When Breath Becomes Air

Paul Kalanithi was a very talented surgeon, a brilliant scientist, an exquisite writer and by the account of those who loved him, a warm, caring person.

His book, When Breath Becomes Air, is an exceptional one. It is an account of his experience as a talented neurosurgeon at the top of his field, ready to reap the rewards of years of study, when he discovers that he has stage IV lung cancer.

It is not an easy read. It is an honestly written book though. He does not shy away from the day to day pain, or the overarching terrors. Nor does he seek false comfort in the easy answers. Instead he simply recounts his own thinking through, his own struggles as he deals with his approaching death. I found that I had to pause often reading it, particularly in the afterward written by his wife, that recounts his final days. It is not an easy read.

But the easy is not necessarily the good. This is a book worth reading.

If the unexamined life was not worth living, was the unlived life worth examining?

… 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.

You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany-a piercing burst of light, illuminating What Really Matters-and more like someone had just firebombed the path forward. Now I would have to work around it.

My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.

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.

I had passed from the subject to the direct object of every sentence of my life.

The curse of cancer created a strange and strained existence, challenging me to be neither blind to, nor bound by, deaths’ approach. Even when the cancer was in retreat, it cast long shadows.

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.

Although these last few years have been wrenching and difficult – sometimes almost impossible – they have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love.


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