In his sixth year of neurosurgical residency at Stanford, Dr. Paul Kalanithi developed night sweats, back pain, and cough. His weight dropped precipitously. In May, 2013, he was diagnosed with stage 4 non-small cell EGFR positive lung cancer. He had never smoked.
He was treated and went back to work.
He published a moving op-ed piece in the NY Times called How Long Have I Got Left.
Dr. Kalanithi died on March 9th this year. His most recent publication, Before I Go, moved me to tears. You’d have to have a heart of stone to react otherwise. The final paragraphs from that article are provided below.
He is survived by his wife, a physician, and his newborn daughter.
Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.
Yet one thing cannot be robbed of her futurity: my daughter, Cady. I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters — but what would they really say? I don’t know what this girl will be like when she is 15; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.
That message is simple: When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, 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.
Like you, I am moved to tears.
And, filled with questions like “why?” It seems so senseless to lose such a man with talent and promise and such heart. I am reminded of David Brooks recent column asking if we are focused on developing our “resume” selves or our “eulogy” selves. Good to give pause to think about that.
Very touching, thank you for sharing. We are all dying men and women, and even if our past or present do not have the joy we seek, it is never to late to claim what is always there. Be present in the moment, smile on what we have in life (we live in amazing abundance), and take (or make) joy in what we have now ( :
Beautifully written. Lovely sentiment.
Would have loved to know him.
Amazing to think of the effects he must have had on family, friends, classmates, colleagues, patients, co-workers, and now, the world.
A full life despite truncation. A testament to the fractal nature of everything.
He knows synthesis rather than entropy…he mentioned it: “The future flattens out…into a perpetual present”–The Immediacy of Eternal Life…where all lived Truth, Oneness, Good and Beauty will be savored. Be not afraid. There is more than this earthly craziness–The “more” is known in science as the Statimuum–like the punctate dot giving the Big Bang: life, sacrifice, virtue, love, humanity, peace, freedom, and death without fear.
Wonderful and deeply moving – a reminder to us approaching the same moment
I lost my sister to the same cursed lung cancer. She too died way too young (39) and never smoked. As a physician I had thought that disease was somehow “intellectually and emotionally manageable” up to that point. Seeing my sister slowly and painfully succumb to the disease and the aftermath of what and who she left behind jolted me into reality.
The pain and anguish written on my fathers face, the hollow desperation as my mother slowly accepted the unthinkable. She kept repeating herself at the funeral “I’ll join you soon. I’ll join you soon. And finally the bewildered look upon her two young daughters who had lived an idyllic life up until that moment,and now will be scarred forever at losing their best friend and their childhood
My sister is now a memory. We have moved on but never will quite overcome that painful loss of unrealized potential.
This terrible loss is one that gives us pause, not just to consider our own mortality (which it surely does), but also to consider other extremely valuable people we have experienced in our own lives. I remember reading the New England Journal of Medicine when a junior in podiatry school. There was an article about a then commonly used pain medication in the Journal. My wife once had hallucinations when given Pentazocine for pain after a surgery. I wrote about this in a letter to the NEJM when Franz Ingelfinger, MD was editor. To my astonishment, it was published in the NEJM. I was not a doctor and not even a DPM at that time.
Later on, I read that Dr. Ingelfinger would be lecturing at the Cleveland Clinic. At the time I didn’t realize that he was dying of esophageal cancer. He himself trained hundreds of residents and treated perhaps thousands with that fatal condition. It was a “farewell” (Abschied) talk. In his minimally German accented English he told us that he was treating himself for a while, and got confused and out-of-sorts with his situation. Finally, one of his children told him: “Dad, you have to find a doctor you trust and give yourself to that person.” He did and then…finally achieved a sense of peace with his own fatal journey. There was not a dry eye in the room. He said that decision finally gave him a chance to say good-bye to his hundreds of ex-residents, dear friends and then…his family.
For some reason he didn’t mind that I was not a real doctor. He felt that what I had to say was important. That was enough for him. I hope his death was not terribly painful. He was a kind, decent and loving physician who gave himself to his patients, profession and students with dignity and understanding. I was told he was a fabulous teacher.
