Suppose in early adult life you were handed a diagnosis of a widespread malignancy for which there were no known cures. How would you plan for the uncertain time ahead?
This was the situation in 2013 when 35-year-old Paul Kalanithi, a senior resident in neurosurgery, learned that his worsening symptoms of weakness and back pain were due to lung cancer that had spread widely. This particular cancer was unusual for a young man who had never smoked.
Clif CleavelandA distinguished career lay ahead for Kalanithi. He had degrees in English literature and biology from Stanford University and a postgraduate degree in the history and philosophy of science from the University of Cambridge University. He graduated cum laude from Yale Medical School, where he married Lucy, then returned to Stanford for a demanding residency in neurological surgery.
Then everything fell apart.
“When Breath Becomes Air,” posthumously published earlier this year, is Kalanithi’s account of dealing with collapsed expectations. Should he simply retire to spend his remaining time with his family and friends? Should he and Lucy have a child? If so, sperm would need to be banked before chemotherapy began. Was it foolhardy to consider returning to work to complete the final year of his residency?
His oncologist offers cautionary hope. Although no cures were at hand, new therapies are available which promise remissions that might extend for a few years. Each medication had complex toxicities, some of which might interfere with a return to the operating room. He opted for the treatment plan most compatible with completing his neurosurgical training.
The relationship of the oncologist and the surgeon who is now the patient offers a model for the doctor-patient relationship. Emotional support and empathy are as vital as the medication.
Kalanithi had an abiding love of literature. He saw writing as a career he might pursue in parallel with his surgical work. Literary passages that he had read and pondered years earlier now gave him comfort and strength. In his drastically changed circumstances, the future became a present marked by pain, weakness and, above all, uncertainty. As his therapy progressed, he used every opportunity to compose an account of the new realities presented by his illness.
In his book, readers are spared nothing. He presents forthrightly the strains that his surgical training placed upon his marriage before he became ill. We witness hope which is then shattered and rebuilt. We pull for the doctor as he battles pain and nausea to complete the requirements of his residency. Attaining this goal, he is too ill to attend graduation.
In all, we have a privileged look into the thoughts of a man who knows that time is running out. He has no unrealistic hopes of a cure but strives to carve out as many good days as possible. He hopes that he can remain clearheaded until the end.
Paul and Lucy decide to have a baby. In-vitro fertilization is successful. Too weak to stand, he rests on a cot in the delivery suite. A daughter is born, bringing unimaginable comfort during the final eight months of his life.
After her husband’s death, Lucy Kalanithi pulled the various files together that he had written and, with the assistance of editor and agent, guided the text into print less than a year after Paul’s death. Her epilogue provides a perfect coda to the work.
This beautiful book is about courage and devotion. Lucy, other family members, co-workers and friends form a network of support during Kalanithi’s two-year campaign against disease. This is a necessary text for anyone – nurse, physician, aide, technician – who is involved in the care of sick people and their families. Any person among the temporarily “abled” will gain a fresh perspective on illness, the complexities of clinical care and decision-making, and the necessary conversations we must all have when our families are faced with frightening uncertainties.
The memoir closes with this message to his daughter:
“There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose live, barring the improbable, is all but past. The message is simple: When you come to one of the many moments in life where 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 days 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. In this time, right now, that is an enormous thing.”
Contact Clif Cleaveland at ccleaveland@timesfreepress.com.