This was a book I finished in two days after receiving it in the mail. Is it weird that I was excited to read a book about a 37-year old neurosurgeon who wrote an autobiography in the final years of his life after his diagnosis with lung cancer? Maybe you might be too.

Review and Rating - ??/10

Having read "Not Fade Away: A Short Life Well Lived by Laurence Shames, Peter Barton”, this was the second autobiography I read about a man reflecting on his life amid a battle with cancer. But unlike Barton, Kalanithi’s just felt so rushed. Not the book, but the journey he was forced to embark on.

I mean, how does one deal with news of getting lung cancer for a healthy 36-year-old (less than 0.01% chance) who is about to finally start his career as an attending physician? In some ways, the excitement (I feel odd using this word but I think it’s the correct emotion) I had towards starting the book was because of the nature of Kalanithi’s career.

It looked like the textbook overachiever’s path from a high school valedictorian to Stanford, Cambridge, and then Yale med school…not to mention he was building an esteemed career as a neurosurgeon and neuroscientist (yes that’s two careers) while being the chief resident at Stanford.

Thanks to countless hours of watching medical dramas (both American and Korean….more data), I had the rough sense that Kalanithi was an all-star in medicine. But a further spurt of excitement came from his unique trajectory into medicine. Despite his father, uncle, and brother being doctors, Kalanthini wanted to be a professor in English literature and he got his bachelor's and masters in literature at Stanford.

That’s fascinating. It might also be why he was able to be so eloquent in his book as well. Frankly, I left with a reading list of authors and books because of the amount of referencing he does to literary greats. I do feel that I missed out on some smart writing because of my limited exposure compared to his repertoire.

I finished the book in two days and that is in part because the book is split into two chapters. And by sticking with my rule of one chapter a day….I left myself no choice.

But it wasn’t an ordeal. On the contrary.

The curiosity on how someone so accomplished deals with death at the prime of his career was bolstered by Kalanithi’s own curiosity with the meaning of life and death in particular. As he points out periodically….there indeed was an irony but something similar to fate….that his pursuit of finding meaning in death led him to medicine as he took up a profession that forestalls death... to eventually face death himself and be able to write about it from all these perspectives.

I imagine every reader will get emotional at different points in the book and that will be thanks to how descriptive Kalanithi is in his experience. As I read through his life, I started picturing myself in his shoes surrounded by my own family and friends. For a split second, it made it seem all so very real in my head. It’s these moments where I had to put the book down to think and let a tear or two slides down my face before continuing.

Throughout most of the book, I could feel the weight of how shitty the situation was. You follow Kalanithi’s journey as he sleeplessly pursues a ‘calling’ (not a 'job' as he frequently points) and you can’t help but root for him and hope your doctor will be someone like him.

You get a peek into his life and the….normal?everyday?… look at how he gets excited thinking about finally getting the big salary as an attending physician (residents make <$50k in some provinces in Canada and I imagine this surprisingly low salary is the same in the U.S….though they also have ridiculous student loans too)…and imagining a new house and a future on a lake with his family. Just things most people would dream about.

He was looking for what was supposed to be the big break. You study for some ten years and nearly kill yourself being a resident and this is supposed to be the big break where you finish residency…but this is when he is hit with cancer.

Just the pure wave of emotion and especially anger……even I felt angry for him…..just makes you sit and think. To at least try…attempt…to understand.

I think everyone will get their own unique insights from reading this book. It’s hard to finish such a book and takeaway nothing, though not impossible I guess. For me, it further reinforced the value of introspecting one’s life to strive to do work that is a vocation. It’s the only way to make the suffering we endure throughout life meaningful.

I thought about rating this book an 8 or a 9. But it felt odd rating an autobiography of a man who was dying and as I imagined Kalanithi’s frail body typing on his silver laptop on his armchair…I felt it best to leave it as “??”.


Book Notes:

Socrates points out the unexamined life is not worth living but Kalanithi inverts it to ask if the unlived life was worth examining. A part of me believes it isn’t worth examining. For one would fare better examining the lived life. However…I can’t help but feel it’s not such a binary question.

At Cambridge, Kalanithi was getting a master's degree in the philosophy of medical science and it was to fill the gap year before medical school would begin. It’s here he points out how ridiculous it is to debate on the life-death questions with theory in absence of direct experience. It really makes you think about the importance of gathering empirical data and experiencing it before being able to talk about it.

Kalanithi makes reference to how a physician (especially surgeon) deals with life-death almost daily in his line of work and how it's such people who will have a greater grasp on debates of morality and philosophical questions to life and death than any philosopher who has never left a university institution.

A scientist/researcher who does not practice….actually applying in the real world….doesn’t seem to be someone worth giving much attention to. It further spurs my skepticism towards PhDs who write books without extensive experience applying things in the real world.

Whether we realize it or not, every choice requires making trade-offs. Two sides to every coin.

Despite 100 hour work weeks for years on end, constantly fighting death daily…Kalanithi notes he didn’t spend a single minute wondering why he did this work or whether it was worth it. This is a good test for the self to see if what they’re doing is a job or vocation and to consciously be making that decision.

Heidegger says boredom is the awareness of time passing. Eloquent description.

Death always wins in the end. As a physician, you need to know that the deck is stacked against you. This doesn’t mean giving up because you know you will lose. Rather, it means to understand you are playing an infinite game of ceaselessly striving for perfection. The joy is being on the journey whilst knowing you will never reach perfection.

Life isn’t about avoiding suffering. It’s finding meaning in the suffering we will all endure throughout life.

Nietzsche and Darwin agreed that the defining characteristic of the organism is striving. It is the most important thing to life.

Hemmingway’s writing process was 1) acquire rich experiences 2) retreat to think and write about it

Kalanithi said his job was a calling. Because if you saw it as a job it was one of the worst jobs there was. One particular bit I chuckled at was when he said a fellow resident quit for an easier life in management consulting. Gives you some perspective.

It’s while one is facing death that they are forced to re-examine their values.

Freud started out as a successful neuroscientist but when he realized how much further (100+ years) neuroscience would need to go to pursue his ambitions, he gave it up to become a therapist instead. Understand where the world is at and the real-world parameters you will have to deal with. Kalanithi too had to accept the research he wanted to do would take 20+ years and that was time he no longer had….so he had to close the door on a professorship while being a neurosurgeon.

Graham Greene said life as lived in the first 20 years and the remainder was just reflection. This was such a profound statement it made me think deeper into how much of what people do post-20s might in one way be connected to regrets and desires from childhood or thoughts beaten out and replaced with the need for social acceptance.

Most ambitions are achieved or abandoned. It’s true, it’s not a success or failure. You either did it or gave up on trying. But one cannot forget that achieved or abandoned, it’s all in the past.

Just as Kalanithi’s daughter gave profound meaning and joy to his life without her knowing it…it would serve us well to also realize our existence has the ability to do that for others as well.