When Breath Becomes Air is one man’s account of moving from life to death in a conscious manner; time to process the experience perhaps the only gift of an early terminal diagnosis. What makes Kalanithi’s narrative unique is his investment in life itself: not simply his own, but Life writ large, the mortality of his fellow human beings quite literally in his hands on a daily basis in his work as a neurosurgeon.
“Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living and what devastation makes it reasonable to let that life end,” writes Kalanithini.“Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”
Though Kalanithi finds deep meaning in his work, it was not initially his chosen path. Raised by a family steeped in medicine, at an early age the author marked his father’s absence in family life and vowed never to repeat his sins. Stalked by existential curiosity, Kalanithi pursues degrees in English literature and human biology at Stanford, and later, the history and philosophy of science at Cambridge. Yet his ontological leanings are not satisfied in these arenas, and though he cannot forget the great toll the practice of medicine had on his childhood, Kalanithi soon realizes that medicine has summoned him to its service. He writes, “Augustine’s voice in the garden commanded, ‘Take up and read,’ but the voice I heard commanded the opposite: ‘Set aside the books and practice medicine.’”
From this point on we are guided through the real-life ramifications of Kalanithi’s decision to pursue medicine. The demands of his residency weigh heavily on his marriage, and he and his wife Lucy contemplate divorce. Paul takes a few days with some friends to reflect. While away, he experiences debilitating pain and returns home knowing something is very wrong with his body.
In short order it is determined that Kalanithi has metastatic lung cancer, which usually implies a rapid progression and significantly shortened lifespan, a prognosis that forces him to reframe his future. He and Lucy have decided against divorce; now, they must choose whether or not to attempt to have children. Kalanithi must conclude whether to attempt to finish his residency and push himself toward the distant possibility that he might practice neurosurgery, or to let go of his medical dreams and instead devote himself to writing – to writing this book, specifically – before his inevitable end. Unable to control his own mortality with a scalpel or pen, Kalanithi finds himself at the mercy of something greater. The final chapters of the book explore his end-of-life grapplings, as much personal as universal.
As much as I was heartened by this book, the words that moved most deeply into my marrow were those of the other Kalanithi – Paul’s wife, Lucy. In her epilogue, Lucy is able to communicate with efficiency and mystery something that Paul, for all of the reasons we should love him, can’t quite do, though of course Lucy speaks from the otherworldly position of voice from beyond the [Paul’s] grave, with a hindsight unavailable to the narrator himself. Lucy describes the transition to parenthood amidst a slur of cancer treatments and the terrible strangeness that is the metamorphosis of Alive to Not Alive in the person she loves. She speaks from the point of witness, and thus the pathos is palpable.
If you do, dear reader, decide to pick up this book – a quick read, really – do so with a mind to the end. That is what Paul Kalanithi did, and perhaps this is the very thing that made his life’s story so incarnationally meaningful: knowing, as he did, that it would all be over soon (for his patients, for himself and ultimately, for all of us) he decided to embody all that he believed while there was still time to do it. And then he wrote about it, and now his words live on.
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