'When Breath Becomes Air': A dying neurosurgeon's moving farewell
January 31, 2016 12:00 AM
Norbert von der Groeben/Stanford Hospital and Clinics
Dr. Paul Kalanithi at Stanford Hospital and Clinics in 2014.
"When Breath Becomes Air" by Paul Kalanithi.
By Eileen Weiner
“When Breath Becomes Air” (Random House, $25) is a remarkable memoir and meditation on living and dying. With its posthumous publication, neurosurgeon Paul Kalanithi, who died in March 2015 at age 37, joins the ranks of physician-writer-philosophers who eloquently explore the subject of facing mortality, their patients’ or their own.
Dr. Kalanithi was a writer before he was a doctor, and his engagement with literature and philosophy enriches his perspective and infuses his syntax; this short book is beautifully written, with literary references illuminating personal insights. He earned undergraduate degrees in human biology and literature from Stanford, master’s degrees in literature from Stanford and in the history and philosophy of science and medicine from Cambridge. Planning to be a writer, he rejected the examples set by his physician father, uncle and elder brother.
From an early age Paul Kalanithi was seeking “a deeper understanding of a life of the mind,” studying literature and philosophy “to understand what makes human life meaningful,” but also neuroscience “to understand how the brain could give rise to an organism capable of finding meaning in the world.” Ultimately, he decided that “direct experience of life-and-death questions was essential to generating substantial moral opinions about them … it was only in practicing medicine that I could pursue a serious biological philosophy.” Following a year of intensive pre-med coursework he was accepted at Stanford Medical School, where he eventually chose the grueling specialty of neurosurgery.
In 2013 he was chief resident in neurosurgery at Stanford, nearing the end of 10 years of training, preparing to launch a singular, shining professional future. He planned to not only practice neurosurgery but also continue research in neuroscience: The surgeon-scientist is the pinnacle of accomplishment in this medical field. Instead, as he writes, “the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated” with a diagnosis of stage 4 metastatic lung cancer.
This memoir tells the story of the almost two years from that diagnosis until Dr. Kalanithi’s death, a tale of living while dying. The book also presents a fascinating portrayal of the training of a surgeon, including the toll that process takes on the individual and personal relationships, along with glimpses of the complicated doctor-patient relationship in high-stakes specialties such as neurosurgery and oncology.
Personal chronicles about any tragic situation, particularly those involving an untimely death from illness, bear a certain burden of expectation. Some readers will look for answers to apply to their own life challenges and situations. Others will seek new insights to old questions, borrowed epiphanies to store away, without having to face (yet) their own personal tragedies. These readers may find some of what they seek in “When Breath Becomes Air,” but the real gift of this book is the opportunity to reflect on the considerations and choices of one unusually thoughtful individual about how to use his limited time to its best advantage, for him and his family.
His answers will change to accommodate shifts in his treatments and strength, but Dr. Kalanithi was able to identify and pursue what was most important to him in each circumstance: He knew what he wanted to do if he were to live three months, two years, five or 10. Among the choices he and his physician wife made was to have a child. Their daughter was born nine months before her father’s death, and the passages describing their time together are among the most moving in the book.
A line from Samuel Beckett becomes Dr. Kalanithi’s mantra: “I can’t go on. I’ll go on.” Ever the writer, he breaks the news of his diagnosis in an email to a close friend saying, “The good news is that I’ve already outlived two Brontës, Keats and Stephen Crane. The bad news is that I haven’t written anything.” No longer true, with this unforgettable memoir destined to become a classic.
Eileen Weiner, a member of the National Book Critics Circle, lives in Shadyside (firstname.lastname@example.org).
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