Inside A Doctor's Mind At The End Of His Life

Transcript

DAVID GREENE, HOST:

Dr. Paul Kalanithi was 36 years old in the final stretch of his seven-year medical residency when he looked at a CT scan, something he'd done with countless patients. But this time, the scan was his.

LUCY KALANITHI: The lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated, cancer, widely disseminated.

GREENE: Kalanithi had stage 4 lung cancer. That diagnosis came in May of 2013. He'd have less than two years left. In that time, he would continue to care for patients while he still had the strength, he'd have a baby with his beloved wife, and he would write a book. "When Breath Becomes Air" is his meditation on being a doctor and a patient, one facing life-changing news. His story has resonated with so many people. And now his wife, Dr. Lucy Kalanithi, finds herself on a book tour for her late husband.

KALANITHI: It's really kind of a bittersweet process as you can imagine, quite bitter and also quite sweet. Paul died nearly 11 months ago, but being able to talk about how I feel and remember Paul is very healing for me, so it's actually kind of wonderful at the same time.

GREENE: Listen to Lucy Kalanithi speak, read her husband's book, and the extraordinary human being Dr. Paul Kalanithi was takes shape. He loved literature and philosophy, but he was also drawn to medicine's most demanding specialty, neurosurgery, because he want to guide patients through life's toughest questions.

KALANITHI: Would you trade your ability to speak for another five months of life, or what type of neurologic devastation would make it more reasonable to stop living than to be alive? And these are not theoretical questions in the neurosurgical context. They're very real, very difficult choices that patients face, especially in neurosurgery where your brain is an organ just like your other organs, but it's what forms your identity.

GREENE: Well, the kind of moment you're describing was devastating to read about, him hitting such a moment when his own cancer was spreading to his brain and having a neurological impact.

KALANITHI: Yeah, that was very hard. This whole second half of the book is about Paul thinking about how to grapple, in a very real way, with his own mortality. And then when he was diagnosed with a form of metastatic brain cancer called leptomeningeal disease, which - this sounds really stark, but it's essentially like tumors are sort of coating your brain and your spinal cord, and it also holds the prospect of seizures or trouble speaking, trouble thinking. So it was so intense on top of everything else to get this diagnosis that meant that his ability to participate in all the things that was bringing him meaning, particularly writing this book and being together with our daughter and our family, was really devastating.

GREENE: But you bring up a person who seemed to bring such joy to the final months of his life, and that's your daughter...

KALANITHI: Yup.

GREENE: ...Elizabeth Acadia Kalanithi, right?

KALANITHI: Oh, man, yeah, she was - she is just perfect. He loved her so much, and he was just thrilled to be a dad, and just the fact of having this infant just breathed this unbelievable life into our house. He was the one who initially had the strong instinct to have a child despite his illness. I really kind of needed to think about it even though it was something we had always hoped to do. I knew that I would be taking on, you know, the responsibility of being a caregiver to both of them and then likely the responsibility of raising her without Paul. And I said to Paul, you know, don't you think that saying goodbye to a child would make your death more painful? And he said, wouldn't it be great if it did? And what he meant by that was the joy and meaning of having a new family member is so great that wouldn't it be great if that made it even more painful?

GREENE: Did you ever get this feeling, just given his interest in our relationship as humans with death, the value of our life, that in some weird way, as devastating as this must have been for you and your family, like that he was made to have this experience and to be able to help us all through this journey?

KALANITHI: Yeah, it's sort of bringing tears my eyes to hear you ask that because he makes this joke in the book where he says something like, well, wouldn't a terminal illness be the perfect gift to this young man who hoped to grasp mortality in a kind of intellectual sense? Those questions became not at all theoretical. Paul really had to draw on all these things that he had been kind of developing his whole life. He really returned to literature to cope. He fell back on his training as a physician. So I know exactly what you're getting at, which was what a funny confluence of factors that would prepare a young person to face this in a particular way despite looking at the fiery light of illness in real time.

GREENE: Well, why does that bring tears to your eyes asking that question?

KALANITHI: Mainly because I feel so proud of Paul, and I think he did such a good job coping and making sense of things and writing this book, which, you know, is partly a journal of his experience, but it's really written to help other people see that path that he went down and, like you say, find some value for themselves in his singular experience but also the fact that it's really a universal experience. We'll all face illness and death. And then I guess it helps me understand and see that Paul does have a legacy, you know. It's something that people are responding to and holding onto. And so that's sort of, you know, what a legacy is, is that it carries forward without you. And so it's wonderful to see that Paul has that.

GREENE: How tough is it to remain so composed in having conversations like this?

KALANITHI: I don't even the answer to that. You know, it's interesting because I kind of have been thinking, you know, if I had to go on NPR and talk about some professional topic or something else, I think I would be much more nervous than I am talking to you today, and I think it's because the only thing I feel like I need to be doing is describing what happened, what's happening. And so it's turning out to feel pretty natural to talk about these things in a real way. And then at the same time, the challenge or the other piece of my own life is that I'm returning to my career. I'm learning to be a mom. There's working on this book and kind of carrying Paul forward but in a way also sort of molting the marriage and learning to move on. So it's sort of a mixture of composure and disorientation, and I have a lot of support to be coping with all of it. It's not easy every day, I'll say that.

GREENE: Thank you. And the book was truly, truly powerful and that - just thanks so much for taking the time to talk about it.

KALANITHI: Thank you so much.

(SOUNDBITE OF MUSIC)

GREENE: That's Dr. Lucy Kalanithi. Her husband's book is "When Breath Becomes Air." Dr. Paul Kalanithi died in March of last year. Transcript provided by NPR, Copyright NPR.