"선배들은 '우선 빨리 하는 걸 배워라. 훌륭하게 하는 건 나중에 배워도 된다'고 가르친다. 모두의 눈은 시계에 가 있다. 얼마나 마취 상태에 있었는지(be under anesthesia) 촉각을 곤두세운다(be on the watch for it). 신경·근육이 손상되거나 신부전(腎不全)을 유발할(cause kidney failure) 수 있어서다. 그러나 다른 한편으론 '오늘은 몇 시에 병원에서 나갈 수 있을까' 전전긍긍한다. 시간과 다툴 때는 토끼와 거북이(hare and tortoise) 두 방법이 있다. 토끼는 서두르다 보니(make haste) 실수를 한다. 수술 절개 지점을 1㎝만 달리 했어도 좋았을 것이라고 뒤늦게 후회하기도(belatedly regret) 한다. 거북이는 두 번 가늠하고 한 번만 절개해 실수는 적지만 시간이 걸린다.
![[윤희영의 News English] 암에 걸린 어느 의사의 글](http://image.chosun.com/sitedata/image/201504/13/2015041303394_0.jpg)
그렇게 6년이 순식간에 지나갔다(pass in a flash). 그런데 체중 감소, 열, 수면 중 식은땀, 끊임없는 요통(weight loss, fevers, night sweats, unremitting back pain) 등 한 무리 증상이 나타났다(develop a constellation of symptoms). 폐암이었다. 레지던트 과정을 겨우 마쳤지만(limp through the end of residency) 화학요법을 받으며(undergo chemotherapy) 오랜 기간 입원을 견뎌야(endure a prolonged hospitalization) 했다.
집에서 요양을 하게 됐다(be left at home to convalesce). 시간이 멈춰 선 것처럼 느껴진다. 수술실에선 그리 정신없이 돌아가더니 움직이지 않는 존재가 됐다. 퇴원 며칠 후 딸이 태어났다. 하루가 다르게 소록소록 피어난다. 시간은 양날을 가졌다(be double-edged). 그 하루하루가 나를 죽음에 더 가까이 떼민다. 달리다가 지쳐버린 토끼…. 누구나 유한성(有限性)에 굴복하게 된다. 야심이란 것은 성취되거나 버려진다(be either achieved or abandoned). 어느 쪽이든(either way) 모두 과거에 속하게(belong to the past) 된다. 돈, 지위, 모든 허영(all the vanities)은 바람을 좇는 것처럼(like a chasing after wind) 허망하다.
딸이 나를 기억할 수 있을 만큼 조금만 더 살 수 있다면 좋겠다. 하지만 그러지 못할 것이니 한마디만 녀석에게 남기련다. '네 인생에서 너 자신에 대해 설명해야 할(give an account of yourself) 순간이 있을 때, 어떻게 살아왔고, 무엇을 했으며, 세상에 어떤 의미였는지 말해줄 수 있는 사람이 돼다오.'"
캘러너시 박사는 지난달 9일 세상을 떠났다(pass away).
[출처] 본 기사는 프리미엄조선에서 작성된 기사 입니다
Before I go
Time warps for a young surgeon with metastatic lung cancer
By Paul Kalanithi
In residency, there’s a saying: The days are long, but the years are short. In neurosurgical training, the day usually began a little before 6 a.m., and lasted until the operating was done, which depended, in part, on how quick you were in the OR.
A resident’s surgical skill is judged by his technique and his speed. You can’t be sloppy and you can’t be slow. From your first wound closure onward, spend too much time being precise and the scrub tech will announce, “Looks like we’ve got a plastic surgeon on our hands!” Or say: “I get your strategy — by the time you finish sewing the top half of the wound, the bottom will have healed on its own. Half the work — smart!” A chief resident will advise a junior: “Learn to be fast now — you can learn to be good later.” Everyone’s eyes are always on the clock. For the patient’s sake: How long has the patient been under anesthesia? During long procedures, nerves can get damaged, muscles can break down, even causing kidney failure. For everyone else’s sake: What time are we getting out of here tonight?
