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How two physicians deal with their own illnesses

Yale Medicine Magazine, 2014 - Autumn


Two young doctors describe their debilitating illnesses.

Paul Kalanithi, M.D. ’07, was nearing the final year of his neurosurgery residency at Stanford when his weight started to drop, his back hurt, and he felt tired all the time. As the symptoms worsened, he suspected cancer. A CT scan revealed masses lacing his lungs and deforming his spine. In May 2013, Kalanithi, a 36-year-old who didn’t smoke, was diagnosed with stage IV non-small-cell EGFR-positive lung cancer. His first response was to prepare to die and to encourage his wife to remarry. But he quickly realized that coping meant making a commitment to living his life and values instead of resigning himself to dying. He began treatment with erlotinib and returned to work. Then Kalanithi and his wife, Lucy Goddard Kalanithi, M.D. ’07, chose to have a baby. “Having children was something we planned to do, and there was no reason not to continue living and achieving the things we wanted to achieve with whatever time I have left,” he explained. Elizabeth Acadia (“Cady”) Kalanithi was born on July 4.

Kalanithi and Christopher H. Lee, M.D., HS ’09, FW ’10, an associate research scientist in the Department of Emergency Medicine at Yale, both faced severe illnesses that radically affected their lives as well as their families. Both recognized that normal would no longer be what it had been, and both found ways to cope, with the help of friends and family.

Having seen families fall apart when faced with illness, Kalanithi made family a priority. “The illness doesn’t just happen to the person,” he explained. “It happens to the whole family. It’s very important to be aware of how everyone is doing emotionally and how they are impacted by my illness.” As a result, he and Lucy have grown closer.

Over the past year, as Kalanithi battled a chronic cough, fatigue, excruciating back pain, and the effects of chemotherapy, friends and family have helped, doing everything from providing meals to running errands. But relinquishing self-reliance wasn’t easy. “We knew if we were going to do some of these life-affirming things, like having a baby, we would need lots and lots of help,” he said. “It’s a funny side of resilience to recognize that you are dependent on other people.” Accepting support became easier when Kalanithi saw how meaningful it was for friends and family to offer their help.

For Kalanithi, resilience includes finding purpose. When his essay “How Long Have I Got Left?” was published in The New York Times, the public response and the purpose he derived from writing surprised him. In the essay, he shared his feelings about the devastating diagnosis, his quest for certainty in statistics, and how the words of Samuel Beckett, “I can’t go on. I’ll go on,” helped him move forward. Then, a relapse this spring required chemotherapy and two hospitalizations. “Relapsing means again finding a way to get back involved in the world,” he said.

Lee was also just 36 years old when, in November 2010, a spontaneous arterial dissection led to a stroke that paralyzed him from head to toe on his left side. It also affected his speech and ability to multitask.

In the four years since the stroke, Lee, who is working on a Ph.D. in investigative medicine, has progressed from a wheelchair to a cane to walking independently, and his speech is now completely normal. Focusing on work has helped him rebound cognitively and emotionally. He recently passed the written and oral qualifiers for his Ph.D. program. “It is huge. It’s reaffirming to know that I can do this and it feels good. It makes me feel like a whole person again,” Lee said. “Appreciating each new accomplishment gives me perspective when life feels difficult.”

For Lee, resilience at its core means perseverance in the face of the severity of his paralysis and the cognitive hit from the stroke. “I am constantly reminded of things I used to take for granted. Who thinks twice about walking across the kitchen to get a drink?” said Lee, an avid athlete prior to the stroke. “Are you going to persevere? Are you going to live and reclaim your life from adversity?”

Lee walks with a limp and has some gait and stability issues. He doesn’t have full use of his left hand, and it is uncertain how much he’ll recover. A former snowboard instructor, he said that his family’s prodding sent him back to the slopes with adaptive equipment last winter. It was a great experience, but he admits feeling conflicted about trying old activities in new ways. “It’s really an ego thing—you can’t let your ego get in the way of doing things,” he said. “I’m learning to accept that life won’t be just like it was before. And I’ve realized that I need to take advantage of things that I’m resistant to embracing.”

But Lee also feels that acknowledging loss is integral to coping and recovery. “Being able to grieve and mourn what has been lost is human,” he shared. “It is important to accept that bad things happen that are entirely out of your control. The only control you have is how you respond.”

Practicing medicine ensures regular encounters with disease, disability, and death. But when the physician becomes the patient, confronting illness can take on new meaning. Lee and Kalanithi both stressed the importance of a strong support system, finding purpose, and participating in life. Kalanithi completed his residency in June 2014 and is trying to regain stamina so that he can enjoy being a father, continue writing, and perhaps perform neurosurgery again. Lee is re-engaging in sports and is researching therapeutic hypothermia for cardiac arrest survivors. He hopes to return to clinical practice. “Resilience is like the third act of a movie,” Lee said. “There’s always some obstacle to overcome.”

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