Podcasts about Paul Kalanithi

Episode 538 - Tony Stewart - Carrying the Tiger - Living With Cancer, Dying With Grace and Finding Joy While GrievingAbout the authorTony Stewart has made award-winning films for colleges and universities, written software that received rave reviews in The New York Times and the New York Daily News, designed a grants-management application that was used by three of the five largest charities in the world, and led the development of an international standard for the messages involved in buying and selling advertisements, for which he spoke at conferences across Europe and North America. Tony and his late wife Lynn Kotula, a painter, traveled extensively in India and Southeast Asia, staying in small hotels off the beaten track and eating delicious food with their fingers when cutlery wasn't available. Carrying the Tiger is his first published book.An inspiring story of love, loss and recovery“[A] beautifully devastating memoir… a remarkable odyssey of learning to ‘live fully in the shadow of death.'” — Publishers Weekly BookLife (Editor's Pick)In the spirit of Joan Didion's The Year of Magical Thinking and Paul Kalanithi's When Breath Becomes Air comes Carrying the Tiger, a life affirming memoir about the full circle of life and death.When Tony Stewart's wife, Lynn, receives a sudden and devastating diagnosis, they scramble to find effective treatment, navigate life threatening setbacks, learn to live fully in the shadow of death, and share the intimate grace of her departure from this world. Then Tony slowly climbs out of shattering grief and, surprisingly, eases toward new love.There is uncertainty, fear, and sorrow, but also tenderness and joy, along with a renewed perspective on what it means to live and love with one's whole heart.“Captures emotions and experiences that will be familiar to anyone who's stood by a loved one facing a cancer diagnosis... this is a work that will strengthen all who read it.” — Khalid Dar, MD, Oncologist, Mount Sinai Morningside“A beautiful and very human love story which breathes an extraordinary generosity of spirit.” — David Newman, author of Talking with Doctorshttps://www.tonystewartauthor.com/Support the show___https://livingthenextchapter.com/podcast produced by: https://truemediasolutions.ca/Coffee Refills are always appreciated, refill Dave's cup here, and thanks!https://buymeacoffee.com/truemediaca

Lessons from 'When Breathe Becomes Air' by Paul KalanithiPaul Kalanithi was a neurosurgeon, writer, and a young father. He was completing his residency training in neurological surgery and a postdoctoral fellowship in neuroscience at Standford when he was diagnosed with stage IV metastatic lung cancer. He died in March 2015, 22 months after. 'When Breathe Becomes Air' is a memoir and Paul's story of battling lung cancer. It was posthumously published on January 12, 2016.Ways to Support:Substack: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://ijmakan.substack.com/subscribe?=⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://becomingantifragile.com/⁠Art: ⁠⁠⁠⁠⁠https://ikranrinmakan.com/-USA: https://amzn.to/3xWPaEL

Listen to ASCO's Journal of Clinical Oncology Art of Oncology article, "I Hope So Too” by Dr. Richard Leiter from Dana-Farber Cancer Institute. The article is followed by an interview with Leiter and host Dr. Mikkael Sekeres. Leiter shares that even in the most difficult moments, clinicians can find space to hope with patients and their families. TRANSCRIPT  Narrator: I Hope So Too, by Richard E. Leiter, MD, MA  “You're always the negative one,” Carlos' mother said through our hospital's Spanish interpreter. “You want him to die.” Carlos was 21 years old. A few years earlier he had been diagnosed with AML and had undergone an allogeneic bone marrow transplant. He was cured. But now, he lay in our hospital's bone marrow transplant (BMT) unit, his body attacked by the very treatment that had given him a new life. He had disseminated graft-versus-host disease (GVHD) in his liver, his lungs, his gut, and, most markedly, his skin. The BMT team had consulted us to help with Carlos' pain. GVHD skin lesions covered his body. They were raw and weeping. Although the consult was ostensibly for pain, the subtext could not have been clearer. Carlos was dying, and the primary team needed help navigating the situation. As his liver and kidney function declined, the need to address goals of care with Carlos' mother felt like it was growing more urgent by the hour. Difficult cases, like a young person dying, transform an inpatient unit. Rather than the usual hum of nurses, patient care associates, pharmacy technicians, and unit managers going about their daily work, the floor becomes enveloped in tension. Daily rhythms jump a half step ahead of the beat; conversations among close colleagues fall out of tune. “Thank goodness you're here,” nurse after nurse told my attending and me, the weight of Carlos' case hanging from their shoulders and tugging at the already puffy skin below their eyes. I was a newly minted palliative care fellow, just over a month into my training. I was developing quickly, but as can happen with too many of us, my confidence sat a few steps beyond my skills. I thought I had a firm grasp of palliative care communication skills and was eager to use them. I asked for feedback from my attendings and genuinely worked to incorporate it into my practice. At the same time, I silently bristled when they took charge of a conversation in a patient's room. Over the ensuing week, my attending and I leaned in. We spent hours at Carlos' bedside. If I squinted, I could have convinced myself that Carlos' pain was better. Every day, however, felt worse. We were not making any progress with Carlos' mother, who mostly sat silently in a corner of his room. Aside from occasionally moaning, Carlos did not speak. We learned little, if anything, about him as a person, what he enjoyed, what he feared. We treated him, and we barely knew him. Each morning, I would dutifully update my attending about the overnight events. “Creatinine is up. Bili is up.” She would shake her head in sadness. “Doesn't she get that he's dying?” one of the nurses asked us. “I feel like I'm torturing him. He's jaundiced and going into renal failure. I'm worried we're going to need to send him to the ICU. But even that won't help him. Doesn't she understand?”  We convened a family meeting. It was a gorgeous August afternoon, but the old BMT unit had no windows. We sat in a cramped, dark gray family meeting room. Huddled beside Carlos' mother was everyone on the care team including the BMT attending, nurse, social worker, chaplain, and Spanish interpreter. We explained that his kidneys and liver were failing and that we worried time was short. Carlos' mother had heard it all before, from his clinicians on rounds every day, from the nursing staff tenderly caring for him at his bedside, and from us. “He's going to get better,” she told us. “I don't understand why this is happening to him. He's going to recover. He was cured of his leukemia. I have hope that his kidneys and liver are going to get better.” “I hope they get better,” I told her. I should have stopped there. Instead, in my eagerness to show my attending, and myself, I could navigate the conversation on my own, I mistakenly kept going. “But none of us think they will.” It was after this comment that she looked me right in the eyes and told me I wanted Carlos to die. I knew, even then, that she was right. In that moment, I did want Carlos to die. I could not sit with all the suffering—his, his mother's, and his care team's. I needed her to adopt our narrative—that we had done all we could to help Carlos live, and now, we would do all we could to help him die comfortably. I needed his mother to tell me she understood, to accept what was going on. I failed to recognize what now seems so clear. Of course, his mother understood what was happening. She saw it. But how could we have asked her to accept what is fundamentally unacceptable? To comprehend the incomprehensible?  At its best, serious illness communication not only empathetically shares news, be it good or bad, but also allows patients and families adequate time to adjust to it. For some, this adjustment happens quickly, and in a single conversation, they can digest difficult news and move to planning the next steps in care for themselves or their loved ones. For most, they need more time to process, and we are able to advance the discussion over the course of multiple visits. My attending led the conversations from then on. She worked with the BMT attending, and they compassionately kept Carlos out of the intensive care unit. He died a few days later, late in the evening. I never saw his mother again. I could not have prevented Carlos' death. None of us could have. None of us could have spared his mother from the grief that will stay with her for the rest of her life. Over those days, though, I could have made things just a little bit less difficult for her. I could have protected her from the overcommunication that plagues our inpatient units when patients and families make decisions different from those we would make for ourselves and our loved ones. I could have acted as her guide rather than as her cross-examiner. I could have hoped that Carlos stopped suffering and, genuinely, hoped he got better although I knew it was next to impossible. Because hope is a generous collaborator, it can coexist with rising creatinines, failing livers, and fears about intubation. Even in our most difficult moments as clinicians, we can find space to hope with our patients, if we look for it. Now—years later, when I talk to a terrified, grieving family member, I recall Carlos' mother's eyes piercing mine. When they tell me they hope their loved one gets better, I know how to respond. “I hope so too.” And I do. Dr. Mikkael Sekeres: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the oncology field. I'm your host, Mikkael Sekeres. I'm professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center at University of Miami. Today I am thrilled to be joined by Dr. Ricky Leiter from the Dana-Farber Cancer Institute. In this episode, we will be discussing his Art of Oncology article, “I Hope So, Too.” Our guest's disclosures will be linked in the transcript. Ricky, welcome to our podcast and thank you so much for joining us. Dr. Ricky Leiter: Thanks so much for having me. I'm really excited to be here. Dr. Mikkael Sekeres: Ricky, I absolutely adored your essay. It really explored, I think, a combination of the vulnerability we have when we're trying to take care of a patient who's dying and the interesting badlands we're placed in when we're also a trainee and aren't quite sure of our own skills and how to approach difficult situations. But before we dive into the meat of this, can you tell us a little bit about yourself? Where are you from and where did you do your training? Dr. Ricky Leiter: Sure, yeah. Thanks so much. So I grew up in Toronto, Canada, and then moved down to the States for college. I was actually a history major, so I never thought I was going to go into medicine. And long story short, here I am. I did a Post-Bac, did a year of research, and ended up at Northwestern Feinberg School of Medicine for med school, where I did a joint degree in medical humanities and bioethics. And that really shaped my path towards palliative care because I found this field where I said, “You know, wow, I can use these skills I'm learning in my Master's at the bedside with patients thinking about life and death and serious illness and what does that all mean in the broader context of society.” So, moved from Chicago to New York for residency, where I did residency and chief residency in internal medicine at New York Presbyterian Cornell, and then came up to the Harvard Interprofessional Palliative Care Program, where I did a clinical fellowship, then a research fellowship with Dana-Farber, and have been on faculty here since. Dr. Mikkael Sekeres: Fantastic. Any thoughts about moving back to Canada? Dr. Ricky Leiter: We talk about it every now and then. I'm really happy here. My family's really happy here. We love life in Boston, so we're certainly here for the time being. Definitely. Dr. Mikkael Sekeres: And the weather's so similar. Dr. Ricky Leiter: Yeah, I'm used to the cold. Dr. Mikkael Sekeres: I apparently did not move to Miami. I'm curious, this may be an unfair question, as you have a really broad background in humanities and ethics. Are there one or two books that you read where you think, “Gee, I'm still applying these principles,” or, “This really still resonates with me in my day to day care of patients who have cancer diagnosis”? Dr. Ricky Leiter: Oh, wow, that is a great question. There are probably too many to list. I think one is When Breath Becomes Air by Paul Kalanithi, which I didn't read in my training, I read afterwards. And I think he's such a beautiful writer. The story is so poignant, and I just think Paul Kalanithi's insights into what it means to be living with a serious illness and then ultimately dying from cancer as a young man, as someone in medicine, has really left an imprint on me. Also, Arthur Kleinman. The Illness Narratives, I think, is such a big one, too. And similarly, Arthur Frank's work. I mean, just thinking about narrative and patient stories and how that impacts our clinical care, and also us as clinicians. Dr. Mikkael Sekeres: And I suspect us as writers also. Dr. Ricky Leiter: Absolutely. Dr. Mikkael Sekeres: We imprint on the books that were influential to us. Dr. Ricky Leiter: Certainly. Dr. Mikkael Sekeres: So how about your story as a writer? How long have you been writing narrative pieces? Is this something you came to later in your career, or did you catch the bug early as an undergrad or even younger? Dr. Ricky Leiter: So I caught it early, and then it went dormant for a little while and came back. As a history major, as someone who is humanities minded, I loved writing my papers in college. Like, I was one of those nerds who got, like, really, really excited about the history term paper I was writing. You know, it was difficult, but I was doing it, particularly at the last minute. But I really loved the writing process. Going through my medical training, I didn't have as much time as I wanted, and so writing was sort of on the back burner. And then actually in my research fellowship, we had a writing seminar, our department, and one of the sessions was on writing Op-eds and perspective pieces. And we had a free write session and I wrote something sort of related to my research at the time I was thinking about, and Joanne Wolfe, who was helping to lead the session, pediatric palliative care physician, she said, “You know, this is really great. Like, where are you going to publish this?” And I said, “Joanne, what do you mean? I just wrote this in this session as an exercise.” She said, “No, you should publish this.” And I did. And then the bug came right back and I thought, “Wow, this is something that I really enjoy and I can actually make a difference with it. You know, getting a message out, allowing people to think a little bit differently or more deeply about clinical cases, both in the lay press and in medical publications.: So I've essentially been doing it since and it's become a larger and larger part of my career. Dr. Mikkael Sekeres: That's absolutely wonderful, Ricky. Where is it that you publish then, outside of Art of Oncology? Dr. Ricky Leiter: So I've had a couple of pieces in the New York Times, which was really exciting. Some in STAT News on their opinion section called First Opinion, and had a few pieces in the New England Journal as well, and in the Palliative Care Literature, the Journal of Palliative Medicine. Dr. Mikkael Sekeres: Outstanding. And about palliative care issues and end of life issues, I assume? Dr. Ricky Leiter: Sort of all of the above. Palliative care, serious illness, being in medical training, I wrote a fair bit about what it was like to be on the front lines of the pandemic. Dr. Mikkael Sekeres: Yeah, that was a traumatic period of time, I think, for a lot of us. Dr. Ricky Leiter: Absolutely. Dr. Mikkael Sekeres: I'm curious about your writing process. What triggers a story and how do you face the dreaded blank page? Dr. Ricky Leiter: So it's hard to pin down exactly what triggers a story for me. I think sometimes I'm in a room and for whatever reason, there's a moment in the room and I say, “You know what? There's a story here. There's something about what's going on right now that I want to write.” And oftentimes I don't know what it is until I start writing. Maybe it's a moment or a scene and I start writing like, “What am I trying to say here? What's the message? And sometimes there isn't a deeper message. The story itself is so poignant or beautiful that I want to tell that story. Other times it's using that story. And the way I think about my writing is using small moments to ask bigger questions in medicine. So, like, what does it mean to have a good death? You know, one piece I wrote was I was thinking about that as I struggled to give someone what I hoped would be a good death, that I was thinking more broadly, what does this mean as we're thinking about the concept of a good death? Another piece I wrote was about a patient I cared for doing kidney palliative care. And she was such a character. We adored her so much and she was challenging and she would admit that. This was someone I wanted to write about. And I talked to her about it and she was honored to have her story told. Unfortunately, it came out shortly after her death. But she was such a vibrant personality. I said, “There's something here that I want to write about.” In terms of the blank page, I think it's overcoming that fear of writing and procrastination and all of that. I think I have a specific writing playlist that I put on that helps me, that I've listened to so many times. You know, no words, but I know the music and it really helps me get in the zone. And then I start writing. And I think it's one of those things where sometimes I'm like, “Oh, I really don't like how this is sounding, but I'm going to push through anyways.” as Anne Lamott's blank first draft, just to get something out there and then I can play with it and work with it. Dr. Mikkael Sekeres: Great. I love the association you have with music and getting those creative juices flowing and picking ‘le mot juste' in getting things down on a page. It's also fascinating how we sometimes forget the true privilege that we have as healthcare providers in the people we meet, the cross section of humanity and the personalities who can trigger these wonderful stories. Dr. Ricky Leiter: Absolutely. Absolutely. It's such a privilege and I think it often will go in unexpected directions and can really impact, for me certainly, my practice of medicine and how I approach the next patients or even patients years down the road. You remember those patients and those stories. Dr. Mikkael Sekeres: Right. You write with such obvious love and respect for your patients. You also write about that tenuous phase of our careers when we're not yet attendings but have finished residency and have demonstrated a modicum of competence. You know, I used to say that fellowship is really the worst of all worlds, right? As an attending, you have responsibility, but you don't have to do as much of the grunt work. As a resident, you do the grunt work, but you don't really have the responsibility. And in fellowship, you've got it all. You've got to do the grunt work, and you have the responsibility. Can you tie those two concepts together, though? How does our relationship to our patients change over the course of our careers? Dr. Ricky Leiter: Early on, if you think about the imprinting of patients as you go down the road, so many of the patients who have imprinted on me were the ones earlier in my career, before I was more formed as a clinician because of experiences like the one I wrote about in “I Hope so Too,” where the skills are forming, and sometimes where it's smooth sailing, and sometimes we're muddling through. And those cases where we feel like we're muddling through or things don't go as we hope, those are the ones that really leave an impact. And I think it's those little moments that sort of nudge your career and your skill set in different ways. I think the patients now, they still leave a mark on me, but I think it's in different ways. And I think oftentimes it's less about my skills. Although my skills are still very much developing, even, you know, almost a decade out, they impact me differently than they once did. I feel more confident in what I'm doing, and it's more about my relationship to this situation rather than the situation's impact on my skills. Dr. Mikkael Sekeres: Got it. Got it. It's interesting. I once wrote a piece with Tim Gilligan, who also spent some time at Dana Farber and is a communications expert, about how there's this kind of dualism in how we're trained. We're trained with communications courses and how to talk to patients, and it almost does the opposite. It kind of raises the flag that, “Wait a second, maybe I've been talking to people the wrong way.” And as you get more mature in your career, I almost feel as if you revert back to the way you were before medical school, when you just talked to people like they were people and didn't have a special voice for patients. Dr. Ricky Leiter: Yeah, I think that's right. And I think in palliative care, we spend so much time thinking about the communication. And this was the most challenging piece about fellowship because then- and our fellowship directors told this to us, and now we teach it to our fellows. You know that you come in, the people who choose to go into palliative care, have a love of communication, have some degree of skill coming in, and then what happens is we break those skills down and teach them a new skill set. So it gets clunkier before it gets better. And the time I was writing about in this piece was August of my fellowship year, exactly when that process was happening, where I'm trying to incorporate the new skills, I had my old way of doing things, and it's just not always aligning. And I think you're right that as the skills become embedded, as you go on throughout your career, where it feels much more natural, and then you do really connect with people as people still using the skills and the techniques that we've learned in our communication courses, but they become part of who you are as a clinician. Dr. Mikkael Sekeres: Nicely put. Your story is particularly poignant because the patient you described was dying from the very treatment that cured his leukemia. It's this, I'm going to use the term badlands again. It's this terrible badlands we sometimes find ourselves where, yes, the treatment has been successful, but at the cost of a human life. Do you think that as healthcare providers, we react differently when a patient is sick, from side effects to our recommendations, as opposed to sick from their disease? Dr. Ricky Leiter: I think we probably do. It's hard because I think every patient in every case pulls at us in different directions. And this case was Carlos, who I called him, it was such a challenging situation for so many reasons. He was young. He really couldn't communicate with us. We were talking to his mom. Like, there were so many layers to this. But I think you're right. that underlying this, there's a sense of “We did everything we could beautifully, to cure him of his disease, and now he's dying of that, and what does that mean for us as clinicians, physicians. That becomes really hard and hard to sit with and hold as we're going back every day. And I say that as the palliative care consultant. So I can only imagine for the oncology team caring for him, who had taken him through this, what that felt like. Dr. Mikkael Sekeres: Well, you describe, again, beautifully in the piece, how the nursing staff would approach you and were so relieved that you were there. And it was, you know, you got the sense- I mean, obviously, it's tragic because it's a young person who died, but you almost got the sense there was this guilt among the providers, right? Not only is it a young person dying, but dying from graft versus host disease, not from leukemia. Dr. Ricky Leiter: Absolutely. There was guilt because of what he was dying of, because of how he was dying that he was so uncomfortable and it took us so long to get his pain under control and we really couldn't get him that balance of pain control and alertness that we always strive for was pretty much impossible from the beginning. And so it was layer upon layer of distress and guilt and sadness and grief that we could just feel every day as we stepped onto the floor. Dr. Mikkael Sekeres: Yeah. I don't know if you've ever read- there's a biography of Henry Kaplan, who was considered the father of radiation therapy, where there was this incredible moment during his career when he presented at the AACR Annual Meeting the first cures for cancers, right? No one believed it. It was amazing, actually curing cancer. And then a couple years later, people started dribbling into his clinic with cancers because of the radiation therapy he gave, and he actually went into a clinical depression as a result of it. So it can affect providers at such a deep level. And I think there's this undiscussed guilt that permeates the staff when that happens. Dr. Ricky Leiter: Absolutely, absolutely. It's right there under the surface. And we rarely give ourselves the space to talk about it, right? To really sit down and say, how are we approaching this situation? How do we feel about it? And to sit with each other and acknowledge that this is horrible. It's a horrible situation. And we feel guilty and we feel sad and we feel grief about this. Dr. Mikkael Sekeres: It's been just terrific getting to know you and to read your piece, Ricky Leiternd, a we really appreciate your writing. Keep doing what you do. Dr. Ricky Leiter: Oh, thank you so much. It's a privilege to get the piece out there and particularly in JCO and to be here with you. So I really appreciate it. Dr. Mikkael Sekeres: Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of ASCO's shows at asco.org/podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio: Dr. Ricky Leiter is from the Dana-Farber Cancer Institute.

