Paul Kalanithi teaches us why technical excellence is not enough

Paul Kalanithi, M.D., was a neurosurgeon and writer. He graduated from Stanford University in 2000 with a B.A. and M.A. in English Literature and a B.A. in Human Biology. He earned an M.Phil in History and Philosophy of Science and Medicine from the University of Cambridge before attending medical school. In 2007, Paul graduated cum laude from the Yale School of Medicine. He returned to Stanford for residency training in Neurological Surgery and a postdoctoral fellowship in neuroscience. In 2013 he was diagnosed with stage IV lung cancer, though continued to work, completing his neurosurgery residency in 2014. He also authored the book When Breath Becomes Air, which detailed his journey through treatment and eventually his death in March 2015. He is survived by his wife Lucy and their daughter Cady.

Although I’d heard of this book before, I first stumbled across it in a charity shop about one month after I’d finished 5 months of chemotherapy for colorectal cancer. I cried my way through much of the book, but I had to read about Paul’s journey and his exploration of life and death.

Working, as he saw himself, at “the crucible of identity” (the human brain), he was a man who was:

Compelled by neurosurgery, with its unforgiving call to perfection; like the ancient Greek concept arete, I thought, virtue required moral, emotional, mental, and physical excellence. Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: neurosurgery, ICU medicine, neurology, radiology. Not only would I have to train my mind and hands, I realised, I’d have to train my eyes, and perhaps other organs as well. The idea was overwhelming and intoxicating.

In his first day at the hospital as an intern, the chief resident had said to him: “neurosurgery residents aren’t just the best surgeons, we’re the best doctors in the hospital. That’s your goal. Make us proud”. Paul humbly recognised that being a good doctor was about more than just operating on patients, but he feared that he was: “on his way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focused on the rote treatment of disease – and utterly missing the larger human significance”.

He also feared that “amid the tragedies and failures, [he] was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient. Technical excellence is not enough. As a resident, my highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness”.

And so, with a renewed focus, informed consent – the ritual by which a patient signs a piece of paper, authorizing surgery – became not just a juridicial exercise in naming all the risks as quickly as possible  but an opportunity to forge a covenant with a suffering compatriot:

Here we are together and here are the ways through – I promise to guide you as best as I can to the other side.

Transcending technical excellence, to a place where we can guide those we work with is just as important concept in business as it is in medicine (though the implications differ). Whether we are coaching, consulting, mentoring or otherwise advising the entrepreneur or employee who seeks our help, we should remember that technical excellence is not enough to take us into a truly trusted space. We must have the empathy and compassion to acknowledge another’s situation, guide them to a better understanding of it and on through it. Paul, from the altar of mastery and expertise, thank you for reminding us all just how important this is.