Life after becoming Terminally III – A cancer patient’s thoughts

A neurosurgeon learned about living after he became terminally III. Dr. Paul Kalanithi at the Stanford Hospital and Clinics died in March 2015, 22 months after he was diagnosed with stage IV lung cancer.

By the time he was 36 years old, Paul Kalanithi 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 descovered he had stage IV lung cancer. The diagnosis was immediate.

Here are four insights from his memoir:

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

When Kalanithi first learns he has terminal lung cancer, he presses his oncologist to be specific about his prognosis. Instead of giving in to his request, Emma tells Kalanithi to “find his values.” It’s a mandate he finds challenging, because 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 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.

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

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

As Kalanithi settles into life as a resident, he starts to worry that although he’s gaining competence as a physician, he’s becoming desensitized to trauma and human suffering. It takes a fellow medical school student’s death in a car crash for Kalanithi to course-correct. “Nobody has it coming,” he realizes. In practice, Kalanithi transforms his informed consent process from an obligation into an “opportunity to forge a covenant with a suffering compatriot.”

4. Life isn’t about avoiding suffering, even if it comes to cancer.

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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