In de podcastserie proefschriften spreekt aios interne geneeskunde dr. Tessa Steenbruggen met promovendi. In deze aflevering spreekt zij met Lisanne de Koster over haar proefschrift, getiteld: “Management of indeterminate thyroid nodules: changing the paradigm”. Lisanne bespreekt de opzet van de EfFECTS-studie die het gebruik van [18F]FDG-PET/CT onderzocht als rule-out test in de diagnostische work-up van Bethesda III- en IV-schildkliernodi, met als doel het aantal niet bijdragende diagnostische operaties voor goedaardige nodi te verminderen. Aan bod komen ook de kosteneffectiviteitsanalyse en invloed op kwaliteit van leven wanneer deze aanpak wordt gevolgd en inzet van moleculaire diagnostiek. Lisanne zal op 6 maart haar proefschrift verdedigen aan de Universiteit van Leiden bij dr. Dennis Vriens, prof. dr. Lioe-Fee de Geus-Oei en prof. dr. Wim Oyen. Referenties When breath becomes air - Paul Kalanithi EfFECTS-studie: De Koster EJ, et al. Eur J Nucl Med Mol Imaging 2022;49:1970–84. Radiomic EfFECTS-studie: De Koster EJ, et al. Eur J Nucl Med Mol Imaging 2022;49:2174–88. Kosteneffecitiviteitsanalyse EfFECTS-studie: De Koster EJ, et al. Eur J Nucl Med Mol Imaging 2022;49:3452–69. Kwaliteit van leven EfFECTS-studie: De Koster EJ, et al. Endocr Connect 2022;11:e220014. Validatie moleculaire diagnostiek: De Koster EJ, et al. Thyroid 2024;34:41–53.

Chapter 1:Summary of When Breath Becomes Air"When Breath Becomes Air" is a memoir by Paul Kalanithi, published posthumously in 2016. It chronicles Kalanithi's life and experience as a neurosurgeon faced with terminal lung cancer at the age of 36. The book is divided into two main sections: the first part focuses on his journey through medical education and his development as a neurosurgeon, while the second part delves into his confrontation with his own mortality and his role reversal from physician to patient.Kalanithi eloquently explores profound questions about the relationship between life, death, and identity, and how these elements are irrevocably altered by the inevitable approach of death. The narrative begins with Kalanithi's literary and philosophical interests which gradually evolve into a passion for medicine, drawn by its unique combination of critical thinking, human connection, and ethical challenges.Throughout his career, Kalanithi is dually influenced by the highs of saving lives and the emotional toll of losing patients. His perspective takes a dramatic turn when he is diagnosed with stage IV lung cancer. Facing his diminishing future, Kalanithi is forced to grapple with what it means to truly live a meaningful life and how to make the most of the time he has left.In the wake of his diagnosis, he reflects on his relationships, particularly with his wife, Lucy, and his aspirations for their future together, including the discussion about having a child. Deciding to have a daughter, even as he battled with his health, reinforced his faith in the importance of hope and legacy.The book ends with an emotional and philosophical reflection on the process of dying, with a poignant epilogue written by his wife following his death in March 2015. "When Breath Becomes Air" is a touching, deeply personal exploration of what it means to face death but also how defining life through the lens of death can profoundly reshape our understanding of purpose and identity. It's a meditation on the intersection of the professional and the personal, the scientific and the existential, providing readers with insights into both the fragility and resilience of the human spirit.Chapter 2:The Theme of When Breath Becomes Air"When Breath Becomes Air" is a profound and deeply moving memoir by Paul Kalanithi, a neurosurgeon who faced a terminal cancer diagnosis at the pinnacle of his career and just as he was starting his own family. The book is an introspective journey that provides a unique insight into the intersections of life, death, and purpose. Here are some key plot points, character development, and thematic ideas explored in the book: Key Plot Points:1. Career and Passion: Kalanithi excels in literature and biology. His insatiable quest for understanding the meaning of life leads him to study English literature and human biology. Later, he pursues a degree in medicine, specializing in neurosurgery and neuroscience.2. Diagnosis: At the peak of his career, Kalanithi is diagnosed with stage IV lung cancer. This abrupt transition from a doctor to a patient makes him confront the realities of what it means to face death.3. Reflection and Writing: As his health declines, Kalanithi reflects on his life, beliefs, and the values that define him. He begins to write "When Breath Becomes Air," aiming to share his unique perspective on facing mortality.4. Family and Fatherhood: Amid his illness, Kalanithi's relationship with his wife, Lucy, undergoes strain but also deepening growth. They decide to have a child, a testament to their hope and love, even in the face of death.5. Death: Kalanithi dies at the age of 37, leaving behind his manuscript, which is later completed by his wife Lucy. Character Development:- Paul Kalanithi: Throughout the memoir, Kalanithi evolves from a curious...

A great book can be life-changing.  Join the co-hosts as they share 12 of their favorite "must read" books which transcend both professional and personal interest.  Book List "Being Mortal" by Atul Gawande  recommended by Laura "When Breath Becomes Air" by Paul Kalanithi recommended by Laura "The Little Prince" by Antoine de Saint-Exupéry recommended by Maritess John Maxwell Books on Leadership recommended by Maritess "If Disney Ran Your Hospital" by Fred Lee recommended by Laura and Maritess "The Ride of a Lifetime" by Bob Iger recommended by Maritess "Extreme Ownership" by Jocko Willink and Leif Babin recommended by Maritess "An American Sickness" by Elizabeth Rosenthal recommended by Neil "Love" by Leo Bascaglia  recommended by Neil "Personhood" by Leo Bascaglia recommended by Neil "But Not the Hippopotamus"  by Sandra Boynton recommended by Laura "The Nightingale of Mosul" by Susan Luz recommended by Sydney   MEET OUR CO-HOSTS   Samantha Bayne, MSN, RN, CMSRN, NPD-BC is a nursing professional development practitioner in the inland northwest specializing in medical-surgical nursing. The first four years of her practice were spent bedside on a busy ortho/neuro unit where she found her passion for newly graduated RNs, interdisciplinary collaboration, and professional governance. Sam is an unwavering advocate for medical-surgical nursing as a specialty and enjoys helping nurses prepare for specialty certification.    Laura Johnson, MSN, RN, NPD-BC, CMSRN has been a nurse since 2008 with a background in Med/Surg and Oncology.  She is a native Texan currently working in the Dallas area.  She has held many positions throughout her career from bedside nurse to management/leadership to education.  Laura obtained her MSN in nursing education in 2018 and is currently pursuing her DNP.  She has worked both as a bedside educator and a nursing professional development practitioner for both new and experienced staff.  She enjoys working with the nurse residency program as a specialist in palliative care/end of life nursing and mentorship.  She is currently an NPD practitioner for oncology and bone marrow transplant units.     Neil H. Johnson, RN, BSN, CMSRN, epitomizes a profound familial commitment to the nursing profession, marking the third generation in his family to tread this esteemed path. Following the footsteps of his father, grandfather, grandmother, aunt, and cousin, all distinguished nurses, Neil transitioned to nursing as a second career after a brief tenure as an elementary school teacher. Currently on the verge of completing his MSN in nurse education, he aspires to seamlessly integrate his dual passions. Apart from his unwavering dedication to nursing, Neil actively seeks serenity in nature alongside his canine companions. In his professional capacity, he fulfills the role of a med-surg nurse at the Moses Cone Health System in North Carolina.   Eric Torres, ADN, RN, CMSRN is a California native that has always dreamed of seeing the World, and when that didn't work out, he set his sights on nursing.  Eric is beyond excited to be joining the AMSN podcast and having a chance to share his stories and experiences of being a bedside medical-surgical nurse.   Maritess M. Quinto, DNP, RN, NPD-BC, CMSRN is a clinical educator currently leading a team of educators who is passionately helping healthcare colleagues, especially newly graduate nurses. She was born and raised in the Philippines and immigrated to the United States with her family in Florida. Her family of seven (three girls and two boys with her husband who is also a Registered Nurse) loves to travel, especially to Disney World. She loves to share her experiences about parenting, travelling, and, of course, nursing!   Sydney Wall, RN, BSN, CMSRN has been a med surg nurse for 5 years. After graduating from the University of Rhode Island in 2019, Sydney commissioned into the Navy and began her nursing career working on a cardiac/telemetry unit in Bethesda, Maryland.  Currently she is stationed overseas, providing care for service members and their families.  During her free time, she enjoys martial arts and traveling.   

Death is understandably difficult – and for some people, nearly impossible – to conceive of and talk about. Especially our own. It may seem like there's nothing we can do to prepare for our last moments on earth, but several innovative panelists at the 2023 Aspen Ideas Festival would disagree. Alua Arthur is a “death doula,” who helps people find peace with themselves when nearing the end of their life. A former lawyer, she founded the organization Going With Grace to help redefine the end-of-life experience. Dan Diaz was thrust into advocacy when his wife, Brittany Maynard, was diagnosed with terminal brain cancer in 2014 at age 29. Maynard wanted control over how she died, and the couple moved to Oregon for the last months of her life, where medical aid in dying was legal. Diaz has been pushing to expand legalization of medical aid in dying ever since, and has helped pass legislation in several states since Brittany's death. Designer Katrina Spade invented a way to turn humans into compost after life, and founded the company Recompose. Human composting is now legal in five states, thanks to efforts led by Recompose. Stanford medical professor and health care culture advocate Dr. Lucy Kalanithi moderates the conversation. Kalanithi's husband Paul Kalanithi died of cancer in 2015, after writing the memoir “When Breath Becomes Air.” aspenideas.org

Marcy Langlois was born with a physical deformity, which required 23 surgical procedures before the age of 18, and was involved in a devastating, life-changing accident at the age of 17. She shares her story and opens up about the ways in which she has been able to heal and to focus on life's infinite possibility. Look for her podcast Living Beyond Limits.This episode is sponsored by Paul Kalanithi's bestselling memoir When Breath Becomes Air, available wherever books are sold. For more go to www.prh.com/BREATHMore about Marcy: www.MarcyLanglois.comWAYS TO HELP THE MIHH PODCASTSubscribe via iTunes and leave a review. It costs nothing. https://itunes.apple.com/us/podcast/mental-illness-happy-hour/id427377900?mt=2Spread the word via social media. It costs nothing.Our website is www.mentalpod.com our FB is www.Facebook.com/mentalpod and our Twitter and Instagram are both @Mentalpod Become a much-needed Patreon monthly-donor (with occasional rewards) for as little as $1/month at www.Patreon.com/mentalpod Become a one-time or monthly donor via PayPal at https://mentalpod.com/donateYou can also donate via Zelle (make payment to mentalpod@gmail.com) To donate via Venmo make payment to @Mentalpod Try Our Sponsor's Products/ServicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Lessons from 'When Breathe Becomes Air' by Paul Kalanithi Paul Kalanithia was a neurosurgeon, writer, and a young father. He was completing his residency training in neurological surgery and a postdoctoral fellowship in neuroscience when he was diagnosed with stage IV metastatic lung cancer. He died in March 2015, 22 months after. 'When Breathe Becomes Air' is a memoir and Paul's story of battling lung cancer. It was posthumously published on January 12, 2016 - USA: https://amzn.to/3xWPaEL CA: https://amzn.to/49YuYPU - Social & Website Instagram ⁠⁠⁠⁠⁠⁠https://www.instagram.com/ijmakan⁠⁠⁠⁠⁠⁠ Twitter ⁠⁠⁠⁠⁠⁠https://twitter.com/ijmakan⁠⁠⁠⁠⁠⁠ Website: ⁠⁠⁠⁠⁠⁠https://becomingantifragile.com⁠⁠⁠⁠⁠⁠ Newsletter ⁠⁠⁠⁠⁠⁠https://ijmakan.substack.com - 00:00 - Excerpt 01:46 - We all have a terminal illness, so what then is our call? 03:34 - Who is Paul Kalanithi and why he didn't want to become a doctor 06:30 - Seeking to answer life's greatest questions, and learning to understand the “physiological-spiritual” man 09:00 - Surrounded by death becoming a better doctor 12:26 - Neurosurgery must be a calling—it can't be a job 15:30 - Life is ephemeral. Ask if yourself if you're ready for death, and then if what you're doing is something externally or internally motivated 25:16 - “…the culmination of decades of striving, evaporated” What are you going to do with your life? 33:40 - Live each day at a time 38:00 - When you see past the illusion, the most important things become clear 40:20 - Challenge

