Paul Kalanithi was a husband and neurosurgery resident at Stanford when he began to experience a dire combination of symptoms: a cough, fevers, back pain, and unexpected weight loss. Quick tests confirmed that he had metastatic lung cancer, which would eventually prove fatal.
Paul’s wrote about his journey with lung cancer in a book called When Breath Becomes Air. I read it some years ago and often think about what it says about our shared experiences life, death, and mortality. Shortly after he finished the book in 2015, Paul passed away. He is survived by his wife, Dr. Lucy Kalanithi, and his newborn daughter.
Recently, I read an interview published on the fifth anniversary of Paul’s passing (which is worth a read) which revealed something new about the Kalanithis: it wasn’t until after the diagnosis that they decided to have a child. At first glance, that seems like an strange choice. Now that Paul and Lucy know that Paul will be dead within 1-2 years, they choose to have a child together. There is an important lesson in the details of that decision.
Interviewer: In all of that intensity [of a cancer diagnosis], how did you decide to have a child?
Dr. (Lucy) Kalanithi: It seemed pretty crazy to do that. Paul was more sure than I was that he wanted to have a child. I said, “It’s going to make it really hard. You’re really sick. I worry that having to face dying and having a new baby who you need to say goodbye to is going to make it really hard. What do you think about that?” He said, “Wouldn’t it be great if it did make it really hard?” It was such a lovely statement of what our lives are about. Sometimes you cannot have joy without risking pain.
I love Paul’s perspective on pain. “Wouldn’t it be great if it did make it really hard?”
Pain is a fascinating subject. Our instinctive response to pain is to avoid it all costs. We hide things from others to avoid the pain of being separated from our social groups. We put off difficult conversations that need to happen to avoid the pain of dealing with interpersonal conflict. We attempt to ignore our problems by numbing our emotions through distraction, vice, or even success. We hope that with just enough numbing, we can avoid pain.
And in our frantic attempts to escape the inevitable, we learn that we can never get enough of what we don’t really need. The numbness wears off and we realize we have merely postponed dealing with the root cause of our discomfort.
Paul’s perspective teaches a lesson that needs constant relearning: Our purpose in life is not to avoid pain and discomfort. Our purpose is to find those things that are worth our pain and discomfort. Learning to be ok with ourselves, building healthy relationships, investing in others’ well-being, saving money for the future, crossing a finish line, or dealing with our demons — these things open us up to pain, but they are worth that cost. Paul and Lucy knew this. They ignored the instinct to avoid pain. Paul had a perspective that would bring him joy in his final months: “Wouldn’t it be great if it did make it really hard?” They made a choice to pursue something that would be worth the pain that it would cost.
At 2:11am on July 4, 2014, Lucy gave birth to Elizabeth Acadia, whom they nicknamed Cady. In the last paragraphs of his autobiography, Paul gives us a taste of the coupling of pain and joy that he experienced as a father, watching his own life end while Cady’s life was beginning.
Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room.
Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire…
I hope I’ll live long enough that she has some memory of me. Words have a longevity I do not. I had thought I could leave her a series of letters—but what would they say? I don’t know what this girl will be like when she is fifteen; I don’t even know if she’ll take to the nickname we’ve given her. There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.
That message is simple:
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.
Our purpose in life is not to avoid pain and discomfort. Our purpose is to find those things that are worth our pain and discomfort. And then once we find them, to pursue them with all we have, purchasing with our pain a life of meaning and “a joy that does not hunger for more and more, but rests, satisfied.”
Hugh Spackman 