When Breath Becomes Air

Paul Kalanithi’s book When Breath Becomes Air is an unsettling read which at the same time leaves the reader with a compelling sense of optimism.  It is a stirring experience of knowing a man’s mind from the frighteningly close distance of his own words, as he prepares himself to meet his end. It certainly doesn’t seem like death. To use that word would be to demean all that Paul strives for since the time his terminal illness is confirmed by medical examinations. It isn’t death. It is a man trying to re-size a life time’s plan into the shortened time that he is given. The book is an account of the short span when every day is lived as a conviction to finish all that one can, instead of a surrender to the inevitable. It is not a fight as the popular versions of experiences with terminal illness go. Paul’s is a preparation and finding satisfaction in what is.

Paul is diagnosed with state IV lung cancer at the age of thirty-six and at a time in his career when he is about to reap the fruits of his long training as a neurosurgeon and neuroscientist. What does a man think in those moments after he is told that he doesn’t have much time to live? When instead, he has lived with a belief that there is a lifetime ahead to work and achieve his dreams? Does he pass away in dejection or makes the best of what he has? If he makes the best possible use of his time, then I wanted to know what does it take to be that hopeful against the hard and cold ceiling of the inevitability of fast approaching death. Paul’s writing answers much of it. In the face of mortality, Paul manages to show remarkable thoughtfulness and compose. From insights into a surgeon’s work to a young man’s quest and aspirations in life and on to a couple’s heartbreaking journey through the illness, the book is an insight into lived experience in situations of life that one tends to not imagine upon oneself.

Here is an intelligent young man who isn’t succumbing to despair but rather manages to see things objectively. From one of his early meeting with his Oncologist, he writes –

I began to realize that coming in such close contact with my own mortality had changed both noting 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.

Personally, to not despair in the wake of difficult situations has been hard. Perhaps, this makes the book even more important for me at this time in my life.

Again, the following conversation between Paul and his wife is extraordinary, in the face of what they face ahead and the clarity about suffering.

“What are you most afraid or sad about?” she asked me one night as we were lying in bed.

“Leaving you,” I told her.

(…)

“Will having a newborn distract from the time we have together?” she asked. “Don’t you think saying goodbye to your child will make your death more painful?”

“Wouldn’t that be great if it did?” I said. Lucy and I both felt life wasn’t about avoiding suffering.

In face of daily life situations one tends to feel pushed against the wall. Coping with them feels daunting. Reading this book is to know what the extremes can be and that there are people who have responded to such situations in a constructive manner. As the last moments of Paul’s life are described in the epilogue by Paul’s wife, Lucy, one sees a family united in sorrow yet cherishing a life that left behind a certain kind of completeness and contentment that is felt typically when people die in their nineties.

For the importance of this book, I find the reason in Paul’s remark “Words have a longevity I do not.” The final words of the book are for his daughter Cady, who is eight months old when Paul died. He leaves this passage for her and I believe this to be indicative of his attitude towards his illness and mortality. This shall remain a very fine piece on human spirit in the face of insurmountable odds, for me –

There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.

That message is simple.

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.

As this year draws to a close, I realize that I have spent several months grieving over matters that can never be as soul destroying and hopeless as Paul’s illness. In his writing I find an attitude to work and life that was unknown to me. If I were on as short time as Paul’s, these months I lost doing very little would have been a colossal waste. The book then brings back the importance of time and making the most of it, while has the good fortune of having that time.