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If you can fully embrace the unpredictability of your death, you will truly live in the present and appreciate every moment before you now.

If you can fully embrace the unpredictability of your death, you will truly live in the present and appreciate every moment before you now.

None of us can predict when and how we will die. If you can fully embrace the unpredictability of your death, you will truly live in the present and appreciate every moment before you now.
- +positive masters+, Jon Riki Karamatsu, 1/20/2020 -

On Thursday, January 17, 2020, my mom called my cell phone. Her voice was filled with elation and joy, "Mia got the job at Stanford University!" My younger sister Mia is a trauma care doctor, a partner of a group of medical doctors at California Pacific Medical Center at San Francisco, California. 

"Oh man, I'm so happy! I'm so happy for her! This is awesome!" My voiced cracked with joyful laughter. 

My mom continued, "Earlier, I heard dad cheer, 'Wohoo!' probably when Mia told him the good news!" My dad was talking with Mia on the phone before my mom. For those of you who know my dad, this type of celebratory action by him is extremely unusual. He's normally stoic and logical, fitting for a former electrical engineer who helped build and fix nuclear submarines and warships at Pearl Harbor, Hawaii.

Mia fulfilled a dream of my mom's mom, my grandma Ellen Sakai. When my two sisters and I were little, she told us that we should become doctors. She emphasized how important doctors were. Grandma also told many of her other grandchildren this.

One Summer, while I attended Summer classes at the University of Hawaii at Manoa, majoring in political science, I was living with her and grandpa Tadao Sakai at their small home on Citron Street, in the heart of McCully, Honolulu, Hawaii. Grandma and I had another one of those talks about whether or not I would become a medical doctor.

"Grandma, I plan to go to law school."

"Ah, lawyers are dime-a-dozen," she answered.

"I'm not going to be a regular lawyer, I'm going to be President of the United States."

I smiled as my grandma laughed away. "No one knows you," she said while continuing to laugh, "You have to be like Jon Yoshimura (a Honolulu politician who became the Chairman of the Honolulu City Council and had a segment on the local news station called "Ask a Lawyer" where viewers got their legal questions answered.). Why don't you become a doctor?"

Years later, when Mia participated in the white coat ceremony at the John A. Burns School of Medicine, University of Hawaii at Manoa, Grandma Sakai's face was filled with pride and joy. So was the expression on my grandma Bessie Karamatsu's face, my dad's mom. There was immense pride among all of us, my dad, mom, baby sister Lara, and I. To serve others as a medical professional is a great calling. Every single one of us needs a doctor. We all get sick. We all will die. It's our doctor who will help us when we face every illness and disease, and ultimately, our death. It's not just the skills and knowledge that our doctor continuously develops, but the empathic and caring words that he/she says to us that will help comfort our suffering.

"When Breath Becomes Air," an incredible memoir by Paul Kalinithi, who at the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon and neuroscientist, was diagnosed with stage IV lung cancer.
Just as my sister Mia was embarking on an exciting new path of medical care practice, public speaking, and research and development to create new healthcare services and products at Stanford University, I picked up the book "When Breath Becomes Air," an incredible memoir by Paul Kalanithi,who at the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon and neuroscientist, was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Paul's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life?" 

As I read "When Breath Becomes Air," I felt a deep sadness on how Paul Kalanithi's potential was cut short from cancer, which mixed with the happiness I felt for my sister Mia who will be heading to Stanford University, starting this Summer to expand her medical career as a practitioner and researcher. The connection, Stanford University, made Paul's story and my sister's story very real, on top of them being the same age. You see, Paul did amazing work for Stanford University before he died. In addition to his work in the operating room as a neurosurgeon, he was a neuroscientist in a lab at Stanford University, where he worked on neural prosthetic technology that would allow paralyzed people to mentally control a computer cursor or robot arm. I kept thinking on how Mia and many other doctors will continue on their trajectory, something Paul would have loved to do.

I read this book in two sittings. His journey opened my eyes. I was in awe of the work neurosurgeons and neuroscientists do. It wrenched my heart as he struggled with his emotions and logic when faced with extremely difficult situations that brain trauma patients and loved ones of the patients face such as deciding whether to keep a patient alive knowing that the patient could risk losing knowledge of one's self and everyone and everything around him/her. Without this function, a person loses his/her purpose. The innocence and excitement felt by Paul and his fellow medical classmates were replaced by fatigue, stress, and death after they ventured into their different residency programs at hospitals and medical centers across the country.

Paul's writing brought me into his world as if I was with him through his every struggle. I loved it when things seemed to be getting better for him and his wife. I chuckled at his humor. When he cried, I cried. I had to pause from my reading numerous times as tears streamed down my cheeks. In fact, I cried as I wrote this article in a Starbucks coffee shop in Waikele, Hawaii packed with people. That's how impactful Paul's book has been on me. He wrote it as he was dying, racing against precious seconds. I felt every word of his as if he was talking to me.

In the past, I've written numerous times about death and how embracing it can motivate us to be appreciative of everything we have and make the most of our life. However, unless I face my own dying moments, I won't fully understand what it's like to be dying, whether its quick and instant or slow and gradual. Likewise, none of you will know until it's your time as well. Well, Paul, through his writing shows us exactly what he was feeling as he moved towards his death. His experience became my experience. I could see myself in his life and by doing so, I felt myself experiencing death surrounding me. I will forever keep Paul's book close to me, opening it every time I stress about challenges for my businesses or clients, financial hardship, public ridicule for my failures, and facing prison time for my driving under the influence case, all of which look so small in comparison to dying. 

I've lost a lot of loved ones over my lifetime. Last year was especially hard with the passing of my aunty JoAnn Matsumoto (My mom's cousin and a former elementary school teacher), family friend Eric Kanemoto (My soccer coach, Cub Scout Master, Intermediate School teacher for metal shop, and my dad's close friend. He and my dad coached my soccer teams, led the cub scouting program I was in, volunteered in the parent and teacher association for my Pearl City High School, and worked together on many other projects. They enjoyed talking with each other and the simple pleasures of life), and uncle Glenn Karamatsu (My dad's younger brother and co-founder of a civil engineering firm in Hawaii). Reading "When Breath Becomes Air" has helped me cope with the deaths of my loved ones. 

I love life. I'm extremely grateful to have an opportunity to try many things while I'm alive. I'm super appreciative of my dad, mom, sisters, nieces, nephew, relatives, and friends. And I'm thankful to be able to speak to you. As I move closer towards my death, I hope I'll be strong, vulnerable, joyful, sad, and loving. After all, I went through it with Paul and felt his breath become air. 

Love your life and make the most of it.

Dr. Paul Kalanithi, a neurosurgeon and neuroscientist, wearing his white coat.


I dedicate this article to Paul Kalanithi's wife Lucy, daughter Cady, mom, dad, siblings, family, and friends.

Paul and Lucy Kalanithi at their wedding.

Dr. Paul Kalinithi, Lucy Kalanithi, and their daughter Elizabeth Acadia.

Dr. Paul Kalanithi, Lucy Kalanithi, and their daughter Elizabeth Acadia.

I also dedicate this article to my dad, mom, sisters, brothers-in-law, nieces, nephew, extended family, and friends.

To read Paul Kalinithi's "When Breath Becomes Air," click here: When Breath Becomes Air by Paul Kalanithi.

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