Hodgepodge 56/365 - Book Report (When Breath Becomes Air)

Paul Kalanithi, When Breath Becomes Air (2016) (12/23/16)

This is a beautiful book, written by a man dying at age 36 of lung cancer, who looks with exacting attention at what it means to live a full, meaningful life, and how to die well. It's thoughtful and thought-provoking, urgent and wise, moving but not the least bit sentimental.

He tells his story through the lens of his training as a neurosurgeon and the many interactions he had with patients. "While all doctors treat diseases," he writes, "neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. . . . 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?"

His own final journey, guided by a well-respected oncologist, asks similar questions. And on this journey he seeks wisdom and solace outside science as well: in literature (he read voraciously, and always entertained the ambition of being a writer), in his reexamined Christian faith, in friendships and family, in his newborn daughter, only eight months old when he died.

I very much enjoyed his matter-of-fact narration, the questions he asked, his explorations of self, identity, and meaning. But it all came together in the epilogue, written by his wife, Lucy. It was in the epilogue that the tears arrived—for Paul, for the life he'd lived, for the lives and love he left behind. As she explains, "Paul's voice in When Breath Becomes Air is strong and distinctive, but also somewhat solitary. Parallel to this story are the love and warmth and spaciousness and radical permission that surrounded him. We all inhabit different selves in space and time. Here he is as a doctor, as a patient, and within a doctor-patient relationship. He wrote with a clear voice, the voice of someone with limited time, a ceaseless striver, though there were other selves as well. Not fully captured in these pages are Paul's sense of humor—he was wickedly funny—or his sweetness and tenderness, the value he placed on relationships with friends and family. But this is the book he wrote; this was his voice during this time; this was his message during this time; this was what he wrote when he needed to write it. Indeed, the version of Paul I miss most, more even than the robust, dazzling version with whom I first fell in love, is the beautiful, focused man he was in his last year, the Paul who wrote this book—frail but never weak."

His choice to have a child even though he might not live to see her born, never mind grow up, impressed me about his character. In part two, "Cease Not Till Death," he and Lucy discuss the idea. She asks, "Don't you think saying goodbye to your child will make your death more painful?" He replies, "Wouldn't it be great if it did?" He then goes on: "Years ago, it had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes. After so many years of living with death, I'd come to understand that the easiest death wasn't necessarily the best." By having a child, "We would carry on living, instead of dying."

In the epilogue, Lucy points to the last line of part one, "In Perfect Health I Begin," as a statement that epitomized his life: "You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving." That is an excellent metaphor for us all to keep in mind, that we might try to live our own lives as bravely and well as we can.