There are two strategies to cutting the time short, like the tortoise and the hare. The hare moves as fast as possible, hands a blur, instruments clattering, falling to the floor; the skin slips open like a curtain, the skull flap is on the tray before the bone dust settles. But the opening might need to be expanded a centimeter here or there because it’s not optimally placed. The tortoise proceeds deliberately, with no wasted movements, measuring twice, cutting once. No step of the operation needs revisiting; everything proceeds in orderly fashion. If the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins.
The funny thing about time in the OR, whether you frenetically race or steadily proceed, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, this is the opposite: The intense focus makes the arms of the clock seem arbitrarily placed. Two hours can feel like a minute. once the final stitch is placed and the wound is dressed, normal time suddenly restarts. You can almost hear an audible whoosh. Then you start wondering: How long till the patient wakes up? How long till the next case gets started? How many patients do I need to see before then? What time will I get home tonight?
It’s not until the last case finishes that you feel the length of the day, the drag in your step. Those last few administrative tasks before leaving the hospital, however far post-meridian you stood, felt like anvils. Could they wait till tomorrow? No. A sigh, and Earth continued to rotate back toward the sun.
But the years did, as promised, fly by. Six years passed in a flash, but then, heading into chief residency, I developed a classic constellation of symptoms — weight loss, fevers, night sweats, unremitting back pain, cough — indicating a diagnosis quickly confirmed: metastatic lung cancer. The gears of time ground down. While able to limp through the end of residency on treatment, I relapsed, underwent chemo and endured a prolonged hospitalization.
I emerged from the hospital weakened, with thin limbs and thinned hair. Now unable to work, I was left at home to convalesce. Getting up from a chair or lifting a glass of water took concentration and effort. If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: The day shortened considerably. A full day’s activity might be a medical appointment, or a visit from a friend. The rest of the time was rest.
With little to distinguish one day from the next, time began to feel static. In English, we use the word time in different ways, “the time is 2:45” versus “I’m going through a tough time.” Time began to feel less like the ticking clock, and more like the state of being. Languor settled in. Focused in the OR, the position of the clock’s hands might seem arbitrary, but never meaningless. Now the time of day meant nothing, the day of the week scarcely more so.
Verb conjugation became muddled. Which was correct? “I am a neurosurgeon,” “I was a neurosurgeon,” “I had been a neurosurgeon before and will be again”? Graham Greene felt life was lived in the first 20 years and the remainder was just reflection. What tense was I living in? Had I proceeded, like a burned-out Greene character, beyond the present tense and into the past perfect? The future tense seemed vacant and, on others’ lips, jarring. I recently celebrated my 15th college reunion; it seemed rude to respond to parting promises from old friends, “We’ll see you at the 25th!” with “Probably not!”
Yet there is dynamism in our house. Our daughter was born days after I was released from the hospital. Week to week, she blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks of 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 double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time, it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. But even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder, some days I simply persist.
Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.
Yet one thing cannot be robbed of her futurity: my daughter, Cady. 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 really say? I don’t know what this girl will be like when she is 15; 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.
[Editor's note: Paul Kalanithi died March 9, 2015, at age 37. Here is our obituary.]
Paul Kalanithi, writer and neurosurgeon, dies at 37
Paul Kalanithi wrote essays for The New York Times and Stanford Medicine reflecting on being a physician and a patient, the human experience of facing death, and the joy he found despite terminal illness.
Paul Kalanithi said his daughter, Cady, filled him with "a joy unknown to me in all my prior years." He passed away on March 9.
Gregg Segal
Stanford neurosurgeon Paul Kalanithi, MD, who wrote eloquently and movingly about facing mortality after being diagnosed with lung cancer, died of the disease March 9. He was 37.
Kalanithi, who had recently completed his neurosurgery residency at the Stanford University School of Medicine and become a first-time father, was an instructor in the Department of Neurosurgery and fellow at the Stanford Neurosciences Institute.
