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Amid death’s throes, young doctor examines life for meaning

February 4, 2016 at 6:20 PM EDT
By age 36, neurosurgeon Paul Kalanithi had earned five degrees across various fields and was at the end of a residency at Stanford. Then he was diagnosed with lung cancer, a disease that killed him 22 months later. Facing death, he wrote “When Breath Becomes Air,” a memoir of his search for meaning in his last days. His widow, Lucy Kalanithi, joins Jeffrey Brown to discuss the book.
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JUDY WOODRUFF: What makes a life worth living? What gives it meaning? And how does that change when the time one has left collapses? These are some of the profound questions taken up in a new memoir by a doctor who suddenly faced his own mortality.

Jeffrey Brown has our newest addition to the “NewsHour Bookshelf.

JEFFREY BROWN: As a neurosurgeon, Paul Kalanithi was used to dealing with life-and-death issues. He was, by his own account, a driven man who studied literature and philosophy before turning to medicine, earning five degrees along the way.

He was near completion of a rigorous residency at Stanford when, at age 36, he got a diagnosis of lung cancer.

DR. PAUL KALANITHI, Author, “When Breath Becomes Air”: Five years down the line, I don’t know what I will be doing. I may be dead. I may not be.

JEFFREY BROWN: He would live just 22 months more, and in that time have a child with his wife, Lucy, and write an indelible memoir, “When Breath Becomes Air.”

DR. LUCY KALANITHI: He had thought maybe he would have a long career as a neurosurgeon or a scientist and then maybe a writer.

JEFFREY BROWN: He had planned on all this, right?

DR. LUCY KALANITHI: That’s right. He said: “I think I may be years into my retirement now, at age 36. And so what do I want to do?” And the answer was write.

JEFFREY BROWN: Lucy Kalanithi is also a doctor. The two met at Yale Medical School and were married nine years before Paul’s death in 2015.

DR. LUCY KALANITHI: He was sort of a perpetual learner and a seeker and somebody who was very interested in kind of understanding what it is to be human and what makes — what sort of makes life meaningful. And he approached that…

JEFFREY BROWN: From the beginning, right?

DR. LUCY KALANITHI: That’s right, yes.

JEFFREY BROWN: Yes.

DR. LUCY KALANITHI: He went to grad school in English literature, and sort of made his way into neuroscience because he wanted a real understanding of kind of consciousness and what makes us human. So he kind of came at that from different angles.

JEFFREY BROWN: One of the themes that comes through clearly in his life and his book is identity, right, is sort what makes us, us.

DR. LUCY KALANITHI: Yes.

You know, when you have a brain disorder or you’re having surgery on your brain, you are thinking about questions like, will this affect my language, will this affect my personality, not just, how does this illness affect my body in other ways?

So it’s kind of a very intense place for decision-making about identity. And he was very interested in that.

JEFFREY BROWN: And then, of course, it happens to him. And he starts — as he’s dying, he’s thinking about, if you’re dying, rather than living, in a sense, then are you still you?

DR. LUCY KALANITHI: In the moment of diagnoses, he sort of saw his life trajectory and his self kind of come tumbling down. He wasn’t going to be a neurosurgeon for years and years.

And we thought initially that he actually had less time to live. We thought he might have months or less than a year. And then he started a therapy that allowed him a lot more kind of functionality than he expected and a longer prognosis potentially. And so then it was this big question of, I don’t know how much time I have left and how do I spend that time? Who am I?

JEFFREY BROWN: Paul spoke of this in a video released by his publisher.

PAUL KALANITHI: It’s a careful load to balance. If you don’t think about the bad case, that ending is going to be very rough on you and your family.

But if you don’t think about the good case, you’re going to miss an opportunity to really make the most out of your life and time.

JEFFREY BROWN: You know, one of the things that struck me also here is, he learns a lot about doctoring, right, that he had never seen as a doctor.

DR. LUCY KALANITHI: Yes, yes, yes.

