This is a sad but beautiful story of a neurosurgeon facing impending death – a doctor experiencing what it takes to be a terminally ill lung cancer patient and how he makes use of his remaining precious limited time. The celebration of his daughter’s birth is beautifully juxtaposed with the terror of mortality in his memoir – When Breath Becomes Air.
Paul Kalanithi epitomised the modern-day successful man, gifted in both science and humanities.
The son of immigrant Indians, he majored in English and Biology at Stanford before getting a master’s in English literature there followed by a master’s in philosophy from Cambridge and in deciding whether to pursue a career in English literature or medicine, he wrote: “I could either study meaning or experience it.” And he chose medicine. He went to medical school at Yale.
In 2013 at the age of 36 when he was looking forward to a promising career in medicine, he had a rude awakening after he was diagnosed with stage 4 lung cancer.
Kalanithi was a non-smoker and enjoyed reading and the outdoors. His life changed when weight loss and severe back pain sent him to consult the doctor. He knew what was coming even before the CT scan results revealed multiple tumours.
“I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumours, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.”
As a neurosurgeon at Stanford Medical Center, Kalanithi was used to looking at CT scans of patients. What he was not accustomed to was looking at his own, and that’s what happened to him. At a young age of 36 he read his own death sentence in the medical report.
It’s a remarkable book, especially for its description of his transition from an all-powerful doctor to an anxious patient.
Though disturbed, Kalanithi had a clear idea of his next steps. “Prepare to die. Tell my wife that she should remarry.”
He died in less than two years time in March 2015. But in the interim period, he wrote about his experience facing mortality as a doctor and as a patient. Still ambitious to finish his residency, he returned to work when his cancer responded to chemotherapy.
Among the choices he and his physician wife (Dr Lucy Kalanithi) made during this phase was to have a baby. Their daughter Elizabeth Arcadia, known as Cady, (conceived through IVF) was born nine months before his death.
The decision to have a child was very important to Kalanithi.
“As soon as he got diagnosed he wanted to do it right away,” Lucy says.
She asks him: “Don’t you think saying goodbye to your child will make your death more painful?”
He replies: “Wouldn’t it be great if it did?”
On his little bundle of 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 her existence he truly found the meaning of his life.
The passages describing their time together are among the most moving in the book.
“As a doctor, you have a sense of what it’s like to be sick, but until you’ve gone through it yourself, you don’t really know. It’s like falling in love or having a kid,” Kalanithi writes.
When cancer struck, he went back to literature to understand his experience and make sense of death. Ultimately, he made a decision: “Even if I’m dying, until I actually die, I am still living.”
Kalanithi’s father is an eminent cardiologist, his mother trained as a physiologist in India, one brother is a neurologist and the other works in consumer electronics.
Kalanithi never intended to take up medicine. He knew medicine only by its deficits. He writes about “the absence of a father growing up, one who went to work before dawn and returned in the dark to a plate of reheated dinner”.
He wanted to be a writer. Along the way, he became fascinated by human biology. It impressed upon him the notion that the brain was a biological organ that enabled the mind to make sense of the world and, among other things, appreciate the meaning of literature.
Although his first love was literature, Kalanithi became a neurosurgeon because he wanted to learn about “what really matters in life”.
His decision to go to medical school, he writes, was an effort “to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay”.
Lucy Kalanithi, an internal medicine doctor at Stanford Health Care, still lives in the town of San Carlos in northern California where she and Paul settled after marrying in 2006.
A moving and thoughtful memoir of family, medicine and literature, one of the most poignant things about Kalanithi’s story is he learned how to live while dying. He learned to live in the present until he died surrounded by family. His mental state was alive. He didn’t die until he died. He was just 37 when the end came.
Kalanithi did not live to see his book published.
