Paul Kalanithi: How Long Have I Got Left?
Selected Excerpts
“I have sat with countless patients and families to discuss grim prognoses: It’s one of the most important jobs physicians have. It’s easier when the patient is 94, in the last stages of dementia and has a severe brain bleed. For young people like me — I am 36 — given a diagnosis of cancer, there aren’t many words. My standard pieces include “it’s a marathon, not a sprint, so get your daily rest” and “illness can drive a family apart or bring it together — be aware of each other’s needs and find extra support.”
“Poring over studies, I kept trying to find the one that would tell me when my number would be up… Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.”
“In a way, though, the certainty of death was easier than this uncertain life. The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day?”
Discussion Questions
Kalanithi wrestles with a desire for prognostic and statistical certainty. How do you interpret his relationship with statistical data? Does it resonate with your own experience?
Kalanithi writes powerfully of the profound uncertainty that comes with his diagnosis. How does his story deepen your understanding of uncertainty, and what it feels like to live with it?
Reflecting on Kalanithi’s essay and Chana Bloch’s poem, “In the Land of the Body (#2),” what can doctors and other caretakers do to support patients as they face profound uncertainty?
Reflections from #MedHumChat
“I think this excerpt focuses on the the real melancholy of statistics. Often to deal with a difficult prognosis, people turn to stats to gain hope, or rally against it thinking that they would be the exception. This conundrum I think lends itself to the quote.” — @pskantesaria
“we face this struggle in so many ways throughout medical school. We work so hard to understand the nitty gritty of scientific processes and sometimes lose sight of the reason why we’re learning these things - losing sight of the forest through the trees … Applying it more to patient care I feel like it is quite easy to fixate on scientific principles and the data because that is what we have been trained to count on. We trust it. The uncertainties of actual outcomes and mortality are scary, the data is comforting” — @CarlySokach
“It reminds me that I shouldn't assume that what I'm telling a patient is what they want, or really need, to hear. But also that I may not have all the answers to all of their questions. Maybe we need to be better guides through death?”—@kirstahoffman
“It's really quit a soul crushing paradox How can I live, while I'm dying?”—@UroPoet
“Meet them where they're at. Don't rush them through processing. Be there to talk, but don't force conversations. Listen actively & be willing to sit w/ fear, discomfort, anger, etc. Hold space for their feelings, make sure you have your own support network, too.”—@AmelieMeltzer
About this #MedHumChat
“How Long Have I Got Left?,” was paired with “In The Land of the Body (#2),” a poem by Chana Bloch for a #MedHumChat discussion on February 27, 2019 exploring Uncertainty In the Patient Experience.
The pieces for this chat, along with the discussion questions, were selected by Colleen Farrell.
About the Author
Paul Kalanithi (1977-2015) was a neurosurgeon and writer who died of metastatic lung cancer, an experience he shares in his memoir, “When Breath Becomes Air.” You can learn more about him here.