[The reader] can get into these shoes, walk a bit, and say, ‘So that’s what it looks like from here… sooner of later I’ll be back here in my own shoes.’ That’s what I’m aiming for, I think. Not the sensationalism of dying, and not exhortations to gather rosebuds, but: Here’s what lies up ahead on the road.”
– Paul Kalanithi, in an email to his best friend (Epilogue)
Neurosurgeon Paul Kalanithi was diagnosed with metastatic lung cancer at the age of 36. When Breath Becomes Air is his frank and moving account of the experience of his illness and how it deepened the questions of human meaning he’d wrestled with long before, questions that led him to practice medicine. Even as a daily witness to life and death hanging in the balance, it was not an experience he (nor anyone else) could be prepared for.
Growing up, Kalanithi loved literature and knew for sure he would never be a doctor, before he became captivated by neuroscience. Throughout the book, he reflects on what constitutes a meaningful life: the balance of making meaning through human relationships and studying meaning through philosophy, literature, and neuroscience. He writes about the night that confirmed his decision to go into neurosurgery, watching a surgeon talk to the family of young boy with a brain tumor:
And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise.”
One of the great accomplishments of When Breath Becomes Air is how it reveals the overwhelming nature of the experience, even for a physician whose daily work involved judgment calls about life and death. Kalanithi wrestles especially with the notion of prognosis. If he just knew how much time he had, he ponders at various points, he would know what to do—if 10 years, neurosurgery and science; if 2 years, he would write, as he had always wanted to in the second part of his career. But the information he asks for is unknowable. It is amid this uncertainty that his oncologist, who refuses to project numbers, first protects certain opportunities, like his chance to do neurosurgery again with a less neurotoxic chemotherapy, and then gives him the space to navigate his own values. And so Kalanithi continues to live in a nether zone, facing that central question of dying in today’s society: how does one live knowing for months, or even years, that death is near?
His own writing reflects the momentous decisions he made throughout the almost 2 years after his diagnosis: to have a child, go back to neurosurgery, then stop once and for all, turn down a dream job offer, and finally how to die, peacefully, surrounded by his family. Kalanithi’s death was marked not only by the publication of his book this month but also accompanying articles by himself, his wife Lucy, and writer Lisa Rosenbaum in The New Yorker, The New York Times, and The New England Journal of Medicine. Standing alongside his own magnum opus, these moving pieces add richness to the conversation about bereavement and the ways that our culture of medicine can draw on empathy, hope, and realism in our efforts to make dying better.
Photograph: Norbert von der Groeben/Stanford Hospital and Clinics