When Breath
Becomes Air
Paul
Kalanithi (Random House, 2016)
Paul
Kalanithi was a brilliant young neurosurgeon near the end of his
training at Stanford when he learned he had Stage Four lung cancer.
His report of crossing the boundary from doctor to patient is the
fulfillment of his youthful ambition to become a writer; his death in
the spring of 2015 represents not just a loss to his legion of family
and friends, but to medical writing, as well.
It may not
be surprising that someone facing death in his thirties should think
deeply about the meaning of life, but Dr. Kalanithi seems to have
done so from a very young age. The son of first-generation Americans
from India, Paul moved with his family into the Arizona desert at
the age of ten, where his father established a cardiology practice.
His mother, dismayed by the difference in the educational
opportunities out West, set out a course of reading, into which young
Paul dove avidly. He read Robinson Crusoe and Billy Budd,
Brave New World and Hamlet, his wide-ranging curiosity
forming his moral imagination.
At
Stanford, he studied biology and neuroscience alongside literature
and philosophy, eventually deciding on medical school, which "would
allow me a chance to find answers that are not in books, to forge
relationships with the suffering, and to keep following the question
of what makes human life meaningful, even in the face of death and
decay." He found that it did so, but also put up some barriers:
to dissect a cadaver, you may have to suppress your awareness of its
history as a human being. "Seeing the body as matter and
mechanism is the flip side to easing the most profound human
suffering. By the same token, the most profound human suffering
becomes a mere pedagogical tool."
Becoming a
neurosurgeon, studying neuroscience on the side, was the natural
outgrowth of his interests, and of his drive to excel. "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." He was only a year and half from finishing his residency
when backaches, fatigue, and weight loss announced the abrupt
shortening of his brilliant career.
The
question of meaning now arose in a more demanding form. He would not
have the luxury of spending twenty years in research and teaching,
then twenty more as a writer. Should he and his wife try to have a
child he would not live to see grow up? His oncologist refused to
predict how long he had to live, beyond assuring him that he could
complete his residency. Not only was the span of his life unknowable,
as he knew very well from the doctor's side of the desk, it depended
on what he valued. 'The tricky part of illness is that, as you go
through it, your values are constantly changing. You try to figure
out what matters to you, and then you keep figuring it out.... Death
may be a one-time event, but living with terminal illness is a
process."
Though he
must have had a harder and harder time concentrating, Paul Kalanithi
kept writing through his first rounds of cancer treatment. He writes
about the last day he performed surgery, and the way his life is
already described in the past perfect tense: "Most ambitions are
either achieved or abandoned; either way, they belong to the past."
Early on, he tried to participate in his own care, suggesting lines
of testing and arguing about treatment. He shows us the loss, and the
relief, of letting that go.
His wife,
Lucy, had to finish the book, describing the family gathering around.
As his energy fades, his baby daughter learns to coo and to sit up.
They passed each other on earth for only eight months, of which he
must have treasured every second. Lucy writes, "He let himself
be open and vulnerable, let himself be comforted. Even while
terminally ill, Paul was fully alive; despite physical collapse, he
remained vigorous, open, full of hope not for an unlikely cure but
for days that were full of purpose and meaning."
In that he
succeeded resoundingly, and I am grateful.
Any Good
Books – February 2016
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