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Tag Archives: Paul Kalanithi

The 16 Best Books of 2016

Rewarding reads on love, life, knowledge, history, the future, and tools for thinking. Out of all the books I read this year, here is a list of what I found most worth reading in 2016.

1. The Psychology of Man’s Possible Evolution
These lectures, which were originally called Six Psychological Lectures, were first privately printed in the 1940s. Of the first run of 150 copies, none were sold. The essays were published once again after Ouspensky’s death, and unlike last time became a hit. While the book is about psychology, it’s different than what we think of as psychology — “for thousands of years psychology existed under the name philosophy.” Consider this a study in what man may become — by working simultaneously on knowledge and inner unity.

2. The Island of Knowledge: The Limits of Science and the Search for Meaning
Imagine the sum of our knowledge as an Island in a vast and endless ocean. This is the Island of Knowledge. The coastline represents the boundary between the known and unknown. As we grow our understanding of the world, the Island grows and with it so does the shores of our ignorance. “We strive toward knowledge, always more knowledge,” Gleiser writes, “but must understand that we are, and will remain, surrounded by mystery.” The book is a fascinating and wide-ranging tour through scientific history. (Dig Deeper into this amazing read here.)

3. When Breath Becomes Air
It’s been a while since I’ve cried reading a book. This beautifully written memoir, by a young neurosurgeon diagnosed with terminal cancer, attempts to answer the question What makes a life worth living? If you read this and you’re not feeling something you’re probably a robot.

4. The Sovereign Individual: Mastering the Transition to the Information Age
The book, which argues “the information revolution will destroy the monopoly power of the nation-state as surely as the Gunpowder Revolution destroyed the Church’s monopoly,” is making the rounds in Silicon Valley and being passed around like candy. Even if its forecasts are controversial, the book is a good read and it’s full of interesting and detailed arguments. I have underlines on nearly every page. “Information societies,” the authors write, “promise to dramatically reduce the returns to violence … When the payoff for organizing violence at a large scale tumbles, the payoff from violence at a smaller scale is likely to jump. Violence will become more random and localized.” The Sovereign Individual, who, for the first time “can educate and motivate himself,” will be “almost entirely free to invest their own work and realize the full benefits of their own productivity.” An unleashing of human potential which will, the authors argue, shift the greatest source of wealth to ideas rather than physical capital — “anyone who thinks clearly will potentially be rich.” Interestingly, in this potential transition, the effects are “likely to be centered among those of the middle talent in currently rich countries. They particularly may come to feel that information technology poses a threat to their way of life.” The book predicts the death of politics, “weakened by the challenge from technology, the state will treat increasingly autonomous individuals, its former citizens, with the same range of ruthlessness and diplomacy it has heretofore displayed in its dealings with other governments.” As technology reshapes the world, it also “antiquates laws, reshapes morals, and alters preconceptions. This book explains how.”

5. To Kill a Mockingbird
I know, I know. Hear me out. Someone I respect mentioned that he thought Atticus Finch was the perfect blend of human characteristics. Tough and skilled, yet humble and understanding. He’s frequently rated as a “most admired” hero in fiction, yet he’s a lawyer competing with Jedis, Detectives, Spies, and Superheroes. Isn’t that kind of interesting? Since it had been at least 15 years since I’d read TKM, I wanted to go back and remember what made Atticus so admired. His courage, his humility, his understanding of people. I forgot just how perceptive Finch was when it came to what we’d call “group social dynamics” — he forgives the individual members of the mob that show up to hurt Tom Robinson simply because he understands that mob psychology is capable of overwhelming otherwise good people. How many of us would be able to do that? Atticus Finch is certainly a fictional, and perhaps “unattainably” moral hero. But I will point out that not only do real life “Finch’s” exist, but that even if we don’t “arrive” at a Finchian level of heroic integrity and calm temperament, it’s certainly a goal worth pursuing. Wise words from the book Rules for a Knight sums it up best: “To head north, a knight may use the North Star to guide him, but he will not arrive at the North Star. A knight’s duty is to proceed in that direction.” (Here are some of the lessons I took away from the book.)

6. Lee Kuan Yew: The Grand Master’s Insights on China, the United States, and the World
If you’re not familiar with Lee Kuan Yew, he’s the “Father of Modern Singapore,” the man who took a small, poor island just north of the equator in Southeast Asia with GDP per capita of ~$500 in 1965 and turned it into a modern powerhouse with GDP per capita of over $70,000 as of 2014, with some of the lowest rates of corruption and highest rates of economic freedom in the world. Finding out how he did it is worth anyone’s time. This book is a short introduction to his style of thinking: A series of excerpts of his thoughts on modern China, the modern U.S., Islamic Terrorism, economics, and a few other things. It’s a wonderful little collection. (We’ve actually posted about it before.) Consider this an appetizer (a delicious one) for the main course: From Third World to First, Yew’s full account of the rise of Singapore. (Dig deeper here.)

