Saturday, July 16, 2016

One Man's Mortality

When Breath Becomes AirWhen Breath Becomes Air 
by Paul Kalanithi

"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 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." (p 115)

I cannot remember reading a more courageous book. The author, a neurosurgeon who was both a reader and a writer, was able to face being diagnosed with stage IV lung cancer and write about his experience of being treated. More than that he writes about a demonstration of transformation through his own example; first from a young student of literature into a Neurosurgeon/ Neuroscientist; and second, from an intelligent thriving man into a seriously ill man facing the imminent nature of his own mortality. How he was able to face both that battle and his own limitations that resulted from the battle comprise this inspirational story.

The demands placed upon a medical student are tremendous.  They are described in detail with a beautiful prose style that blends reality with metaphor in a seamless way. These demands are nothing compared to the demands that Paul placed on himself as he traversed the difficult course toward his twin goals of neurosurgeon and neuroscientist. His residency is described as a breathless experience, yet one that allowed him eventually to breathe a little as he observes, "By this point in my residency, I was more experienced. I could finally breathe a little, no longer trying to hold on for my own dear life." (p 88)
He describes the tension when operating on the brain or near the spinal cord; where minuscule movements can make the difference between life and death or, even worse, life without some necessary brain function. The suspense of these moments is palpable for the reader.

After being diagnosed with lung cancer and beginning to undergo treatment that, perhaps, might extend his life enough to provide at least the possibility or part of the life he had originally planned, he underwent periods of pain that made his life incredibly difficult. One thing from his earlier life became a life-saver, however temporary, for him. It is a moment when he shares, "Lost in a featureless wasteland of my own mortality, and finding no traction in the reams of scientific studies, intracellular molecular pathways, and endless curves of survival statistics, I began reading literature again: Solzhenitsyn's Cancer Ward, B. S. Johnson's The Unfortunates, Tolstoy's Ivan Ilyich, Nagel's Mind and Cosmos, Woolf, Kafka, Montaigne, Frost, Greville, memoirs of cancer patients--anything by anyone who had ever written about mortality." (p 148) He was trying to make sense of death and find a way to begin to define himself with a vocabulary that was meaningful and helpful. It was a vocabulary that would help him understand his own experiences. It was a process that worked as he concluded, "And so it was literature that brought me back to life during this time. . . I got out of bed and took a step forward, repeating the phrase over and over: 'I can't go on. I'll go on.' [Beckett]" (p 149)

He was able to return to work for a period of time. Not at the level he had been at when first diagnosed, but at a level that allowed him to contribute and attempt to be the surgeon he once was. But the joy was gone, and eventually the cancer returned. Paul writes eloquently of the final days with his wife and new-born baby. Yet his life did not have the longevity that his words would. His life, his breath, allowed him to share a story of fortitude and courage, becoming an inspiration for his family, friends, and all who have the honor to read his memorable memoir.

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Brian Joseph said...

Great review of this book.

I have heard really good things about this from several sources.

Focusing on literature while fighting a terminal l disease seems so meaningful and tragic.

James said...


Thanks for your comment. This is a book that I recommend without reservation. The life of the author was one of the most intelligent, courageous, and meaningful that I have encountered. A classmate in our class on the art and practice of dying handed it to me at the end of class last Tuesday and by the end of the following day I had finished reading the book. I cannot remember the last time a book gripped me quite so completely, mentally, physically, emotionally.