The Autobiographical Account Of The Journey Of Dr. Paul Kalanithi

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The book is an autobiographical account of the journey of Dr. Paul Kalanithi, a young man at the threshold of a promising neurosurgery-neuroscience career when he is diagnosed with stage IV of an inoperable lung cancer at the age of thirty six. There is a foreword by the renowned physician-author, Abraham Verghese and a deeply moving epilogue by Paul’s wife, Lucy. The book provides a peek into the transformation of the author from a curious medical student to a confident chief neurosurgical resident calling the shots, to a patient with a rapidly progressing terminal disease. The title of the book perfectly captures the essence: From a state of being to a state of nothingness. The inspiration for the title is from a verse of the poem Caelica by Fulke Greville: “Now find it air that once was breath. New names unknown, old names gone”.

The memoir is presented in two parts: ‘In Perfect Health I Begin’ and ‘Cease Not till Death’. In Part 1, the author chronicles his life long quest to understand: What makes human life meaningful and What makes a life worth living? It is this question that underlies all the author’s choices: His love and study of literature and his subsequent decision to study medicine especially neurosurgery. His every action is tinged by how it affected his interpretation of the meaning of his life. The author explains that he chose neurosurgery as brains give rise to our ability to form relationships and to make life meaningful. Throughout the book, we understand the author’s motivations in life through references to literature and detailing of his experiences treating patients.

The author raises the question “If the unexamined life was not worth living, was the unlived life worth examining?” The author treats his profession as a calling not a job and is deeply aware of the moral dimension of his job. He believed that human relationality undergirded the meaning of life and this was exemplified through his deeply personal relationship with his patients. He believed that the true nature of job of a doctor was to be an empathetic compatriot to the patient and to consider them as persons and not mere paperwork. He strived to transcend the doctor’s bane of mere mechanical treatment of patients and technical excellence. He believed in the Greek concept of Arete that virtue required moral, emotional, mental and physical excellence. The reflections of his personality come through clearly when he says that “You can’t ever reach perfection but you can believe in an asymptote towards which you are ceaselessly striving”. This beautiful thought can serve as a talisman for every action that one undertakes in one’s life.

When grappling with understanding his patient’s mortality and going beyond dealing with concepts of life and death not as mere abstractions but as an everyday reality the author quotes from Thomas Browne’s Religio Medici: “With what strife and pains we come into the world we know not, but ‘tis commonly no easy matter to get out of it.” This is played out in the second part of the book where the author details his struggles with the long treatment regimen, the uncertainty of the time remaining and his fight with the disease making him reevaluate his priorities. After learning about his diagnosis a conversation snippet between Paul and his wife Lucy about whether to have a child precisely captures the poignancy of the book: “Don’t you think saying goodbye to your child will make your death more painful?” she asks, and he responds, simply, “Wouldn’t it be great if it did?” The juxtaposition of an ebbing life and a new life is beautifully captured in the book.

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The author makes one deeply think about death and mortality. People rarely think actively about death. While everyone knows that death is a fundamental fact of existence and that all organisms, be it a gold fish or one’s own grandchild, die eventually, situations in which one needs to confront one’s own mortality seldom arise fortunately in most people’s life. The author writes about time and what it meant to him in the context of his illness. He compares the limited supply of time to someone who is forced to budget after his credit card has been taken away. Faced with the reality of limited time, just as Paul’s oncologist urges him to consider and discover his values and evaluate his life choices accordingly based on the limited time, the book forces one to introspect and reflect on one’s own life choices.

The book is written dispassionately, devoid of self pity and with almost clinical detachment. Yet the author conveys his deeply moving story of his transformation from a confident neurosurgeon taking life and death decisions on behalf of his patients to being a patient himself confronting the reality of his own mortality. One is reminded of Viktor Frankl’s fortitude in the Auschwitz Concentration camp described beautifully in Man’s Search for Meaning when he says: ““Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” When diagnosed with a terminal illness the author’s own fortitude is apparent in the way he tries to define a purpose for the limited time that he has been given.

The book may appear too detached and clinical on the surface as the author describes his own bout with a terminal illness just as he would detail a patient’s diagnosis. But as the author himself states in an email to his best friend: “Thats what I’m aiming for, I think. Not the sensationalism of dying, and not exhortations to gather rosebuds, but: Here’s what lies up ahead on the road”. His act of not averting his eyes from his own death and punctuating his days with purpose and meaning gracefully made him fully alive even when he was terminally ill. I believe that the beauty of the book lies in the fact that it never gives in to a fatalistic world view. Even in the depths of existential quandaries the book believes that the defining characteristic of an organism is striving. The author’s life exemplifies Samuel Beckett’s quote: “I can’t go on. I’ll go on”.

The book is well rounded by the dispassionate account of the author weighed against the moving epilogue by his wife. The honesty and courage in the writing filter through as the author records his moments of absolute vulnerability – troubles in his marriage, depression and frustration at seeing his decades worth of struggle dissolve into nothingness, the wasted potential of his life, the grief at knowing that he wouldn’t be present as his daughter grows up. The book succeeds in making the reader share this grief across time and lands even as the author exists only in memory when the book is published. It makes one ponder the ephemeral nature of life and that “life is merely an instant, too brief to consider”.

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