Blog Post

How one doctor died

March 13, 2015

    Dan Diamond, Executive Editor

    I can't forget Paul Kalanithi's chilling, honest question.

    "How long have I got left?"

    Turned out the answer was 13 months.

    Kalanithi was a Stanford neurosurgeon, a new father, a patient with metastatic cancer. He was the author of a much-read essay in the New York Times in January 2014—an essay that posed the aforementioned question.

    He was 37 years old when he died this week.

    Near the end of his life, Kalanithi lived like, well, a human being. He attended football games. He made plans with friends and family. He spent time bouncing his baby daughter, trying to make her laugh.

    But his lung cancer obviously ruled his life. As his condition worsened, Kalanithi's days became slower, longer, indeterminate.

    "Now unable to work, I was left at home to convalesce," he wrote in Stanford Medicine Magazine. "The day shortened considerably. A full day’s activity might be a medical appointment, or a visit from a friend. The rest of the time was rest."

    Not every cancer patient can write with Kalanithi's grace, or his knowingness. (Kalanithi reviewed his own CT scans, for instance.)

    So Kalanithi tried to open his unique window up for others through writing, speaking, teaching. In his final weeks, Kalanithi even helped develop a Stanford teaching module on palliative care, too.

    "The module would teach the lessons he learned from being on both sides of the aisle—being a neurosurgeon at the top of his game to being a patient with cancer," said VJ Periyakoil, director of Stanford’s palliative care education and training program. "We talked about how being the doctor is all about having control and wielding power, while being a patient is all about loss of control and feeling vulnerable."

    How we think about death

    Kalanithi's original essay appeared at a time when the public conversation around living—and dying—has seemed to shift.

    Last year saw the publication of Atul Gawande's award-winning book "Being Mortal," as well as Peter Bach's much-discussed essay, "The Day I Started Lying to Ruth." 

    Also see: One nurse's dying wish—teaching empathy

    And thanks in part to these conversations, it's even more clear that there are issues we're still grappling to solve. Not just figuring out the still-impossible, the virtual countdown clock of how much time we have left. But the deeply personal issues. How much should we spend to get one more day of life? When should we know to say goodbye?

    And what does it mean to have a good death?

    In his New York Times essay last year, Kalanithi memorably tried for an answer. As he wrote:

      The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: "I can’t tell you a time. You’ve got to find what matters most to you."

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