We miss people like that. We really do. At least Dr. Ingelfinger got a chance to contribute to his beloved profession and students. The loss of Dr. Paul Kalanithi at the age of only 37 robs not only us, but also the potential lives and people he could have saved if he had a chance to live longer. If there is a heaven, I hope that Franz greets him personally with a hug, for surely he is there too.
Michael M. Rosenblatt, DPM
Yes, this is beautifully and powerfully written. I feel for the man’s family.
Medicine daily slaps in the face with stark reality. As an Emergency Physician for 10 years I saw the sudden unexplained tragedy that people experience. As a husband I experienced the sudden loss of my wife to a basilar artery aneurysm.
Left behind were a husband and 3 confused sad children 11, 9 and 4.
As a pathologist I see malignancy daily through the microscope.
There are also many physicians younger than me that have passed away of various illnesses.
All this highlights the need to count each day as a blessing. The past is history. The future may not be experienced. What is important is now.
Each day at dawn I count my blessings and thank God for being alive one more day.
Then I joyfully dive in to experience one more day which could be my last.
Sincerely Ed Hartle
Profound and beautiful. Thank you for sharing.
A similar heartbreaking story that I was fortunate to come across on the internet is attached below that I believe some of you will appreciate.
Perry C. Rothrock III, M.D.
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Father finds heartbreaking note from daughter days after she died of cancer
‘Maybe it’s not about the happy ending, maybe it’s about the story’
By Dylan Stableford, Yahoo NewsJune 5, 2014 7:27 AMYahoo News
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The father of a 12-year-old girl who lost her battle with cancer last week says he was shocked to find she had left behind a long, handwritten message on the back of a mirror.
“It was a stand-up mirror in her room, and it was always lent up against the wall so we never saw behind it,” Dean Orchard, of Leicester, England, told the Leicester Mercury. “She never mentioned it, but it’s the kind of thing she’d do.”
Athena Orchard was diagnosed with cancer in December after discovering a lump on her head and collapsing in her home. She died on May 28.
“She was a very spiritual person, she’d go on about stuff that I could never understand — she was so clever,” Dean recalled.
Dean was moving things around in Athena’s room when he discovered the message.
“When I moved the mirror after she died, I couldn’t believe it,” the 33-year-old said. “I saw all this writing — it must have been about 3,000 words.”
Here are just some of them:
Happiness depends upon ourselves.
Maybe it’s not about the happy ending, maybe it’s about the story.
The purpose of life is a life of purpose.
The difference between ordinary and extraordinary is that little extra. Happiness is a direction, not a destination.
Thank you for existing. Be happy, be free, believe, forever young.
You know my name, not my story.
You have heard what I’ve done, but not what I’ve been through.
Love is like glass, looks so lovely, but it’s easy to shatter.
Love is rare, life is strange, nothing lasts and people change.
Life is only bad if you make it bad.
Remember that life is full of ups and downs, without the downs the ups don’t mean anything.
I’m waiting to fall in love with someone I can open my heart to.
Love is not about who you can see spending your future with, it’s about who you can’t see spending your life without.
Life is a game for everyone, but love is the only prize.
“When I first saw it, it just blew me away,” Dean Orchard said. “I started reading it but before long I had to stop because it was too much — it was heartbreaking.”
The message, written in marker, also makes reference to her cancer diagnosis:
Every day is special, so make the most of it. You could get a life-ending illness tomorrow so make the most of every day.
Athena’s funeral is scheduled for June 12.
“She was the bravest person I know,” her mother, Caroline, told the paper. “She was always trying to make sure other people were OK before worrying about herself. She was always being positive.”
Amen.
Thanks for this Post.
As I am a physician cancer survivor myself that may well have been relateed to my work without a Radiation Exposure Badge and without a Radiation Exposure Shield I would like to hear from other physician cancer survivors who may have the same. I take comfort from the following
“I WILL BE TRUE FOR THERE ARE THOSE WHO TRUST ME.”
“I WILL BE PURE FOR THERE ARE THOSE WHO CARE”
“I WILL BE STRONG FOR THERE IS MUCH TO SUFFER”
“I WILL BE BRAVE FOR THERE IS MUCH TO DARE”
Respectfully submitted with my thoughts and my prayers for the family.
Amazingly written words and thoughts by Dr. Kalanithi. Wisdom for all of us.
This is a tremendous loss to his family, friends and medicine. His legacy will live in his words. We all suffer a future without this amazing man.