Saturday 24 February 2018

A challenging yet valiant memoir that prompts the reader to consider how we choose to live

Memoir: When Breath Becomes Air, Paul Kalanithi, The Bodley Head, hdbk, 256 pages, €17.99

Search for meaning: Paul Kalanithi with Jocelyn Newark at the Stanford Hospital and Clinics in 2014
Search for meaning: Paul Kalanithi with Jocelyn Newark at the Stanford Hospital and Clinics in 2014
When Death Becomes Air

Mary McEvoy

The verdict on a challenging yet valiant memoir that prompts the reader to consider how we choose to live.

When Breath Becomes Air is the autobiography of Paul Kalanithi, a talented young American neurosurgeon. On the face of it, it follows the usual path of autobiography - childhood and its adventures with siblings, the college years and decisions about what path to take in life, and then, those decisions made, the challenges of that chosen path.

Paul Kalanithi wanted to be a writer but was strongly drawn to medicine so he became a doctor, and then a surgeon specialising in neurosurgery. His reasoning was that he would give 20 good years to neurosurgery and then for the next 20 years, he would concentrate on writing. A good plan one might think. Paul Kalanithi died last March of lung cancer. He was 37.

This book is largely about his struggle, a struggle he did not expect so soon, with his illness and with death. And Paul Kalanithi did struggle. He did everything in his power to stay alive, and when the fight was lost, he struggled to live fully until the end.

This book is a challenging read. I did not want to read it because in spite of being religious in my practise of Buddhism, and being fascinated by spirituality, I, like many, I would venture to say, am death-phobic.

Paul Kalanithi writes beautifully. There is no doubt he would have had a fine career as a writer had he lived. He also writes with great candour.

His experiences of his medical training, and his feelings about the patient-doctor relationship make fascinating reading, perhaps essential reading for those in the medical profession. Death is ever present though and this book prompts a question; a question that must be wrestled if life is to be lived with the meaning Paul Kalanithi sought with such passion: What would you do if you knew you hadn't long to live?

I have, like many I'm sure, asked myself that question at times, when I had the courage, but I have always metaphorically put my hands over my ears, and chanted "la la la" as loudly as I could. This book won't let you look away. It doesn't distract with funny stories or wry observations. Paul Kalanithi was a spiritual man. He even reflects once in the book that he could have been a pastor. He chose to specialise in neurosurgery for metaphysical reasons as much as medical ones. He writes: "I was compelled by neurosurgery, with its unforgiving call to perfection; like the Ancient Greek concept Arete, I thought virtue required moral, emotional and physical excellence. Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity and death."

To return to the question posed earlier, what would you do if you knew you hadn't long to live?

Let's ask it a bit differently. What would you do if you knew you were going to die? Because we are going to die. For all our avoidance of it, for all that we run from the knowledge of it, death is the only certainty in life. We may not know the when but there is no if. So what are we to do? Surely there is more to life than going through the motions. There has to be more to the experience of being alive than drifting through the various stages of birth, childhood, adulthood, sickness, old age and finally the D word. Surely there has to be some meaning to this human existence.

'Meaning' is a word that Paul Kalanithi returns to again and again. In the western world at least, a decrease in religious practise and belief has left a malaise that is being filled with stuff. We buy, we eat, we daydream, we avoid the present, either glamorise the future or fear it, and look for distraction everywhere. When Breath Becomes Air makes one aware of the futility of flight from life or death. Paul Kalanithi's search for meaning not only prompts the reader to consider death but also how we choose to live. As he died, Paul Kalanithi became a father. Though he was gravely ill, he attended the birth of his daughter. He was too cold to hold his newborn baby but the nurse wrapped the baby and gave her to him to embrace. Death and life intertwined. When Paul Kalanithi died (his wife finishes his story in the book's epilogue), his death was a hard one, but it was also full of love and tenderness and peaceful witnessing. He was surrounded by people stripped back to the marrow of their humanity by their love, regard and grief.

The way he died and the way he was held in his dying had great meaning. It had a meaning that transcended religion or creed. It is a meaning that cannot be described in words but only felt in the depths of our faltering frail humanity.

It is some days since I finished the book. Am I clearer about death? I don't know. I am still in love with life, still curious, still careless, still, at times feckless. Like every other human being.

Something has shifted though. Through reading this book I have looked the bogeyman death in the face. Maybe it was the briefest of glances, and I want to play a little before I look again, but I feel richer for it. It is a sombre richness and there is sadness in it, but I am grateful. Grateful for this book and to its valiant author. May he rest in peace.

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