“We are all devastated by the tragedy of his sudden illness and untimely demise,” said Gary Steinberg, MD, PhD, professor and chair of neurosurgery. “Paul spent seven years with us. He’s very much part of our neurosurgical family. It affects us like a death in a closely knit family.”
Kalanithi’s essays, “How Long Have I Got Left?” for The New York Times and “Before I Go” for Stanford Medicine, reflected his insights on grappling with mortality, his changing perception of time and the meaning he continued to experience despite his illness.
He closed his Stanford Medicine essay with words for his infant daughter: “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.”
In a March 10 Facebook post, Suman Kalanithi, one of Kalanithi’s brothers, wrote, “Yesterday my brother Paul passed away about two years after being diagnosed with metastatic lung cancer. He did so with customary bravery and poise, and died in peace on his own terms with his family around him. My brother achieved more in his short life than what most people do in twice that time. He was a good doctor, a good husband, a good father and a good man. I am extremely proud of him, both in life and in death. Rest in peace, my beloved brother.”
Undergraduate years at Stanford
Kalanithi was born in New York, moving at age 10 with his family to Kingman, Arizona. He went to college at Stanford, where he was involved in Stanford Sierra Camp and the Leland Stanford Jr. University Marching Band. He graduated in 2000 with bachelor’s and master’s degrees in English literature and a bachelor’s in human biology.
“If you asked me when I was 17 what I would be doing with my life, I would have said, ‘Oh, I’d definitely be a writer.’ For me, literature was always a powerful reflecting tool for thinking about life,” Kalanithi said in an interview for a Stanford Medicine magazine video. “But I found after I completed my undergraduate studies and thought about what I was really passionate about, medicine was in fact the perfect place.”
He next studied the history and philosophy of science and medicine at the University of Cambridge, earning a master’s degree, before attending the Yale School of Medicine. In 2007, he graduated from Yale cum laude, winning the Lewis H. Nahum Prize, awarded for his research on Tourette’s syndrome, and membership in the Alpha Omega Alpha medical honor society. At Yale, he also met classmate Lucy Goddard, whom he married in 2006.
He returned to Stanford for a residency in neurological surgery and a postdoctoral fellowship in neuroscience, developing optogenetic techniques in the laboratories of Krishna Shenoy, PhD, and Karl Deisseroth, MD, PhD. He authored more than 20 scientific publications and received the American Academy of Neurological Surgery’s highest award for research.
Cancer diagnosis
But then, in Kalanithi’s sixth year of residency, his weight dropped precipitously, and he developed night sweats, unremitting back pain and a cough. In May 2013, Kalanithi, who had never smoked, was diagnosed with stage-4 non-small-cell EGFR-positive lung cancer.
His first reaction was to prepare to die and to encourage Lucy to remarry, he wrote in his New York Times essay. But his cancer responded to treatment, he regained strength and he returned to work in late 2013, completing his residency last year. He and Lucy also decided they wanted to have a child. Elizabeth Acadia “Cady” Kalanithi was born on July 4, 2014.
In addition to returning to surgery, Kalanithi shared his reflections on illness and medicine, authoring essays in The New York Times, The Paris Review and Stanford Medicine, and participating in interviews for media outlets and public forums.
It completely surprised me that it resonated with so many people.
Despite a relapse in the spring of 2014, Kalanithi continued to speak to the public and write, including working on a book.
His essays tapped an outpouring of gratitude from readers — from young people who had lost parents to seniors facing their own mortality, to teachers desiring to share his essay with students. “It completely surprised me that it resonated with so many people,” Kalanithi wrote of the response to the Times piece in a 2014 San Francisco Magazine essay. “I still get an email nearly every day from someone with heart disease or depression or another medical illness, saying that it helped clarify his or her own situation. The second, and really pleasing, development was the number of doctors who emailed to say that they planned to give the article to their patients or incorporate it into medical school curricula to help students understand the human impact of disease. That was really touching.”
