in which my grandmother could act, could do, could live. Without them, her life would take on a daily rhythm far worse than firebombing: wake up; wait for the nurses to bring breakfast; eat; look around the room; and repeat, until bedtime. In my eyes, it was a fate worse than death. It was the antithesis of a life.
But what is a life?
Contrast my grandmother’s present life with my own. I am an active, energetic, 23-year-old man—though I often feel like a boy—in good health. I have my health concerns, certainly, but the insurance companies aren’t terribly worried about me. Six days a week, I wake up at five in the morning and either run 10 miles, or lift weights at the gym. Then I bike to work and generally revel in the sweeping, endorphin-filled breaths which follow strenuous exercise. I take my seat, pull out my laptop, and jump into my research or writing from the previous day. Sundays I take off, sleep in until seven a.m., then stroll and read around Palo Alto before church. Those sabbath days are, quite literally, wonderful. They are defined by a sated peace, a contentment and wonder—what Oliver Sacks referred to as “a stopped world, a time outside time.” That wonderous joy is one of the best metaphors I can imagine for what it means to be alive.
We could thus compare my life with that of my grandmother by looking through the lens of wonder, or vitality. We might return to our original question and say that a life is not defined as a state—not, say, the biological maintenance of homeostasis—but rather by a set of feelings. If one feels alive, one is alive. And if that is the case, we should all be doing things that make us feel alive. We should all be running, biking, wondering, or whatever else will imbue upon us those sweeping and endorphin-filled breaths which remind us that we exist in the world. Such feelings are, in this view, what matter in the end.
But things are not so simple. My grandmother’s stroke illuminated another great difference between her and I, shining light on a deeper, more restless idea. Remember that second worldview of mine—that my life is somehow defined as a list of accomplishments, a ledger which I must present to others to prove what I have given, or meant, to the world. Even in a culture which so values experiences, moments, presence, it is difficult to avoid this sweeping current. It is difficult to outrun the idea that life is, at its core, about producing, achieving, doing. “Time is money,” Ben Franklin famously noted, and this perspective, mixed with the incessant need to produce and achieve, can twist life’s most human endeavors into something quite alien.
At the same time that my grandmother suffered her second stroke, I was in the last legs of my medical school interview season. Four years of college, and one year of post-graduate research, had culminated in a whirlwind tour of the United States, where my precious schedules and priorities were thrown to the wind. I had hours upon hours to myself, staring thousands of feet downward while riding 400 miles per hour through the sky. In those moments I found a new sort of contrast: the relentless pace of research and writing stymied by the slow, molasses-like rhythm of cross-country travel. Reflecting on that difference—while in the air, or while exploring new cities—I realized something about my hectic life rhythms. On the one hand, my relentless pace was driven by a genuine aspiration to impact people, and communities, throughout my medical career. This was the very lifeblood of my studying, writing, and researching. (Though, thankfully, I enjoyed the work in and of itself.)
But on the other hand was the pride, the vanity, which, as in many people, pushed me to achieve and accomplish for the sake of achievements and accomplishments. I wanted to succeed more, produce more, do more. Like Frederick Winslow Taylor—the pioneer of American industrial efficiency—I wanted to turn my world into a sort of system; a system which would separate my time, my efforts, my life, from what Taylor called “the larger wastes of human effort, which go on every day” and which, perhaps in his view, define a larger waste of human life.
And so my incessant drive drove me: I approached each week, each day, each hour, each moment, scrutinizing my efficiency and productivity, as if I were my own twentieth-century Frederick Winslow Taylor. To live was, in a sense, to do; and if I was not doing something with my life, at each and every moment, I was wasting it.
But what is a life?
The thought pounced upon me as my grandmother scanned the room with her reddened eyes. It seemed a laughable contrast: my life, a restless amalgam of striving and future, held against the slow, sedentary world of my grandmother. But the contrast made me think. I found myself unsettled by the possibility—the probability, the certainty—that I would be in the same position. That I would live most of my life as if it were a list of action items, and then, one day, I would no longer be able to act. I would no longer be able to do. What would happen then? Would I die, even as I lived? The question seems paranoid now, obsessive. But in the moment it was very real. I had to determine what my life was, or risk losing it while I still lived.
My grandmother was staring out her window as I returned to the world. I asked her what she had planned for the afternoon. “I will nap,” she said, “and then the nurse will bring me lunch. Then I will take another nap, and then the nurse will bring me dinner.”