On this episode of Currently Reading, Kaytee and Mary are discussing: Bookish Moments: fun new hobbies and maybe not having a bookish moment Current Reads: all the great, interesting, and/or terrible stuff we've been reading lately Deep Dive: our love for all things memoir The Fountain: we visit our perfect fountain to make wishes about our reading lives Show notes are time-stamped below for your convenience. Read the transcript of the episode (this link only works on the main site) .  .  .  .  .  1:39 - Our Bookish Moments of the Week 8:06 - Our Current Reads 8:14 - Bride by Ali Hazelwood (Mary) 10:29 - Wolfsong by T.J. Klune 11:58 - Unhinged by Vera Valentine 12:29 - Renegades by Marissa Meyer (Kaytee) 12:40 - Cinder by Marissa Meyer 15:47 - The Extraordinaries by T.J. Klune 16:47 - Listen for the Lie by Amy Tintera (Mary) 19:55 - An Inconvenient Cop by Edwin Raymond (Kaytee) 20:03 - Booktenders 24:51 - A Letter to the Luminous Deep by Sylvie Cathrall (Mary) 28:26 - @ginnyreadsandwrites on Instagram 28:44 - Fairyloot 29:07 - Pango Books 30:16 - Truly Devious by Maureen Johnson 30:34 - Divine Rivals by Rebecca Ross 31:53 - A Natural History of Dragons by Marie Brennan (Kaytee) 32:10 - Betty by Tiffany McDaniel 35:29 - Deep Dive: Our Love For Memoirs 36:10 - Sarah's Bookshelves 39:49 - The Black Count by Tom Reiss 41:43 - My Life in France by Julia Child 42:30 - Is Everyone Hanging Out Without Me by Mindy Kaling 42:32 - Why Not Me? by Mindy Kaling 42:46 - Bossypants by Tina Fey 42:51 - Spare by Prince Harry 43:12 - Becoming by Michelle Obama 43:42 - Stories I Only Tell My Friends by Rob Lowe 43:47 - I Have Something to Tell You by Chasten Buttigieg 44:04 - I Have Something to Tell You by Chasten Buttigieg (young readers' edition) 44:59 - Waypoints by Sam Heughan 45:31 - Finding Me by Viola Davis 46:20 - As You Wish by Cary Elwes 46:58 - Year of Yes by Shonda Rhimes 47:50 - Great with Child: Letters to a Young Mother by Beth Ann Fennelly 47:55 - Heating and Cooling by Beth Ann Fennelly 48:06 - Glitter and Glue by Kelly Corrigan 48:10 - These Precious Days by Ann Patchett 49:04 - Soil by Camille T. Dungy 49:15 - An Exact Replica of A Figment of My Imagination by Elizabeth McCracken 50:29 - Dancing at the Pity Party by Tyler Feder 50:37 - What Looks Like Bravery by Laurel Braitman 50:43 - After This by Claire Bidwell Smith (amazon link) 50:58 - Tragedy Plus Time by Adam Cayton-Holland 51:15 - Maybe You Should Talk To Someone by Lori Gottleib 51:30 - When Breath Becomes Air by Paul Kalanithi 51:53 - A Woman in the Polar Night by Christiane Ritter 52:02 - At Home in the World by Tsh Oxenreider 52:52 - Animal, Vegetable, Miracle by Barbara Kingsolver 53:05 - The Anthropocene Reviewed by John Green 53:12 - A Homemade Life by Molly Wizenberg 53:43 - The Sun Does Shine by Anthony Ray Hinton 53:45 - Just Mercy by Bryan Stevenson 53:48 - The Other Wes Moore by Wes Moore 54:03 - Braiding Sweetgrass by Robin Wall Kimmerer 54:15 - I Take My Coffee Black by Tyler Merritt 55:17 - Meet Us At The Fountain 55:21 - I wish to press the Ember Quartet series, starting with Ember in the Ashes by Sabaa Tahir. (Mary) 55:30 - Ember in the Ashes by Sabaa Tahir 56:52 - A Court of Thorns and Roses by Sarah J. Maas 56:53 - Fourth Wing by Rebecca Yarros 57:22 - Iron Flame by Rebecca Yarros 58:38 - My wish is for more bookish board games. (Kaytee) 58:47 - By the Book game Support Us: Become a Bookish Friend | Grab Some Merch Shop Bookshop dot org | Shop Amazon Bookish Friends Receive: The Indie Press List with a curated list of five books hand sold by the indie of the month. April's IPL comes to us from A Room Of One's Own in Madison Wisconsin! Trope Thursday with Kaytee and Bunmi - a behind the scenes peek into the publishing industry All Things Murderful with Meredith and Elizabeth - special content for the scary-lovers, brought to you with the special insights of an independent bookseller The Bookish Friends Facebook Group - where you can build community with bookish friends from around the globe as well as our hosts Connect With Us: The Show: Instagram | Website | Email | Threads The Hosts and Regulars: Meredith | Kaytee | Mary | Roxanna Affiliate Disclosure: All affiliate links go to Bookshop unless otherwise noted. Shopping here helps keep the lights on and benefits indie bookstores. Thanks for your support!

When he travels, he's a man of reflection. When he creates, he's a man of action. Utsav Mamoria joins Amit Varma in episode 376 of The Seen and the Unseen to talk about his philosophy towards travel, creating and living. (FOR FULL LINKED SHOW NOTES, GO TO SEENUNSEEN.IN.) Also check out 1. Utsav Mamoria on Twitter, LinkedIn and Instagram. 2. Postcards From Nowhere -- Utsav Mamoria's podcast. 3. The 6% Club.. 4. Episodes of The Seen and the Unseen on the creator ecosystem with Roshan Abbas, Varun Duggirala, Neelesh Misra, Snehal Pradhan, Chuck Gopal, Nishant Jain, Deepak Shenoy, Abhijit Bhaduri and Gaurav Chintamani.. 5. The Universe of Chuck Gopal -- Episode 258 of The Seen and the Unseen. 6. Getting Meta. -- Chuck Gopal's podcast. 7. The legendary Simblified. 8. Sabbaticalling -- Episode 85 of Simblified (w Utsav Mamoria). 9. The Untravel Show -- Abhishek.Vaid's YouTube show. 10. Chuck Gopal interviews Utsav Mamoria. 12. Horizon -- Barry Lopez. 13. Imaginary Cities -- Darran Anderson. 14. Invisible Cities -- Italo Calvino. 15. The Hiking Episode -- Episode 35 of Everything is Everything. 16. I Play to Play -- Amit Varma. 17. Unboxing Bengaluru -- Malini Goyal and Prashanth Prakash. 18. Lords of the Deccan -- Anirudh Kanisetti. 19. Anirudh Kanisetti's podcasts. 20. Are You Just One Version of Yourself? -- Amit Varma. 21. Don't Get Into a Box -- Amit Varma. 22. Shoveling Smoke -- William Mazzarella. 23. Swapna Liddle and the Many Shades of Delhi — Episode 367 of The Seen and the Unseen. 24. From Cairo to Delhi With Max Rodenbeck — Episode 281 of The Seen and the Unseen. 25. The Stanford Prison Experiment. 26. Imagined Communities — Benedict Anderson. 27. Indian Society: The Last 30 Years — Episode 137 of The Seen and the Unseen (w Santosh Desai). 28. Santosh Desai is Watching You — Episode 356 of The Seen and the Unseen. 29. Dhadak Dhadak -- Song from Bunty and Babli. 30. The Prem Panicker Files — Episode 217 of The Seen and the Unseen. 31. The Language of Food -- Dan Jurafsky. 32. Bihar Review -- Kumar Anand's twitter account on Bihar. 33. Interior design for 10 crore kids. 34. Amitava Kumar Finds His Kashmiri Rain -- Episode 364 of The Seen and the Unseen. 35. Amadeus -- Miloš Forman. 36. Arctic Dreams -- Barry Lopez. 37. The Art of Travel -- Alain De Botton. 38. The School of Life. 39. Robert Macfarlane and Pico Iyer on Amazon. 40. Kurzgesagt – In a Nutshell. 41. Marginlands -- Arati Kumar-Rao. 42. Wanderers, Kings, Merchants: The Story of India through Its Languages — Peggy Mohan. 43. Understanding India Through Its Languages — Episode 232 of The Seen and the Unseen (w Peggy Mohan). 44. Tarana Husain Khan, Sadaf Hussain and Krish Ashok on Amazon. 45. The Language of Cities -- Deyan Sudjic. 46. Italo Calvino on Amazon. 47. When Breath Becomes Air -- Paul Kalanithi. 48. Coke Studio Pakistan. 49. Kabir, Kabir Cafe and Songs of Kabir. 50. The soundtracks of Qala, Udaan and Lootera. 51. Ud Jayega Hans Akela -- Kumar Gandharva. 52. Spotlight -- Tom McCarthy. 53. Grave of the Fireflies -- Isao Takahata. 54. My Neighbour Totoro -- Hayao Miyazaki. 55. Woman in the Dunes -- Hiroshi Teshigahara. 56. Departures -- Yōjirō Takita. 57. Abbas Kiarostami, Mohsen Makhmalbaf, Majid Majidi, Tahmineh Milani and Yasujirō Ozu. Amit's newsletter is explosively active again. Subscribe right away to The India Uncut Newsletter! It's free! Amit Varma and Ajay Shah have launched a new video podcast. Check out Everything is Everything on YouTube. Check out Amit's online course, The Art of Clear Writing. Episode art: ‘Travel' by Simahina.

When Kathy Giusti was told she had multiple myeloma one fateful day in 1996, she was 37 and in the midst of a successful rising career. She was the mother of a one-year-old baby with plans to have a second child. The disease had few treatments and she was given three years to live. Instead of sitting back, however, Kathy took action to create her own hope. That meant not only conducting  research on treatments where there was none, but doing it with unprecedented speed and precision. She founded the Multiple Myeloma Research Foundation and became its first CEO. In the two decades since, the foundation has spearheaded a clinical network that has conducted nearly 100 trials and launched more than 150 new drugs, drastically increasing the life expectancy of patients from 3 to 10 years. For her work, she has been included among Fortune Magazine's list of the World's 50 Greatest Leaders and TIME Magazine's 100 Most Influential People in the world. Kathy is also the author of the 2024 book Fatal to Fearless, which helps cancer patients understand and navigate their own care. Over the course of our conversation, Kathy describes her life before and after her diagnosis of multiple myeloma, how and why she took initiative to create new treatments for her own disease, what happened after she received a new diagnosis of breast cancer in 2022, and how all patients can better make the healthcare system work for them.In this episode, we discuss: 3:00 - Kathy's life before she was diagnosed with cancer4:56 - What is multiple myeloma? 8:58 - Kathy's reaction upon learning her diagnosis, both intellectually and emotionally 18:36 - How Kathy navigated the experience of concurrently going through IVF and cancer treatment22:30 - The sources of support that Kathy leaned on throughout her cancer journey24:40 - How Kathy and her sister started the Multiple Myeloma Research Foundation  34:53 - How the treatment landscape for multiple myeloma has changed since Kathy was diagnosed in 199641:00 - A glossary of medical terms that have been discussed in this episode44:33 - The current status of Kathy's multiple myeloma 50:39 - Kathy's key advice for both cancer patients and health care professionals for navigating cancer treatment  Kathy Guisti is the author of From Fatal of Fearless: 12 Steps to Beating Cancer in a Broken Medical System (2024).In this episode we discuss the book When Breath Becomes Air by Paul Kalanithi, and the essay The Median is Not the Message by Jay Gould, PhD, and our past episode The Physician Who Cured Himself (with Dr. David Fajgenbaum).Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. Copyright The Doctor's Art Podcast 2024

This week, Logan and Mary share their favorite books of all time. From personal to professional, they share their top reads over the years and you might just find a new favorite to add to your reading list. SHOW NOTES: In no particular order, here are all the books/series that we mentioned: Mary's Reading List: 1. 2-second lean 2. Feeling Good 3. Harry Potter series 4. The Lunar Chronicles 5. Near Eat Alone 6. The Hiding Place 7. The First Time Manager 8. Never Split the Difference 9. Set Boundaries, Find Peace Treating People Well Logan's Reading List: 1. Profit First 2. 4-Hour Workweek 3. Harry Potter Series 4. Mysteries 1. Nancy Drew Series 2. Robert Galbraith (author) 3. Agatha Christie (author) 4. Jo Nesbo (author) 5. Richard Osman's Thursday Murder Club Series 5. 10% Happier by Dan Harris 6. The Defining Decade: Why your twenties matter and how to make the most of them 7. The House in the Cerulean Sea by TJ Klune 8. When Breath Becomes Air by Paul Kalanithi 9. The Invisible Life of Addie LaRue by V.E. Schwab 10. Burnout: The Secret to Unlocking the Stress Cycle by Emily & Amelia Naoski Rewatch the replays from the 2023 Better Events Conference: https://bettereventspod.com/conference Buy Us a Coffee Link: https://www.buymeacoffee.com/bettereventspod THANKS FOR THE LOVE! Love this podcast? Please share with your event friends, tag us, and leave a review! Leave us a rating on Spotify: https://open.spotify.com/show/04ivq77TMgF5HhJHJOMe1V Leave us a review on Apple Podcast: https://podcasts.apple.com/us/podcast/better-events/id1561944117 —— FOLLOW US ON INSTAGRAM: @bettereventspod @loganstrategygroup_events (Logan) @epeventsllc (Mary)

It's easy for academics and critics to dismiss the Stoics as depressing or dark. They're not wrong, exactly, because it's true: There are some dark and depressing passages in Meditations. Seneca is not always cheerful. Both writers seem to dwell on death, they paint life as something that can be painful and tragic, they speak of Fortune as something not to be trusted—that the ground beneath your feet can shift in a moment, shattering everything around you.But what's unfair about this criticism, insensitive even, is that it totally ignores the context and the experience of these men—of all the Stoics. Marcus Aurelius buried six of his children. Six! Seneca lost a child and was exiled to a distant island on trumped up charges all at once. Can you imagine what that must have been like for them?“Grief from the loss of a child is not a process,” a mother is quoted as saying in the fascinating book Empire of Pain by Patrick Radden Keefe which examines the opioid crisis. “It's a lifelong weight upon one's soul.” Marcus Aurelius and Seneca bore that weight—of course it shaped what they wrote and thought. There was an exchange between Marcus and his teacher Fronto about how he felt “suffering anguish” in his bones from the loss of Fronto's grandchild. When we interviewed the philosopher and translator Martha Nussbaum on the Daily Stoic podcast, she spoke quite movingly about the loss of her own daughter. She pointed out that Cicero, a philosopher who wrote extensively on the Stoics and buried his daughter Tullia, was transformed by grief. It changed him. How could it not have?One book on this topic we've recommended over the years has been Death Be Not Proud by John Gunter, who was similarly trying to make sense of the short but inspiring life of his son Johnny. Paul Kalanithi's book When Breath Becomes Air is also worth reading. And Seneca's writings on death have been collected in an interesting edition called How To Die.-✉️ Sign up for the Daily Stoic email: https://dailystoic.com/dailyemail

Join Ned Buskirk in conversation with Dr. Lucy Kalanithi, Clinical Associate Professor of Medicine at Stanford University & the widow of Dr. Paul Kalanithi, author of the #1 New York Times-bestselling memoir When Breath Becomes Air, while they talk about her ongoing relationship to Paul, his impact/presence in her life still, & parenting their daughter in the wake of his death.dr. lucy kalanithi'swebsite: https://lucykalanithi.com/twitter: https://twitter.com/rocketgirlmdpodcast GRAVITY: https://lucykalanithi.com/podcastdr. lucy kalanithi wants you to supportBe A Hero: https://beaherofund.com/Camp Kesem: https://www.kesem.org/Caring Across Generations: https://caringacross.org/Produced by Nick JainaSoundscaping by Nick Jaina”YG2D Podcast Theme Song” by Nick JainaTHIS PODCAST IS MADE POSSIBLE WITH SUPPORT FROM LISTENERS LIKE YOU.Become a podcast patron now at https://www.patreon.com/YG2D.

Caregiver, physician, wife, and griever - Dr. Lucy Kalanithi shares her remarkable journey with her husband Dr. Paul Kalanithi, author of When Breath Becomes Air. Lucy's experience with her terminally-ill husband and his death has shaped how she approaches patient care and thinks about human suffering. Dr. Kalanithi is a Fellow of the American College of Physicians, a member of the Alpha Omega Alpha national medical honor society and an honoree of Mass General Cancer Center's “the one hundred” and Stanford's Medical Staff Awards. She has implemented novel healthcare delivery models in primary care, hospitals and health systems, and served on leadership boards for TEDMED, the Coalition to Transform Advanced Care and the American College of Physicians. She has appeared on stage at TEDMED, on NPR, PBS Newshour, and Yahoo News with Katie Couric. Her award-winning podcast, Gravity, explores narratives of suffering. Connect with Dr. Lucy Kalanithi on lucykalanithi. Find Dr. Lucy Kalanithi on X (formerly Twitter) Read Ady Barkan's article “I'm Dying. Here's What I Refuse to Accept with Serenity” in The Nation here. If you have questions about hospice care or need to troubleshoot the care you're already receiving, book a session with an expert Hospice Navigator at theheartofhospice.com. Need a dynamic speaker for your event or conference? Book podcast host Helen Bauer to speak by sending an email to helen@theheartofhospice.com. Find more podcast episodes from The Heart of Hospice at The Heart of Hospice Podcast (theheartofhospice.com) Follow The Heart of Hospice on Facebook, Instagram, and LinkedIn. Connect with The Heart of Hospice podcast on The Whole Care Network, along with a host of other caregiving podcasts by clicking here.

In this episode, we explore the profound impact of empathy in the life of Dr. Paul Kalanithi, author of "When Breath Becomes Air." We'll delve into how his journey as a neurosurgeon and his battle with terminal illness bring powerful insights into the human condition and the essence of empathy. Key takeaways include: ✅ The transformative power of empathy in healthcare. ✅ Balancing medical knowledge with human understanding. ✅ The role of empathy in facing life's ultimate challenges. ✅ How personal suffering can deepen our capacity for empathy. ✅ Paul Kalanithi's enduring legacy through his words and actions.

