The tragic doctor who couldn’t heal himself
When Paul Kalanithi was diagnosed with inoperable lung cancer, he did not draw up a bucket list.
he made no plans to swim with dolphins, to parachute, to climb everest. he wanted, more than anything, to go back to work.
After ten years of ‘relentless’ medical training, Kalanithi was 36 and within sight of a professorship at an Ivy League university. Just 15 more months of his residency and the hours would ease.
he would have more time for his wife, Lucy, a specialist in internal medicine. Time, too, to try for children.
‘I had reached the mountain top,’ he wrote. ‘I could see the Promised Land.’
he was already fantasising about the catamaran he and Lucy would sail at weekends. Then, on rounds, in surgery, holidaying with friends, he began to suffer debilitating chest pains. he woke in the night pouring sweat. he lost more than 2 st in weight. he suffered back spasms so severe that he lay on the floor screaming. Yet he kept working — 36 straight hours in the operating theatre on complex cases: giant aneurysms, intracerebral arterial bypasses, arteriovenous malformations.
After one last operation, before staggering home, he had scans taken of his chest and back. For years, he had examined such scans, deciding how to treat a patient, how long they might have to live. This time, it was different: he was the patient.
‘The lungs were matted with innumerable tumours, the spine deformed, a full lobe of the liver obliterated. ‘Cancer, widely disseminated.’ Lucy was there with him. They wept. ‘And with that,’ he writes in his memoir, ‘the future I had imagined, the one just about to be realised, the culmination of decades of striving, evaporated.’
It is not spoiling the book to tell you that Kalanithi did not live to see it published. he died in March 2015, aged 37.
In the little more than a year between his diagnosis and his death, Kalanithi did not for a moment stop striving. he had worked too hard, had too much more he wanted to achieve, to be beaten back by cancer.
his parents, born in southern India, had eloped to new York, called there by the great American Dream. his father, a cardiologist wanting to set up an independent practice, later moved his young family to Kingman, Arizona — a place of desert plateaus.
his mother was more worried about the district’s high-school dropout rate — the highest in America. But the Kalanithi children defied statistics.
Paul followed his brother to Stanford, studying for a degree in english literature and human biology.
he read T. S. eliot, Vladimir nabokov, and Joseph Conrad and studied neuroscience, medical ethics and philosophy. he
spent a year in England reading history and philosophy of science at Cambridge. Then, with the coolheaded confidence of the Renaissance man, he embarked on a medical degree at Yale.
At weekends, he ran half-marathons, hiked, camped and mountain-biked.
After his diagnosis, he sought solace in books, dosing himself not only with cancer drugs, pain-killing ibuprofen and anti-emetics to calm his nausea, but with the essays of Leo Tolstoy, Virginia Woolf and Michel de Montaigne, the poetry of Robert Frost, the plays of Samuel Beckett.
‘It was literature,’ he wrote, ‘that brought me back to life.’
He made a mantra of Beckett’s phrase: ‘I can’t go on. I’ll go on.’ And go on he did. He returned to work, pushing himself through 16-hour days, fighting nausea, pain and fatigue.
‘ The more tortured my body became,’ he wrote, ‘ the more I relished having done the work.’
He had always imagined turning to writing in retirement. He confided to a friend: ‘The good news is I’ve already outlived two Brontes, Keats and Stephen Crane. The bad news is that I haven’t written anything.’
That wasn’t quite true. In his last months, wearing seamless, silverlined gloves to protect his fingers (chemotherapy had left them marked with painful fissures), he wrote this book, typing in bed next to Lucy. He lived long enough to see their daughter, Cady, born.
Lucy finished the book, adding an afterword to Kalanithi’s final chapter. It is a moving coda.
Kalanithi’s intellect and precision sometimes give a sense of detachment to his writing, while the warmth and tenderness of Lucy’s epilogue gives us Kalanithi as a husband, father and son.
His chapters are about the triumph of the mind, of ambition, of determination over cancer in the final months of life; hers are about the triumph of the heart.