“I’ve made a long voyage to a strange country,” wrote Thomas Wolfe, the twentieth-century American novelist, in his last letter before dying of tubercular meningitis at age 37. “And I’ve seen the dark man very close.”
Before passing away on a mid-September day in 1938, Wolfe spent his prime years as a prolific and poetic author, writing four tome-length novels and numerous smaller works. His final letter was written from a hospital room in Seattle, Washington, where he was receiving treatment for a sudden bout of pneumonia. Wolfe would spend three weeks in that hospital before skirting east to Johns Hopkins, where an exploratory brain surgery would reveal his terminal meningitis.
Yet, for all the uncertainty and suffering which must have clouded Wolfe’s mind, his thoughts were piercing and lucid as he approached his last, painfully numbered days. Just before he came down with pneumonia, the young man had arrived in Washington by way of a two-week expedition through (what were then) the 11 national parks of the West. He had never encountered that part of the country before, and one imagines the awe, the wonder, the life which must have shone before him amidst the enormous and overwhelming scenes.
The enormity of those scenes was matched only by the poignancy of illness. At 37, Wolfe was, perhaps, America’s most promising novelist. “There was within him an unspent energy,” the New York Times noted in his obituary, “an untiring force, an unappeasable hunger for life and for expression.” One wonders, then, what Wolfe must have felt—what voyage and country he was thinking of as his life morphed, transformed, dissolved before his eyes into something different. Was it his voyage through the West, coming face to face with transcendent, natural beauty? Or was that physical voyage but a foil to his subsequent journey, his cruel twist of plot which even a novelist wouldn’t dream for himself? And who, after all, was the dark man?
“So much of mortality still clings to me,” Wolfe continues in his letter, written to Maxwell Perkins, an old friend and editor of his. “I wanted most desperately to live and still do.” But as his reflections develop, they meet a new aspect of his sufferings—a sentiment which, to people like myself, feels almost like a warning. Hoping against hope, the author longs that he might take back what he once had, or pursue what he has not yet caught. “There was the impossible anguish and regret of all the work I had not done,” he bemoans—“of all the work I had to do.”
Impossible. His anguish is impossible. But for what reason?
Implicitly, Wolfe’s self-examination strives against itself in the effort to define a life. The young author wrestles with the tension of my own heart—work as the measure of life, the mountain which Sisyphus must desperately climb. The same measure which has driven me, and countless others, to that self-imposed state which rarely rests, rarely sits satisfied. To what degree Wolfe is tied to his anguish—to what degree his life was defined by his work—we know not. But his anguish is, in his words, impossible.
And yet there is hope. Coming on the heels of Wolfe’s anguish is yet another aspect to the problem—the idea that somehow, in his debilitating illness, Wolfe has witnessed something akin to wonder, or peace, or rightness. “And I know now I’m just a grain of dust,” he writes, “and I feel as if a great window has been opened on life I did not know about before.” Just as the blinds of his life close—as “mortality still clings” to the man—Wolfe conjures up an insane hope, a yearning that he might be a better man, that “in some strange way I can’t explain I know I am a deeper and wiser one.” But how? What about Wolfe’s suffering leads him to this window?
The answer is by no means certain; yet I wonder if Wolfe’s great window has opened, at least in part, because he now sees the emptiness, the minutiae of the meritocratic life. Perhaps the anguish of work unfinished is not, after all, impossible. Perhaps, in its wake, Wolfe has glimpsed something larger, something more spectacular and enormous. Something tied deeply, inherently, necessarily, to his messy and uncertain sufferings. Something which not even the majesty of 11 national parks could bring about. I wonder Wolfe saw through that window.
As he closes his letter, losing strength and time in a strange hospital bed, Wolfe turns to a memory. It seems that, amidst all the grieved remembrances of a life cut short, Wolfe’s great mirror has reminded him of the wonder of life. It has opened his gaze to a place, a scene, alluded to in his first novel: a country of “hot mazes, lost, among bright stars,” a state where “speechlessly we seek the great forgotten language, the lost lane-end into heaven, a stone, a leaf, an unfound door.” But these writings from his novel were not offered to Perkins—they were penned with the unspent energy, the untiring force, which was still alive within him at the time. Yet there is something to glean from these unfound doors, these hot mazes of Wolfe’s. There is the great portrait of longing and not-belonging, the idea that somehow, we are yearning for something real, something good, but until the windows have been opened, we are doing so in all the wrong ways.
