“Patients First” Plenary
/ IASLC World Conference on Lung Cancer
/ Sept 24, 2018 Lucy Kalanithi, MD, FACP
"I am so honored and happy to be here among this community of clinicians, researchers, advocates, patients and families. While I would never have chosen the circumstances that brought me here, being part of the lung cancer community has brought such meaning into my life. And that meaning is what I want to speak about this morning. I’m a physician, but I’m here today in a different role—because in 2013, my husband, Paul Kalanithi, was diagnosed at 36 with stage IV EGFR-mutant nonsmall cell lung cancer. Paul and I had met twelve years earlier as medical students. He was smart and kind and super funny. I fell in love with Paul in part because he used to keep a gorilla suit in the trunk of his car. He’d say he kept it there, “you know, in case of emergency.”
Paul lived with lung cancer for 22 months. During that time, he finished his training as a neurosurgeon, I gave birth to our daughter Cady, and Paul wrote the manuscript for When Breath Becomes Air, a memoir about his transformation from physician to patient. In his writing, Paul reflected on his own life and on what makes human life meaningful, even in the face of death. To keep a promise to him, I shepherded the book to publication after he died, and it has since become a #1 New York Times bestseller translated into more than 40 languages. When your husband writes a book like When Breath Becomes Air, you get asked a lot of questions like: • Has doing a book tour helped you through grief? Yes, definitely. • Has this experience changed how you practice medicine? Yes and no. • How’s your daughter doing? Great! She is feisty and funny, just like her dad. But there's only one question that really scares me. Well, other than being asked, “So, who would play you in the movie?” The most difficult question I’m ever asked is point-blank is: "So, what is the meaning of life?” It’s a question, like many others, that I wish Paul were here to answer, too.
But lately, I’ve considered this question for myself—and especially for myself as a physician. Reflecting on the moment of his initial diagnosis with lung cancer, Paul wrote, “The future I had imagined, the culmination of decades of striving, evaporated.” Until that moment, I hadn’t quite realized how much of our identities are tied up in our imagined futures, in who we plan to become. When you’re faced with a lifethreatening illness, the perennial question “How long have I got left?” can also mean “Who am I still?” And the question “What’s the meaning of life?” becomes both urgent and quotidian: “What’s the meaning in my life?” For Paul, that crisis of identity was almost as great as the challenge of facing mortality. He was fighting for survival and fighting to rediscover a purpose and the meaning that would sustain him through illness. So what exactly is meaning, and how do we create it?
Well, one of the best answers I’ve come across is by Dr. Viktor Frankl. Dr. Frankl was a psychiatrist and neurologist living in Austria who, in 1942, was arrested and transported to a Nazi concentration camp. Three years later, he was one of the few who survived to see the camp liberated, and he reflected on his experiences in his book titled, Man’s Search for Meaning. Frankl shared the stories of fellow prisoners whom he counseled while in the camps. For example, one was a scientist with a series of books still left to write. Another was the parent of a young child who awaited him in a foreign country. Frankl came to believe that for a person to maintain even the slightest chance of survival while living in the camps, she had to hold on to her sense of meaning. And he hypothesized that there are three main sources of meaning in our lives. The first is work: in other words, the deeds we do, the things we create. The second is love—the love that we feel for our experiences and, of course, for our fellow human beings.
One of my favorite book reviews of When Breath Becomes Air says that the book crackles with life. If you had seen Paul at the time that he wrote it, the phrase might have seemed preposterous because he had become physically debilitated. But Paul was crackling with life. He had nurtured those first two sources of meaning—work and love--in his growing manuscript and in our growing family. In a sense, he was thriving. As Nietsche said, and Viktor Frankl believed, “he who has a why to live can bear almost any how.” Though we had always planned to have children toward the end of Paul’s residency, it wasn’t part of our plan for Paul to become ill at the same time.
After his diagnosis, we wrestled with whether to try have a child. I remember asking Paul, “Don’t you think having to say goodbye to a child would make dying more painful for you?” His answer astounded me. He said, “Wouldn’t it be great if it did?" I really wish I knew what Paul thought about Viktor Frankl, and I don’t. But I imagine they might have agreed on this last thing: Dr. Frankl believed that the most significant way we create meaning in our lives is through the way we respond to unavoidable suffering; he believed that suffering ceases to be suffering at the moment it finds a meaning and that the pure fact of enduring hardship can be intrinsically triumphant. I saw that in Paul as he set out to face his mortality and put it to paper. The task was immensely rewarding, in part because it was so hard. Just like having a child. Just like working in medicine. At its best—and especially when we focus on patients first—working in health care connects us to all three sources of meaning: work and love and suffering."
