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By Shane Parrish
March 7, 2016
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Shane Parrish writes Farnam Street

Dr. Paul Kalanithi was 36 years old and in his final year as a neurosurgical resident when he was diagnosed with terminal cancer. His beautifully written memoir, When Breath Becomes Air, published posthumously, chronicles his lifelong quest to learn what gives life meaning.

Kalanithi’s wife Lucy, also a doctor, explains in the epilogue why he chose to write about his experience.

In a letter to a friend, he writes, “That’s 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.”

In When Breath Becomes Air, Kalanithi shares his journey along that road as he transitions from doctor to patient and comes face-to-face with his own mortality.

As a student

Before studying medicine at Yale, Kalanithi had earned a BA and an MA in English literature, a BA in biology and an MPhil in the history and philosophy of science and medicine. He was interested in discovering where “biology, morality, literature and philosophy intersect”.

After years of theoretical discussions about mortality and the meaning of life, he came to the conclusion that “direct experience of life-and-death questions was essential to generating substantial moral opinions about them”. And so, he chose to study medicine.

As a physician

In Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande, calls for change in the way medical professionals deal with illness. While medical science has given us the ability to extend life, it does not ask – or answer – the question of when life still has meaning.

As a neurosurgical resident, Kalanithi was well aware of this paradox and the interplay between our medical choices and the things that give our lives meaning.

Both Gawande and Kalanithi help us recognize that knowing what we – and our loved ones – value in life will inform the choices we make about death when that time comes.

As a patient

What happens to your identity and sense of purpose when your plan for the next 40 years is suddenly wiped off the table?

After the diagnosis, Kalanithi was forced to re-evaluate what was most valuable to him.

The old adage to ‘live each day as if it were your last’ loses strength under scrutiny. What gives our lives meaning on any given day depends to some extent on how imminent we believe death is.

In searching for solace, Kalanithi returned to his love of literature.

In one of the most profound passages of the book, Lucy and Paul discuss whether to have a child, “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?”

Kalanithi comes to believe that life is about striving, not about avoiding suffering.

He leaves behind this impassioned message for his daughter, Cady, eight months old at the time of his death.

When Breath Becomes Air, paired with Being Mortal, will get you thinking about what matters in your life and about ‘what lies up ahead on the road’.

This piece originally appeared on Farnam Street. You do want to get smarter, don’t you? Connect with Farnam Street on Facebook and Twitter for more insight.

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