In my own life, I have had to wrestle with this confusing duality: the idea that I am looking for something good, and perhaps already have it, but that I am constantly closing the great window as I search. I think especially of my faith, the love and acceptance of my community; and I wonder how I came to accept—albeit implicitly—that my life was tied up in productivity, in accomplishment, in efficiency.
And now I also think of David Foster Wallace, who spoke at my college’s commencement ceremony years before I matriculated, delivering the famous and important speech, “This is Water.” The address begins with two fish, swimming along in the everyday current which has always surrounded them. They encounter a third fish, who passingly remarks “Morning, boys, how’s the water?” The two younger fish continue on for a bit—before one cannot help but ask, “What the hell is water?”
There are many, many layers to Wallace’s remarkable speech, and to fully process those insights one should simply read or listen to the address. But the present essay is already far too long, so let me highlight the key point: our default setting in life—the lens through which we look at the world, and what happens in it—is deeply, inherently, self-centered. Even more so, it is almost never chosen: it is passively absorbed, no more strange or thought-provoking than a fish in water.
That, to Wallace, is the issue. Our cultures, our media, our histories, our personal baggage, will never remove themselves from the way we look at the world, or the way we look at others. But “if you’ve really learned how to think, how to pay attention,” Wallace says to the graduates, “then you will know you have other options.” If the world will call us to account, demanding a ledger of what we have done, we have alternatives. We have choices beyond the meritocratic understanding of self; beyond the definitions of life as a set of accomplishments, or experiences, or exotic getaways. We have the option to see a broader, more human totality; a notion which feels right to accept, but difficult to practice—an “awareness of what is so real and essential, so hidden in plain sight all around us.” That is, in essence, the option to see our lives as something more than what they might plainly appear to be.
My choice, the option which I have taken, has already been mentioned: my Christian faith. I think it is an important option. But I am far too young, naïve, and short-witted to act like I can see through this water with unaffected clarity. I see that there are many other answers to the question, “What is a life?”—just as there are chemical, ecological, and philosophical answers to the question of Wallace’s fish. There are things I don’t know and biases I still haven’t uncovered, all of which remind me that I am not so wise and certain of my own worldview as I believe myself to be. “Please don’t think that I’m giving you moral advice,” Wallace says during his own speech. What I am putting forth is not advice, but a question. It is the explicit descendant of Wallace’s inquiry, and a very simple one: What is a life?
Perhaps this is not a useful question to other people. But I know that I struggle daily with the rhythms, the implications of a culture so obsessed with winning, with profit, with productivity, that its people grow anxious and angry when they cannot achieve—when they cannot do—at the level that others deem appropriate. I know that I want to measure value, measure my life, by a different standard. And to do that—to even begin to pierce the barriers which separate my true and ideal selves—I must always be asking the question. I must always be examining value systems I did not know I held, then looking back to my central hope—what I truly love—and, like Wallace’s fish, remind myself that “This is water, this is water.”
Hope. And now we return to Thomas Wolfe. Despite the young man’s impossible anguish, Wolfe’s final written words are stunning for their hopefulness. Yet they are not hopeful as most of us imagine hope. They are not hopeful of a certain future, a state in which all that was lost might be returned. They are hopeful in a sorrowful sort of way.
The final portrait, the ultimate tapestry which Wolfe weaves has nothing to do with the work unfinished, the previous markings of a prolific and productive life. The author seems to have stepped out from the ocean, out from the fishbowl, onto dry land—into the warm and revealing sun. His final literary portrait is illuminated by imagery itself: the mysterious, organic absorption of a scene, a moment—a stone, a leaf, an unfound door. There is the sense that the author has gazed up from his lifetime ledger, and witnessed something beautiful through the great window. As the tremulous moments of action and accomplishment sputter, Wolfe stares out this window—stares at his life; that of his friend—and harkens on a moment, an image.
“I shall always think of you and feel about you the way it was that 4th of July 3 yrs. ago,” he closes, “when you met me at the boat, and we went out on the café on the river and had a drink and later went on top of the tall building and all the strangeness and the glory and the power of life and the city were below – Yours always,
It was the week before Thanksgiving when I began this scrambled, disorganized collection of thought. My family and I had planned to bring grandma over for dinner on that Thursday night: her farthest journey in years, hospital visits excluded. I was joyful, expectant, but also uncertain. What would it be like, I wondered, for grandma to reenter the world in one sense, but remain an outsider in another? It was an ordeal for her simply to move from the bed to the wheelchair, and I couldn’t imagine any amount of conversation, laughter, or yams, which might rekindle the life she once had. She would be an observer; a tired spectator watching a familiar yet fuzzy scene unfold around a giant turkey. I imagined her exhaustion, her lack of energy, and worried that the dinner might only burden her.
