When Breath Becomes Air by Paul Kalanithi

When Breath Becomes Air is an incredible, honest book. Written in the face of cancer by a man who happened to have spent the better part of his life trying to gain an understanding of death, the book has the urgency of a story that needs to be told. There is no scope for pretences, there are no airs and, perhaps, Kalanithi held only a vague awareness of a reader in mind, and little concern for the impression the book would have on a prospective reader. Its authenticity is its driving force, which is a rare quality for memoirs.

“Most lives are lived
with passivity toward death — it’s something that happens to you and
those around you. But Jeff and I had trained for years to actively
engage with death, to grapple with it, like Jacob with the angel, and,
in so doing, to confront the meaning of a life. We had assumed an
onerous yoke, that of mortal responsibility. Our patients’ lives and
identities may be in our hands, yet death always wins. Even if you are
perfect, the world isn’t. The secret is to know that the deck is
stacked, that you will lose, that your hands or judgment will slip, and
yet still struggle to win for your patients. You can’t ever reach
perfection, but you can believe in an asymptote toward which you are
ceaselessly striving.” 

I sometimes feel like my childhood was a montage of medicine names
and hospital tales. I grew up around doctors and hospitals and what was
most interesting to me about this book was how so many of Paul’s
experiences with and views on medicine paralleled my father’s. The book
felt very personal. When Breath Becomes Air offers an insider’s view on
medicine, as a
profession, as a calling, as something that exists on the slippery slope
of morality. It gives a glimpse of the doctor’s view that we often fail to consider. 

Medicine, the hard reality of a doctor’s life, requires you to suspend the values you
have internalised – of what is right and wrong, what is permissible and
what is just, and most significantly, what is possible. Kalanithi writes, delicately, about music blasting in the
operation room, about dissecting cadavers in med school and about each time that a doctor has to tell a family that he is
sorry he could not help. 

When Breath Becomes Air is not about cancer. It is written by a man dying of lung cancer, yes. It is most definitely about death, or about life, which is rather the same. But it is not about struggling against the disease. It is not the glorification of a short life, it is not about making the most of your time left, it is no ‘Tuesdays with Morrie’ (as my sister put it) and while there is nothing wrong with being any of these, I appreciated that the book was written not because the man had cancer but because he wanted to be a writer. His diagnosis only sealed the chosen fate.

“Before my cancer was diagnosed, I knew that someday I would die, but I
didn’t know when. After the diagnosis, I knew that someday I would die,
but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one.
The fact of death is unsettling. Yet there is no other way to live.”

This book has a lot going for it. The biggest reason it appealed to me is for how it has planted this narrative in my head – this internal argument that forced Kalanithi to write the book. Have you read Because I could not stop for Death by Emily Dickinson? It is about the constant presence of death in the carriage of life. There is a persistent awareness of mortality in us, that Kalanithi suggests is what being human entails, be it in the form of loss or disease. What then, taking into account the inevitability of death, constitutes a meaningful life? A brilliant young man, in his final hour, muses on how to live.

When Breath Becomes Air lies on a fascinating intersection of
Literature (with an L) and science. Kalanithi writes at length about
studying literature with the aim to untangle the complexities of the
mind and later, almost dissatisfied with the limits of literature,
majoring in neuroscience to analyse the brain and its role in making
life meaningful. He flutters between the two, building a life around the
practice of science in the best of times, seeking comfort in Samuel
Beckett in the worst. He writes about where the two meet, philosophy and
science, their intersection. This book is about what literature and
science offer and what they lack, explained by a man who intimately
knows and loves both.

The book is also about family. About the fate of relationships and ties in life and death. Even as I write this, I wonder how a slip of a book was so many things… and this particular aspect of it, I don’t want to spoil with my words. I leave this for you to explore and experience. Terry Pratchett wrote, ‘no one is actually dead until the ripples they cause in the world die away.’ Paul Kalanithi has left us with a stormy ocean. Do read the book.