I have read two books recently where I could simply and honestly say, “You should read this.” The second of the two, which I finished reading Saturday morning, seemed to be the appropriate one where I should sit down and capture my thoughts immediately.
When Breath Becomes Air by Dr. Paul Kalanithi has been on the New York Times Bestseller list and was a top book of 2016 on many lists. There’s a reason. This is a book where, as the Times reviewer noted, “Finishing this book and then forgetting about it is simply not an option.”
Paul Kalanithi was a neurosurgeon and writer who – at age 36 and near the end of residency training at Stanford – was diagnosed with stage IV lung cancer. This memoir is his look at confronting death with all the knowledge of a top-trained doctor and all the uncertainty of a human being who imagined a whole life of promise in front of him.
Kalanithi studied English literature, human biology and philosophy before turning to a decade of medical school training. A classic seeker and striver, he was asking the essential questions of life and death while reading literature, seeking answers in words. Then he turned to the real time grappling with life and death that doctors face every day.
The first half of the book explains how he reached that point, of how he fought the idea of becoming a doctor because of his cardiologist father’s absences from his family while Paul was growing up. Paul’s search was for “what makes life meaningful?” He eventually turns to the medical profession, which would “allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.”
At the end of this section entitled “In Perfect Health I Begin,” Kalanithi writes about the suicide of a fellow resident, after a difficult complication in a surgery he is performing. It is an agonizing segue to the book’s second part, “Cease Not Until Death.”
“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 and 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.”
Where the book’s first half looks unflinchingly at the challenges of being a neurosurgeon, Part II takes an equally direct look at facing death. Especially facing death at a time where one’s whole life and promise is still assumed to lie ahead.
There are many brave and wise souls who show up in Kalanithi’s inevitable march. Chief among them is his lung cancer oncologist, Emma Hayward. As the doctor overseeing Kalanithi’s treatment, she shows up throughout the story. But to Kalanithi, her gentle but persistent questions about what really mattered to him and his family, knowing that would change on a regular basis as they faced death, was key. In a 2014 interview for a Stanford Medical Journal, Kalanithi explained this important aspect of the work of the oncologist:
“Patients are bombarded with well-meaning advice, from dietary recommendations to holistic therapy to cutting-edge research. It can easily occupy all a patient’s time, when you ought to also spend time thinking about the priorities in your life (emphasis mine). Physicians can also advise patients, as my dad would insist, that they can stop skipping dessert.”
In his beautiful yet straightforward prose, Kalanithi writes about hope in light of medical statistics, and he notes that “It occurred to me that my relationship with statistics changed as soon as I became one.”
There are many elements of the story of Paul and his wife Lucy’s journey worth mentioning. Especially touching is their decision to have a child, who is born eight months before Paul dies. The book is dedicated to Cady – that child – and Kalanithi’s last paragraph is focused on her life and the meaning of her existence. The epilogue, written by Lucy after Paul’s death, is also heart rendering. I made sure not to read that on the train, as I knew – accurately – that my eyes would well up with tears that I couldn’t control.
But there is one final segment I want to highlight: Paul’s faith. He talks in a straightforward way about his time of doubt, but well before his diagnosis he had returned to his roots in faith.
Paul Kalanithi wrote that although he spent much of his 20s believing in a “material conception of reality” and a “scientific worldview that would grant complete metaphysics” except for “outmoded concepts like souls, God and bearded white men,” he found a problem.
“The problem, however, eventually became evident: to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning — to consider a world that is self-evidently not the world we live in.”
“That is not to say that if you believe in meaning you must also believe in God,” he added. “It is to say, though, that if you believe that science provides no basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn’t have any. In other words, existential claims have no weight; all knowledge is scientific knowledge.”
This is a wonderful book. But Kalanithi would not expect us to find all the answers here. Just like Emma, his voice comes through this book, saying, “You have to figure out what’s most important to you.”
“In the end, it cannot be doubted that each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl driver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth. Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.”
Just read it.
More to come…