Welcome to our Christmas Eve Lit for Christmas party! In this episode, Marty and his friend and new cohost and co-drunk, Andrea, talk about the meaning of life, joy, and Christmas as they discuss Paul Kalanithi's When Breath Becomes Air.  It's an episode that's sure to appreciate your loved ones this holiday season.  BONUS POINTS: Take a shot anytime you hear a terrible dad joke!  WARNING: THERE ARE A LOT OF THEM! GHOST OF CHRISTMAS PRESENT: The Brain Cocktail (recipe adapted from cookingchanneltv.com) Ingredients: 1 1/2 shots of peach schnapps (substitute peach juice for virgin version) 1 1/2 shots of Bailey's Irish Cream (substitute Bailey's Coffee Creamer for virgin version) Dash of grenadine Directions: Pour peach schnapps in a glass. Slowly add Bailey's Irish Cream, allowing it to clot. Slowly drizzle with a dash of grenadine on top. GHOST OF CHRISTMAS PRESENT NONALCOHOLIC ALTERNATIVE: Use ingredients and follow above directions, making the substitutions listed above. YOUR HOSTS Marty has a Master's in fiction writing, MFA in poetry writing, and teaches in the English Department at Northern Michigan University in the Upper Peninsula of Michigan.  He served two terms at Poet Laureate of the Upper Peninsula, and has published the poetry collection The Mysteries of the Rosary from Mayapple Press.  For more of Marty's thoughts and writing visit his blog Saint Marty saintmarty-marty.blogspot.com) or listen to his other podcast Confessions of Saint Marty, also on Anchor.fm.  Marty is a writer, blogger, wine sipper, easy drunk, and poetry obsessor ho puts his Christmas tree up in mid-October and refuses to take it down until the snow starts melting. Andrea has had several careers and has a hard time labeling herself.  She has an art degree from Michigan State and considers herself an anti-social hockey mom, timid badass, and defender of public resources.  She currently works at Peter White Public Library as the hype girl. Music for this episode: "Jingle Bells Jazzy Style" by Julius H, used courtesy of Pixabay. "A Christmas Treat" by Magic-828, used courtesy of Pixabay. Other music in the episode: McLachlan, Sarah.  "In the Bleak Midwinter."  Wintersong by Sarah McLachlan.  Arista, 2006. A Christmas Carol sound clips from: The Campbell Theater 1939 radio production of A Christmas Carol, narrated by Orson Welles and starring Lionel Barrymore. This month's Christmas lit: Kalanithi, Paul.  When Breath Becomes Air.  Vintage, 2017.

Listen to ASCO's Journal of Clinical Oncology essay, “Gosses and the Dalmatian Puppy” by Dr. Zvi Symon, Senior Consultant at the Sheba Medical Center in Israel. The essay is followed by an interview with Symon and host Dr. Lidia Schapira. Symon reflects on an ancient Jewish tradition while seeking to palliate a dying patient. TRANSCRIPT Narrator: Gosses and the Dalmatian Puppy, by Zvi Symon, MD  A few months ago, I was paged to see a newly diagnosed patient in the hospital with a malignant trachea-esophageal fistula to consider palliative radiotherapy. Despite the 60-minute delay that had already accumulated in my clinic, I hurried past the folks in my waiting room as they scowled their dismay, and promised to return quickly.  My new consult was a 70-year-old man who had lost 30 kg over the past few months. He was a heavy smoker with chronic bronchitis and a squamous cell carcinoma of the upper esophagus gnawing into the cartilage of the upper airway. The surgeons ruled out any hope for surgical remediation. The gastroenterologist attempted to insert a stent but could not get past the tumor's stricture, so radiation therapy became the last option. On the edge of the bed near the hospital room's window sat Vladimir, a ghost of a man, coughing intermittently with a constant drool of saliva dripping into a stainless steel bowl that he held in his lap. I introduced myself, but he hardly acknowledged my presence, consumed by his own discomfort. I turned to his pleasant, gray-haired wife sitting in the blue armchair next to his bed. Before proceeding, I asked her what he knew about his condition, and she referred the question to him in Russian. Vladimir closed his eyes, sighed heavily and said softly: “I don't feel well and… cannot eat.” His wife watched me as a sad smile played on her lips, and she struggled not to cry. I paused for a moment, remembering my full outpatient waiting room, but wanting to give his story justice. I turned to Vladimir's wife. “Tell me a bit about Vladimir, what did he do before he became ill?” I drew up a chair and sat closer and she sighed. “He worked as a builder. When the family emigrated to live here in Israel, his mother died soon after. He became deeply depressed and took to the bottle, spending most of the day sitting on the porch, drinking vodka, and chain smoking. A few years ago, I bought him a cute clumsy Dalmatian puppy who adored him, romping around happily, licking his hands, and jumping all over him. He developed a special relationship with the dog, stopped drinking and took the dog each day for a long walk—well, perhaps the dog took him for a walk.” A smile flickered across her face briefly. “Unfortunately, the dog died a few months ago and he sank back into a depression, stopped eating, and has lost weight.” I was touched and saw the tears in her eyes flowing freely. “Do you have any family, perhaps children you would like to call to perhaps join us for the discussion?” I asked. “We have two grown-up sons. One is currently ill with COVID and cannot come, and the other son also suffers from major depression: He has a hysterical paralysis and does not leave the house. I work as a cashier in the supermarket and am the only breadwinner for my sick son and husband.” I wondered if she had any idea of his prognosis and started a discussion regarding treatment options. Vladmir's wife told me that she had heard that radiation therapy could help. And while I would have loved to have played the role of knight in shining armor, saving him from the ravages of his cancer with radiotherapy, the reality is that the intervention is controversial in the treatment of trachea-esophageal fistula. Should I raise the possibility of not doing the treatment? How would it be received? What could I offer in lieu? Was this an opportunity for a being and not doing discussion, one that talks about dignity and love and communication, about having the chance to say goodbye forever and even to confess and bless and confide? Patients and family are so often focused on the battle against the disease; they are loath to any suggestion of not doing, despite the minimal odds for a helpful treatment.  I saw Vladimir's wife struggle to control her tears. She seemed so vulnerable and carried so much on her shoulders. I wondered if a hospice discussion, at that moment, would add to her huge burden. There was also a part of me that also debated, selfishly, if I should launch into a lengthy end-of life discussion with the angry waiting patients outside my clinic door? So often, we turn to our treatment armamentarium to avoid these deeply painful and complex discussions surrounding the end of life, particularly with patients we barely know. I breathed deeply, calmed myself and decided to keep it simple and avoid the dilemma. I gently explained that I could not guarantee good results, but radiation therapy may improve his pain and perhaps allow him to eat and drink. It was the answer she was looking for, though I grimaced as I wondered if it was the answer I should have provided. She seemed relieved and encouraged Vladimir to sign consent. Vladimir arrived at the computed tomography (CT) simulation suite sitting bent forward on the stretcher, drooling into the bowl between his legs. The radiation therapists, already running behind schedule, looked at each other, as if wondering if this was another futile heroic effort.  “I know what you are thinking,” I said to them. “But perhaps we can help. Let me tell you something about Vladimir, he had a Dalmatian puppy he loved, who took him out of his home for a walk every day after years of deep depression.” Vladimir was contorted in pain, and the attempt to transfer him from the stretcher to the CT couch seemed impossible. All eyes turned to me with a perhaps this is too much look. Suddenly, Ilan, a young Russian-speaking radiation technologist who had recently joined the department, had an idea. “Vladimir, rest a few minutes. You know, I too have a Dalmatian, let me show you a picture.” The deep lines on Vladimir's face faded into a broad smile as he took Ilan's cellphone to see the picture of the dog. From the look on his face, he seemed to be transported far from the simulation suite, and I imagined him romping with his Dalmatian puppy in a sun-swept meadow with gurgling streams and lush green grass and watched as Ilan then slid him effortlessly onto the couch of the scanner. The scan was completed, Vladimir returned to the ward, and I retreated to my workroom to complete the contouring of the structures for the radiotherapy plan. It was a nasty 12-cm mass involving the full circumference of the upper esophagus and eroded into the trachea, almost obstructing the left lung. The dosimetrist calculated a conformal treatment plan, and as I approved it, I uttered a little prayer that this would make him more comfortable. Suddenly, Ilan rushed in, hair tousled, pale and agitated, and eyes red. We were too late. On returning to the inpatient ward, Vladimir experienced a massive aspiration and died less than half an hour after we had scanned him. Ilan was terribly upset. As a young therapist, this was perhaps his first patient who died so quickly and unexpectedly. I tried to comfort him. “I know it hurts, but nothing we could have done would have changed what happened. Did you see his face after you mentioned his puppy and showed him the photo of yours? We did our best for him.” After Ilan left my room, I reflected on the day's events. Was Vladimir what the rabbis refer to as a “Gosses?”2 (Gosses is a Hebrew word meaning a moribund patient). And if that was the case, was I wrong to even transport him from his room? When death is imminent in hours or days, Jewish religious law defines a state of Gosses in which it is forbidden to touch or move a moribund patient in case this could hasten death. The guttural rattle of a dying patient, unable to clear secretions, indicating death within hours or days, reminded the rabbis of the sound of bubbling when stirring the food in the cauldron. This onomatopoeia, in addition to a didactive narrative identifying the significance of performing an action which potentially changes the natural course of events, resulted in the analogy that moving a terminally ill patient which may hasten death is like stirring the food in the cauldron which may hasten the cooking on Sabbath, hence the term Gosses. The ancient rabbinic sages from the beginning of the first millenium drew an additional analogy between touching a Gosses and touching a dripping candle at the end of its wick which may hasten quenching of the light. Another aspect of the law of Gosses forbids performing any act which may prolong suffering and delay a merciful death. Thus, moving a patient to receive a futile treatment would also be forbidden under law of Gosses.  2000 years later, the notion that we should neither delay nor accelerate death was front of mind formeas I reflected on my treatment of Vladimir. I wondered if the ancient rabbis incorporated into their moral discussion the difficulty of stopping the roller coaster of trying to do more and more to help the patient. How about when the treatment itself fell into a gray area of effectiveness? What advice would they have given a physician with competing demands on his time and a waiting room full of outpatients who demanded his attention? In retrospect, the painful journey of Vladimir down to the simulator may have hastened his massive aspiration and would have been best avoided. In that sense, the Gosses may have been violated. But it also allowed him and Ilan to meet and share wonderful memories of a Dalmatian puppy which made him smile and forget his pain, even for a few precious moments. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Associate Editor for Art of Oncology and a professor of medicine at Stanford University. Today, we are joined by Dr. Zvi Symon, until recently Chair of Radiation Oncology and currently Senior Consultant in the Department and Director of the National School of Radiotherapy at the Sheba Medical Center in Israel and Clinical professor of Oncology at Tel Aviv University Medical School. In this episode, we will be discussing his Art of Oncology article, “Gosses and the Dalmatian Puppy.” Our guest disclosures will be linked in the transcript.  Zvi, welcome to our podcast and thank you for joining us. Dr. Zvi Symon: Thank you, Lidia. I'm very happy to be here. Dr. Lidia Schapira: To start, I'd like to ask authors to tell us what they're reading or perhaps what they've enjoyed reading and would like to recommend to fellow listeners. Dr. Zvi Symon: Okay, so it's been a bit of a stressful time reading, but I may mention some books I've read in the last few months. I've been reading memoirs. One that I particularly found very touching was Paul Kalanithi's, When Breath Becomes Air. As a physician who had cancer himself and his struggle with his transition from being a consultant neurosurgeon to being a terminal lung cancer patient, I think it's an amazing and beautifully written and touching book.  Dr. Lidia Schapira: It's a beautiful book. It's evocative and fresh. And you're absolutely right - we're completely in sympathy with and empathic with his amazing desire to live life till the last moment, right? It's just beautiful.  Dr. Zvi Symon: It's really beautiful. And I think that memoirs is a very powerful genre for me. And another book that I enjoyed very much is Jan Morris' Conundrum, which is a story of a person who made a transition from male to female over 10 years. She was actually a member of the British team that climbed Everest and a journalist in The Times. It's a beautiful book describing what she actually felt inside and how she went through the medical process as well, of her sex change. And it's also beautiful. Dr. Lidia Schapira: Thank you for that. I haven't read it, but I will add it to my lovely list here.   Tell me a little bit about writing and what that means for you. Are you somebody who has been writing throughout your career, or was this a story that sort of popped for you, that just needed to be told?  Dr. Zvi Symon: Right. I think it goes back to when I was a high school student where my Math teacher told my parents, "Your son shouldn't do medicine. He should study English literature." My parents were devastated by that statement because my father was a physician and my mother's family were all physicians, and they were very angry at the time. And I was kind of a writer in high school, and then I kind of left it through my medical career. And now, as I have sort of finished my stint as the chair of the department and I have a bit more time on my hands, I've sort of tried my hand at getting back to writing. I needed to read a lot in order to do that. So I was reading genres. I think maybe some of the initial versions of this piece were written sort of more as a memoir, rather than an article for the Art of Oncology. And I think you guys helped me a lot.  Dr. Lidia Schapira: I'm so glad to hear that we helped. Sometimes editors aren't particularly helpful in the views of authors, but I'm glad you feel differently.   So let's talk a little bit about the creative process and sort of bringing in all of these themes that you did here. And back to your prior comment that this is in the memoir genre. You have a very interesting philosophical discussion of what a Gosses is and sort of the ethical moral conflict when a patient is extremely vulnerable, instead of recognizing when perhaps all that you need to do, or perhaps what you need to do is to be present instead of trying to fix or intervene. And I loved how you made us all really suffer with you, as you're debating this internally. Can you talk a little bit about that part of the story? Dr. Zvi Symon: Yes, I think just to put it into context, in my training in internal medicine, I worked in a hospital where hospice care was part of the rotation in internal medicine. I spent three months in the hospice, and at night, when we were on call, we were in charge of the ICU and the hospice. So you would be called to treat a patient in pulmonary edema and with CPAP, or intubate him or an acute MI, and then you would be called to a dying patient in the hospice. And the transition was initially very difficult for me. I actually felt my feet would not carry me to the hospice, and I didn't want to go there, and I had to kind of force myself. But after some time, I realized that it's actually much easier to treat pulmonary edema  to than be able to sit and listen and talk to a dying patient. But the fulfillment that I began to feel when I overcame that kind of fear of going to speak to a dying patient, the fulfillment was far greater than getting somebody out of pulmonary edema. And that's kind of stayed with me to this very day.  So although radiation oncology is a kind of something you have to do, and you sort of radiate, when I'm called to patients like this, and I do have time, then I kind of sit down with a patient and discuss the options and try to give other options because very often it's a kind of turf in the house of God. Somebody doesn't want to have that conversation with a patient, and they're kind of turfing the patient in a house of God sense to have some radiation. And I'm not sure that radiation in such cases– So this is something that I'm confronting quite often in my daily practice, and it becomes more and more complex culturally because when one is confronted with families who also want to be very active and are dreading having to live with the idea that maybe there's something they could have done that they never did, and they're putting a lot of pressure, then it's a very tough situation. So I'm very sensitive to these situations.  I've often had end-of-life discussions with patients like that, sometimes against the wish of families that are close by. And the patient would say- well, they'd say to me, 'No, don't talk to him." And the patient said, "No, I want you to go away. Because I think this is the first time someone's listening to me, and I want to hear what he has to say." I feel very passionately about these– Dr. Lidia Schapira: I have so many comments that we would need hours to discuss. But, of course, the first comment I wanted to make is that some of the most humane oncological specialists I know are radiation oncologists, so I don't see you guys as just treaters and physicists wearing scrubs. I see you as incredibly compassionate members of the cancer team.   And that brings to mind a lot of the current discussion about palliative radiation, this idea that we can just throw some rads at people because there's nothing to lose and maybe there'll be some improvement in function. So can you talk a little bit about that? I mean, here you are in a very busy clinic falling behind. You've got to walk through a waiting room of people who are sort of looking at you saying, “How can you be walking out when we had an appointment with you half an hour ago?” And you go and find Vladimir, who's despondent and can't have a conversation with you. And I'm pretty sure that you must have been going through this internal conflict even before you met your patient about what to do. Tell us a little bit more about the emotional impact for you. Dr. Zvi Symon: Yeah. With great trepidation, I actually go up to the department to speak to a patient like this. I think the electronic medical record, for all the problems with that, it allows us to kind of really quickly glimpse and get a true picture of what the situation is. So I had seen the imaging and I'd seen the size of this really very nasty tumor. And I sort of remembered the literature that it's a relative contraindication and it actually may make things worse. But I was getting calls from the department and the medical oncologist who consulted that I must see this patient, and they want that patient to get treated today. So with a kind of a heavy heart, I go up the stairs. I breathe deeply on the way to calm myself and take the staircase up to the 6th floor and walk very slowly up the stairs, trying to go through my mind, what am I going to do, and kind of enter the ward. And then I am confronted by this person who is terribly suffering, very terribly. And he doesn't actually want to look at me at all. His eyes can't meet and he looks kind of, his eyes are very dull. And I see his wife watching me and watching him and turn to her. They are immigrants to the country. And there's also a cultural issue and language problems and difficult socio–  Dr. Lidia Schapira: If this were fiction, you could not have made it harder. I mean, when I remember reading the manuscript thinking, this poor immigrant, he's depressed, his son is depressed, the other son has COVID, his wife is weeping and says she's the one who's tried to make ends meet. You have all of these barriers in addition to this internal clock that you have somewhere else to be. Can't begin to imagine the pressure. So how did you get through that? Dr. Zvi Symon: Yeah, I think my mind was kind of ticking over and I think that sometimes we make very practical choices. And I knew that if I sat for too long and I fired a warning shot and said, “Well, this may not help and this may not do it,” but I think that culturally I had the feeling that it was the wrong thing to do and that there was an expectation and the expectation had been created by the team, and it's very difficult to turn down that expectation. And I also felt that she was so frail and that she had really no support and maybe if one of her kids would have come within half an hour, I would have said, “Well, I'll come back after my clinic in the afternoon and let's have a chat with your son.” But the situation was such that I thought, “Well, you just have to be practical and you have to get back to your clinic.” It's a hard feeling that we make value decisions just because it's more comfortable for us. We want to finish our clinic and also go – Dr. Lidia Schapira: No question about that. Yes, and I think the reader will feel for you, as I did when I read it. I mean, I could immediately sort of imagine all these things playing out. So you follow your intuition, you assess it, you say, “Okay. We'll give it a try,” right? And then you have your team to deal with and your lovely radiation therapist, the technologist who gets personally involved. And then you introduce the idea that perhaps connecting with something in Vladimir's recent past that brings him joy. Can this image of this puppy romping through the fields, is something that can maybe help you all? Like the glue, the emotional glue that keeps you together. Talk a little bit about that part, about how you tried to bring this element out in the story, to give another dimension for the reader, a view not only as the physician giving Vladimir care, but also leading your team. Dr. Zvi Symon: So I think that an open question to a patient about their– “Just tell me a little bit about yourself,” is an invitation for a person to tell you about the things that they care most about, about the people they love most, that the things were of the most importance in their lives. And I think that kind of human connection, if we can kind of latch onto that and harness that to improve the way we communicate with the patient and the way we get the rest of the team to communicate with the patient, I think that can be very powerful. I mean, I myself love dogs, and I was like, really, my Border Collie just died a few months ago, and we buried her after 12 years, and she was a wonderful animal and part of the family. And in the two minutes that I had to listen to- that's what she told me about, she told me about the dog. And when I tried to motivate the team to add him as an urgent sim and he wasn't cooperating, then it just occurred to me to tell them about it. Dr. Lidia Schapira: It worked. It was amazing. Dr. Zvi Symon: And it worked. Yeah. Dr. Lidia Schapira: It was a beautiful story. I too, am a lover of dogs. I have a wonderful puppy now, and he brings tremendous joy. But your message is so full of compassion and humanity. It's basically back to Dame Cicely Saunders' idea that you want to know who the person is that you're treating and you want to know what matters to them. And so here you caught this moment of connection with the family and with the patient and with your young radiation therapist who needed to feel that he was actually helping this person. So it's a beautiful story. I want to just give you a chance to finish the interview by telling us something perhaps that you want the readers or the listeners to take away from your piece. Dr. Zvi Symon: Well, I think that the situation of, I think as physicians, we don't really ever know when the patient precisely is going to die. And the whole idea, I think, of a Gosses and my thoughts about the Gosses were, because it's sort of defined within Jewish religious law, someone that is going to die within 72 hours. Now, it's very difficult to define. We don't know that. We never do know that. But I think that that sensitivity to the comfort of a suffering patient and offering a treatment that may be futile or that is highly likely to be futile and that may be involved in an enormous amount of discomfort, I think that we have to be able to sit down with these patients and with their families and discuss other options as just very good sedation and not necessarily, I think, doing, but rather just being there, as you mentioned, for the patient. Dr. Lidia Schapira: It's a beautiful thought, and I think we all agree with you. And I think what made this story so poignant is that here you are, that time is compressed and you're introduced to the family as somebody who potentially could help fix something or provide something. So it's very difficult to step back, as you say, and do the deep work of sitting and talking and counseling and accompanying. But I think your humanity comes through and your desire to help comes through beautifully in the story. And I really thank you for bringing this concept to our attention. I think that it may be an old idea, but one that is still very relevant. And thank you for sending your work to JCO. Dr. Zvi Symon: Thank you very much. Dr. Lidia Schapira: Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcast.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio:  Dr. Zvi Symon is a Senior Consultant in the Department and Director of the National School of Radiotherapy at the Sheba Medical Center in Israel and Clinical professor of Oncology at Tel Aviv University Medical School.  