7. An Illustrated Book of Bad Arguments
Perfect summer reading for adults and kids alike. One friend of mine has created a family game where they all try to spot the reasoning flaws of others. The person with the most points at the end of the week gets to pick where they go for dinner. I have a suspicion his kids will turn out to be politicians or lawyers.

8. Intuition Pumps and Other Tools for Thinking
Dan Dennett is one of the most well known cognitive scientists on the planet . This book is a collection of 77 short essays on different “thinking tools,” basically thought experiments Dennett uses to slice through tough problems, including some tools for thinking about computing, thinking about meaning, and thinking about consciousness. Like Richard Feynman’s great books, this one acts as a window into a brilliant mind and how it handles interesting and difficult problems. If you only walk away with a few new mental tools, it’s well worth the time spent. (You can learn a lot more about Dennett here, here, and here.)

9. The Seven Sins of Memory (How the Mind Forgets and Remembers)
I found this in the bibliography of Judith Rich Harris’ No Two Alike. Schacter is a psychology professor at Harvard who runs the Schacter Memory Lab. The book explores the seven “issues” we tend to find with regard to our memory: Absent-mindedness, transience, blocking, misattribution, suggestibility, bias, and persistence. The fallibility of memory is so fascinating: We rely on it so heavily and trust it so deeply, yet as Schacter shows, it’s extremely faulty. It’s not just about forgetting where you left your keys. Modern criminologists know that eyewitness testimony is deeply flawed. Some of our deepest and most hard-won memories — the things we know are true — are frequently wrong or distorted. Learning to calibrate our confidence in our own memory is not at all easy. Very interesting topic to explore. (We did a three part series on this book. Introduction and parts One, Two, and Three).

10. Talk Lean: Shorter Meetings. Quicker Results. Better Relations
This book is full of useful tips on listening better, being candid and courteous, and learning what derails meetings, conversations, and relationships with people at work. Don’t worry. It’s not about leaving things unsaid that might be displeasing for other people. In fact, leaving things unsaid is often more detrimental to the relationship than airing them out. Rather, it’s about finding a way to say them so people will hear them and not feel defensive. If you want to get right to the point and not alienate people, this book will help you. I know because this is something, personally, I struggle with at times.

11. The Master Algorithm: How the Quest for the Ultimate Learning Machine Will Remake Our World
I recently had a fascinating multi-hour dinner with the author, Pedro Domingos, on where knowledge comes from. Historically, at least, the answer has been evolution, experience, and culture. Now, however, there is a new source of knowledge: Machine learning. The book offers an accessible overview of the different ways of machine learning and the search for a master, unifying, theory. The book also covers how machine learning works and gives Pedro’s thoughts on where we’re headed. (Dig deeper in this podcast.)

12. Why Don’t We Learn from History?
This is a short (~120pp) book by the military historian and strategist B.H. Liddell Hart, a man who not only wrote military history but surely influenced it, especially in Germany in the World War period. He wrote this short synthesis at the end of his life and didn’t have a chance to finish it, but the result is still fascinating. Hart takes a “negative” view of history; in other words, What went wrong? How can we avoid it? The result of that study, as he writes in the introduction, is that “History teaches us personal philosophy.” Those who learn vicariously as well as directly have a big leg up. Something to take to heart. I plan to read more of his works.

13. A Powerful Mind: The Self-Education of George Washington
What a great book idea by Adrienne Harrison. There are a zillion biographies of GW out there, with Chernow's getting a lot of praise recently. But Harrison narrows in on Washington’s self-didactic nature. Why did he read so much? How did he educate himself? Any self-motivated learner is probably going to enjoy this.

14. Sapiens: A Brief History of Humankind
One of the best books I’ve come across in a long time. Sapiens is a work of “Big History” — in the style of Jared Diamond’s Guns, Germs, and Steel — that seeks to understand humanity in a deep way. Many of Professor Harari’s solutions will be uncomfortable for some to read, there is no attempt at political correctness, but his diagnosis of human history is undeniably interesting and at least partially correct. He draws on many fields to arrive at his conclusions; a grand method of synthesis that will be familiar to long-time Farnam Street readers. The book is almost impossible to summarize given the multitude of ideas presented. But then again, most great books are. (Dig deeper into this amazing read here, here, and here.)

15. Becoming Wise: An Inquiry into the Mystery and Art of Living — A refreshing signal in world of noise that should be read and immediately re-read. There is so much goodness in here that scarcely will you find more than a page or two in my copy without a mark, bent page, or highlight. The entire book offers texture to thoughts you knew you had but didn't know how to express.

16. The Happiness Trap: How to Stop Struggling and Start Living
The way most of us search for and attempt to hold onto fleeting moments of happiness ends up ensuring that we’re miserable. A great practical book on developing mindfulness, which is so important in many aspects of your life, including satisfaction. Might be the best self-help book I’ve read.