JEFFREY BROWN: He writes, for example, at one point, “Realizing how little doctors understand the hells through for which we put patients.”

He was really getting to see things from a different side.

DR. LUCY KALANITHI: He had been in medicine for a decade as a student and then a resident, but all these tiny little experiences — like, as an example, when you get an I.V. and they start infusing normal saline into your vein, you can taste the salt.

And he said: “I have been a doctor for a decade, and I never knew you could taste the salt.”

And it’s all these tiny details that sort of come to the fore. And that’s not even to mention the physical and emotional suffering that comes with being sick and the way it rocks you and rocks your family. So, yes, we really kind of felt that.

JEFFREY BROWN: He could look at it intellectually, but he also then had to look at it very realistically.

DR. LUCY KALANITHI: Yes.

When we got the news of this terrible chest X-ray that looked really kind of dense with tumors, and kind of helped explain why he had been having weight loss and back pain and real kind of health troubles for a few months, both of us knew that the next day we were going to the hospital. He would have a C.T. scan and it would likely show metastatic cancer.

Being doctors, we could see that path. And when we packed for the hospital, I was packing socks and pillows and phone chargers, and he just packed three books. He packed “Mere Christianity” by C.S. Lewis, Heidegger’s “Being and Time,” and Solzhenitsyn’s “Cancer Ward.”

And I think it was that transition right away where he said: “This is becoming so personal that I need my books. Like, I need to understand this through literature.”

When he became ill, he kind of translated the experience back into writing and words to make sense of it. And this book is part of that.

JEFFREY BROWN: And what about for you? What did you feel when you read it?

DR. LUCY KALANITHI: So, I read it in real time, as he was writing it.

I would read it daily or weekly. And it was kind of a great communication tool for us, actually.

JEFFREY BROWN: Oh, really?

DR. LUCY KALANITHI: Because he would talk about — oh, yes.

Seeing him write the book was really amazing, because even though his body was sort of in this state of physical collapse, his mind was so engaged, still, in this process.

And kind of the reviews of the book that I like the best capture that somewhat. There’s an author named Gavin Francis who wrote a blurb for the book. And he wrote something like, “This is a tremendous book, crackling with life.”

And that idea, like, it brings tears to my eyes to think of crackling with life, because, if you had seen Paul, you know, he’s wrapped up in a blanket, he’s sitting in this armchair. He looks frail and wan, you know? He looks ill.

JEFFREY BROWN: As he’s writing?

DR. LUCY KALANITHI: But he’s crackling with life. And that was just really true. And the book was a big part of that.

JEFFREY BROWN: The two of you made a very important, major decision in the midst of this, which was to have a child.

DR. LUCY KALANITHI: That’s right.

JEFFREY BROWN: Was that a tough decision?

DR. LUCY KALANITHI: We had always wanted to have children together. We hadn’t done it by the end of his residency. That was around the time we had pictured we always would.

And right at that time was when he was diagnosed with terminal cancer, terminal lung cancer. And it was a series of really intense conversations to figure out if we wanted to do that and could we handle that, and both of us had the instinct to do it.

But we needed to think very hard about what it would mean. You know, we talked really frankly about his prognosis and what was happening. And I said that, “Don’t you think that saying goodbye to a child would make your death even more painful?”

And he said, “Well, wouldn’t it be great if it did?”

PAUL KALANITHI: Since Cady’s birth, my time with her has had a very peculiar and free nature. In all probability, I won’t live long enough for her to remember me, and so the time is — just is what it is.

DR. LUCY KALANITHI: That was kind of this amazing thing, where it’s like life isn’t just about avoiding suffering. It’s about finding meaning. And having a child was part of that for us.

JEFFREY BROWN: The very powerful book is “When Breath Becomes Air” by Paul Kalanithi.

Lucy Kalanithi, thank you so much.

DR. LUCY KALANITHI: My pleasure. I wish it were Paul here. Thank you.

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