/ IASLC World Conference on Lung Cancer
/ Sept 24, 2018 Lucy Kalanithi, MD, FACP
"I am so honored and happy to be here among this community of clinicians, researchers, advocates, patients and families. While I would never have chosen the circumstances that brought me here, being part of the lung cancer community has brought such meaning into my life. And that meaning is what I want to speak about this morning. I’m a physician, but I’m here today in a different role—because in 2013, my husband, Paul Kalanithi, was diagnosed at 36 with stage IV EGFR-mutant nonsmall cell lung cancer. Paul and I had met twelve years earlier as medical students. He was smart and kind and super funny. I fell in love with Paul in part because he used to keep a gorilla suit in the trunk of his car. He’d say he kept it there, “you know, in case of emergency.”
Paul lived with lung cancer for 22 months. During that time, he finished his training as a neurosurgeon, I gave birth to our daughter Cady, and Paul wrote the manuscript for When Breath Becomes Air, a memoir about his transformation from physician to patient. In his writing, Paul reflected on his own life and on what makes human life meaningful, even in the face of death. To keep a promise to him, I shepherded the book to publication after he died, and it has since become a #1 New York Times bestseller translated into more than 40 languages. When your husband writes a book like When Breath Becomes Air, you get asked a lot of questions like: • Has doing a book tour helped you through grief? Yes, definitely. • Has this experience changed how you practice medicine? Yes and no. • How’s your daughter doing? Great! She is feisty and funny, just like her dad. But there's only one question that really scares me. Well, other than being asked, “So, who would play you in the movie?” The most difficult question I’m ever asked is point-blank is: "So, what is the meaning of life?” It’s a question, like many others, that I wish Paul were here to answer, too.
But lately, I’ve considered this question for myself—and especially for myself as a physician. Reflecting on the moment of his initial diagnosis with lung cancer, Paul wrote, “The future I had imagined, the culmination of decades of striving, evaporated.” Until that moment, I hadn’t quite realized how much of our identities are tied up in our imagined futures, in who we plan to become. When you’re faced with a lifethreatening illness, the perennial question “How long have I got left?” can also mean “Who am I still?” And the question “What’s the meaning of life?” becomes both urgent and quotidian: “What’s the meaning in my life?” For Paul, that crisis of identity was almost as great as the challenge of facing mortality. He was fighting for survival and fighting to rediscover a purpose and the meaning that would sustain him through illness. So what exactly is meaning, and how do we create it?
Well, one of the best answers I’ve come across is by Dr. Viktor Frankl. Dr. Frankl was a psychiatrist and neurologist living in Austria who, in 1942, was arrested and transported to a Nazi concentration camp. Three years later, he was one of the few who survived to see the camp liberated, and he reflected on his experiences in his book titled, Man’s Search for Meaning. Frankl shared the stories of fellow prisoners whom he counseled while in the camps. For example, one was a scientist with a series of books still left to write. Another was the parent of a young child who awaited him in a foreign country. Frankl came to believe that for a person to maintain even the slightest chance of survival while living in the camps, she had to hold on to her sense of meaning. And he hypothesized that there are three main sources of meaning in our lives. The first is work: in other words, the deeds we do, the things we create. The second is love—the love that we feel for our experiences and, of course, for our fellow human beings.
One of my favorite book reviews of When Breath Becomes Air says that the book crackles with life. If you had seen Paul at the time that he wrote it, the phrase might have seemed preposterous because he had become physically debilitated. But Paul was crackling with life. He had nurtured those first two sources of meaning—work and love--in his growing manuscript and in our growing family. In a sense, he was thriving. As Nietsche said, and Viktor Frankl believed, “he who has a why to live can bear almost any how.” Though we had always planned to have children toward the end of Paul’s residency, it wasn’t part of our plan for Paul to become ill at the same time.
After his diagnosis, we wrestled with whether to try have a child. I remember asking Paul, “Don’t you think having to say goodbye to a child would make dying more painful for you?” His answer astounded me. He said, “Wouldn’t it be great if it did?" I really wish I knew what Paul thought about Viktor Frankl, and I don’t. But I imagine they might have agreed on this last thing: Dr. Frankl believed that the most significant way we create meaning in our lives is through the way we respond to unavoidable suffering; he believed that suffering ceases to be suffering at the moment it finds a meaning and that the pure fact of enduring hardship can be intrinsically triumphant. I saw that in Paul as he set out to face his mortality and put it to paper. The task was immensely rewarding, in part because it was so hard. Just like having a child. Just like working in medicine. At its best—and especially when we focus on patients first—working in health care connects us to all three sources of meaning: work and love and suffering."
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