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Expect the unexpected, Lucy Kalanithi advises new students

The Stanford internist spoke with Dean Lloyd Minor about medicine, empathy and physician burnout at an event for incoming students.

- By Katie Gray

Lucy Kalanithi, whose late husband wrote the best-selling memoir When Breath Becomes Air, talks with Lloyd Minor on Aug. 25.
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What advice would Stanford physician Lucy Kalanithi, MD, give to students beginning their medical journey?

 That was one of the questions Lloyd Minor, MD, dean of the School of Medicine, asked Kalanithi at an Aug. 25 talk for incoming MD and physician-assistant students.

Her answer: to expect the unexpected.

Kalanithi’s late husband Paul Kalanithi, MD, a Stanford neurosurgeon, wrote the memoir When Breath Becomes Air before dying of lung cancer in March 2015.

“I never thought I’d be speaking so publicly about such personal stuff,” she said. She added that while she used to think medicine offered a direct path, she has since learned that many unforeseen events can take people down unanticipated roads. The key to adapting to change is to be open to uncertainty, she said, and to “keep rising to the occasion.”

That’s exactly what Kalanithi and her late husband had to do four years ago after he was diagnosed with cancer. Since his memoir — in which he reflects on end-of-life care, medical training and meaningful living — was published in January 2016, the book has been on The New York Times best-seller list for 65 weeks.

“What struck me most” about the book, said Minor in his opening remarks, “was Paul’s perfect articulation of the vivid bond between physician and patient.”

Minor, who is collaborating with Kalanithi, a clinical assistant professor of medicine, as part of a winter seminar called “Literature, Medicine and Empathy,” also asked Kalanithi what she learned about the patient’s perspective during her husband’s illness.

“I was desperate for people to empathize and listen,” she said. On a given day, while a care provider may be thinking about the long list of cases they need to handle, the patient has waited weeks and weeks for that one encounter, she said.

“There’s real data on patient adherence being related to how much they feel allied with you as their provider,” she said. “You are the medicine.”

Noting that the memoir describes this responsibility as both an enormous blessing and a burden, Minor asked Kalanithi about physician wellness. She said medical institutions have a clear role to play in removing the stigma of asking for help.

“If you feel burned out, or if you feel depressed or anxious, it’s not that there’s something wrong with you. It’s a greater system issue,” she said, adding that Stanford Medicine is becoming a national leader in the field of physician wellness.

As for her own well-being, Kalanithi talked about navigating life in the years since the death of her husband. She said she thinks often about how to describe him to their daughter, Cady, who is now 3.

“I’m really happy that he wrote this book because he did it in part for her,” she said.

In response to an audience member’s question about whether her definition of happiness has changed since losing Paul, she said, “I used to think, ‘I want to be happy all the time’ or ‘I want to raise a happy kid,’” she said. “Now I really want to have meaning in my life and I really want to raise a resilient kid.”

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