What gives life meaning?
Is it love, faith and family or is it making a difference, striving to make the most of one’s talents in the time on hand. These questions loom large in Dr. Paul Kalanithi’s memoir When Breath Becomes Air.
At thirty-six, Paul was the chief resident in neurosurgery at Stanford. He held degrees in literature and in the history and philosophy of medicine. He was about to graduate to become a neurosurgeon and neuroscientist when he was diagnosed with an aggressive form of cancer.
When Breath Becomes Air is written in two parts. The first part describes why Paul decided to become a neurosurgeon while the second part describes his transition from being a doctor to a patient as his health deteriorated.
Paul was a second generation immigrant, his parents were Indian doctors and he spent his formative years in a sun-kissed (and rattlesnake infested) town in Arizona. His mother, despairing at the state of the local school system, had Paul and his brothers read widely – a story familiar to many second generation immigrants. This led to a love of literature that stayed with Paul throughout his life and has a major influence on this memoir.
At Stanford, Paul majored in English literature and Biology.
“I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful? I still felt literature provided the best account of life of the mind, while neuroscience laid down the most elegant rules of the brain.”
Frustrated with academia, Paul turned to medicine. He specialised in neurosurgery, an especially challenging field. Paul describes the pressure of being a neurosurgeon – the hours are long and the pace unrelenting; an incision off by a few millimetres could lead to “locked-in” syndrome.
Paul loved his job and it’s attendant challenges. He struggles with his perceived lack of empathy and describes how the challenges of his job strained his marriage. He describes, in elegant prose, a doctor’s role in helping those who are facing horrendous decisions.
“We had assumed an onerous yoke, that of mortal responsibility. Our patient’s lives and identities may be in our hands, yet death always wins.”
Paul’s career and plans for the future – a career as a neurosurgeon and neuroscientist; having a family and financial stability were all put on hold by the diagnosis of terminal cancer. He lost weight, and as his health deteriorated, he was put on a variety of medical and physical therapies.
A new biological treatment led to some improvement and allowed Paul to go back to work. He was back in the operating theatre following intensive and painful physical therapy. He and his wife Lucy decided to have a child. When asked whether having a child would make his death more painful, “Wouldn’t that be great?”
Paul suffered a remission, and, in the end, had no choice but to give up work and attempt more aggressive treatments.
In the final, moving, pages of When Breath Becomes Air – Paul knew time was running out,
“Everyone succumbs to finitude.. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder towards the goals of life, flattens out to a perpetual present.”
The book finishes with Paul spending time with his daughter Caddy and wondering what she would make of her absent father.
Lucy Kalanithi, in a moving epilogue to Paul’s memoir, describes Paul’s final days. We find out that the book is unfinished – Paul’s health deteriorated too fast for him to complete When Breath Becomes Air. Yet, we also hear about his drive to finish the book; struggling to find the right words through a fog of drugs and pain.
I was in tears when I finished the book. I suspect most people would be.
As a young man, Paul found meaning in literature, as a doctor in helping and healing his patients, and finally, as a dying man, he found meaning in spending time with his infant daughter, his family and in God. What I found were humanity and inspiration.