This week we have a book recommendation episode. We hunker down for November and embrace fall. We call this our Free For F(all) episode because we each give you a recommendation in 5 November themed categories: Autumn, Native American Heritage Month, Diwali, Day of the Dead/ All Soul's Day, and No-Shave November. For show notes for any episode, go to our website at www.perksofbeingabooklover.com. Instagram @perksofbeingabookloverpod and on FaceBook - Perks of Being a BookLover. To send us a message, go to our website and click the Contact button. Books mentioned in this episode: 1- Rez Dogs by Joseph Bruchac 2- We All Want Impossible Things by Catherine Newman 3- Waiting for Birdy: A Year of Frantic Tedium, Neurotic Angst, and the Wild Magic of Growing a Family by Catherine Newman 4- Love Deleted by Paul Indigo 5- An Event in Autumn by Henning Markell 6-Deer Season by Erin Flanagan 7-Sees Behind Trees by Michael Dorris 8- Winter Counts by David Heska Wanbli Weiden 9- When Breath Becomes Air by Paul Kalanithi 10- A People's History of Heaven by Mathangi Subramanian 11- The Orphan of Cemetery Hill by Hester Fox 12- The Forgetting Time by Sharon Guskin 13- Where the World Ends by Geraldine McCaughrean 14- These Honored Dead (A Lincoln and Speed mystery) by Jonathan F. Putnam 15- Determined: A Science of Life without Free Will by Robert M. Sapolsky 16- Plight of the Living Dead: What Real Life Zombies Reveal About Our World and Ourselves by Matt Simon A 5 star book recommendation by a fellow book Lover - The Change by Kirsten Miller. recommended by Anne Persico @annother_bookstagram Podcasts mentioned-- 1- Ologies with Alie Ward https://www.alieward.com/ologies/neuroparasitology Movies mentioned-- 1- Eternal Sunshine of the Spotless Mind (2004) 2- Fargo (1996) - movie 3- Fargo - (2014 - present, FX) - TV series Bookish news-- She challenges one book a week: https://www.washingtonpost.com/education/2023/09/28/virginia-frequent-school-book-challenger-spotsylvania/ 1 parent is responsible for a book ban in North Carolina- https://www.npr.org/2023/09/08/1198373620/1-parent-is-responsible-for-a-book-ban-in-north-carolina#:~:text=One%20school%20board%20in%20North,parent%20was%20behind%20the%20move. Scholastic Book Fair Dilemna https://www.nytimes.com/2023/10/25/us/scholastic-book-fair-race-gender.html Erin Flanagan podcast episode episode: https://ThePerksofBeingaBookLover.podbean.com/e/s-7-ep-143-mind-games-with-guest-erin-flanagan-8-17-22/ Robert Sapolsky doesn't believe in free will https://www.nytimes.com/2023/10/16/science/free-will-sapolsky.html

Dr. Lucy Kalanithi is a physician, storyteller, and widow of Paul Kalanithi, the author of the New York Times Bestseller, When Breath Becomes Air. She's dedicated to helping others choose end-of-life experiences that best align with their values, but, more than anything, she's a widowed mom.   Hear Dr. Lucy's experience of losing her husband Paul, her insights on the surprising manifestations of grief, and what it means to live a life that includes pain and suffering.   Get full show notes and more information here: https://www.coachingwithkrista.com/231  

In this week's episode of Veterinary Innovation Podcast, Shawn and Ivan chat with Ryan Gallagher from Scribenote about how their technology streamlines SOAP-format medical record-keeping, freeing up valuable time for veterinarians.   Learn more about Scribenote at scribenote.com. Mr. Gallagher recommends When Breath Becomes Air Hardcover by Paul Kalanithi.

Khi Hơi Thở Hóa Thinh Không là quyển tự truyện của Paul Kalanithi - một bác sĩ phẫu thuật thần kinh bị chẩn đoán mắc bệnh ung thư phổi ở tuổi 36, khi đang ở đỉnh cao của sự nghiệp. Quyển sách mang cái nhìn chân thực và đầy văn minh của chính tác giả khi cận kề cái chết với đủ mọi cung bậc cảm xúc từ hy vọng tới tuyệt vọng, từ buồn đau tới sung sướng, và rồi thanh thản, bình yên. Buông xuôi và phó mặc chờ đợi cái chết là một chuyện vô cùng đơn giản. Nhưng đối đầu với nó lại là một quyết định không hề dễ dàng. Bởi trong những thời điểm nguy cấp như vậy, "câu hỏi không chỉ đơn thuần là sống hay chết mà còn là cuộc sống nào đáng sống”.--Về Fonos:Fonos là Ứng dụng âm thanh số - Với hơn 3.000+ nội dung gồm Sách nói có bản quyền, Ebook, Tóm tắt sách, Thiền định, Truyện ngủ, Nhạc chủ đề, Truyện thiếu nhi. Tất cả chương 1 đều miễn phí, tải app ngay: https://fonos.link/PCFonos--Tìm hiểu thêm về Fonos: https://fonos.vn/Theo dõi Facebook Fonos: https://www.facebook.com/fonosvietnam/

On this week's episode of Currently Reading, Kaytee and Meredith are discussing: Bookish Moments: comfort social accounts and mother daughter bonding Current Reads: four regular reads and our two bossy presses Deep Dive: how we felt about pressing books to each other and our experiences reading them The Fountain: we visit our perfect fountain to make wishes about our reading lives As per usual, time-stamped show notes are below with references to every book and resource we mentioned in this episode. If you'd like to listen first and not spoil the surprise, don't scroll down!  We are now including transcripts of the episode (this link only works on the main site). The goal here is to increase accessibility for our fans! *Please note that all book titles linked below are Bookshop affiliate links. Your cost is the same, but a small portion of your purchase will come back to us to help offset the costs of the show. If you'd prefer to shop on Amazon, you can still do so here through our main storefront. Anything you buy there (even your laundry detergent, if you recently got obsessed with switching up your laundry game) kicks a small amount back to us. Thanks for your support!*   . . . . 1:20 - Our Bookish Moments of the Week 1:40 - @megs.tea.room on Instagram 1:40 - @megstearoom on Tiktok 2:01 - Legends and Lattes by Travis Baldree 3:56 - Book of the Month 6:21 - Current Reads 6:28 - Clean Air by Sarah Blake (Meredith) 8:40 - @fictionmatters on Instagram 10:30 - The Need by Helen Phillips 10:33 - Leave the World Behind by Rumaan Alam  10:56 - The Displacements by Bruce Holsinger 10:57 - Station Eleven by Emily St. John Mandel 10:58 - Curfew by Jayne Cowie 11:22 - Everything Happens for a Reason by Kate Bowler (Kaytee) 13:35 - When Breath Becomes Air by Paul Kalanithi 13:39 - Everything Happens podcast 15:36 - Dark August by Katie Tallo (Meredith) 17:55 - The Book Drop Subscription 19:49 - We Begin at the End by Chris Whitaker 20:29 - Ander & Santi Were Here by Jonny Garza Villa (Kaytee) 20:37 - CR Season 5: Episode 45 25:07 - Chain Gang All Stars by Nana Kwame Adjei-Brenyah (Meredith) 29:55 - Friday Black by Nana Kwame Adjei-Brenyah 34:22 - Fates and Furies by Lauren Groff (Kaytee) 42:38 - Deep Dive: Being The Presser and the Pressee 44:33 - BookRiot 45:45 - To Kill A Mockingbird by Harper Lee 47:19 - Matrix by Lauren Groff  51:32 - Fates and Furies by Lauren Groff 52:20 - Meet Us At The Fountain 53:58 - I wish those of us with littles would let them choose our reads sometimes. (Meredith) 54:07 - I wish we would practice letting go of the reins. (Kaytee) Connect With Us: Meredith is @meredithmondayschwartz on Instagram Kaytee is @notesonbookmarks on Instagram Mary is @maryreadsandsips on Instagram Roxanna is @roxannatheplanner on Instagram currentlyreadingpodcast.com @currentlyreadingpodcast on Instagram currentlyreadingpodcast@gmail.com Support us at patreon.com/currentlyreadingpodcastand www.zazzle.com/store/currentlyreading

During Nam-joon's 2019 Rkive studio tour, "When Breath Becomes Air" by Paul Kalanithi. This is a powerful memoir of a terminally ill neurosurgeon trying to find meaning in life. Join Alison and Megan for a deep dive into this power story.NEW! Afternoona Army is now on PATREON!Join The BTS Buzz and get access to Afternoona Army's exclusive DISCORD channel, get shout outs on-air in podcast, and receive invitations to quarterly live support groups. Questions? Email afternoonaarmy@gmail.com for more information.Sign Up for Our Newsletter!Want our thoughts on Yunki's hair extensions in a 500-word essay? More book recs? This is the place to get it. Sign up HERE! Are your family and friends sick of you talking about K-drama? We get it...and have an answer. Join our AfterNoona Delight Patreon and find community among folks who get your obsession. And check out our sister pod www.afternoonadelight.com for more episodes, book recs and social media goodness.Want to find more great BTS content? Head over to Afternoona Army for "thinky, thirsty and over thirty" takes on Bangtan life and links to our social media.

Sign-up for my free 20-day devotional, The Word Before Work Foundations, at http://TWBWFoundations.com--Series: Wisdom for Work from the PsalmsDevotional: 3 of 7Teach us to number our days, that we may gain a heart of wisdom. (Psalm 90:12)I've noticed a strikingly consistent theme in the biographies of history's most impactful Christians: They thought about death—a lot. At the age of 29, Martin Luther told a mentor “he didn't think he would live very long.” William Wilberforce “seriously believed he was likely to die violently” before he completed his life's work of abolishing the slave trade. And Alexander Hamilton “imagine[d] death so much it [felt] more like a memory.”These men lived and worked hundreds of years ago when death was far more common and thinking about it was in some ways inevitable. That stands in stark contrast to our culture today. In an essay titled The Pornography of Death, anthropologist Geoffrey Gorer argued that death has replaced sex as the most taboo topic of our modern age.But in Psalm 90, Moses says that meditating on death is one of the wisest things we can do. Why? Because dwelling on death leads us to “walk [carefully], not as fools but as wise, redeeming the time, because the days are evil” (see Ephesians 5:15-16).So here's my encouragement to you: Find a way to remind yourself of the brevity of life today. Here are just four ideas.#1: Choose a passage of Scripture to memorize that will remind you of the sobering reality of death. Some of my favorites are Psalm 39:5, Psalm 90:12, Psalm 144:4, Job 7:7, Ecclesiastes 7:2, James 4:14, and Ecclesiastes 12:7.#2: Take a walk in a cemetery on your drive to or from work today.#3: Read a great book on death from a Christian perspective. Two that I return to often are On Death by Tim Keller and When Breath Becomes Air by Paul Kalanithi.#4: Put physical reminders of death around you. Ancient merchants would often write the Latin memento mori (meaning “think of death”) in large letters on the first page of their accounting books. I have “running out of time” written inside my running shoes. Whatever works for you, works.These practices will look foolish to the world, but Scripture says they are wise for the believer. Do something to dwell on death today so that you may gain a heart of wisdom and redeem your time for the glory of God and the good of others!

Lucy Kalanithi is a doctor, a mom, and the widow of Dr. Paul Kalanithi, author of the bestselling memoir, “When Breath Becomes Air.” Lucy was at Paul's side through his final days, both at home and at the hospital. In this conversation, she reflects on how his death transformed her relationship to time, and how we make meaning in the world.   If you enjoyed this episode, we recommend this one from the archives: "Losing Dixie” For a behind-the-scenes look at the show, follow @DrMayaShankar on Instagram. See omnystudio.com/listener for privacy information.

