• Neurosurgery's Polymath: Paul Kalanithi

    Author: Anand Veeravagu, MD





    Paul Kalanithi, MD, was a neurosurgeon, a writer, and a great friend of mine. Paul grew up in Kingman, Arizona, and attended Stanford University, where he graduated with a BA and MA in English Literature and a BA in Human Biology. He earned an MPhil in History and Philosophy of Science and Medicine from the University of Cambridge before attending medical school. In 2007, Paul graduated cum laude from the Yale School of Medicine, winning the Lewis H. Nahum Prize for outstanding research, and membership in the Alpha Omega Alpha medical honor society. He returned to Stanford for residency training in neurological surgery and a postdoctoral fellowship in neuroscience.

    Paul’s essays on doctoring and illness—he was diagnosed with stage IV lung cancer in 2013, though he never smoked—include the essays “How Long Have I Got Left?” published in the New York Times, January 1, 2014, and “Before I Go” published in the Washington Post, March 12, 2015, and on the Stanford Medicine website. Despite his illness, Paul completed his neurosurgery residency in 2014 while also working on his memoir, When Breath Becomes Air.

    Paul died in March 2015. He is survived by his wife, Lucy Kalanithi, MD, and their daughter, Cady. When Breath Becomes Air was published posthumously in January 2016, and debuted as a 1 New York Times bestseller. Lucy, who wrote the epilogue to Paul’s book, is one of his greatest champions and an incredible friend. It is an honor for me to speak with Lucy about Paul, and all that the two of them have accomplished together.

    Congress Quarterly: Thank you so much for spending time with us today. Lucy, the whole world now knows how incredible a writer Paul was. When did you first experience or learn of Paul’s eloquence and mastery of the English language?

    Dr. Lucy Kalanithi: Okay, let’s go way back. I met Paul during our first year of medical school at Yale in 2003. We were in the same medical school class. Initially, I knew he was a very smart and intellectual guy—he was running a bioethics seminar with another student, and was clearly an advanced writer. Paul went on a trip with his family to India over the first winter holidays when were students, and he wrote this unbelievably long, hilarious, really insightful set of emails that he called travelogues. Actually, later, in retrospect, he told me it was a way of seducing me, because he sent them to a whole group of friends, but he wanted me to be impressed by his writing as we were starting to become more interested in each other. And it totally worked. He never wrote a boring email, or even a boring word. Almost everything he wrote was gold; really funny and insightful. He always thought he would be a writer, well before he decided to enter medicine and then neurosurgery. He was also relatively prolific in scientific literature. He couldn’t get enough of the written word.

    CQ: How about Paul’s love for reading? I know neurosurgery residency is strenuous, and he probably didn’t have much time to read, but when he did have a break, what did he read?

    LK: Paul studied English literature and human biology at Stanford. In his book, he said, “I felt that literature provided the best account of the mind, and neuroscience laid down the most elegant rules of the brain.” Initially he dreamed of becoming a writer, but once he hit college he found himself unexpectedly drawn to neuroscience because he was interested in asking big questions: What makes us human? What is our consciousness? How do we build meaning and value in our lives while knowing that we are physical bodies and we’re mortal? Paul’s interest in literature and neuroscience is what ultimately brought him into medicine where he could grapple face-to-face with real-life human stories and challenges.

    I’ll give you one example that illustrates Paul’s deep love of literature. In 2013, we got the terrible chest x-ray result and saw that Paul’s chest was riddled with nodules. With both of us being physicians, and knowing he had been having unintentional weight loss and excruciating back pain, it became quite clear that it was metastatic cancer. (And you know you are having a bad day when you are hoping for disseminated TB and Pott’s disease because that would be better than the alternative.) So, we were packing for the hospital for further workups, and I was packing a suitcase full of comfy pillows and socks and computer chargers. Paul only packed three books: Mere Christianity by C.S. Lewis, Being and Time by Martin Heidegger, and Cancer Ward by Aleksandr Solzhenitsyn. That captures Paul literary and philosophical mind. As he stood on the brink between surgeon and patient, his immediate impulse was, I need books. I don’t think he had read a real novel as a neurosurgery senior resident, but now he reached for them immediately. And when he was ill and first returning to neurosurgical work, and then writing When Breath Becomes Air, he was always reading—everything from memoirs on mortality to poetry.

    Lucy, Paul, and Cady Kalanithi. Photo by Suszi Lurie McFadden

    CQ: Anyone who has read Paul’s book would know that he came from an incredible literary background. Tell us a little bit about why Paul chose neurosurgery of all the specialties ready to welcome him—why neuroscience, and why surgery?

