What A Neurosurgeon Learned About Living After He Became Terminally Ill

"What makes human life meaningful, even in the face of death and decay?"
Dr. Paul Kalanithi at the Stanford Hospital and Clinics in 2014. Kalanithi died in March, 22 months after he was diagnosed with stage IV lung cancer.
Norbert von der Groeben
Dr. Paul Kalanithi at the Stanford Hospital and Clinics in 2014. Kalanithi died in March, 22 months after he was diagnosed with stage IV lung cancer.

By the time he was 36 years old, neurosurgeon Paul Kalanithi had also earned a master's degree in English literature and won neuroscience's highest research award. He was married to a successful internist and was considered a top prospect for a prestigious neuroscience professorship at Stanford University.

Then he found out he had stage IV lung cancer.

"The diagnosis was immediate," he wrote in his new memoir, When Breath Becomes Air, which was published posthumously this month (Kalanithi died in March 2015). "In my neurosurgical training, I had reviewed hundreds of scans for fellow doctors to see if surgery offered any hope. I’d scribble in the chart 'Widely metastatic disease -- no role for surgery,' and move on."

The new book tracks Kalanithi's thoughts during his last year and a half of life, including his quest to answer one of the existential questions that prompted him to devote his life to medicine in first place: "What makes human life meaningful, even in the face of death and decay?"

Here are four thoughtful insights from Kalanithi's memoir:

1. It's up to you to find your values.

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When Kalanithi first learns he has terminal lung cancer, he presses his oncologist, Emma, to be specific about his prognosis.

"If I had a sense of how much time I have left, it'd be easier," he responds when Emma refuses to put a number on his life expectancy. "If I had two years, I'd write. If I had 10, I'd get back to surgery and science."

Instead of giving in to his request, Emma tells Kalanithi to "find his values." It's a mandate he finds challenging, because, as he writes, "the tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out."

Kalanithi returns to neuroscience for a short stretch, but eventually transitions into the role of family man, husband, and, of course, writer. While the prospect of death speeds up Kalanithi's life shift, the notion of reinventing his values as he transitions through different life stages is a valuable one.

"Emma hadn't given me back my old identity," Kalanithi writes. "She'd protected my ability to forge a new one."

2. Each of us can only see part of the picture.

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When Kalanithi returns to his own hospital as a patient in a hospital gown, instead of as a surgeon, he sees for the first time how different cancer is on the other side of the white coat.

"Human knowledge is never contained in one person," he realizes, noting that a doctor, patient, engineer, economist, pearl diver, alcoholic, cable guy, sheep farmer, beggar and pastor all see the world differently. "It grows from the relationships we create between each other and the world, and still it is never complete."

Regardless of Kalanithi's neuroscience awards or talent with a scalpel, it takes becoming a cancer patient himself before he can truly empathize with his patients' and their families' suffering.

3. Nobody 'has it coming.'

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As Kalanithi settles into life as a resident, he begins to worry that although he's gaining competence as a physician, he's becoming desensitized to trauma and human suffering, and making "more moral slides than strides," as he puts it.

These aren't baseless anxieties. Kalanithi recounts being too busy to answer cancer patients' questions thoroughly, and an incident with a defiant veteran who re-injured himself within weeks of ignoring his doctors' advice. "I stitched the dehiscent wound as he yelped in pain, telling myself he'd had it coming," Kalanithi writes.

It takes a fellow medical school student's death in a car crash for Kalanithi to course-correct. "Nobody has it coming," he realizes. "As a resident, my highest ideal was not saving lives -- everyone dies eventually -- but guiding a patient or family to an understanding of death or illness."

In practice, Kalanithi transforms his informed consent process from an obligation into an "opportunity to forge a covenant with a suffering compatriot." It's also a good reminder to all of us about the power of human connection.

4. Life isn't about avoiding suffering.

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When Kalanithi and his wife, Lucy, discuss whether or not to have a baby together during Kalanithi's final months, Kalanithi has the perfect response to Lucy's question about whether saying goodbye to a child would ultimately make his death more painful.

"Wouldn't it be great if it did?" he replies, observing that both he and Lucy felt that life wasn't about avoiding suffering. Indeed, Kalanithi's relationship to his daughter, Cady, is the underpinning of his memoir and a shining light in his last moments:

"You filled a dying man's days with a sated joy," he writes. "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."

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