When Breath Becomes Air, the book written by Dr. Paul Kalanithi, moved and inspired me. Many of you said you enjoy my takeaways about a particular book. So today I want to share some lessons from this piercing work. Recently, I read this book for the third time and got more from it this time than ever. I think the reason is that I'm older and have had more experiences. Some of them have been exhilarating. Others have been sobering. And I have also experienced grief more acutely. Even though the book is imbued with the wisdom of death looming, it is life-affirming. Reading it has definitely opened up my life. What I mention in this episode:Why the depth of experience I went through has made this book more precious to mePaul Kalanithi's biography Four main lessons I learned from the bookWhat you'll learn from it:The importance of deciding what's really important to you to make the most of your timeHow to live in your questions rather than rushing to get answers The sacredness in finding the work you are meant to do on this EarthWhy you don't have to explain the reason you like or dislike somethingI hope this book gives you the same goosebumps it gives me every time I read it. xo, KavethaPS- Want to create an unshakable foundation and cultivate meaningful relationships?My program for women, Heal Your Relationships, offers evidence-based tools, training, and community to build an unshakeable foundation and rock-solid relationships.In this 8-week program, you will get the HYR™ Framework and Tools, and weekly calls with certified coaches in a group environment and privately. Besides, you'll be surrounded by a community of women who have each other's back. Click here to learn more and connect for a breakthrough call with me: https://healyourrelationships.com/ In This Episode:00:00 Welcome back to another episode of Emotional Mastery01:38 Today I have a special treat for you 03:58 Introduction to the book When Breath Becomes Air by Paul Kalanithi06:55 General summary of the book 11:19 First lesson from the book16:47 Second lesson from the book19:03 Third lesson from the book 23:33 Forth lesson from the book 25:44 Connection of this book with the five remembrances 27:31 I would love to hear from you Resources: - Podcast episode about Viktor Frankl's teachings - https://podcasts.apple.com/us/podcast/wiseish-010-5-lessons-from-viktor-frankl/id1622617195?i=1000565759860 - Book “When Breath Becomes Air” by Paul Kalanithi - https://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X -

When Breath Becomes Air by Paul Kalanithi (2016)

Recommend this show by sharing the link: pod.link/2Pages I've been very lucky to work with some of the TED Fellows, a program where young people of promise are given access to the TED world. For three years, I attended a gathering of these extraordinary young people to offer some support, facilitation, and coaching. What became obvious to me over the years was the commonness of brilliance, achievement, and disintegration. They were often exhausted, overwhelmed, and struggling with their so-called success. Of course, there was a range of coaches and experts who were able to provide support and accelerate most of them to the plateau of sustainability. As you know, I love good questions, so: What does ‘sustainable' success look like? How do I not sacrifice my life for my ambition?  Laurel Braitman is a best-selling writer, secular clinical chaplain-in-training, and the Director of Writing and Storytelling at the Stanford School of Medicine where she teaches those in the medical field to communicate more clearly and vulnerably with their patients. She's also a TED Fellow, which is where I met her a decade and some ago. Get‌ ‌book‌ ‌links‌ ‌and‌ ‌resources‌ ‌at‌ https://www.mbs.works/2-pages-podcast/  Laurel reads two pages from ‘When Breath Becomes Air' by Paul Kalanithi. [reading begins at 20:15]   Hear us discuss:  “There's really no such thing as happiness, only happy-sad or sadly happy.” [14:10] |  Gaining a lived understanding of love. [24:30] | “Let life surprise you, maybe it'll surprise you in a good way.” [29:03] | Learning to dance with your limitations: “My drug of choice is excellence.” [30:52] | What success really means. [35:52] | The mission for What Looks Like Bravery. [40:32] | “There's nothing like the gift of believing in someone when they don't believe in themselves.” [45:58]

When Breath Becomes Air Full Free Audio Book SummaryCome to Bookey Book Summary to unlock more content. After many years of hard study and medical practice, Paul finally caught a glimpse of his own Promised Land. He was poised to receive a tenure-track professorship and a chance to start his own neuroscience lab from the Stanford University School of Medicine. At that moment, he joined the 0.12 unlucky people out of every ten thousand who contracts lung cancer before the age of 36. From then on, he began to explore the truth behind death as a doctor and a patient. While we listen in to this bookey, Paul, its author, has already passed away. His breath has turned into air, yet the courage he possessed in the face of death lives on. Overview | Chapter 1Hi, welcome to Bookey. Today we will unlock the book When Breath Becomes Air. For every ten thousand people in the modern world, of those under the age of 36, only 0.12 will contract lung cancer. The book's author Paul Kalanithi happened to be one of this tiny unfortunate minority. At Stanford University, Kalanithi attained dual honors in his Bachelor's degree in English literature and human biology. He went on to earn a Master of Philosophy in History and Philosophy of Science and Medicine at the University of Cambridge. Finally, at the Yale School of Medicine, his stellar research was acknowledged with a PhD. During his six to seven years of residency, he worked a hundred hours a week. For his efforts in this period of intensive research, the American Academy of Neurological Surgery acknowledged him with their highest award. In short, at Stanford University, he was hailed as one of the most gifted doctors. However, in his final year of residency, as he was poised to receive a tenure-track professorship as well as an opportunity to head his own neuroscience lab at Stanford University School of Medicine, Kalanithi was denied the time to savor the fruits of his years of hard labor. He was diagnosed with stage four lung cancer and forced to confront his mortality. Death itself is not shocking but having life snatched away prematurely often leaves people with a tragic sense of regret. From the moment when a person is diagnosed with cancer, they will inevitably yearn to set the clock back and live their life again. Yet, a fact is a fact. Going back to the old life, as well as the future that one imagined, is now seen to be nothing more than extravagant dreams. What should one do in this predicament? Merely wait for death to come? No. Paul Kalanithi decided to continue living as he would have lived had he not been given his tumultuous cancer diagnosis. The Paul of the past had wanted a child. After much deliberation, a post-cancer Paul made the same decision to extend his family, even if this might make saying goodbye even more excruciating. Paul had always regarded medicine to be his life-long mission. After his diagnosis, Paul went back to the operating theatre whenever his physical condition allowed. Paul had always wanted to write. So, despite suffering intense physical pain from his condition, he propped himself up and forced his weakened frame to write ceaselessly. And finally, he completed When Breath Becomes Air. Although cancer had the effect of accelerating Paul's life to its end, he remained faithful to his heart's desires. He kept asking himself what was meaningful, what was truly important. Then, he channeled all his remaining strength and spirit into those enterprises. When he finally came to the brink and faced death, he smiled. Paul said, ‘I...

Not many veterinary professionals would deny the unbridled joy of a new puppy or kitten visit. But it's the complex emotions, accumulated experiences, and deeply rooted relationships (not to mention those wobbly legs and gray faces) that can make senior pet appointments the most rewarding and memorable of all. Mary Gardner, DVM, author, innovator, and co-founder of Lap of Love, did us the honor of serving on the task force for the newly released 2023 AAHA Senior Care Guidelines, and in this episode she shares how veterinary teams in any field can make their practices more senior-friendly – and how we can harness the power of the gray muzzle/creaky cat advocates on our teams to take senior care and end-of-life care to the next level.  Find out more about Dr. Mary, including her newest books, It's Never Long Enough and Nine Lives Are Not Enough, at drmarygardner.com. Other books mentioned in today's episode: Bittersweet: How Sorrow and Longing Make Us Whole, by Susan Cain, and When Breath Becomes Air, by Paul Kalanithi.   Read the brand new 2023 AAHA Senior Care Guidelines and associated resources FREE at aaha.org/senior-care – and check out all of AAHA's most up-to-date Guidelines, including resources for your clients and team, at aaha.org/guidelines.  Wish you could watch these conversations? Catch Central Line on YouTube.   Got something to say? We're always up for constructive comments and conversation. Send us feedback or questions anytime at podcast@aaha.org.  This podcast was produced by Clear Contender, LLC.

When Dr. Paul Kalanithi faced a stage IV lung cancer diagnosis in his last year as a neurosurgical resident, his wife, Dr. Lucy Kalanithi faced it with him. In the twenty-two months that followed, they continued to work, had a child and he wrote a best selling book . But since his death, how have her grief and her love showed themselves? She made sure that his book, when Breath Becomes Air, was published and promoted, most importantly by her. She carried his love forward into her own life and parenting of their daughter Cady. And she lent her energy to projects that reflect the intersection between that most impactful walk through cancer with Paul, and her interest in meaning in medicine, patient-centered care and end-of-life care. So it is no surprise that she is on the advisory board of the OpenIDEO end of life challenge, exploring how to improve end of life experiences world wide. Hear how this newest passion connects with what she and Paul experienced during his illness and death.

When Dr. Paul Kalanithi faced a stage IV lung cancer diagnosis in his last year as a neurosurgical resident, his wife, Dr. Lucy Kalanithi faced it with him. In the twenty-two months that followed, they continued to work, had a child and he wrote a best selling book . But since his death, how have her grief and her love showed themselves? She made sure that his book, when Breath Becomes Air, was published and promoted, most importantly by her. She carried his love forward into her own life and parenting of their daughter Cady. And she lent her energy to projects that reflect the intersection between that most impactful walk through cancer with Paul, and her interest in meaning in medicine, patient-centered care and end-of-life care. So it is no surprise that she is on the advisory board of the OpenIDEO end of life challenge, exploring how to improve end of life experiences world wide. Hear how this newest passion connects with what she and Paul experienced during his illness and death.

When Dr. Paul Kalanithi faced a stage IV lung cancer diagnosis in his last year as a neurosurgical resident, his wife, Dr. Lucy Kalanithi faced it with him. In the twenty-two months that followed, they continued to work, had a child and he wrote a best selling book . But since his death, how have her grief and her love showed themselves? She made sure that his book, when Breath Becomes Air, was published and promoted, most importantly by her. She carried his love forward into her own life and parenting of their daughter Cady. And she lent her energy to projects that reflect the intersection between that most impactful walk through cancer with Paul, and her interest in meaning in medicine, patient-centered care and end-of-life care. So it is no surprise that she is on the advisory board of the OpenIDEO end of life challenge, exploring how to improve end of life experiences world wide. Hear how this newest passion connects with what she and Paul experienced during his illness and death.

Heidi and Ellen take questions from Sue-Kate and Kate. Both have many Scorpio placements. Sue Kate is an actor, writer, and filmmaker. Her last few years have been filled with lots of flow. She asks how to raise her visibility moving forward (11:40). Kate is embarking on a new life adventure. She is starting business school in the spring but first, she wants to learn about commercial real estate- specifically adaptive reuse projects. She asks about ideas for confidence as she embarks on this new path (23:05).  Ellen and Heidi talk about LOTS of movies and shows, including The Fablemans, Black Panther: Wakanda Forever, The Crown, The HBO documentary Spielberg, White Lotus, The Swimmers, and Mammals.  Ellen is also re-reading the beautiful book When Breath Becomes Air by Paul Kalanithi (33:10).  

The literary heir to Oliver Sacks and Paul Kalanithi, a scientist and doctor with the eloquence and humanitarian sensibility of a philosopher-poet, Dr Siddhartha Mukherjee's work answers the question of what it means to be alive. He joined Adam Rutherford live on stage in London to tell a story that is both panoramic and intimate, taking us on a journey from the first days of the Scientific Revolution into the present day and beyond: the story of cells. Learn more about your ad choices. Visit megaphone.fm/adchoices

Listen to ASCO's Journal of Clinical Oncology essay, “Preparing for the End Game,” by Dr. William Beck, a University Distinguished Professor Emeritus and Professor of Pharmacology and Molecular Genetics at The University of Illinois at Chicago. The essay is followed by an interview with Beck and host Dr. Lidia Schapira. Beck reflects on his own mortality and what it means to live, following his good friend's illness and death from lung cancer.   TRANSCRIPT  Narrator: Preparing for the End Game, by William T. Beck, PhD (10.1200/JCO.22.01758) Recently, Jordan, a dear friend who had stage 4 lung cancer, died of his disease, a year and a half from his diagnosis. His tumor had activating mutations in the epidermal growth factor receptor, making him a candidate for treatment with osimertinib, a targeted therapy, one of the recent rewards of the remarkable advances in precision medicine. Jordan was my age, late 70s when he died. He was a lifetime nonsmoker, had several outstanding lung cancer oncologists, and was determined to fight his disease. That said, 3-year and 5-year survival rates for people with his disease are not high, but living beyond those years is statistically and biologically possible. That was not so in Jordan's case. Jordan's illness was distressing to me because he was my good friend. We went back decades and began our academic careers together, and we bonded through our shared academic experiences and our love of good wines, food, books, humor, and politics. Over the course of his illness, I tried to think of how I could be there for Jordan and his wife, also a good friend, as he went forward on this very difficult journey. Jordan was very fortunate to have state-of-the-art medical care, a loving wife and adult children, and many close and caring friends who wanted to walk with him on this journey to the extent that he wanted us with him. Because I was in the cancer field, I was able to help him and his wife better frame the questions to ask his oncologists, understand the tests ordered and drugs he was taking, identify other oncologists for second opinions, and search the literature to help them find the best treatments to hold the tumor at bay.   Jordan's illness, however, was distressing to me for another reason. It made me think about my own mortality and how, if it were me, would I want to spend my last months and years, knowing that the end is now a reality. Jordan was a retired academic, scientist, and long-term and consequential university administrator. Like my friend, I have been retired for a few years, having run a productive academic cancer research laboratory and having held a number of administrative positions as well. My distress was compounded by external events over these past few years. We have seen the deaths of so many people from COVID-19 in this country and the world, all so painful and many unnecessary. We have also seen the continued violent deaths due to guns and drugs. These, however, were largely deaths in the abstract; they did not have a face for me. That began to change with the extraordinary culmination of the epidemic of Black deaths at the hands of the police, especially the murder of George Floyd. These deaths brought home to me the face and randomness of death and fragility of life, writ large. The past year brought more faces of death to me: many prominent artists and baseball players, whose careers I had followed; internationally impactful cancer scientists and physicians, many of whom I knew personally; and the untimely death of the famous architect, Helmut Jahn, at age 81 years, in a bicycle accident. All these passings have given me pause in a way that I had not expected and starkly reminded me that there is absolutely no guarantee of a tomorrow. Indeed, I will no longer live by the brilliant conceit offered by William Saroyan: “Everybody has got to die, but I have always believed an exception would be made in my case. Now what?”1 Now what, indeed. One frequently hears about people who have survived near-death experiences or those who have been diagnosed with a terminal illness, having an epiphany and wanting to live each day to the fullest extent possible. One also hears about realists who exhort us to live every day as if it were our last. Certainly sound advice. But do we normals really adhere to these dictums? Many people probably do, but my experience, both personal and from talking with friends, is that most of us still go about our lives doing the quotidian things that we have always done. There is always tomorrow, but Jordan's illness has caused me to rethink that. Indeed, it has become increasingly clear to me, finally, that I should not put off doing things for another tomorrow, a tomorrow that is not guaranteed. Despite knowing—in the abstract—that much more of my life is behind me than in front, my good health and full days have led me to think that this can go on for some time, with the inevitability of death still relatively far in the future. Jordan's situation, however, has changed that perception and has got me thinking about how I would like to spend my remaining days, hopefully many, and thinking about how to really prepare for this end game, taking these final laps. Paul Kalanithi, a young surgeon, wrote so tenderly in When Breath Becomes Air2 about his struggles while suffering the ravages of lung cancer and his hopes for his wife and young children. Even at my advanced age, I too have similar hopes for my wife, children, and grandchildren. And Christopher Hitchens chronicled, in Mortality,3 his last year with esophageal cancer as fiercely as he had always done in his critical atheist's view of the world. But it was not until Jordan's sickness and death that I have taken Hitchens's clear view of life's limitations to heart. In his book, Being Mortal,4 Atul Gawande, the physician-writer, has chronicled both the advances and limitations that modern medicine has brought us as we face the end, including the complications that limit our autonomy in this passage. Gawande notes that as we age and become infirm, either as a normal process or because of disease, we become more dependent on medical and social networks that may, unfortunately, effect on our independence. Gawande suggests that a good death may be difficult to achieve but a good life less so. I saw this good life in Jordan's terminal illness. Indeed, another physician-writer, Oliver Sacks, emphasized in a short collection of four essays entitled Gratitude,5 the utility of a good and fulfilling life in helping us cope as we approach the end. Near the end of his life, as his body was being consumed by cancer, Sacks continued to do what he always did, for as long as he could: His days were always full, and he wrote beautifully of his clinical and social observations. Importantly, Sacks expressed enormous gratitude for his life as a sentient and thinking person, who loved and was loved, and whose life was consequential. What more can one want? My friend Jordan was such an individual: sentient, smart, and funny; a man who lived a consequential and impactful life, who loved and was loved. His illness, however, was not one of going softly into the good night, as was depicted in the movie Love Story.6 Toward the end, my friend suffered with pain, balance problems, fractures from falls, shortness of breath, insomnia, and the like. But through it all, he presented, at least to me, an admirable grace and equanimity that gave us all hope that despite his suffering, there would be one more day, one more week, one more month. My wife and I went out to northern California last winter to visit Jordan and his wife, and although unsaid, to say good-bye. But now, more than a half year later, he died, just days short of their 50th wedding anniversary. We have stayed in close contact with Jordan's wife since his death. The funeral was private, but my wife and I attended a subsequent memorial service for Jordan at which family, friends, and colleagues remembered him and his consequential life and bid him a proper farewell. So, here we are. My good friend is gone, and his struggles have been hard to watch, even from a distance, but he has helped me see more clearly that this all does come to an end at some point. So how do I want to pursue this end game? Certainly, I want to stay engaged in my science-related activities. But I also want to use what time I have left while I am healthy to spend as much time as I can with my wife and family, to be with good friends as much as they will tolerate me, to continue to read, to go to theater and concerts, to travel, finding humor in life, and enjoying good wines and food—all the typical things that people do and say they want to do as they approach the end game. Indeed, I want to do as many of these things as possible, but with a renewed sense of wonderment and gratitude, gratitude in the way Oliver Sacks expressed it. My friend, Jordan, the academic, still has some lessons to offer, so I will try to follow his example to live as good a life as possible, and if I become infirm, I will try to remember how he approached the end: with grace, courage, and equanimity and reflect on all the good things I have had in this life, with a great sense of gratitude. Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, brought to you by ASCO podcasts, which covers a range of educational and scientific content, and offers enriching insight into the world of cancer care. You can find all ASCO shows, including this one at: podcasts.asco.org. I'm your host, Lidia Schapira, Associate Editor for Art of Oncology and Professor of Medicine at Stanford University. Today, we are joined by Dr. William Beck, a university distinguished Professor Emeritus, and Professor of Pharmacology and Molecular Genetics at the University of Illinois, at Chicago. In this episode, we will be discussing his Art of Oncology article, 'Preparing for the End Game.' At the time of this recording, our guest has no disclosures. Bill, welcome to our podcast. Thank you for joining us. Dr. William Beck: Thank you, Lidia. I appreciate the opportunity. I think this is a unique and valuable feature of JCO, and I hope I can do it justice. Dr. Lidia Schapira: It's terrific to have you. Tell our listeners a little bit about the motivation for writing about Jordan, and the effect that his illness and passing had on you. Dr. William Beck: Yes. Well, his illness and death made me think of my own mortality, and how if it were me, would I want to spend whatever remaining days I have, hopefully, many. But hopefully, in a way that would allow me to honor his life, and also do justice to my own situation. So, that was the nexus of the issue. I spoke to a writer friend, Eric Lax, he's written a number of books; one is, The Mold in Dr. Florey's Coat. If you haven't read it, I highly recommend it. It's about commercialization issues during World War II, and he's written some other books as well, a book with the hematologist Robert Peter Gale on radiation. And I asked him what he thought about this, and he was very positive. As you, I'm not accustomed to opening myself up in the scientific literature. I write scientific papers, and they're not emotional. One might get emotional about the reviewer's comments, but that's another story. And so, this was a difficult thing for me to write, but I felt if done correctly, it might be useful not only to help me articulate my own feelings, but it might be useful for others, especially oncologists with whom I've been around in my entire professional life, and who deal with these matters daily, as you do. But most likely, and of necessity, keep their thoughts and their own mortality locked away. And I sort of thought that this might be a way to help others think about ‘Preparing for the End Game'. Dr. Lidia Schapira: You bring up some interesting points because in order to write a piece that will resonate with others, you have to allow yourself to be vulnerable, and that is not something that we are taught to do in our academic and professional lives. Was that hard for you? Dr. William Beck: Very, yes. Dr. Lidia Schapira: And how did you work through that period of deciding to make yourself vulnerable and then share that with colleagues whom you may never know or meet? Dr. William Beck: Thank you for that question. I wanted to write somewhat of an homage for my friend, Jordan, and that made it a little easier to open myself up. And I might add, I shared this, after it was accepted, with Jordan's family - his wife, who is a friend, and his two adult children. And they all very, very much appreciated what I had done. So, I felt I was on the right path with that. So, it was in part for an homage to Jordan, and I had walked with him and his wife during his illness, and then with his death, and I wanted to mark the event in a way that I felt more than just giving money to a memorial fund. I felt I wanted to make it very personal, he was a good. I don't know if that answers your question, but that's why I started it. Dr. Lidia Schapira: In thinking about your essay and the way you chose to honor your friend and his memory, what do you think is the message for some of our young readers? Dr. William Beck: That's a good question. I put myself in the 40-year-old Bill Beck mindset, and back in those days, as I said in my essay, you know, everyone has to die, but in my case, I thought an exception would be made. Jordan's death, and those of others around my age have led me to understand that an exception will not be made, and I want to make the best of it, and if our young readers who know that this is an abstract that's very far away, but it becomes more and more of a reality as you approach the end, and I'm guessing that our younger readers who are oncologists can wall that off with difficulty, but can wall it off to a certain extent. But it's there. It's inescapable, and so, maybe preparing early, if it even makes you think about enjoying a little bit more time with your kids, enjoying a vacation for another day, or even putting a little bit more money away for your IRA for your retirement, that could be very useful for them. Dr. Lidia Schapira: On the flip side of that, Bill, you write in your essay that you have continued to remain involved in your science, and I imagine that's because you love your science. So, tell us a little bit more about how you're thinking now, as you are mature-- I won't use the word senior, or old, about continuing to remain involved in a career that is not just work, but something that you love. Dr. William Beck: I could not imagine retiring. What I enjoy about my retirement is that I basically do everything that I did before, except the administrative part - the running a department for so long. And I do it on my schedule, not somebody else's schedule, and that is liberating. I just came back from a two-hour lecture that I gave yesterday; I mentor young people, I review grant applications and manuscripts, I read the literature. So, I stay involved. I can't imagine not being involved. And as Oliver Sacks, whom I've cited in the essay, he went at it all the ways best he could all the way to the end, and I hope that I will have that opportunity to do so as well. Dr. Lidia Schapira: What advice would you have for some of our listeners who are themselves accompanying a friend who is ill, or perhaps a relative who is facing a chronic or terminal illness? Dr. William Beck: I'm loath to give advice, but I would suggest that they might want to be there as much as their friend wants them to be there for them. To be there, and for them to know that they're there. I was in a unique position because I knew a little bit about the cancer field, and I could help Jordan and his wife navigate the shoals of interacting with physicians, and understanding their drugs, and getting second opinions, actually, for them. So, I was in a fairly unique position, but I think that the key thing is to be there to the extent that the individual wants you to be there with them is important. That's what I've learned from my deep emotional involvement with Jordan, but with others as well. Dr. Lidia Schapira: As you know from reading the essays we've published in Art of Oncology, Grief is a common theme, and I ask many of our authors to recommend, perhaps, some books they've read, or works of art that have helped them in processing their own grief. So, let me ask you if you can recommend any books, or poems to our listeners. Dr. William Beck: I'm not much into poetry, but I did happen to see an amazing interpretation of Psalm 23 on the Jewish Broadcasting Network recently that was eye-opening to me as a non-religious person. That was very interesting. In terms of books, I think a good start is the beautiful essays of Gratitude by Oliver Sacks. I've started to peel into, and peer into a book on Morality, by Jonathan Sacks-- no relation, I don't think. He was the Chief Rabbi of the UK. And in terms of art, I can think of music - the ‘Pastoral', by Beethoven, and the ‘9th', by Beethoven, are the ones that just are so uplifting to me, that I think would be very important to calm one's soul. Also, if I might add, The Stones are pretty good too, for that. Dr. Lidia Schapira: So, let me conclude our interview by asking you a little bit more about the role of storytelling, and essays, and narrative, in helping us come together as a community of professionals who are actually dedicated to looking after patients who are seriously ill. How have you used stories in your approach to Medicine and Academia, and what do you see as the role of these narratives in the future education of oncologists and hematologists? Dr. William Beck: So, I think young people, especially, need to hear stories of how these things begin. They need to hear origin stories, and middle stories, and end stories. Joseph Campbell, is one who's delved into where we came from, and about storytelling, as being very important in development of societies and traditions. So, I've tried in my work, even though it's scientific work, and maybe some of my reviewer critics would say, "Well, it's all stories and fables," but I've tried to develop several lines of science storytelling for our colleagues. And I think in general, whether it's in science or this kind of essay, yes, it's very important that the young people get outside of the, "What do I need to know for the exam?" mentality, to look at the bigger picture; and I'm afraid that's getting lost in modern education. The guy who introduces me, when I give the general lecture to all the students who are first time, first day in the room, never to be in the room again, always says, "And Dr. Beck won't answer any questions about what's on the exam." Dr. Lidia Schapira: Well, I thank you for sharing some of your humanity with the readers of JCO, through the essay. I know, as you told us, during the review, that you're not used to writing these kinds of essays, and you're much more comfortable with scientific work. But I think we need to show the human side of our scientists. I think that Jordan's family is right in thanking you for the tribute you paid to him through this essay, and I'm very glad that you did write it, and decided to share it with us. Dr. William Beck: Thank you. Well, I'm really glad that you have this venue, and I'm honored to have my essay published in it. I thank you, and your colleagues. Dr. Lidia Schapira: Thank you, Bill. Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, wherever you listen. Be sure to subscribe, so you never miss an episode. JCO's Cancer Stories: The Art of Oncology is just one of ASCO's many podcasts. You can find all of the shows at: podcasts.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement. Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review.   Bio: Dr. William Beck is a university distinguished Professor Emeritus, and Professor of Pharmacology and Molecular Genetics at the University of Illinois, at Chicago.  

