Thoughts About Death and Life: When Breath Becomes Air

I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. 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. (pp. 131-132)

Bibliophiles know about When Breath Becomes Air by Paul Kalanithi: the heartbreaking memoir of a highly gifted (degrees from Stanford University, University of Cambridge, Yale School of Medicine) neurosurgeon and writer who was diagnosed with Stage IV lung cancer at the age of 35, only months away from completing his surgical training. The book is dedicated to his infant daughter, the child he and his wife, also a doctor, chose to have after his diagnosis.

Of course the book is sad and poignant for many reasons: first and foremost, because his daughter will grow up without her father. His wife, whom he loved deeply, is now a widow. He was incredibly talented and on the cusp of realizing the pinnacle of his professional training. Given his expertise, he could have helped many more people. Now all that is for naught. His premature end is both tragic and cosmically wasteful. And yet his life was rich and full of meaning.

When Breath Becomes Air is a brave book. Death hovers on almost every page, but the book is not macabre. It’s beautifully written, and at times, even profound in what Kalanithi observes; his perspective shifts back and forth between writer as doctor and writer as patient. He observes death, is aware of death, even feels the presence of death as a medical student and throughout the stages of his training. He writes about how his training taught him to “actively engage with death” and thus, to “confront the the meaning of life.” Being a doctor meant assuming mortal responsibility, and it was a responsibility he embraced forcefully and with passion. Kalanithi was a man who ran toward challenges.

Near the end of his life, contemplating the brief overlap of his life with that of his daughter’s, he muses about what wisdom he can leave her. The message he wrote is this:

When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing. (p. 199)

 

The idea of ‘providing a ledger of what you have been, and done, and meant to the world’ is one of the book’s central ideas. As Kalanithi’s disease progresses and various drugs and treatments he is pursuing lose their effectiveness, his options narrow and the time he has left dwindles. He mourns the losses of his life, of dreams not realized, children he and his wife would not have together, of not growing old with the one you love. But he accepts these hard truths and strives to make the most of his remaining time, energy, and concentration. He labors to complete this book, to leave some tangible record of his thoughts, before the cancer overtakes him.

For each of us, the idea of what we have meant to the world, is unique and intensely personal.   Kalanithi made his life matter. He made a difference to those around him and touched many, mostly strangers, with his thoughts about making the most of his remaining time. A teacher and researcher to the very end, he found ways to contribute at Stanford even when he could no longer operate or treat patients. You will think about this compact book long after you complete it.

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