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Books: Casting a cold eye on life and also on death


Meditations on mortality: Neurosurgeon Paul Kalanithi with his wife Lucy and their child Cady born months before his death.

Meditations on mortality: Neurosurgeon Paul Kalanithi with his wife Lucy and their child Cady born months before his death.

When Breath Becomes Air

When Breath Becomes Air


Meditations on mortality: Neurosurgeon Paul Kalanithi with his wife Lucy and their child Cady born months before his death.

Two years ago, a New York Times article opened dramatically: a doctor surveyed a CT scan showing lungs riddled with cancer. The scan didn't belong to a patient, but to the doctor himself, Paul Kalanithi, a neurosurgeon at the Stanford University School of Medicine, who was 36 years old at the time. The article was arresting; an internet search revealed other articles by Kalanithi, including a brilliant essay in Stanford Medicine magazine, meditating on the nature of time. It was called Before I Go.

I kept an eye out for Kalanithi's work and checked in on his Twitter profile occasionally, where he described himself as a "writer, neurosurgeon, sports enthusiast, dude with lung cancer (not necessarily in that order)." But after March 3, 2015 there were no tweets, and it emerged that Kalanithi had died on March 9.

When Breath Becomes Air is his book, a blend of memoir, philosophical reflection and an attempt to come to terms with his own impending death. As a student and then a surgeon, he had wanted to understand what makes us tick, philosophically and physically. Now death, as he writes, "so familiar to me in my work, was … paying a personal visit."

Kalanithi wrote the book while grievously unwell, the first section on his youth and childhood scripted last, as metastatic tumours moved into his brain.

Though eloquently crafted, there is a sense of the unfinished about it, a draft hewn together in a race against time.

In a way, however, its incompleteness is what makes the book compelling, offering a particularly self-conscious take on death-written by a young man who is dying as he writes, and who will be dead by the end.

Having probed the brains of the seriously ill many times, he is familiar with the language of death, and how we often respond. "As a doctor, I knew not to declare, 'Cancer is a battle I'm going to win!' or ask 'Why me?'" he says. "(Answer: Why not me?)"

With research making progress, even a diagnosis of metastatic lung cancer contains elements of hope, and Kalanithi receives a drug that has a dramatic effect at first, making the tumours all but disappear.

The positive results mean he has to recalibrate his attitude towards death, which might now come in months or years. Uncertainty is part of cancer's burden. Kalanithi, a precise thinker, wonders where his case will fit on the curve showing length of survival, noting that his relationship with statistics changed once he became ill.

"Could we divide the curve into existential sections, from 'defeated' to 'pessimistic' to 'realistic' to 'hopeful' to 'delusional'?"

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He describes the exhaustion that comes with cancer and its therapies. A limited lifespan brings an urgency to enjoy life to the fullest but fatigue shrinks the energy to do so. Previously so driven, he writes, "It is a tired hare who now races. … I plod, I ponder. Some days, I simply persist."

What allows When Breath Becomes Air to succeed is of course not the topic itself but Kalanithi's approach. Never maudlin, he writes with clarity, elegance, and honesty about the more surprising implications of the disease, such as its effect on his relationships; pre-diagnosis, excess ambition and workload had left his marriage on the rocks, and in the weeks before the diagnosis his wife, Lucy, had suggested they spend some time apart. In fact, by placing their relationship in the sharpest focus, cancer "had helped save our marriage," he says. The couple decided to conceive a child, and their daughter was born in the months before her father succumbed to the disease.

When Breath Becomes Air is a deeply personal and moving book, a glimpse at how one family responded to a devastating but not unique situation. Kalanithi died leaving the book unfinished. He left, though, his voice, speaking through this book about death and implicitly about life.

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