When Breath Becomes Air
July 19, 20225 min read⭐ ⭐ ⭐ ⭐ ⭐
The tears came uncontrollably after reading the last few pages of this heart-rending account of Paul Kalanithi’s life and legacy.
His interest with living a meaningful life was evident from his childhood, and he quickly understood that neurosurgery was the place he wanted to be after finishing degrees in English Literature and History. In his pursuit to be in the nexus of philosophy, science, and meaning he pursued medicine.
He never thought of the work he did as merely a job, since it would be one of the worst jobs; but rather a calling.
“Don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness. Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”
Following his stellar studies he became a neurosurgeon resident, and it was during this time that his health started deteriorating. The fruits of his and his wife’s (who was also studying to be a doctor) labour, study, and sacrifice were nearly ready to bear, but out of nowhere Paul was diagnosed with stage IV metastatic lung cancer.
Paul recounts a first person account being faced with mortality. He takes you along the sinusoidal journey of recovery, and suffering and embarks on answering the question he once explained to his own patients—“What makes life meaningful enough to go on living?”
The vulnerability in his writing makes me feel like I was there in his dying days. This is not a book with an answer to life, but instead it is a mortal reminder that as with all things that live, we must eventually die. The timing is uncertain, but the event certain.
I believe that Paul lived a life touched many people, and whilst tragic it was not a tragedy. In the end that’s the best we can hope for.
Some quotes I loved:
“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.”
“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
“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.”
“There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.”
“When there’s no place for the scalpel, words are the surgeon’s only tool.”
“If the unexamined life was not worth living, was the unlived life worth examining?”
“Moral speculation was puny compared to moral action.”
“Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?”
“The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.”
“There we were, doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now was no more, and no less. than two people huddled together, as one faces the abyss. Doctors, it turns out, need hope, too.”
“And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.”
Created by Apurva Shukla.
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