Book Review
Paul Kalanithi
The Bodley Head, 228pp
Reviewed by Robin Osborne
In all respects except one, Dr Kalanithi’s memoir continues the tradition of fine authorship by US doctors of Indian descent. His most notable predecessors are Siddhartha Mukherjee, author of the Pulitzer Prize winning study of cancer, The Emperor of All Maladies, and the forthcoming The Gene, and Atul Gawande (Being Mortal, The Checklist Manifesto).
The key difference is that while the others still practice medicine and write, Kalanithi’s book has been published posthumously, following his death last year of metastatic lung cancer, at the age of just 37.
While the book is thus immensely sad, it is also an inspiring portrait of the mind and work of a brilliant man.
Kalanithi’s family, devout Christians, came from southern India and settled in America, initially on the east coast, and then in rural Arizona when a better job opportunity arose for his cardiologist father.
His mother, a physiologist, was so dedicated to educational improvement that “she took it upon herself to transform the Kingman [Arizona] school system.”
She sparked his interest in literature - giving him 1984 at age ten - and this would become his first field of study until medicine took hold and became the career choice.
Towards the end of an English lit degree at Stanford he was reading through his course catalogue when a pair of subjects caught his eye: biology and neuroscience.
“I studied literature and philosophy to understand what makes life meaningful, studied neuroscience and worked in an Functional MRI lab to understand how the brain could give rise to an organism capable of finding meaning in the world…”
Kalanithi studied pre-med, completed History and Philosophy of Science studies at Cambridge, returned to the US and entered Yale medical school. His journey to becoming a respected neurosurgeon is marked by insights across the professional and personal spectrums.
“All of medicine, not just cadaver dissection, trespasses into scared spheres,” he writes.
“Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escort them into the world, and then back out.”
Our mortality, and before long his own, were of particular interest.
“I was pursuing medicine to bear witness to the twinned mysteries of death, its experiential and biological manifestations, at one deeply personal and utterly impersonal.”
Later, describing the powerlessness of being confronted by an inoperable case, he writes, “When there’s no place for the scalpel, words are the surgeon’s only tool… that first conversation with a neurosurgeon may forever colour how the family remembers the death, from a peaceful letting go to an open sore of regret.”
Marrying another doctor, Lucy, who writes a moving epilogue to the book, he sees his surgical career blossoming, but then, with slight warning, finds himself on the other side of the consultation desk.
“Severe illness wasn’t life-altering, it was life-shattering… The lung cancer diagnosis was confirmed. My carefully planned and hard-won future no longer existed.”
The second half of the book describes a medley of oncologists, CT scans, drug regimes, hospital admissions, and sad gatherings with family and the colleagues he can no longer work with.
His describes his last operation (published in The New Yorker earlier this year) involving spinal nerve surgery, when an assisting doctor makes a slip that needs rectification.
When done, it was over to Kalanithi to close up, in every sense.
He gathered his things, accumulated over seven years of work, and drove home: “I hung up my white coat, and took off my ID badge. I pulled the battery out of my pager. I peeled off my scrubs and took a long shower.”
While the doctor had become the patient, he was also the father of a baby girl, to whom the book he was writing would be dedicated.
Sprinkled with references to T S Eliot - after diagnosis, he mentions being “lost in a featureless wasteland of my own mortality” - Graham Greene, the scriptures and more, it is a literate insight to the medical world.
In the words of Henry Marsh, another neurosurgeon/author (Do No Harm), “Every doctor should read this book… it helps us understand and overcome the barriers we all erect between ourselves and our patients.”
It is just as relevant to those on the other side of the desk.
