![]() There we were, doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now, was no more, and no less, than two people huddled together, as one faces the abyss. She said it, instead, like a plea.” He is remarkably forgiving of this fudging and fibbing, this hesitation to be brave: Having pulled her patient through this crisis, she reverted to her relentless optimism: “” You have five good years left,” she said.” Kalanithi, however, saw this wishful, magical thinking for what it was: “She pronounced it, but without the authoritative tone of an oracle, without the confidence of a true believer. Kalanithi refers to this as “the WICOS problem” – Who Is the Captain Of the Ship? Emma – who had been away on holiday – returned, and took over the role of captain. On the day he was due to attend the graduation ceremony from his residency program, Kalanithi was taken suddenly ill, and ended up in the Intensive Care Unit, where various specialists, including nephrologists, endocrinologists, intensivists and gastroenterologists squabbled over his treatment. “This is not the end,” she said, a line she must have used a thousand times – after all, did I not use similar speeches to my own patients? – to those seeking impossible answers. When a CT scan showed that his disease was advancing again, “Emma Hayward” managed to put a defiant, Churchillian spin on the situation: Inevitably, as his disease progressed, he knew he could no longer work as a surgeon. ![]() Coming home each night, I would scarf down a handful of pain pills, then crawl into bed. The visceral pleasure I’d once found in operating was gone, replaced by an iron focus on overcoming the nausea, the pain, the fatigue. Another part wished she’d said, “Going back to being a neurosurgeon is crazy for you – pick something easier.”” Returning to the operating theatre, he had to lie down during his first case, but “over the next couple of weeks, my strength continued to improve, as did my fluency and technique.” Soon, however, the stark reality of his disease caught up with him:īut the truth was, it was joyless. I’ll go on”), he returned to work as a surgeon: “One part of me exulted at the prospect of ten years. Encouraged by his oncologist’s optimism, as well as Samuel Beckett’s famous exhortation (“I can’t go on. But looking at you, thinking about ten years is not crazy.”Īs it turned out, Kalanithi survived for twenty-two months following his diagnosis, some distance short of ten years. You’ve still got a ways to go before we’re that comfortable with your cancer. Going over the images with me, Emma said, “I don’t know how long you’ve got, but I will say this: the patient I saw just before you today has been on Tarceva for seven years without a problem. Give me ten years, I’d get back to treating diseases.” After an initial encouraging response to chemotherapy, his oncologist is wildly optimistic: Examining his options, he reasoned: “Tell me three months, I’d spend time with family. The angst of facing mortality has no remedy in probability.”īut statistics and probability were important for Kalanithi. Getting too deeply into statistics is like trying to quench a thirst with salty water. I shared Kalanithi’s initial reaction: “ Go back to work? What is she talking about? Is she delusional?” He argues that for the patient, cancer survival statistics are of little help or succour: “It occurred to me that my relationship with statistics changed as soon as I became one. At their first consultation, Emma refused to discuss survival statistics for stage IV lung cancer, but encouraged Kalanithi to return to work as a surgeon. ![]() “Emma Hayward” – not her real name – is a central figure in his posthumously-published memoir When Breath Become Air. He was referred to an oncologist specializing in lung cancer. Paul Kalanithi was nearing the end of his neurosurgical training at Stanford when aged thirty-six, he was diagnosed with stage IV lung cancer. When Breath Becomes Air by Paul Kalanithi. ![]()
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