 

 

When Breath Becomes Air: What Makes Life Worth Living in the Face of Death?

“When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.”

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Dr. Paul Kalanithi was 36 years old and in his final year as a neurosurgical resident when he was diagnosed with terminal cancer. His beautifully written memoir, When Breath Becomes Air, published posthumously, chronicles his lifelong quest to learn what gives life meaning.

Kalanithi’s wife Lucy, also a doctor, explains in the epilogue why he chose to write about his experience.

Paul confronted death – examined it, wrestled with it, accepted it – as a physician and a patient. He wanted to help people understand death and face their mortality. Dying in one’s fourth decade is unusual now, but dying is not.

In a letter to a friend, he writes, “That’s what I’m aiming for, I think. Not the sensationalism of dying, and not exhortations to gather rosebuds, but: Here’s what lies up ahead on the road.”

In When Breath Becomes Air, Kalanithi shares his journey along that road as he transitions from doctor to patient and comes face-to-face with his own mortality.

As a student

Before studying medicine at Yale, Kalanithi had earned a BA and an MA in English literature, a BA in biology and an MPhil in the history and philosophy of science and medicine. He was interested in discovering where “biology, morality, literature and philosophy intersect”.

I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful? I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.

Throughout college, my monastic, scholarly study of human meaning would conflict with my urge to forge and strengthen the human relationships that formed that meaning. If the unexamined life was not worth living, was the unlived life worth examining?

After years of theoretical discussions about mortality and the meaning of life, he came to the conclusion that “direct experience of life-and-death questions was essential to generating substantial moral opinions about them”. And so, he chose to study medicine.

As a physician

In Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande, calls for change in the way medical professionals deal with illness. While medical science has given us the ability to extend life, it does not ask – or answer – the question of when life still has meaning.

The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet – and this is the painful paradox – we have decided that they should be the ones who largely define how we live in our waning days.

As a neurosurgical resident, Kalanithi was well aware of this paradox and the interplay between our medical choices and the things that give our lives meaning.

While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact…At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability – or your mother’s – to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

Both Gawande and Kalanithi help us recognize that knowing what we – and our loved ones – value in life will inform the choices we make about death when that time comes.

As a patient

What happens to your identity and sense of purpose when your plan for the next 40 years is suddenly wiped off the table?

My brother Jeevan had arrived at my bedside. “You’ve accomplished so much,” he said. “You know that, don’t you?”

I sighed. He meant well, but the words rang hollow. My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced. The lung cancer was confirmed. My carefully planned and hard-won future no longer existed.

After the diagnosis, Kalanithi was forced to re-evaluate what was most valuable to him.

While being trained as a physician and scientist had helped me process the data and accept the limits of what that data could reveal about my prognosis, it didn’t help me as a patient. It didn’t tell Lucy and me whether we should go ahead and have a child, or what it meant to nurture a new life while mine faded. Nor did it tell me whether to fight for my career, to reclaim the ambitions I had single-mindedly pursued for so long, but without the surety of the time to complete them.

Like my own patients, I had to face my mortality and try to understand what made my life worth living…

The old adage to ‘live each day as if it were your last’ loses strength under scrutiny. What gives our lives meaning on any given day depends to some extent on how imminent we believe death is.

Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die – but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d go back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?

In searching for solace, Kalanithi returned to his love of literature.

And so it was literature that brought me back to life during this time. The monolithic uncertainty of my future was deadening; everywhere I turned, the shadow of death obscured the meaning of any action. I remember the moment my overwhelming unease yielded, when that seemingly impassable sea of uncertainty parted. I woke up in pain, facing another day – no project beyond breakfast seemed tenable. I can’t go on, I thought, and immediately, its antiphon responded, completing Samuel Beckett’s seven words, words I had learned long ago as an undergraduate: I’ll go on. I got out of bed and took a step forward, repeating the phrase over and over “I can’t go on. I’ll go on.”

That morning, I made a decision: I would push myself to return to the OR. Why? Because I could. Because that’s who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.

In one of the most profound passages of the book, Lucy and Paul discuss whether to have a child, “Don’t you think saying goodbye to your child will make your death more painful?” she asks, and he responds, simply, “Wouldn’t it be great if it did?”

Kalanithi comes to believe that life is about striving, not about avoiding suffering.

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

He leaves behind this impassioned message for his daughter, Cady, eight months old at the time of his death.

When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.

When Breath Becomes Air, paired with Being Mortal, will get you thinking about what matters in your life and about ‘what lies up ahead on the road'.

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Two related Farnam Street Posts:

Tiny Beautiful Things. A famous advice columnist operates under a pen name allowing her to be intimate and frank — dispensing advice built on a foundation of deep personal experience.

Richard Feynman’s Love Letter to His Wife Sixteen Months After Her Death. The famous physicist understood more about living a meaningful life than physics.

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