When Breath Becomes Air -- Lesson 1 (Patient Delay)

When Breath Becomes Air offers lessons on Healthy Survivorship. One is about dealing with a delayed diagnosis.

Six months before Dr. Kalanithi's cancer diagnosis he developed significant weight loss and "ferocious" back pain. The 36-year-old neurosurgeon said that for a patient with those symptoms, "the obvious answer would be (C) cancer."

Kalanithi's doctor ordered plain x-rays, an insensitive test. The results were normal, so they attributed his symptoms to "hard work and an aging body." For months Kalanithi rationalized his symptoms, even as they worsened and new symptoms developed.

Kalanithi knew he likely had cancer. Yet instead of pushing for further evaluation, he kept working until he was debilitated. Of note, his doctor-wife also worried yet didn't push him to see a doctor.

 MyJanuary 22nd post introduces Kalanithi as an example of a Healthy Survivor. What did he say about anyone's role in the delayed diagnosis? 

Nothing. Not a single word about blame or guilt. Why?

Here's my guess, based on reading everything he's published and my experiences as a physician, patient and writer: He let it go, knowing that blame and guilt wouldn't help him get good care or live as fully as possible. Those feelings would only poison life-enhancing relationships and activities.

Whatever thoughts and feelings he had about the delay were insignificant compared to the insights about life and death that he chose to share before he died.

Healthy Survivors let go of guilt and blame. Next: What if it's not easy to let go of guilt? 

Comments

[Debbie Pronitis]

Loved his book. I expected it to be depressing, but it turned out to be so hope-filled. The author never lost his ability to live life, despite having such a devastating diagnosis. I admired his choice to have a child. Life goes on!

[Bill Kleine]

It's so easy to look back and rethink; it is beautiful to look forward and see promise. A friend's surgeon took out a healthy appendix, missing his colon cancer until it was all over his liver. He told his wife, Mary, we're all human, please don't blame him. Tom looked forward to each day. I can't wait to start this book. I put it off with until I read Debbie's "hope-filled" assessment. She convinced me to start.

[Wendy S. Harpham, M.D.]

Debbie, Thanks for sharing your experience with the book. Obviously, it influenced others, like Bill.

And Bill, Wow, thanks for sharing that.
with hope, Wendy

[Deb Konrad]

Letting go of blame was enpowering for me as it allowed me to work with the oncologist who actually had an idea of how to treat my cancer. The first 2 oncologists seemed incapable of thinking outside the box and descisions they made did me more harm than good, but dwelling on it served me no purpose, I was too sick and lacked the energy anyway...much better to direct my limited energy reserves towards following my new oncologists instructions and treatment plan.

[Jeanne M Hannah]

I read Dr. Paul Kalanithi's book in one sitting. I agree with what Abraham Verghese says in the Foreword. Kalanithi's writing is stunning. It is hopeful. In this book he makes clear that despite his knowledge of what was ahead, he would live each day to the fullest, continue to seek purpose and meaning in life, that he would continue to care for and about his wife's future. Making the joint decision to have a child was an amazing and beautiful choice--one that enhanced the meaning and love of his last days.

[Wendy S. Harpham, M.D.]

Thanks, Jeanne. I'm now re-reading it, slowly, savoring the language, as well as the ideas.

[Jeanne M Hannah]

Wendy, I too plan to re-read this wonderful book. Dr. Lucy Kalanthi's description of her husband's final hours in the Epilogue took my breath away. When the issue of a ventilator arose that could only prolong his life and the watchful sorrow of his family, Lucy said to his doctors: "He doesn't want a Hail Mary. If he doesn't have a chance at meaningful life, he wants to take the mask off and hold Cady." When she returned from this hallway consult, Paul looked at her and said: "I'm ready." Paul was able to die with dignity surrounded by family, to exchange I love yous, gratitude, goodbyes, with the soft reminiscences of his loved ones paving his way to a gentle death. This example is one that bears witness and respect--it is an example for all.