Paul Kalanithi, a Stanford neurosurgeon, had devoted his life to a vision of helping the dying. But just as he was finishing his residency, terminal illness paid a personal visit.
Kalanithi died in March 2015, almost a year before the release of his extraordinary memoir, When Breath Becomes Air. The book (a No. 1 New York Times bestseller) tells the story of his incurable diagnosis, and the way he found his life reinvigorated in the shadow of death. And even though many readers miss this theme, the story shows how he and his wife, Lucy, both doctors, grew to understand Christianity’s promise of new life in profound ways.
As a reader, I have an unfortunate kinship with Kalanithi. I was diagnosed with an incurable cancer less than a year before he received his medical “death sentence.” I was 39; he was 35. Like Paul and Lucy, my wife and I found our lives in a fog. A sinister arithmetic shattered our hopes and plans for the decades ahead: the disease could bring death within months, or years, or decades. We were told to live one day at a time. Kalanithi received the same advice, but found it sorely inadequate. He cuts through this cliché with a surgeon’s scalpel:
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 with that day?
In prose that verges on poetic, Kalanithi exposes the chasm between doctor and patient, one he had never recognized during years of carefully treating dozens of dying patients. He does not offer self-help “lessons” or present himself as a “hero” in the war on cancer. Instead, as a lover of medicine, he fearlessly points to both its potential and its profound limits.
While Kalanithi wrote this book after his diagnosis (in the final 20 months of his life), he found that as he looked back, his whole life seemed to be preparing him for this trial. In college and graduate school, he was obsessed with death and the meaning of life. He studied literature and philosophy with great earnestness. Ultimately, he chose one of the most rigorous medical routes—neuroscience—because it confronted these questions concretely, with real people. He wanted to be present to those with severe brain damage and their families. He could not be their savior, but he could help them navigate their excruciating end-of-life decisions.
Sometimes he acted, in his own words, as “death’s enemy.” But often, he had to be “its ambassador,” preparing his patients for what was to come: “They see the past, the accumulation of memories, the freshly felt love, all represented by the body before them. I see the possible futures, the breathing machines connected through a surgical opening in the neck, the pasty liquid dripping in through a hole in the belly, the possible long, painful, and only partial recovery.” Kalanithi directed his life’s quest toward facing these realities head-on in the presence of the dying. “Had I been more religious in my youth, I might have become a pastor” for the dying, he observes. “For it was the pastoral role that I sought.”
Kalanithi’s work took a toll on his marriage. The years he and Lucy spent working long hours in their residencies left them emotionally isolated. When Paul started to worry that he might have cancer, he withdrew. “I feel like we’re connected halfway,” Lucy told him. She needed a week apart to consider the state of their marriage.