Thursday, June 2, 2016


#TBRChallenge Reading: When Breath Becomes Air by Paul Kalanithi


2016 TBR Reading Challenge
Book: When Breath Becomes Air
Author: Paul Kalanithi
My Categories: Nonfiction, Memoir
Wendy Crutcher's Category: Something Different (outside your comfort zone, unusual setting, non-romance, etc.)

Unforgettable! This book is simply unforgettable. This young man— brilliant neurosurgeon, literary scholar, son, husband, father—has lived life with such grace, such elegance that you feel you're going to miss his presence even though you've only known him through the pages of this book. It's my regret that I will never have the chance to meet him and to shake his hand and convey to him how profound an impact his book has had on me. A few people come into your life, and unknowingly change it forever. This is one such person.

Every year, I have one book that impinges on my consciousness and stays with me for all time. Last year, it was Between the World and Me by Ta-Nehisi Coates. This year, it's When Breath Becomes Air. The book first came to my attention when I read about it on BrainPickings. After reading the smattering of quotations and Maria Popova's comments on them, I knew that I had to read the book in its entirety.

The question this remarkable young man, Paul Kalanithi, pondered all throughout his life was: What makes human life meaningful?

At first, he tried to find that meaning through literature and biology at Stanford. He did his masters in literature while also studying under a well-known analytical philosopher. But he realized that the distance literature and philosophy take towards studying life and its meaning was not what he was seeking. He went to Cambridge to do an MPhil in the history and philosophy of medicine to see if that would bring him any closer to what he was seeking.

And yet: Moral speculation was puny compared to moral action.

He wanted to wrestle with the messiness and weight of daily living. He decided to go to medical school at Yale. Through his residency in neurosurgery and research as a neuroscientist at Stanford, he felt that he was coming ever closer to finding the answer. It was his belief that medicine should be practiced with objective excellence and compassionate humanity. It were his patients who taught him that how people live, how they approach life, and how they face their mortality give meaning to life. And if he could help them in his capacity as a surgeon, a pastoral role, then it gave meaning to his life. You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

And finally, he was months away from graduating as chief resident, months away from finally living the life he had pursued with such dedication and tenacity.

At age thirty-six, I had reached the mountaintop; I could see the Promised Land, from Gilead to Jericho to the Mediterranean Sea. I could see a nice catamaran on that sea that Lucy, our hypothetical children, and I would take out on weekends. I could see the tension in my back unwinding as my work schedule eased and life became more manageable. I could see myself finally becoming the husband I’d promised to be.

And he found that he had stage IV lung cancer.

A young nurse, one I hadn’t met, poked her head in.
"The doctor will be in soon."
And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.


That this should happen to this gifted young man of such promise, such potential, such thoughtfulness is the tragedy of humanity.

Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle. I’d always imagined the doctor’s work as something like connecting two pieces of railroad track, allowing a smooth journey for the patient. I hadn’t expected the prospect of facing my own mortality to be so disorienting, so dislocating. Severe illness wasn't life-altering, it was life-shattering. I faced the same existential quandaries my patients faced.

First as a doctor, and now as a patient, with the help of science and literature, he wrestled with the meaning of life. He refused to give in to his illness even in the face of encroaching deterioration.

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present.

And he wanted to be very much present in the life he had left. As his tumors stabilized and shrank a bit, he returned to the OR. As his tumors resurged, he turned to his writing. He and his wife decided to have a child. Love sustained the life he had left. And joy and laughter.

To his daughter, Cady, he wrote: 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.

In this praise of Paul, not much is made of the tremendous courage and support of his wife, Lucy. Her epilogue, in which she wrote about the abrupt ending of Paul's life, is eloquent in its beauty and love. She encouraged him, aided him, was his lover and his confidant, and ultimately, his only strength.

These seven words of Samuel Beckett sustained him in his quest to write this book despite failing health and flagging energy: "I can’t go on. I’ll go on."


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