Neurosurgeon Resident Paul Kalanithi on How Life Changes When Dying

Paul Kalanithi (1977-2015), an Indian-American Neurosurgeon resident at Stanford, was diagnosed with stage IV metastatic lung cancer in the final year of his decade-long training to become a neurosurgeon. In this training, he had helped guide many patients through their medical crises, as they wrestled over the existential questions thrust upon them by their prognoses. He himself was then unexpectedly thrown into the same position. When Breath Becomes Air is his poignant memoir, written in the last years of his life, chronicling his journey through the medical world as both a physician and patient.

After being diagnosed with terminal cancer, Paul Kalanithi struggled to define what mattered:

The tricky part about 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. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with a terminal illness is a process.

What is the best use of the life that we have left? It is a question we all face, but perhaps not with the same solemnity of those who are terminally ill. For Paul, this question was quite difficult to answer.

Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die–but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do that day?

He continues,

The most obvious [response to his terminal cancer diagnosis] might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoise-like approach. I plod, I ponder. Some days, I simply persist.

Yet one thing is certain: In facing death, life becomes focused. Many of the concerns that bogged one’s life prior to that point become less than nothing. As Paul Kalanithi concludes,

Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.

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