This letter from a reader in response to the Stanford Medicine essay is representative: “Dr. Kalanithi, I could not hold my tears while reading your story. It is a sad story, but at the same time it is an amazing story to share. These are the type of stories that stop us, and make us re-think life and the way that we are living it. Your story has touched me deeply in a very positive way.”
Kalanithi appeared to live by his words. After his diagnosis, he continued to joke, and laugh, enjoy the company of family, friends and colleagues, spend time appreciating nature and go wild at football games. He also helped raise money for lung cancer awareness. As top fundraiser (due, he said, to an overwhelming response from his friends, family and colleagues — including many from Stanford), he won the Chris Draft Family Foundation’s Lung Cancer Survivors Super Bowl Challenge, which landed him and family in Arizona for the 2015 Super Bowl.
Continuing to teach
In what proved to be his last days of life, Kalanithi worked on a teaching module with the director of Stanford’s palliative care education and training program, VJ Periyakoil, MD. “The module would teach the lessons he learned from being on both sides of the aisle — being a neurosurgeon at the top of his game to being a patient with cancer. We talked about how being the doctor is all about having control and wielding power, while being a patient is all about loss of control and feeling vulnerable,” said Periyakoil, a clinical associate professor of medicine.
His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine.
“His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine. We talked about the design of the module and how we could tailor it to make our medical students understand that the so-called soft skills of medicine are the truly hard skills to teach and to learn.”
As a chief resident, Kalanithi was a skilled mentor, said current chief resident Anand Veeravagu, MD. “He has a way of identifying your strengths and weaknesses to elevate your skills in unison. Gifted,” Veeravagu said, adding that Kalanithi was also a dedicated advocate for the human being inside each of his patients.
“As surgeons, we often become so entrenched in treating the disease that we forget who it is we are treating,” Veeravagu continued. “I remember when Paul returned to the neurosurgical service and started operating again back in late 2013. At that time, I was Paul’s shadow, learning and supporting however possible.
“We walked out of the operating room corridor together, toward the intensive care unit and I was complaining of being tired and worn out — and he looked at me and said, in his very satirical voice, ‘You know I have lung cancer, right?’ I looked at him with great surprise, as if such things shouldn’t be said out loud, and I’ll never forget what he said to me next. ‘Don’t forget what you do, and who you do it for. These are people who you can help, and you shouldn’t forget that.’ Paul is, to me, the hero of all heroes.”
Kalanithi is survived by his wife, Lucy Goddard Kalanithi, MD, FACP, a clinical instructor in medicine at Stanford; daughter, Cady; parents, Sujatha Kalanithi and A. Paul Kalanithi, MD; brothers, Suman Kalanithi, MD, and Jeevan Kalanithi; and Jeevan’s wife, Emily Kalanithi, JD. and their children, Eve and James.
A memorial service will take place at 2 p.m. March 31 at the Memorial Church on the Stanford campus. A reception will take place afterward at the Arrillaga Alumni Center at 326 Galvez St. (Those attending the memorial are advised to arrive before 1:30 p.m. to allow plenty of time for parking. The Galvez Lot at 270 Galvez St. has been reserved for those attending the service. Enter code 3380 at pay stations for complimentary all-day parking. Free shuttle buses marked “Kalanithi Memorial” will run from the Galvez Lot to the top of the Oval, near Memorial Church, beginning at 1 p.m. Following the service, return shuttles will run from the top of the Oval to the reception at the Alumni Center. The reception will continue until 5 p.m.)
Gifts in Kalanithi's memory may be sent to the Dr. Paul Kalanithi Memorial Fund at Stanford University, Development Services, P.O. Box 20466, Stanford, CA, 94309-0466. Gifts can also be made online; instructions are available at http://paulkalanithi.com/donate/. The fund will be used to recruit and support rural American students in the pursuit of a transformative education, a cause Kalanithi cared deeply about.
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