Neurosurgeon, Patient, Both

Breath Becomes Air

In 2013, at the age of 36, while nearing the end of neurosurgery residency, Paul Kalanithi was diagnosed with lung cancer. Before medical school, Paul had pursued undergraduate degrees in English literature and Biology, received a master’s degree in English literature, and completed a degree of history and philosophy of science and medicine. In his poignantly written, posthumously published book, When Breath Becomes Air, he described his transition from physician to patient; Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany…and more like someone had just firebombed the path forward…My life had been building potential, potential that would now go unrealized.

As his wife Lucy, wrote in the book’s epilogue, what happened to Paul was tragic, but he was not a tragedy; he assisted numerous patients during his time as a neurosurgeon and left a legacy that benefits both physicians and individuals diagnosed with cancer. He emphasized the importance of patient-centered care and shared exemplary illustrations on how this can be achieved, some of which are shared here.

Paul described his standard of care which had developed over the course of his years in residency:

  • How instead of focusing on the amount of paperwork he was required to complete, he resolved to treat all my paperwork as patients, and not vice versa.
  • He shared the importance of developing a relationship with patients and imparting knowledge to patients in a way that will assist them in decision-making; Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.
  • And how his approach to care included understanding the patient’s goals; Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end.

He also outlined communication strategies he had used as a neurosurgeon when treating his patients, as well as techniques employed by his treating oncologist, which strengthen the patient-physician relationship:

  • Paul had made it a practice to ask his patients, If you don’t mind, can you tell me what you understand is happening? It’s always helpful for me to hear, to make sure I don’t leave anything unanswered.
  • He noted during his first meeting with his treating oncologist that she pulled up a chair in front of me, to talk face-to-face, eye-to-eye. And then said I know there’s a lot to discuss, but first: How are you doing?
  • Paul also noted that his treating oncologist asked for his thoughts throughout his treatment, enabling him to have a role in his care.

When Breath Becomes Air is honest, informative, heartbreaking at times and beautifully written. For an introduction to Paul’s story, read his New Yorker published article, My last day as a Surgeon.  And have a tissue(s) on hand.

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