When Breath Becomes Air

The Ultimate How-To Book

When Breath Becomes Air by Paul Kalanithi. New York: Random House, 2016. 228 pages


Despite what recently appears to be a tsunami of meanness in the world, we may be able to find drops of consolation in those pools of compassion that still exist. More often than not we are willing to soothe suffering of others with waves of concern.

As a group, members of the heath care professions seem to have extra reserves of sympathy; otherwise they wouldn’t have chosen a medical profession in the first place, nor would they have remained there for long. Although we personally may have come across an autocratic nurse or a doctor whose so-called “bedside manner” may seem less-than-warm, we generally find comfort within the realm of direct care providers.

The old expression, “Physician, heal thyself” is usually employed as a reprimand, but in the case of Paul Kalanithi, it became a cri de coeur, when his role reversed from doctor to patient. As a resident neurosurgeon at Stanford University, he had just begun a postdoctoral fellowship when he learned that he had contracted lung cancer at age 36.

The devastating news was the germ of Kalanithi’s autobiography, the writing of which required the speed of urgency rather than the protracted reminiscence favored by other memoirists. This is not to say that this book lacks reflectiveness and profound insight. What remains is a powerfully moving account of a universal yet deeply personal existential crisis.

Kalanithi divides the book into two parts. The first, subtitled “In Perfect Health I Begin,” skillfully illustrates the career decision made in his early years. His active interior life began remarkably early, providing an avenue to search for answers to the philosophical questions about the meaning of life which not only nagged him but set him on two roads, one leading to literature and the other to medicine.

With the clarity of scientific discourse, Kalanithi relates his medical training experience, describing procedures with enough details for a layperson to understand without the confusion of inside-baseball-type intricacies. The scenes in the anatomy lab concerning cadavers perhaps might not be for the squeamish, but are significant in showing how Kalanithi and his colleagues eventually comprehend the inherent dignity of a human being. Similarly poignant is the account of his emotional state upon the first time one of his patients died.

The second half of the book, called “Cease Not ‘til Death,” depicts the physical and psychological anguish of discovering one has cancer and undergoing treatment, along with the unbearable knowledge of imminent death. Kalanithi does not shrink from candidly revealing how this devastating illness affects every aspect of his family’s life and pounds its sledgehammer on every decision.

As it turned out, the young neurosurgeon ran out of time before he completed the book, although the reader is not left with a feeling of incompleteness. His widow, Lucy, provides a brief afterword with her own perspective about her husband’s exemplary character. She decries the fact that the book doesn’t show enough of Paul’s sense of humor, but some readers might disagree, finding flashes of endearing wit throughout the book.

Finally, we often read in obituaries that the deceased died “after a courageous bout with cancer.” Ask anyone suffering from cancer if he or she considers himself or herself “courageous.” The patient will vehemently bristle, for no one who has ever had cancer can claim he or she wasn’t paralyzed with fear.

On the other hand, the word “courageous” endows cancer with a power it does not deserve. And no one deserves death, especially a relatively young man with what middle-class women used to describe as “everything going for him.” This brilliant, imaginative doctor had much to offer to the world before being denied further opportunity to share his extraordinary gifts. Yet in his short time on earth Kalanithi managed to give us what might be called the ultimate “how to” book, not to teach us how to die but how to live.

I always remember Aunty the line by one author, (not too old) dying from cancer that, what struck him most once he realized his imminent demise was " the nowness of everything."

Fondest wishes
M.

I finished a book by Anita Moorjani, "What if this is heaven?", this past week which is her second book after "Dying to be me". She came back from her deathbed after her cancer unexpectedly left her.

Thanks for both your comments. YesNo, I will look up Anita Moorjani. And MANICHAEAN, about the "nowness of everything," truly it must mean that when one knows his or her time is short, he or she must make every moment count. On the flip side, I don't agree with some of the advice often given cancer patients -- keeping a cancer journal," sewing needlepoint samplers saying "Cancer sucks," and so forth. In my opinion --which becomes increasingly more humble with each passing day -- it's probably not good idea to let cancer take over one's entire life. It might be better to keep it at bay by regarding it as something a little more than a nuisance. Having a cancer fetish is really self-defeating.