But then, part of me felt that her presence was necessary. Not necessary for her, but for myself, for my family. Living in a paradigm where one must always be doing, there are innumerable ways to drive oneself crazy. There are innumerable ways to convince oneself that life is, indeed, a ledger-list. Perhaps having my grandmother over for dinner would force me to confront the world I had been living in for the better part of a year—a world where moments unworked are moments unlived. Looking into my grandmother’s gentle, tired eyes, I would search her soul for the answer to my own insecurities. I would look in her eyes, and ask myself if she—if I—was living.
That is a difficult question for a grandson to ask of his disabled grandmother. And that is why the question was, and is, so important. As an aspiring physician, I seek the privilege of entering into the suffering of others; of shouldering a piece of their burden, however small or large. To do so is to walk headlong into the worlds, the suddenly-blurred futures, of people who may feel that their illnesses have dissolved their very lives. Medical treatment is a crucial tool to bring order from that abominable chaos. But there is a deeper salve, too. There is a potent and oft-untapped art, in which human suffering is recognized as a thing itself, a reality, one which can be understood only in the context of a human life. That recognition, in my experience, goes a long way in healing the broken human soul, which creaks so precariously amidst life-threatening illness.
Yet to recognize, we must first understand. And only when we understand a person’s desires, a person’s fears, troubles, joys, values, stories—only then will their suffered lives make sense in all their fearful humanness. The mother suffering from terminal cancer, worrying for her grieving family; the young boy wrestling with a rare, isolating, chronic disease—how could we heal such people without knowing what, for them, is broken? And how could we know what is broken if we don’t know what it means to be whole?
There is only one way out of this problem. And that is the way in. To heal lives which are burdened by illness, broken by suffering, we must enter into those burdens, enter into that brokenness. In doing so, we may witness a shadowy confusion which feels oddly familiar. A confusion that things are not as they should be; that so much of our lives are spent covering this strange vulnerability with objects, projects, endeavors, work; that illness, disability, the wedge between our desires and our realities, cannot be covered through action, through achievement, through status. It is the very nature of illness to keep us from these things.
Is life wasted in such moments? When we lose our work and activity to cancer, chronic pain, infection, stroke, or old age, do we still have value? Are we still living? And what, after all, is a life?
I have been a hospice volunteer long enough to know that I don’t have good answers for most of these questions. I do not know what to tell someone when an active and vibrant father—or mother, or spouse, or child—is stripped of energy, work, hope. But I find now, thinking of my grandmother, that I don’t need answers to all these questions. In fact, I find that so many of these questions are actually permutations of the same core tension. They are distant ripples circling the definition of a life. They gesture towards dreams, visions, hopes integral to that definition: children to raise, friends to enjoy, goals to accomplish. The anguish brought about by these questions is the anguish of Thomas Wolfe, the poignancy of Paul Kalanithi, the question of David Foster Wallace. But like Wolfe, whose anguish was at first impossible, there may yet be hope.
As our lives—or the lives around us—grow unrecognizable through suffering, we may be able to restructure hope, reimagine what it would mean to have life and have it to the full. And it all starts with the question: What is a life? Once we have stripped away the superfluous—the accomplishments, the statuses, the ornaments of our daily rhythms—that question is answered in a far messier, far richer way than we might expect. It is answered with work, vitality, biology, philosophy—yes, all these and more. But in turn, these multiform answers provide the broad outline to meet our deepest struggles. The dying mother is given comfort and time with her children; the isolated boy is uplifted by accepting and compassionate friends.
When one lives in water, one can’t help but forget what water is. But when we ask the question, over and over again, our lives may look different from what we thought they once were. And in that realization, there is tremendous hope. There is the hope of dust before great windows: the hope that if we can recognize our fragility, our humanness—if we can stop, for but a moment, covering our brokenness—we can truly live. And, like Wolfe gazing down at the glory and the power and the life of the city below, we can exist for a moment, awestruck, resting in moments which feel right, even as they are sorrowful.
Thanksgiving was a trying and tiring night for my grandmother. But needless to say, it was important for us both.