“What would you do if today was your last day?”
Over 20 years as a transplant doctor at Stanford University Medical Center, I asked thousands of patients this very question when I first met with them to discuss getting a lifesaving lung transplant. It was a way to get them talking, and for me to learn what the person valued: in short, not if they wanted to go on living, which was obvious because the patient was in my clinic room — but why they wanted to go on living.
To hear their answers was a unique privilege. Most of us don’t get to ask that question of people who had weeks, months and sometimes years to sit on the side of their own coffin and contemplate what life really meant to them. Ultimately, they taught me the difference between mere lifespan and health span. Listening to them and sharing some of their stories is akin to participating in a unique kind of master class. If we know how we would spend our last day, we can then make decisions about how to spend our second to last day, our last year, our last decade and every day from this moment forward.
If we know how we would spend our last day, we can then make decisions about how to spend our second to last day, our last year, our last decade and every day from this moment forward.
When I met *Nancy in my office, she was emaciated and I could tell she knew that death was an imminent possibility. I learned that she’d been plagued by a feeling of not being enough, instilled by her parents from an early age: not smart enough, not thin enough. She felt that she needed to do more, be more. She walked around with this heavy weight every day of her young life. But then she found a drug that made her feel better. With crystal meth, she felt she could conquer the world, that she could be anything she wanted, no matter what anyone else thought. That feeling lasted until her addiction turned into a life-threatening lung disease called pulmonary hypertension. When I asked her “What would you do if today was your last day?” she thought for a moment, then said in hushed tones, “All my life, I tried to be what everyone else wanted me to be — the pretty girl, the smart girl, the girl who achieved stardom.” Then she paused. “So, on my last day, I would want to live up to only one person’s expectations: my own.” She slowly nodded as a way to make her point. “That way, I could at least have one day of peace.”
I asked my nurse to get her on the waiting list as soon as possible. It occurred to me that when I asked thousands of patients my question, not one answered, “Gee, I wish I had lived my life in accordance with other people’s expectations — that would have been awesome!”
I asked myself: Have we really spent enough time thinking about how we would live if we were free of expectations? And would we regret living by our own accord at the end of our days? I’m pleased to share that Nancy did get the chance to reboot and live the way she wanted to, with two healthy lungs.
Not all patients are like Nancy. We’re taught to treat everyone the same in medical school, but Larry tested me.
When *Larry, a white man, learned that his life had been saved by a transplant using a donated lung from a Black man, he aggressively questioned why he hadn’t been informed earlier — and given the opportunity to refuse the lung. It left all of us in the clinic room speechless, as Larry’s words echoed with the weight of centuries-old hatred, ignorance and prejudices.
But as the months went by in Larry’s recovery, something shifted within him. Perhaps the question of how he would live his last day lingered, or his newfound health gave him an appreciation for the gift of life, but either way, a curiosity in him stirred about the person who had given him a second chance. He sought out the family of his donor, thanked them in a sincere way, closely connecting with people he had once viewed through a lens of ignorance. In a moment of profound humility, at one of our post-op check-ins, Larry admitted that he had shaped many of his beliefs from ignorance. He even expressed shame that he had spent so much of his life judging people based on race, acknowledging that “everyone’s blood runs red.” I assured him that it did.
Although I have advocated for patients who need a transplant no matter their race or socioeconomic status, I wondered about prejudices we carry within us that we are not fully conscious of. Larry, for example, was so blinded by prejudice he was ready to give back a healthy lung. As opposed to spinning down into a depressing thought cycle about deeply embedded prejudices and damaging judgements, I asked myself: What opportunities for growth, connection and happiness might we discover if we shed our protective layers against those we consider “other”? And how does considering health span, and not just lifespan, encourage us to do that? It seems most people wouldn’t waste their last day on judging and hating others.
Lastly, meet *Katherine. Katherine had been sick most of her life with cystic fibrosis, hospitalized over 40 times during her 31 years on the planet. When she wasn’t in the hospital, Katherine adhered to a treatment regimen that took 4-6 hours per day. The rest of the time, exhausted, she tried to stitch together a life. That life included a man named Henry, whom she met on a dating app. When Katherine told Henry, after a few dates, that she had CF, Henry said, “I know.” “How?” Katherine asked.
“My sister did, too. She died when we were young. I helped my parents take care of her.” Henry knew what the disease looked like, long before he met Katherine, and perhaps had received his own master class in how to live through his experience with his sister. Instead of running away from Katherine, Henry ran toward her. They went on to marry and found themselves in my lung transplant clinic one day as Katherine’s lungs got worse and she was bedridden, bound to oxygen 24/7.
They held hands as I discussed the process involved with getting a transplant. When I was finished with the logistics, I asked her, “What would you do if today was your last day?” Tears ran down Katherine’s face before I could even get the entire question out. I looked over at Henry, and he was crying too.
“That’s the easiest question of the day, doc,” she said. “I would spend it with Henry, walking in a park by our house, holding his hand, telling him how much I loved him, how he kept me going. And when we couldn’t walk anymore, when I gave out, I would sit with him on a bench overlooking one of the lakes in the park and tell him that his love has made me the luckiest person alive, not just now, but ever.”
I had no follow-up questions.
Luckily, because most transplants are successful, including Katherine’s, my patients had a chance to mid-course-correct, to hit the most powerful reset button there is. But they’re not exceptions to the rule: The clock is running — for all of us. If we truly accept the fact that we don’t have forever, can we identify what really matters to us, and make the changes needed to live with that as our North Star?
My guess is that if everyone did this, we would stop trying to find what matters on our screens, on social media, or through the echo chamber of cable news.
We are one of the most sick, depressed, anxious and stressed-out cultures in the world — and yet we are obsessed with longevity. It seems odd that we are obsessed with lifespan, but the quality of our life is usually, well, sucky? (Yes, that’s a medical term.) So what’s keeping us obsessed with trying to stay alive longer when we have yet to determine what would comprise our best life?
My hunch is that while we spend an ungodly amount of time on external things like our appearances, overpacking out schedules, striking through the to-do list, and of course somehow making time for doomscrolling, we spend hardly any time on our inner life, going deep into self-discovery. That is what I took away from the 20-year master class that my patients gifted me — that it’s important we spend time doing the contemplative, meditative, looking-within work, which includes asking ourselves the hard question of what we would do if we had one day to live.
Spend the time now thinking about what really matters to you. You will win if you spend every day as though it may be your last — because one day, it will be.
*Names of patients have been changed to protect their privacy.