“Often I return to the grave after leaving flowers – tulips, lilies, carnations – to find the heads eaten by deer. It’s just as good a use for the flowers as any, and one Paul would have liked. The earth is quickly turned over by worms, the processes of nature marching on, reminding me of what Paul saw and what I now carry deep in my bones, too: the inextricability of life and death, and the ability to cope, to find meaning despite this, because of this. What happened to Paul was tragic, but he was not a tragedy.” ~ Lucy Kalanithi, epilogue to her husband Paul Kalanithi in When Breath Becomes Air
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If you haven’t read the book When Breath Becomes Air, I strongly encourage you to consider reading it. In this poignant memoir, Dr. Paul Kalanithi, a neurosurgery resident at Stanford, recounts the unimaginable – being diagnosed with terminal lung cancer on the precipice of starting an impressive career and having so much life yet to live. His book was published after his death in March 2015 at the young age of 37. His wife Lucy, also a physician, and Paul decided to have a child after his diagnosis, saying:
“Will having a newborn distract from the time we have together?” she asked. “Don’t you think saying goodbye to your child will make your death more painful?”
“Wouldn’t it be great if it did?” I said. Lucy and I both felt that life wasn’t about avoiding suffering.
Even though death is ultimately unavoidable, we often live as though we have a lot more time than we do on earth. Whether we are 20 or 80, we may in fact have the same amount of time left to live. Paul’s story reminds me of many others both personally and professionally where the diagnosis seems illogical, such as breast cancer in a 23 year old and a new mom with stage 4 lung cancer in her early 30’s. Paul talks about his oncologist not wanting to entertain statistics and numbers when it came his prognosis – I can understand why given he didn’t fall into a statistical scenario that made sense in the first place. As I always say, if it happens to you it is %100 anyways.
In Lucy’s words: “Even while terminally ill, Paul was fully alive; despite physical collapse, he remained vigorous, open, full of hope not for an unlikely cure but for days that were full of purpose and meaning.”
What a beautiful message for us all. It is not that we search for meaning when faced with death, but through death we are reminded that we should live each day with a sense of purpose and meaning.
Dr. Atul Gawande, author of Being Mortal: Medicine and What Matters in the End, examines the reality that our ultimate goal is a good life until the very end. This can sometimes be overlooked in our advanced healthcare system where sustaining life does not equate to living. As Atul says:
“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
We have the opportunity to learn from the very recent death of another young physician, Dr. Kate Granger. She had a rare form of sarcoma and died on July 23, 2016 at the age of 34. She was a champion for compassion in healthcare through her #hellomynameis campaign, encouraging an added level of humanity in medicine. Kate blogged about her terminal diagnosis and had a very engaging approach, often writing a letter to her cancer. She touched the lives of so many people, especially those also affected by cancer in some way.
On the topic of living, she wrote about resuscitation on August 22, 2015 saying:
“But we do as a society have to accept that some health conditions are incurable. That as we age our bodies do eventually wear out. We are all going to die, nothing in life in more certain. Whether the media want to make us all more frightened of this fact is their business, what I want to focus on as a clinician is achieving comfortable, dignified deaths for my patients when that time has come and hope that somebody will do the same for me when it’s time for me to meet my maker too.”
Kate’s approach seems similar to Paul’s to me, as Lucy says:
“What happened to Paul was tragic, but he was not a tragedy.”
The search for purpose and meaning they have added to my life and the lives of countless others, especially their families, friends and patients, is a testament to how they lived their lives, until the very end.