When Breath Becomes Air
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When Breath Becomes Air
Determined to finish the last months of his residency, he ignores whatever symptoms have not subsided. A few weeks later, the symptoms come back, stronger than before. Around this time, Kalanithi and his wife experience conflict in their relationship when Lucy feels that he is not communicating with her. Visiting friends in New York, Kalanithi is almost certain that he has cancer and says it out loud for the first time to his friend Mike. Returning home, upon landing in San Francisco, Kalanithi receives a call from his doctor telling him that his lungs "look blurry." When he arrives home with Lucy, both of them know what is happening. The next day, Kalanithi checks in to the hospital, and the room where he examined his patients, delivering good and bad news, becomes his own.
Kalanithi's life takes an unexpected turn when, after weeks of health problems, it is confirmed that he has lung cancer. Images obtained from a CT scan show organ systems compromised by the cancer, causing him and his wife great sadness. Searching for the best experts in the field of oncology, Kalanithi begins treatment with a doctor named Emma Hayward. Because of his status, rather than stepping back and letting Hayward offer her professional opinion, Kalanithi expects to be treated as a consultant, even if it is his own case. Hayward suggests to find the root of his cancer before determining treatment options. In the meantime, Kalanithi's family helps him through his transition from doctor to patient and, together with Lucy, he decides to explore reproductive options before he dies. They visit a sperm bank and make the decision to have a child. Test results arrive and Kalanithi discovers that his cancer is derived from a mutation in the epidermal growth factor receptor (EGFR). This fact gives him a bit of relief because it means that he can be treated with Tarceva, which typically results in less-severe side effects compared to traditional chemotherapy.
He was just thrilled to be a dad, and just the fact of having this infant just breathed this unbelievable life into our house. He was the one who initially had the strong instinct to have a child despite his illness. ... I said to Paul, "Don't you think that saying goodbye to a child would make your death more painful" And he said, "Wouldn't it be great if it did" And what he meant by that was the joy and meaning of having a new family member is so great that wouldn't it be great if that made it even more painful
A few months before he died, I interviewed Paul Kalanithi, MD, for a 1:2:1 podcast about a gorgeous article he wrote for Stanford Medicine entitled "Before I Go." I knew his days were short, yet when he came into the studio I was taken aback by his frailty. I think I was hit broadside because seeing him reminded me so much of my brother, Bill, in his last days alive. On the one hand each was still fighting cancer and yet there before you was a map illustrating how a disease overwhelms a body.
Lucy, your courage to share Paul story with us is a special gift you are giving to all who have say goodbye to a love one early in life. I cried a few times and have taken a few strong breaths to give thanks to you and Paul. The book is a brilliant read and a reminder to cherish life and all its challenges. May the heavens rejoice in the glory of your and Paul gift to us.
During that time, Paul and Lucy also decided to try for a baby; it had always been their plan to do so when his residency was finished, Lucy said, and he had banked sperm before he started erlotinib treatment.
In his book, Paul writes about how important literature had been to him when he was younger. He hadn't had the time to read much during his residency, with its long hours in the operating room, but now he returned.
"When you come to one of the many moments in your life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man's life with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests satisfied. "
Another medical oncologist in the audience brought up this same point, and suggested that the fact that both Lucy and Paul were physicians likely influenced the way that the issue of prognosis was handled. It would have to be spelled out a bit more for other patients, she suggested, and Lucy agreed, adding that when Paul's parents were in the room and discussing the future, then their oncologist was quite firm in framing their expectations.
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I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them. Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action. I finished my degree and headed back to the States. I was going to Yale for medical school.
At the age of 36, after nearly ten years of training as a neurosurgeon, Kalanithi was diagnosed with lung cancer. Initial treatment seemed positive, but then stopped working. Kalanithi details his struggles when the fantasy of his longevity was shattered. Used to being both a midwife of life and death as a doctor, confronting his own death created a variety of conflicts for him in his roles of doctor and patient, husband and son.
Kalanithi was 36 and nearing the end of residency as a neurosurgeon at Stanford University when he was diagnosed with stage 4 lung cancer. As a young boy, Kalanithi devoured books and had ambitions of becoming a writer, but growing up in a family of physicians, he understood medicine's pivotal role in society. In both his undergraduate and graduate studies, he took on double course loads of literature and science, paving his path to be either a writer or a doctor. Kalanithi was fascinated with the moral complexities that come with humanity and realized that as a writer he would only be a casual observer but as a physician he would be on the front lines of life and death. He decided to go to medical school and pursued neurosurgery, one of medicine's most strenuous fields.
His life was progressing, with a child on the way and nearing residency graduation, when a scan revealed another tumor. Despite what everyone else was saying, Kalanithi knew it was the beginning of the end. He left medicine to spend time with his family and write.
Writing the chemotherapy orders was the least important part of her job. She was engaging with him as a human being, which was just so powerful to him. It brought him back to life, in a way. Even when he was dying, it helped him live.
Words began to feel as weightless as the breath that carried them. Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action. I finished my degree and headed back to the States. I was going to Yale for medical school.