Paul Kalanithi spent years training to be a neurosurgeon. He was one of those dazzling people who could have followed any number of paths, studying literature, philosophy and medicine with equal vigour. He trained in neurological surgery at Stanford University, believing brain surgery was his calling. The ridiculous workload (100 hour work weeks) and literal life and death operations, his striving for compassion and excellence in everything he did, his relationship with his girlfriend, Lucy, also a doctor, are all examined in the first half of this book. Kalanithi’s love of literature shines as brightly as his love of medicine.
When he began to suffer with excruciating back pains he wondered if he had cancer, then tried to push that concern away after an x-ray came back clear. He got weaker and the pain intensified. Eventually he had a CT scan, “I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.”
Where the first half of the book is concerned with his striving to be the best surgeon he can and to help others deal with unthinkable disease and their fragility as humans, their lives literally in his hands as he operates on their brains, the second half is him looking frankly at his own situation as he makes the transformation from expert doctor to needy patient.
“Once I had been diagnosed with a terminal illness, I began to view the world through two perspectives; I was starting to see death as both doctor an patient. As a doctor, I knew not to to declare “Cancer is a battle I am going to win!” or ask “Why me?” (Answer: Why not me?)”
“Like my own patients, I had to face my mortality and try to understand what made my life worth living…”
It’s his clear thinking that engages the reader so fully. We, and everyone we know, will die. It is the awful truth we spend our days not looking at and here is someone who has studied the brain extensively, who knows what it is to look right at death, someone who writes with zinging clarity, preparing to share his wisdom with us so that we may go forwards in our own lives in a more meaningful way.
“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”
Everything Kalanithi had worked so hard to achieve in his future, his ambitions and hopes, were lost with diagnosis. He had to examine what was most important to him. As he wrestled with choosing between literature and medicine before specialising, he wrestled again. He returned to surgery for a while, completing his residency with customary excellence despite everything. Offered his dream job he briefly allowed himself the fantasy of accepting it, before turning it down. He and Lucy decided to have a baby. He wrote most of this book. In the end it all boiled down to the deeply personal, as it does for us all. The things that matter are the relationships we have. It’s family and friends and love that count.
This is why When Breath Becomes Air is successful. We are desperate for clues how to live, how to die, how to cope. It’s unfair to expect so much from a book. Its unfair that Kalanithi died when he was 37. Life, and death, is not fair.