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