Listen to ASCO's Journal of Clinical Oncology essay, “Being on The Other Side; An Oncologist's Perspective on Grieving,” by Shannon MacDonald, an Associate Professor at Harvard Medical School and a Radiation Oncologist at the Massachusetts General Hospital & Mass General Brigham. The reading is followed by an interview with host Dr. Lidia Schapira and essay author Shannon MacDonald. MacDonald shares her experience with grief, loss, and love after her husband was diagnosed with a mitochondrial disorder that ultimately took his life. MacDonald explores what grief means and how it can be different from what you originally imagined. TRANSCRIPT Narrator: Being on the Other Side: An Oncologist's Perspective on Grieving, by Shannon MacDonald, MD (10.1200/JCO.22.01363) As an oncologist, I had cared for patients facing grave illness and death. I imagined the loss of loved ones and expected grief to be an unbearable sadness, most poignant in the earliest days and lessening with time. I somehow expected that counseling people who grieved would make me more prepared. When my husband Dan died at age 42 years, I realized that I had no idea how grief felt. It was surreal and disorienting, I was displaced from a life that made sense into a new reality, one my mind acknowledged but my heart and soul would not accept. Dan's initial diagnosis offered a glimpse into a different life. It was unsettling but included us both. When we were newly engaged, Dan abruptly lost vision in one eye quickly followed by the other. I vividly remember the dark, neuro-ophthalmologist's office in New York City where I was a resident. I sat next to a young medical student who appeared fascinated as my 31- year-old fiance´—who did not yet appear blind— struggled to count fingers or the big E projected on the wall before us. As unremarkable magnetic resonance imaging, spinal tap, and laboratory results were posted, rare disorders floated into the differential. Dan had a mitochondrial disorder. My fiance´ had transformed into a medical student case study. It is not possible to understand the impact of a life-altering diagnosis until you are on the receiving end. How dramatically life can change in an instant. How painful the guttural yearning to go back in time can be. Dan and I both came from healthy, loving, families and had a close knit and fun group of friends. Dan had an MBA and ran a family company. I was a doctor in training. We lived active, full lives with plans for our future. We had no medical problems, and although aware as an oncologist that a medical diagnosis can derail a healthy young person's life, we or I never thought this could happen to us. In the weeks that followed Dan's diagnosis, his vision deteriorated. We retreated into a world that included just us. We moved our couch just a few inches from our television. I read menus to Dan at restaurants, and he corrected my mispronunciation of ingredients. I took over as our driver despite being a city dweller with little driving experience. We got handicapped plates, a cane, researched seeing eye dogs, and had a conversation that abruptly ended when I uttered the word “Braille.” One night when I asked why he could not fall asleep, Dan answered, “I am afraid I won't be able to see your face when I wake tomorrow.” We left the lights on and did not sleep that night. Fortunately, Dan's vision loss was not complete and, although painfully slow, he recovered some of his sight. Over time, he reintegrated into his friend circle and work with adaptions and the help of a low vision clinic. We were grateful throughout. Dan was an avid skier and was able to ski again once he realized that muscle memory was more important than vision. With time, he no longer appeared blind. He gained the confidence to return to contact lenses, which allowed him to remove his glasses and sunglasses that hid his eyes. Dan had to face additional challenges. He developed bilateral avascular necrosis of his hips from the single dose of steroids given to him when multiple sclerosis was thought to be his diagnosis. This led to bilateral hip replacements and a year on crutches. This experience taught me to appreciate the subjective nature of function loss: I had perceived vision loss would have the most profound impact on his quality of life, but undergoing hip replacements and loss of mobility were unequivocally worse for Dan. In fact, this triggered such emotional distress that it challenged our relationship more than ever. Anxiety dominated over depression, and rather than medication, Dan used alcohol to soothe his pain. Over time, with therapy and lots of tears, we accepted this life with appreciation for what is truly important and we learned to ignore the trivial. We grew closer than ever, and, for this, I will be forever grateful. I find comfort in the thought that we lived together with more emotion and a deeper passion for each other and for life. Dan died of a sudden cardiac event during a business trip. When his dad called to tell me the news, I was doing yoga, and I recall him asking me “are you sitting down?” So, I kneeled on my yoga mat. I can't recall how many synonyms for death he attempted before he was forced to say the word “dead” to make me understand what had happened. When I got off the phone, I quickly called my sister and bluntly said “Dan is dead” and then repeatedly apologized for not asking her if she was sitting before I told her. I was derailed. I felt utterly unprepared for a life without the man who provided me with guidance, confidence, and experience that I had not had on my own. I never knew what true anxiety was until his death and would never again feel anxious about public speaking after giving his eulogy. I will forever be grateful for the people in my life who sat with me silently, fed me, and even slept in my bed in Dan's place. They would later recall memories in those early disorienting days that I did not. After reading that people often sigh when grieving, I asked my friend Alice if I ever sighed. She looked surprised and responded, “Shannon, you cried softly and sighed all day long.” When I was disappointed that I never dreamed that Dan was alive or woke up having forgotten that he was dead, those closest to me said that I would wake in the middle of the night reaching for him, realize he was not there, and then settle back into some sort of sleep. After his funeral, I became obsessed with determining exactly how he died, as if figuring it out could bring him back. The wait for final autopsy results was excruciating, but the findings of a hypertrophic cardiomyopathy likely related to his mitochondrial disorder was utterly unsatisfying. I remained convinced that if I had joined him for that business trip as I had planned to, I would have been with him, and he would still be alive. I still believe this. I also remember telling his father about my feelings of guilt, and he replied with both surprise and relief saying, “I feel so guilty too.” For months, I could not think of any future and preferred to live in the past. The sadness of missing him was more comforting than the thought of moving forward in a life that did not include him. Although I never thought of doing any harm to myself, I remember spending an hour convincing a patient to accept treatment for an advanced cancer only to walk out of her hospital room thinking that if I were her right now, I would do nothing and welcome death. With the support of friends, family, and therapy and the passing of time, I slowly became more functional and was able to reintegrate into society. My grief morphed into anxiety and feelings of guilt when my memories of Dan became less vivid as if I was not honoring him enough. When I finally had the courage to pack his clothes to give to charities, I was saddened that it evoked less emotion because they no longer carried his scent. What I had thought of in the past as “moving on” and a healthy step in the grieving process was not a simple forward advance but came with a longing to return to a period of greater grieving. Moving on and making new memories made me feel disloyal, as though I was abandoning him. With time, I came to accept my new life that was so different than the one I had planned. Eventually, I reached that place that Didion described: “I know why we try to keep the dead alive: we try to keep them alive in order to keep them with us. I also know that if we are to live ourselves there comes a point at which we must relinquish the dead, let them go, keep them dead.”1 But this took time, support, and a disciplined effort to change myself by reimagining my values and creating a new identity that did not include my husband or the children we planned to have together. My evolution aligned with the teachings of social scientist Boss,2 who refuted the idea of finding closure and instead posited that we must learn to live for a future that contains the loss. I learned over time to accept the discomfort it caused me to speak of him in the past tense. I could be true to myself; my identity was shaped by Dan but not in the present. I learned to say “I” instead of “we.” I accepted that my niece and nephews—and all my patients with pediatric cancer—would be the children in my life. I met a man and partner secure enough to be with a woman who speaks about a man she loves that is not him. Grief is personal, and I am only an expert in my personal grief. I found the support from colleagues, family, and friends helped me, but they could not make me feel close to my old normal—only Dan's return could have done that. I learned that some people simply could not acknowledge the loss and that in turn had a profoundly negative effect on our relationship. Even a card or e-mail would have sufficed, but silence created an awkwardness that was hard to bear. I was told by a coworker that a colleague had tried so many times to say something to me but was too afraid that he would say the wrong thing, so he said nothing. Hearing this helped me understand how his silence was not because he did not care but because his fear of hurting me by saying the wrong thing was paralyzing. I also discovered that avoiding conversation that included Dan made Dan feel more dead. I would have preferred to speak of him, even if this made me emotional. I learned to answer the “how are you” question by replying okay, as I could not lie and say “well.” When my nephew died, I texted my sister daily “How are you on a scale of 1- 10?” She loved this. People said perhaps well intended but strange things, such as “don't worry. You are young and will marry again.” and “you are lucky you did not have children and you will be a mother to somebody else's children.” With these comments I heard, “Dan is replaceable” and “it is good thing that you don't have a piece of him in a child you shared.” I recognized that I sometimes needed more space and that loneliness can feel unbearable. I had no way of predicting my needs, which made it difficult to plan ahead. I found it took years to work through my emotional pain and am forever grateful to those who believed in my ability to heal myself. Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, brought to you by ASCO Podcasts, which covers a range of educational and scientific content, and offers enriching insight into the world of cancer care. You can find all ASCO shows including this one at podcast.asco.org. I'm your host, Dr. Lidia Shapira, Associate Editor for Art of Oncology and Professor of Medicine at Stanford University. Today, we are joined by Dr. Shannon McDonald who's an associate professor at Harvard Medical School and a radiation oncologist at the Massachusetts General Hospital, and Mass General Brigham in Boston. In this episode, we will be discussing her Art of Oncology article; “Being On The Other Side: An Oncologist Perspective On Grieving”. At the time of this recording, our guest has no disclosures. Shannon, welcome to our podcast and thank you for joining us. Dr. Shannon MacDonald: Lidia, thank you so much for having me. It's a pleasure and privilege to be here today. Dr. Lidia Schapira: I'd love to start by having you tell us a little bit about what motivated you to write this essay that is so personal and so important, and to share it with the large community of oncologists. Dr. Shannon MacDonald: So, writing it was easy. I found it very cathartic to write about my experience. So, the act of writing it, I did over many years. I started it soon after Dan died, picked it up a couple of years later, and then put it away for a long time, and recently was motivated to pick it up and start writing again based on reading “Beautiful Boy”, which was one of the Art of Oncology pieces and also, based on another medical narrative that I wrote just before this one. And the decision to publish it and make it public was a little more challenging. Dan was a very private person. We spent many years being very private about his medical problems. He never wanted to be seen as having a disability or a medical issue. I think he was wise enough to know he'd be perceived differently, but I made a decision when I gave his eulogy to share some of his medical history and how brave I think he was during that time. And I think one of the reasons to publish it was to help others. I found reading very helpful when I went through this experience and I think helpful in my career as an oncologist, and reading people's stories, short stories, books, any type of reading about the human experience is helpful to try sort of put yourself in those shoes and try to understand what it feels like. And I was also motivated by giving a few talks or joining others to give talks on grief during the pandemic and speaking about my experience and was told by colleagues a long time ago,' we just want to know how it feels'. And when I gave these talks, I think residents in particular, but also, colleagues of any age were very grateful for the sharing of my experience. And it made me feel sharing this was meaningful. Dr. Lidia Schapira: And when you talk about how it feels, the sentiment I took away from reading the essay, and I've read it many times, is how raw that felt. And your wisdom in saying that you had lived as a professional in a culture that's immersed in grief, and you were exposed to suffering, and the suffering of children even, every day in your professional life, and yet you were unprepared. Can you talk a little bit about what you felt helped you to learn to accept and move on or live with Dan's absence? Dr. Shannon MacDonald: Yeah, so I think what you said about being totally unprepared and what I said in my essay was completely true. I guess, I thought somehow that seeing patients suffer, seeing them lose loved ones, seeing parents lose children would have somehow made me more prepared, but it did not at all, I was completely caught off-guard. And I remember calling a colleague who was also 40 and she lost her husband suddenly, about three months after I lost Dan. And one of the first things she cried out when I called her is, “I can't believe I had no idea what this felt like.” And I think that that resonated with me, I felt exactly the same way, and that's what I answered back to her. And as much as we live it and see it every day, it's so different being on the other side of it. I think we see the illness, the sadness, and you think of it for moments. You can't think of it every moment of every day. And I remember hearing people say that person that I lost is in my mind every moment of every day, and I couldn't understand that, but it's true. Somehow, it's constantly there. Even though Dan was gone, he was constantly there, and to do anything meant sort of pushing him out of my mind in order to do another task. And that part is the part that I think is unimaginable. And why would you want to imagine that, and how could anyone? And that is the part that we don't see. And I think as oncologists, we see our patients through a tremendous amount of suffering. We see them at the time of death of a loved one, and then we see them shortly after, but we don't always see them in the weeks, months, years after that loss. So, it was that part that was so unknown to me until that happened. And I think you do what you can to get through it. It's not easy, it's messy, and it's hard. And I can't say that I could give someone advice on how to get through it in a better way. I think you just have to go through it. And that was yeah, the experience I learned from my loss. Dr. Lidia Schapira: So, you say that it's messy and complicated, and in your essay, you reflect also on the reaction that you had or the way that your colleagues responded to this catastrophe that took you by surprise. It was not as if Dan had a chronic illness and was approaching the end, this was totally unexpected despite the fact that he did have an illness. And you talk about the silence of your colleagues as a wound. At least that's the way I interpret it. Can you talk a little bit about that? Dr. Shannon MacDonald: Yeah, and it's silence of colleagues and also friends. But I think for me anyway, I can only speak about my personal experience — that was the hardest because it created this awkwardness that was hard to get past. So, in my opinion, it's better to say anything or write something if you can't say something. But also, I also have learned, and I understand that it's just so hard and people are so afraid of saying the wrong thing that it's natural to avoid it or to try to say something, and then be too nervous to say something. But I guess, my advice would be to try to write or say something rather than saying nothing because it's so awkward when nothing is said, and it creates an additional stress on that person that's grieving, and sometimes, a sad loss of a relationship for a time or forever. Dr. Lidia Schapira: Sounds like you have used your experience to now, talk about and write about your personal grief, and you're seen perhaps, as a resource for others or a teacher. What does that feel like? Dr. Shannon MacDonald: It feels good. I'd like to be that as much as I can be. Again, it's only my personal experience. I've received feedback that it's helpful, but I'm sure I wouldn't receive feedback that it was unhelpful or negative feedback. But I think that makes me feel like there's some meaning to the writing and the work that I've done, in speaking to others. And I think there's a lot of oncologists, maybe particularly those new to training that are eager for more teaching in the human experience of what we see every day. They certainly want to learn the trade and the skills, and they can find that in textbooks and in our teaching, but the humanistic part of it is more difficult to learn. So, it's been very rewarding to have colleagues and residents tell me that it felt great to be able to ask in a comfortable setting how it feels to have someone die, so that they can understand better how their patients feel. Dr. Lidia Schapira: Can you reflect a little and share with us some of the sort of milestones in your sort of recalibrating and being able to find joy, and then find a relationship and transform your experience into part of who you are and carry with you, but in a way sort of embrace this new place in your life? Dr. Shannon MacDonald: So, I'd say a lot of steps forward and steps back. And if anyone had told me I would be as happy as I am again, now, right after Dan died or within the first year after he died, I would've said no way, that's never going to happen. I'd say in the initial time of his death and months after his death, I had no desire to ever date or be with anyone again. As I mentioned in my essay, it was easier to live in the past than to think about the present in an identity that was no longer what I knew was my identity or the future, was daunting. And I would say, again, time is different for everyone, but maybe after 10 or 11 months, I could be happy again. I could enjoy friends, I thought I was ready to date. And one of my best friends said, “I don't think you are.” And I said, “I think I am.” And then I wore my wedding ring on the first date I was set up on. And I thought maybe foolishly, “Oh, I don't think he noticed or he cared. He knew I was widowed” and he did. And we didn't go out on another date. But in time, I learned to date other people and not feel guilty about it or disloyal to Dan. As I mentioned, I met someone who allowed me to speak of him, which was very important for me that I not lose that past part of my life, and that person could still come forward into new relationships and new friends and family. I still am very close to my in-laws and keep them as part of my family. And I think that keeping my old identity and what Dan did for me and how he shaped me was very important to me in moving forward. And I feel that I'm able to do that now, and know that he lives on in the person he made me, and the other people that he shaped in his life that was too short. Dr. Lidia Schapira: So, the question I'm sure on our listeners' minds is how has that impacted you in your professional life as a radiation oncologist? Dr. Shannon MacDonald: It allows me to be probably more empathetic rather than sympathetic. I remember being taught in medical school, in my psychology rotation that you can only truly be empathetic if you've been through something. And it's still similar, everyone's experience is different. But for some patients, I think it allows a little more empathy. I think in the initial months, years after Dan died, I was too empathetic. I was too sensitive to the losses that other people experienced. And that made me realize that somehow, maybe I built up some desensitization over time that was very subtle. And after Dan died, I worked hard to build that up again to allow me to work with patients and not be too sad and too empathetic, or too upset by what was happening to them. And I do think that that has happened again, but it's beautiful to be able to empathize, but hard to empathize too much. Dr. Lidia Schapira: So, in the last few minutes, Shannon, I'd love to hear your take on the value of narratives, of stories to bring these topics to our discussions in the clinic, to the curriculum of our trainees, and I think create a community of people who really deeply care about our lived experiences and want to support each other. Dr. Shannon MacDonald: So, I think they're extremely important. I love the narratives. I always look at Art of Oncology and I love the New England Journal of Medicine ‘Perspective', and JAMA's ‘Piece of My Mind '. And I also found books; Joan Didion's, The Year of Magical Thinking, and also, those stories by Emily Rapp Black, The Still Point in the Turning World; When Breath Becomes Air by Paul Kalanithi. I think those are three books that I tell my residents to read and narratives, I think we need more of that in the curriculum for our residents and students. And I do feel like there's a generation that is craving that more. I don't know if you've seen this in the residents you mentor, but, in ours, I feel that they're asking more and more for that to be part of their curriculum more so than they had a decade ago. And it may be that this generation is just more comfortable speaking about feelings and acknowledging that that's an important part of medicine. And we want to cure patients. We want to help them live with their cancers for a long time with a good quality of life, and we aim to do that. But the reason we aim to do it is so they can have a human experience. So, that part is so important. It's why we do what we do. And I think that it motivates us to take care of our patients and help them to live as well as they can with their disease. Dr. Lidia Schapira: And we become part of their stories too. I've often thought that in some ways, if we have a strong relationship with patients, we are invited to co-edit those illness narratives, and what a privilege that is. Dr. Shannon MacDonald: I agree. Dr. Lidia Schapira: My last question is; what are you reading now? Dr. Shannon MacDonald: So, what I would recommend that I've recently read for the Art of Oncology listeners would be Between Two Kingdoms by Suleika Jaouad. I love that book. It's also a great audio book. She narrates it herself and does a beautiful job with that. I also recently, probably a year ago now, read Sanctuary by Emily Rapp Black, which I thought was very meaningful as well. So, for your readership, those are two books I would recommend. Dr. Lidia Schapira: Well, Shannon, thank you for an extraordinary essay, for the power of your conversation. And for our listeners, until the next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or a review wherever you listen. Be sure to subscribe so you never miss an episode of JCO's Cancer Stories: The Art of Oncology that is just one of ASCO's many podcasts. You can find all of the shows at podcast.asco.org. Voiceover: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy, should not be construed as an ASCO endorsement. Like, share and subscribe so you never miss an episode and leave a rating or review. Additional Reading: My Beautiful Boy Bio: Dr. MacDonald who is an Associate Professor at Harvard Medica School and a Radiation Oncologist at the Massachusetts General Hospital & Mass General Brigham in Boston.

