Summary:
Paul Kalanithi, diagnosed with stage IV metastatic lung
cancer when he was a neurosurgery resident at Stanford University, was faced
with a decision. Should he truncate his career in neurosurgery in order to
become a writer - a career he had always envisioned for himself after completing
a couple of decades of neurosurgery practice? Married to Lucy Kalanithi, an
internist he had met in medical school, Paul’s career and future had looked
bright and promising. But as he entered his final year of a seven-year
residency, symptoms of excruciating back
pain and significant weight loss began. Garbed in a hospital gown, he examines
his own CT scan – this is how we meet Paul at the beginning of the Prologue. He
then writes of the relatively brief period of misdiagnosis prior to the CT scan. With the initial negative plain x-rays, he is started on nonsteroidal
anti-inflammatory drugs. But breakthrough pain and continued weight loss leads
to the CT. Paul the physician understands the death sentence the images
portend; Paul the patient is just beginning his journey. The diagnosis and
treatment cause him to reassess his decisions about his life, to decide to
father a child even though he knows he will never see the child grow up, and ultimately
to write a memoir, essentially for his daughter.
Paul had graduated from Stanford with undergraduate and
master’s degrees which reflected his dual love of literature and science. He combined these in a second master’s degree from Cambridge
University in the history and philosophy of science and medicine before
attending Yale for his medical degree. He and his wife return
to California for residencies. The book is largely a blend of his dual
interests: a deep and abiding love and faith in literature and how words can
reveal truths, and a passion for the practice and science of neurosurgery. The rupture of fatal illness into his life interrupts his dogged trajectory
towards an academic medical career, and, like all ruptures, confounds expectations and reorients priorities.
The book has five parts: a foreword by physician-writer
Abraham Verghese, who notes the stunning prose Paul produced for an initial
article in The New York Times and exhorts the reader to “Listen to Paul” (page
xix); a brief prologue; two parts by Paul Kalanithi (Part I: In Perfect
Health I Begin, and Part II: Cease Not till Death); and a stunning,
heart-breaking epilogue by Lucy Kalanithi. In the epilogue, written with as
many literary references and allusions as her husband’s writing includes, Lucy
provides the reader with a gentle and loving portrait of her husband in his
final days, reaffirms his joy in their daughter Cady, and chronicles how she
kept her promise to her dying husband to shepherd his manuscript into print.
The bulk of the book is memoir – a childhood in Arizona and
an aversion to pursuing a life in medicine due to his hard-working cardiologist-father,
experiences at Stanford which eventually led him to reverse his decision to
avoid a medical career, the stages of his medical career and caring for
patients, and his devastating cancer. Though initially responsive to
treatment—and indeed, the treatment enables him to complete his residency and
decide to father a child with Lucy—the cancer is, as prognosticated from the diagnosis, fatal.
What makes this memoir so much more than an exercise in
memory and a tribute to the herculean effort to write while sapped by cancer
and its treatment, are the philosophical turns, the clear love of words and
literature, and the poignancy of the writing. He begins reading fiction and
nonfiction again: “I was searching for a vocabulary with which to make sense of
death, to find a way to begin defining myself and inching forward again. The
privilege of direct experience had led me away from literary and academic work,
yet now I felt that to understand my own direct experiences, I would have to
translate them back into language…I needed words to go forward.” (pp 148-9)
Paul’s writing ends with what is arguably some of the most
poetic prose ever written. He concludes by speaking directly to his infant
daughter: “When you come to one of the many moments in life where 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.” (p. 199)
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