Before I Go

Time warps for a young surgeon with metastatic lung cancer.

Comment from Regina: My daughter in law, Marissa, a third year resident in internal medicine, has a unique way of selecting the perfect book for me each holiday season. This year it was Paul Kalanithi’s beautiful work, When Breath Becomes Air. Published posthumously and already a best seller with stellar reviews, and many award nominations, it is a not to be missed read. In the words of Atul Gawande, another gifted physician and writer… “Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi’s memoir is proof that the dying are the ones who have the most to teach us about life.”—

Here is a sample - You will want to read this book
by By Paul Kalanithi, Photography by Gregg Segal, syndicated from stanmed.stanford.edu, Mar 30, 2015
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In residency, there’s a saying: The days are long, but the years are short. In neurosurgical training, the day usually began a little before 6 a.m., and lasted until the operating was done, which depended, in part, on how quick you were in the OR.

A resident’s surgical skill is judged by his technique and his speed. You can’t be sloppy and you can’t be slow.

A chief resident will advise a junior: “Learn to be fast now — you can learn to be good later.” Everyone’s eyes are always on the clock. For the patient’s sake: How long has the patient been under anesthesia? During long procedures, nerves can get damaged, muscles can break down, even causing kidney failure. For everyone else’s sake: What time are we getting out of here tonight?

The funny thing about time in the OR, whether you frenetically race or steadily proceed, is that you have no sense of it passing. Two hours can feel like a minute. Then you start wondering: How long till the patient wakes up? How long till the next case gets started? How many patients do I need to see before then? What time will I get home tonight?

But the years did, as promised, fly by. Six years passed in a flash, but then, heading into chief residency, I developed a classic constellation of symptoms — weight loss, fevers, night sweats, unremitting back pain, cough — indicating a diagnosis quickly confirmed: metastatic lung cancer. While able to limp through the end of residency on treatment, I relapsed, underwent chemo and endured a prolonged hospitalization.

I emerged from the hospital weakened, with thin limbs and thinned hair. Now unable to work, I was left at home to convalesce. A full day’s activity might be a medical appointment, or a visit from a friend. The rest of the time was rest.

With little to distinguish one day from the next, time began to feel less like the ticking clock, and more like the state of being. Languor settled in. Now the time of day meant nothing, the day of the week scarcely more so.

Verb conjugation became muddled. Which was correct? “I am a neurosurgeon,” “I was a neurosurgeon,” “I had been a neurosurgeon before and will be again”? The future tense seemed vacant and, on others’ lips, jarring.

Yet there is dynamism in our house. Our daughter was born days after I was released from the hospital. Week to week, she blossoms: a first grasp, a first smile, a first laugh. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing.

Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire. I plod, I ponder, some days I simply persist.

The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money and status, 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.

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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.

This article originally appeared in Stanford Medicine, Spring 2015.

Paul Kalanithi, MD, was an instructor in Stanford’s Department of Neurosurgery and a fellow at the Stanford Neurosciences Institute. He passed away on March 9, 2015. ■