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  • Gail Wilson Kenna

"Putting Lifestyle First Is How You Find a Job…Not a Calling," wrote Dr. Paul Kalanithi

It seems the cruelest of ironies that a rare cancer, "with its shadow of swift neurological decline" should infiltrate the brain of Dr. Paul Kalanithi, the physician-author of When Breath Becomes Air. The book's foreword is by Abraham Verghese, another physician & writer, known for his fiction and nonfiction. Here is the final paragraph of the book's nine-page foreword.

"Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words. In a world of asynchronous communication, where we are so often buried in our screens, our gaze rooted to the rectangular objects buzzing in our hands, our attention consumed by ephemera, stop and experience this dialogue with my young, departed colleague, now ageless and extant in memory. Listen to Paul. In the silences between his words, listen to what you have to say back. Therein lies the message. I got it. I hope you experience it, too. It is a gift. Let me not stand between you and Paul."


The short life of this neurosurgeon was one of building potential, as he writes in the book. Then at age 36, lung cancer was diagnosed. (The odds of someone his age, and a non-smoker, were one in ten thousand for this occurrence.) When Breath Becomes Air was written during the last year of Paul's life. In the hospital at the end, he asked his family to ensure the publication of an open file on his computer. The book's epilogue, written by his wife Lucy, details some of what transpired before and after her husband's death.

At Stanford University, Paul had been a literature major (B.A. & M.A) and believed that literature provided the best accounting of the life of the mind. He felt that literature not only illuminates human experience but provides the richest material for moral reflection. Yet despite these beliefs, he did not become a professor of literature. He chose to take a year of required courses so he could apply to medical school, believing that "neuroscience laid down the most elegant roles of the brain." In the book, he describes how he was "compelled by neurosurgery, with its unforgiving call to perfection; like the ancient Greek concept arete…a virtue requiring moral, emotional, mental, and physical excellence."

In his book, he dared to ask himself a hard question, whether in his brief time as a physician, he had made more slides than strides? He answered by admitting to "all my occasions of failed empathy…they all returned, vengeful, angry, and inexorable." The diagnosis of his cancer was close to the end of seven required years at Stanford and his graduation as a neurosurgeon. He believed that to understand his experience, it had to be translated into language. "I needed to write to move ahead….and it was literature that brought me back to life during this time." On 199, the final page of his writing in the book, he said, "Words have a longevity I do not." The last paragraph in When Breath Becomes Air are words of cadence and beauty, written to Cady, his infant daughter, born in the year before her father's death on March 9, 2015.

In the time between diagnosis and death, Paul's mantra was to repeat seven words from Samuel Beckett, the famous Irish writer. "I can't go on. I'll go on."

And in Paul's book, who could miss the message from Sir Thomas Browne in Religio Medici “Reader, then make time, while you be, but steps to your eternity."


Note: If you don't have time for the book, do read "How Long Have I Got," January 24, 2014, an article in the New York Times (also a podcast). And in Stanford Medicine, Spring 2015, is an essay, "Before I Go," along with Dr. Paul Kalanithi's obituary.

Until next week… and hoping you subscribe to my weekly posting, which means receiving it each Monday on your computer or cellphone.

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