Paul Kalanithi was only in his mid-thirties, just beginning a successful career as a neurosurgeon after a long period of training, when he was diagnosed with a rare form of lung cancer. He lived around two years afterwards, enough time to accomplish his second life goal of becoming a writer. This book is the result; it is first a reflection on the close relationship a doctor necessarily acquires with death. Second it is an autobiography of Paul and his experiences with cancer.

This book serves as a very effective memento mori. All of us will die, as Paul did... only the timing and circumstances change. It is useless to complain. Go in peace, with dignity.

I appreciated the discussion on what kind of a life is worth living. Modern medicine is remarkable and can keep tissues alive nearly indefinitely. Yet there is definitely a point where life isn't worth living - brain dead with no possible recovery, for instance, is not really worth it. Yes, something is technically alive; but most people and legal jurisdictions agree that the person is already dead. In between this and a full, "normal" life is a wide spectrum. There is indeed a point where struggling to maintain life is much too costly in terms of the quality of life preserved. For instance, see the article "How Doctors Die" (Note: I believe I first encountered mention of Paul's book in a discussion of this article) - when faced with a diagnosis for which they know too well the long and painful treatment, with little chance of regaining a high quality of life, many opt for palliative care and a quick, graceful exit instead.

Impending death forces a re-evaluation of your values and goals.  In Paul's story, he is forced to decide what he wants most - continue to try to be a neurosurgeon? Just enjoy his remaining time on Earth? Start a family? (He did.) Anyway ... since we are all under death sentence anyway ... shouldn't we re-assess our values and goals now? Focus on what is meaningful to you; everything else you just don't have time for.

One final thought. I was impressed by this:

"Will having a newborn distract from the time we have together?" she asked. "Don't you think saying goodbye to your child will make your death more painful?"

"Wouldn't it be great if it did?" I said. Lucy and I both felt that life wasn't about avoiding suffering.

Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteris­tic of the organism is striving. Describing life otherwise was like painting a tiger without stripes. After so many years of living with death, I'd come to understand that the easiest death wasn't necessarily the best. We talked it over. Our families gave their blessing. We decided to have a child. We would carry on living, instead of dying.

What stands out to me is the idea that struggling and suffering in the course of doing something worthwhile (raising a child, in this case) is better than avoiding struggle and enjoying your remaining days. I think research on happiness that I'm aware of would suggest the same thing - we need to find a purpose or cause to work towards to be truly happy.

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