A thirty-six year old physician is diagnosed with terminal cancer—and uses his final months of life to teach the world how to both live and die.
“What makes human life meaningful?” It’s a question that’s long been pondered by the ancient philosophers, present day psychoanalysts, and just about every single one of us as we attempt to reflect on why we’re here on earth. But it’s a question that takes on a new sense of urgency and magnitude when one is confronted with their own mortality.
For Paul Kalanithi, who at the age of thirty-six was diagnosed with stage four lung cancer while on the cusp of completing his training in neuroscience at Stanford University, he was forced to reckon with such a question far sooner than ever expected. His reflections, When Breath Becomes Air, published posthumously last month have now landed him as #1 on the New York Times Bestsellers List and offer the world a rich understanding of what makes both life—and death—meaningful.
I first met Paul in August of 2012. We were then fellows at the newly launched Paul Ramsey Institute, a program that I now run for the Center for Bioethics and Culture Network. The Ramsey Institute, named after one the twentieth century’s leading medical ethicists, aims to bring together some of the brightest minds in the field of bioethics with early career professionals in hopes of training them to become future leaders in a field that desperately needs moral reflection. Paul was both—a future leader to be sure, and yet, already one of the brightest minds and deepest thinkers on matters of medicine and morality.
And yet it was only two years later that Paul informed us of his recent diagnosis. This was a group of well-learned men and women who knew a great deal about medicine and science—how could Paul, a non-smoker in excellent shape, be diagnosed with stage IV lung cancer at his age? Of course, after a decade of medical training, Paul and his wife Lucy, also a physician, had doubtlessly asked themselves similar questions ad nauseam. Ironically enough, the theme for this particular gathering for our Institute was terminal sedation and the debates over the ethics of continuous, deep sedation for dying patients. Paul jokingly remarked that this seemed all too fitting for the occasion.
But such was Paul’s style and in When Breath Becomes Air the world is offered a beautiful, though at times painstakingly brutal, look at how a doctor once tasked with the responsibility of informing patients of their grim prognoses is forced to accept his own.
The quest for meaning and purpose was one that motivated Paul long before his forays into medicine. He ruled out early on that the point of life was not merely the pursuit of happiness—and used his college admissions essay to argue as much. From an early age, books—specifically literature—enlivened and informed his moral imagination. But it was also books the led him to study biology after feeling unsatisfied from reading a trashy novel recommended by his then high school girlfriend. As Paul reasons:
“Though we have free will, we are also biological organisms—the brain was an organ, subject to all the laws of physics too! Literature provided a rich account of human meaning; the brain, then, was the machinery that somehow enabled it. It seemed like magic.”
And thus began Paul’s journey from a Stanford undergraduate double majoring in literature and human biology, to a Yale Medical School student, to a Stanford chief neuroscience residence receiving job offers from every major medical institution on the verge of beginning his dream career—to facing his own impending death.
Despite the unknown prospects for his future—did he have two months left, two years, or ten?—Paul, with his wife Lucy, resolved to go one living—together. In an op-ed for the New York Times that went viral, he wrote in early 2014:
“I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.”
He and Lucy proceeded to start a family and as he saw the final months of his life waning, life was granted anew in the birth of their daughter Cady. In deciding whether or not to pursue parenthood despite his terminal condition, Lucy asked Paul, “Don’t you think saying goodbye to your child will make your death more painful?” “Wouldn’t it be great if it did?” Paul replied. This is the response of an individual who has learned that the point of life is not to avoid pain and suffering, but to relish in the richness of all that it is while there is still time.
Paul died on March 9, 2015—surrounded by his family, with his eight-month-old daughter by his side—a juxtaposition of life in both its nascent and final stages. In an era in which some insist that doctors should use the tools of medicine to assist in ending the lives of those dying, Paul used his medical profession to teach the world that there is meaning to be found—even in the pain, even at the very end.
In When Breath Becomes Air, Paul’s two great loves of literature and medicine are married into one and they offer a testament that in the face of mortality, meaning can and must be found. The legacy of Paul Kalanithi will not merely be of one who died too soon—but one who left behind the keys to discovering how to live along the way.