Paul Kalanithi wrote essays for The New York Times and Stanford Medicine reflecting on being a physician and a patient, the human experience of facing death, and the joy he found despite terminal illness.
March 11, 2015 - By Rosanne Spector
Stanford neurosurgeon Paul Kalanithi, MD, who wrote eloquently and movingly about facing mortality after being diagnosed with lung cancer, died of the disease March 9. He was 37.
Kalanithi, who had recently completed his neurosurgery residency at the Stanford University School of Medicine and become a first-time father, was an instructor in the Department of Neurosurgery and fellow at the Stanford Neurosciences Institute.
“We are all devastated by the tragedy of his sudden illness and untimely demise,” said Gary Steinberg, MD, PhD, professor and chair of neurosurgery. “Paul spent seven years with us. He’s very much part of our neurosurgical family. It affects us like a death in a closely knit family.”
Kalanithi’s essays, “How Long Have I Got Left?” for The New York Times and “Before I Go” for Stanford Medicine, reflected his insights on grappling with mortality, his changing perception of time and the meaning he continued to experience despite his illness.
He closed his Stanford Medicine essay with words for his infant daughter: “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”
In a March 10 Facebook post, Suman Kalanithi, one of Kalanithi’s brothers, wrote, “Yesterday my brother Paul passed away about two years after being diagnosed with metastatic lung cancer. He did so with customary bravery and poise, and died in peace on his own terms with his family around him. My brother achieved more in his short life than what most people do in twice that time. He was a good doctor, a good husband, a good father and a good man. I am extremely proud of him, both in life and in death. Rest in peace, my beloved brother.”
Undergraduate years at Stanford
Kalanithi was born in New York, moving at age 10 with his family to Kingman, Arizona. He went to college at Stanford, where he was involved in Stanford Sierra Camp and the Leland Stanford Jr. University Marching Band. He graduated in 2000 with bachelor’s and master’s degrees in English literature and a bachelor’s in human biology.
“If you asked me when I was 17 what I would be doing with my life, I would have said, ‘Oh, I’d definitely be a writer.’ For me, literature was always a powerful reflecting tool for thinking about life,” Kalanithi said in an interview for a Stanford Medicine magazine video. “But I found after I completed my undergraduate studies and thought about what I was really passionate about, medicine was in fact the perfect place.”
He next studied the history and philosophy of science and medicine at the University of Cambridge, earning a master’s degree, before attending the Yale School of Medicine. In 2007, he graduated from Yale cum laude, winning the Lewis H. Nahum Prize, awarded for his research on Tourette’s syndrome, and membership in the Alpha Omega Alpha medical honor society. At Yale, he also met classmate Lucy Goddard, whom he married in 2006.
He returned to Stanford for a residency in neurological surgery and a postdoctoral fellowship in neuroscience, developing optogenetic techniques in the laboratories of Krishna Shenoy, PhD, and Karl Deisseroth, MD, PhD. He authored more than 20 scientific publications and received the American Academy of Neurological Surgery’s highest award for research.
But then, in Kalanithi’s sixth year of residency, his weight dropped precipitously, and he developed night sweats, unremitting back pain and a cough. In May 2013, Kalanithi, who had never smoked, was diagnosed with stage-4 non-small-cell EGFR-positive lung cancer.
His first reaction was to prepare to die and to encourage Lucy to remarry, he wrote in his New York Times essay. But his cancer responded to treatment, he regained strength and he returned to work in late 2013, completing his residency last year. He and Lucy also decided they wanted to have a child. Elizabeth Acadia “Cady” Kalanithi was born on July 4, 2014.
In addition to returning to surgery, Kalanithi shared his reflections on illness and medicine, authoring essays in The New York Times, The Paris Review and Stanford Medicine, and participating in interviews for media outlets and public forums.
It completely surprised me that it resonated with so many people.
Despite a relapse in the spring of 2014, Kalanithi continued to speak to the public and write, including working on a book.
His essays tapped an outpouring of gratitude from readers — from young people who had lost parents to seniors facing their own mortality, to teachers desiring to share his essay with students. “It completely surprised me that it resonated with so many people,” Kalanithi wrote of the response to the Times piece in a 2014 San Francisco Magazine essay. “I still get an email nearly every day from someone with heart disease or depression or another medical illness, saying that it helped clarify his or her own situation. The second, and really pleasing, development was the number of doctors who emailed to say that they planned to give the article to their patients or incorporate it into medical school curricula to help students understand the human impact of disease. That was really touching.”
This letter from a reader in response to the Stanford Medicine essay is representative: “Dr. Kalanithi, I could not hold my tears while reading your story. It is a sad story, but at the same time it is an amazing story to share. These are the type of stories that stop us, and make us re-think life and the way that we are living it. Your story has touched me deeply in a very positive way.”
Kalanithi appeared to live by his words. After his diagnosis, he continued to joke, and laugh, enjoy the company of family, friends and colleagues, spend time appreciating nature and go wild at football games. He also helped raise money for lung cancer awareness. As top fundraiser (due, he said, to an overwhelming response from his friends, family and colleagues — including many from Stanford), he won the Chris Draft Family Foundation’s Lung Cancer Survivors Super Bowl Challenge, which landed him and family in Arizona for the 2015 Super Bowl.
Continuing to teach
In what proved to be his last days of life, Kalanithi worked on a teaching module with the director of Stanford’s palliative care education and training program, VJ Periyakoil, MD. “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. 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,” said Periyakoil, a clinical associate professor of medicine.
His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine.
“His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine. We talked about the design of the module and how we could tailor it to make our medical students understand that the so-called soft skills of medicine are the truly hard skills to teach and to learn.”
As a chief resident, Kalanithi was a skilled mentor, said current chief resident Anand Veeravagu, MD. “He has a way of identifying your strengths and weaknesses to elevate your skills in unison. Gifted,” Veeravagu said, adding that Kalanithi was also a dedicated advocate for the human being inside each of his patients.
“As surgeons, we often become so entrenched in treating the disease that we forget who it is we are treating,” Veeravagu continued. “I remember when Paul returned to the neurosurgical service and started operating again back in late 2013. 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 his 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.’ Paul is, to me, the hero of all heroes.”
Kalanithi is survived by his wife, Lucy Goddard Kalanithi, MD, FACP, a clinical instructor in medicine at Stanford; daughter, Cady; parents, Sujatha Kalanithi and A. Paul Kalanithi, MD; brothers, Suman Kalanithi, MD, and Jeevan Kalanithi; and Jeevan’s wife, Emily Kalanithi, JD. and their children, Eve and James.
A memorial service will take place at 2 p.m. March 31 at the Memorial Church on the Stanford campus. A reception will take place afterward at the Arrillaga Alumni Center at 326 Galvez St. (Those attending the memorial are advised to arrive before 1:30 p.m. to allow plenty of time for parking. The Galvez Lot at 270 Galvez St. has been reserved for those attending the service. Enter code 3380 at pay stations for complimentary all-day parking. Free shuttle buses marked “Kalanithi Memorial” will run from the Galvez Lot to the top of the Oval, near Memorial Church, beginning at 1 p.m. Following the service, return shuttles will run from the top of the Oval to the reception at the Alumni Center. The reception will continue until 5 p.m.)
Gifts in Kalanithi's memory may be sent to the Dr. Paul Kalanithi Memorial Fund at Stanford University, Development Services, P.O. Box 20466, Stanford, CA, 94309-0466. The fund will be used to recruit and support rural American students in the pursuit of a transformative education, a cause Kalanithi cared deeply about.
About Stanford Medicine
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