RL43: How do you make decisions when your life is short?
One of the most profound books I read this year asks this question of its readers.
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Last week, I read the book, “When Breath Becomes Air”
If you haven’t read the book, pick up a copy here - you’ll thank me later.
The author, Paul Kalanithi, was in the final year of a grueling neurosurgery residency when he was diagnosed with terminal cancer.
It’s ironic that a doctor who has delivered terminal cancer diagnoses to so many people would be handed the same diagnosis at such a young age.
His career until that point had been characterized by a few key pillars -
Delayed gratification - finishing 7-years of residency before a big payoff
Making difficult life and death decisions
Refining his bedside manner as he told patients that they would not survive their cancer diagnosis
He had also spent many years of his life studying literature in school - first as an undergrad, then as a graduate student prior to medical school.
So when his diagnosis came, he struggled with a question -
Should I finish my residency and become a doctor or put down my scalpel and become a writer?
As a Doctor, Paul Hated Mortality Curves
There are datasets about how long patients live with various diseases - these are known as Kaplan-Meier curves.
The graphs start at 1, meaning that all patients are alive at t=0, and drop off as time increases. By day 1,000, only a small percentage of the original set of people are still alive.
When most of us see such a curve, we’re mortified. If we were given this curve, the natural inclination is to look at the outliers and expect that that will be us - we will beat the odds and live on.
That’s not how statistics work, unfortunately.
If only 1 out of 100 patients lives 3 years, we can’t all be that 1 - about 99% of us will be the other 99.
Paul knows this, and accepts his fate nobly.
The question he poses to his doctor is the same question that he regularly endures from patients - how long will I live?
The implications of the question
This is where things get profound -
Paul’s cancer retreats after his initial treatment.
He’s allowed to go back to operating and finish his residency - it’s unclear if he will live for 1 year or 10.
If he is to live for another 10 years, he would like to finish his residency, become a full-fledged doctor and begin his professional career.
If it’s closer to 1-year, he’d rather spend as little of that time as possible in residency, opting to spend the time with his family and writing.
This makes perfect sense, and I suspect most of us would have the same thought process.
Here’s the mind-fuck - Paul has the exact same amount of information that he had before the diagnosis.
Before his diagnosis, he didn’t know if he’d live another 10-years or be hit by a car the next day. Indeed, one of his fellow residents was hit by a car and killed during his time in training.
So what do you do when you’ve delayed gratification for your entire life only to be given an uncertain amount of time to live?
I’ll let you read the book to find out.
In the interim, here’s what I learned from the book -
Live a life aligned with your core values, because you never know how long you have left.
Continue to cultivate relationships with those you care about - sadly, the end is fairly close for all of us.
Death is terrifying, but it’s also the last great adventure into the unknown.
Spending time thinking about our own mortality makes the day feel more special - it’s only a very brief amount of time that we’re on this earth.
When making decisions, it’s a helpful framework to ask the question, “What would I do if I only had a year left?”
For an entrepreneur who often justifies time spent working as acceptable delayed gratification, the book was a great reminder to wake the fuck up, be present, and not work too hard.
Each day is a gift, and I’m glad to be able to share this brief moment with you.
Pick up a copy of this remarkable book here (I receive some $ from Amazon if you purchase through this link).
What is the last book that moved you in a profound way?
Have you read this extraordinary book?
What were your takeaways?
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