What does Value Based Care really mean? Is Value Base Care gaining momentum? Will Value Based Care be effective at improving outcomes and reducing costs? I've decided to pose these questions to our guest today because he and his team are in the thick of it. With me is Dave Mull, CFO of Honest Medical Group, an organization that assists independent physicians in participating in Value Based Care. Dave and I previously worked together at Humana where he had extensive leadership experience in Medicare Advantage operations and finance. Show Notes: Favorite Books:  When Breath Becomes Air by Paul Kalanithi; Grit; The Power of Persuasion and Perseverance by Angela Duckworth; Atomic Habits: An Easy and Proven Way to Build Good Habits and Break Bad Ones by James Clear; and Passionate Action: 5 Steps to Creating Extraordinary Success in Life and Work by Doug Gray.

We discuss When Breath Becomes Air by Paul Kalanithi. Paul Kalanithi was a neurosurgeon who was diagnosed with lung cancer during the last year of his residency. In his memoir, Paul recounts his life before and after his diagnosis and searches for meaning as his passing approaches.

Dr. Mark Lewis and Dr. Jean Luc Neptune talk about how one of their most sacred responsibilities as doctors is to be brutally honest with their patients about what they can do and what they can't. They also share what we all can do to be as prepared as possible. They discuss the importance of living wills, health care proxies and normalizing death. When you welcome death as the natural endpoint, it makes it an approachable conversation.Tweet us your questions @marklewismd or @jeanlucneptune or email us at isitserious@offscrip.com or call us at 855-283-4666.SHOW NOTES: Book recommendations: When Breath Becomes Air by Paul KalanithiBeing Mortal by Atul GawandeCheck out The Heart of Healthcare, from OffScrip Healthhttps://offscrip.com/showsSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Jade describes herself as a spiritual midwife. She spent the first 20 years of her professional life building a consulting business. When her mother was diagnosed with cancer Jade redirected her timme and energy to support her mother. Following her mother's death Jade spent years grieving, healing and recalibratinng her life. She said goodbye to the Bay Area and goodbye to consulting. For the 20 years since then Jade has been deepening her spiritual practice and fine tuning herself as an instrument of healing in the death and dying process. Jade reminds us that healing is not a rush job. As she puts it “you cannot force the river.” In order to become an instrument of healing, Jade first had to let herself heal, and in order to let herself heal, she moved from the fast lane to the slower pace of the Big Island and asked the ocean to hold her grief. This conversation winds and circles back on itself many times, just like the process of grieving. Jade's Reading List & Resources:   AARP – Checklist for My Family: A Guide to My History, Financial Plans and Final Wishes; by Sally Balch Hurme, an Elder Law Attorney quoted frequently in NY Times, Wall Street Journal, USA Today, CNN, NPR, Kiplinger's Retirement Report. BJ MILLER, M.D. Ted Talks – What Really Matters at the End of Life https://video.search.yahoo.com/search/video?fr=mcafee&ei=UTF-8&p=ted+talks+youtube+bj+miller&type=E211US105G0#id=1&vid=68dfedc905fc29bab4f13e4ce08afdc0&action=click Ira Byock, nationally renown palliative care specialist, M.D. – The Four Things That Matter Most: A Book about Living https://irabyock.org/books/the-four-things-that-matter-most/ Atul Gawande, M.D. – Being Mortal: Medicine and What Matters in the End http://atulgawande.com/book/being-mortal/ Paul Kalanithi, M.D. – When Breath Becomes Air     https://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X Katy Butler, award winning journalist - Knocking on Heaven's Door, The Art of Dying Well Joan Halifax, Founder and Director of Upaya Zen Center: Being with Dying: Cultivating Compassion & Wisdom in the Presence of Death. https://www.upaya.org/being-with-dying/ https://www.upaya.org/dox/Being_Dying.pdf Frank Ostaseski, visionary co- founder of SF Zen Hospice, Metta Institute - Five Invitations: Discovering What Death Can Teach Us About Living Fully. This book is an evocative and relevant guide that points to a radical path for transforming the way we live. https://fiveinvitations.com/   the secret teacher hiding in plain sight, helping us Cathy Wurzer, founder of End in Mind: A movement that advocates to shift the fear-based cultural conversation about loss, death, dying, and provides curated resources to families and communities.  https://www.endinmindproject.org/resources/ If you enjoyed this conversation, please leave a review in your podcast app. CancerTalks is a platform for anyone who has been touched by cancer. If you're moved to donate, please visit cancertalks.com/donate

Turning pain into purpose can often be the cornerstone of activism. Dr. Lucy Kalanithi exemplifies that in her work as a physician. In this episode, Lucy walks us through her unconventional journey into activism. She explains what it means to find joy in the midst of suffering, the importance of discovering your purpose, and why she's fighting to make the healthcare system more human and more humane. Check out Lucy's podcast GravityFollow Isha Sesay on Twitter and Instagram. Follow Wonder Media NetworkWebsiteInstagramTwitter

Today Asif asks Ali about his involvement with Canada Reads, which returns on March 28, 2022 (4:43). After a brief digression about the band Genesis, Ali discusses the genesis of Canada Reads. He talks about how it was developed by the CBC and how the guests and books are selected. He then discusses notable guests and books and how he became involved with the show.  Then Asif discusses his favourite medical books (39:24): ‘The House of God' by Samuel Shem, ‘An Anthropologist on Mars: Seven Paradoxical Tales' by Oliver Sachs, ‘How Doctors Think' by Jerome Groopman, and ‘When Breath Becomes Air' by Paul Kalanithi.  The opinions expressed are those of the hosts, and do not reflect those of any other organizations. This podcast and website represents the opinions of the hosts. The content here should not be taken as medical advice. The content here is for entertainment and informational purposes only, and because each person is so unique, please consult your healthcare professional for any medical questions.    Music courtesy of Wataboi and 8er41 from Pixabay   Contact us at doctorvcomedian@gmail.com   Follow us on Social media: Twitter: @doctorvcomedian Instagram:  doctorvcomedian   Show Notes: Canada Reads 2022: https://www.cbc.ca/books/canadareads/meet-the-canada-reads-2022-contenders-1.6326413 Jerome Groopman: http://jeromegroopman.com/ When Breath Becomes Air: https://www.penguinrandomhouse.com/books/258507/when-breath-becomes-air-by-paul-kalanithi/ Five years later: Lucy Kalanithi on loss, grief and love: https://scopeblog.stanford.edu/2020/04/20/five-years-later-lucy-kalanithi-on-loss-grief-and-love/

This week, I'm talking with Dr. Lucy Kalanithi, a physician, a mother, a storyteller, and host of the podcast Gravity. Lucy's late husband, Dr. Paul Kalanithi, wrote When Breath Becomes Air, a book I've read, and loved, and gifted to so many important people in my life. Lucy and I explore raising kids who have lost a parent, living through grief, and using meaning as a something of a lifeboat. I'll also be talking with Heather Winkle, Head of Design at Capital One. 

This episode features conversations with people doing the best they can in difficult circumstances. Like Dr. Lucy Kalanithi, whose husband Dr. Paul Kalanithi was a notable and rising brain surgeon who wrote When Breath Becomes Air, a bestselling memoir about his fatal battle with cancer. And comedian Amber Tozer, who tells a funny and poignant story about walking in on her mother's wedding… on Christmas Day. We will also talk with some of the women of the Hot Young Widows Club on their hopes and dreams for the upcoming year. Plus, stories of people's worst Holidays ever.

This episode features conversations with people doing the best they can in difficult circumstances. Like Dr. Lucy Kalanithi, whose husband Dr. Paul Kalanithi was a notable and rising brain surgeon who wrote When Breath Becomes Air, a bestselling memoir about his fatal battle with cancer. And comedian Amber Tozer, who tells a funny and poignant story about walking in on her mother's wedding… on Christmas Day. We will also talk with some of the women of the Hot Young Widows Club on their hopes and dreams for the upcoming year. Plus, stories of people's worst Holidays ever.  — Sign up today for TTFA Premium! For $7.99 a month, you get access to exclusive bonus content, ad-free episodes *and* the knowledge that you're keeping our show afloat! Visit TTFA.org/Premium to get started. Want (sporadic) emails from Nora and Team TTFA? Sign up here.  When you shop our Bookshop.org store, you support the author, independent bookstores AND our show! Shop here. You can purchase Nora's books here. Shop for your favorite TTFA gear at TTFAmerch.com. Read the transcript for this episode here. You can catch up with TTFA on Instagram, Twitter and Facebook using @ttfapodcast. Nora's Instagram is @noraborealis.And check out our sponsors this week:Shutterfly: shutterfly.comHelp A Human Out: helpahumanout.coStill Kickin': stillkickin.co