    LK: It’s interesting that someone like Paul, who seemed to be seeking answers to bigger questions, ended up devoted to medicine and the even more specialized field of neurosurgery. He said some really beautiful things about neurosurgeons and his mentors, and the importance of the field. In his book he said that he wanted to join the ranks of the polymaths, meaning that neurosurgeons not only need to be superior surgeons but also need to be neuroscientists and humanitarians too. So I think he was really very proud to call himself a neurosurgeon, and that is where he pinned his highest hope. And I think he hoped his retirement would be filled with writing. After his diagnosis of metastatic lung cancer, he had to enter quickly into his retirement plans. When Janet Maslin in her New York Times review called Paul a polymath, I think that was the highest compliment because he had been seeking to become a medical, surgical polymath!

    CQ: When I read Paul’s book, I knew immediately that he, somehow, understood me. But that may be obvious as he and I had very similar training. He taught me many of the things I know how to do today; he was my mentor, and we grew together. But what about the rest of the world? I know that many people who have read his book find a personal relationship with Paul—whether they are in medicine or not. Why do you think Paul was able to connect with people?

    LK: I think there are a few big philosophical underpinnings that Paul tried to live his life by. One was, generally, the idea of love. He called this human relationality—our relationships and what we are doing to take care of each other interpersonally and collectively, to generate meaning through our relationships with one another. This was the basic thing we should be doing as humans. Similarly, he felt that the idea of striving was critical. That means in a basic sense that he wanted to strive to do the right thing, to be a good person, to get better at everything he was trying to do. I’m sharing this with you because this is some of what he wanted me to carry forward with our daughter.

    In simple terms, Paul wanted our daughter to know that 1) she is loved and 2) that it’s important to try hard. I think that’s what a lot of us think about teaching our kids, and what we hope for ourselves too. These are the tenets and themes of his life. Paul would have obviously said them magnificently better than I am right now, but I think those ideas are something people can relate to. Those ideas are what help us define our values, and we struggle to live according to those values. And I think therein lies the communality of everybody. Finally, Paul felt that we are all guaranteed suffering. Suffering is a part of life and you certainly can’t—and shouldn’t—avoid it. He felt that life was about more than avoiding suffering; it’s about creating meaning.

    I think the other thing is that people are curious and empathetic and drawn to art, and Paul is just telling a story about something that happened to him—facing mortality and finding meaning as a physician and a patient. It’s more than just literature; it’s a springboard for really important conversations.

    Photo by Norbert von der Groeben, Stanford Health Care

    CQ: Did the number of people that were able to relate to his writing surprise you personally? I highly doubt it surprised Paul, as I believe he always knew what he was doing and creating, but how about you and your family?

    LK: I think the sheer size of the response has been overwhelming. I was reading the book as he was writing it, daily, or weekly. I was literally lying next to him as I was on maternity leave, and once he was really ill we were together all the time. There are certain things, like a paragraph he writes as a love letter to our daughter Cady, or the title of the book When Breath Becomes Air, drawn from an ancient poem, certain things where, when you read them, they just strike you in a certain way; they bring a tear to your eye, or make you shiver, or you say, “Aha!” or you underline what he wrote. As his wife and knowing him well, I knew that he was a talented writer. Now I have gotten a ton of letters and feedback on his behalf. But yeah, for me, shocking and amazing.

    CQ: We are very proud of Paul, and very proud of you. The two of you have touched so many lives around the world. What can you share with the next generation of neurosurgeons, as they endure rigorous training, fight to carve out personal time, and strive to be the best for their patients?

    LK: You know, Anand, I’m tempted to turn around and quote you! Paul’s obituary included this reflection by you: “(Paul) has a way of identifying your strengths and weaknesses to elevate your skills in unison. Gifted. As surgeons, we often become so entrenched in treating the disease that we forget who it is we are treating. I remember when Paul returned to the neurosurgical service and started operating again back in late 2013 (after he was diagnosed with stage IV lung cancer). At that time, I was Paul’s shadow, learning and supporting however possible. We walked out of the operating room corridor together, toward the intensive care unit, and I was complaining of being tired and worn out—and he looked at me and said, in this very satirical voice, ‘You know I have lung cancer, right?’ I looked at him with great surprise, as if such things shouldn’t be said out loud, and I’ll never forget what he said to me next. ‘Don’t forget what you do, and who you do it for. These are people who you can help, and you shouldn’t forget that.’”

    At the same time, please remember to go home and kiss your spouse! It’s a tough balance. My hat’s off to you. Thank you for sharing Paul’s work with the neurosurgical community and for supporting our family.

    Caelica 83: You that seek what life is in death
    Baron Brooke Fulk Greville

    You that seek what life is in death,
    Now find it air that once was breath.
    New names unknown, old names gone:
    Till time end bodies, but souls none.
    Reader! then make time, while you be,
    But steps to your eternity.

    To read more about Paul Kalanithi’s life, visit paulkalanithi.com.

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