When Breath becomes Air is a journey of Dr. Paul Kalanithi partially completed by his wife in the end. Afer reading the book I felt I should offer my tribute to Dr.Paul Kalanithi by writing about him. The reason why anybody should read this book is because it gives strong message that we are mortals and we as a human being have to ultimately face our death.
He wanted to help people understand death and face their mortality.
The author has very gracefully taken his exit from the earth and he has narrated how he faced his death bravely and why he decided to embrace it wholeheartedly without any complaint.
The book explores such powerful questions such as
Q- How should be our journey from life to death?
Q- What makes a meaningful life?
Q- How to embrace death as inevitable part of life?
But who was Dr.Paul Kalanithi ?
The author Dr.Paul was a award winning neurosurgeon who succumbed to the lung cancer and finally fell prey to the brain cancer as the ultimate irony in his life.
The preface by Abraham Verghese includes such memorable words:
Dr.Paul wasn’t writing about anything—he was writing about time and what it meant to him now, in the context of his illness.
After reading the book you are about to read, I confess I felt inadequate: there was an honesty, a truth in the writing that took my breath away.
Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way.
But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.
In the silences between his words, listen to what you have to say back. Therein lies his message.
The book is written in two parts:
The Part I consists of the healthy Dr.Paul about his various struggles of growing up, choosing career and trying to make a mark in his life as normal like any other teenager. But what strikes me different is that even in young age how profound his thoughts are about life . Dr.Paul was from beginning a book lover and his love of books influenced and molded his thoughts in such a way that you feel like he is philosopher, a poet or some sort of sage who is observing his life from a distance.
“We are never so wise as when we live in this moment.”
Dr. Paul has minutely described how he chose his career in neurosurgery. He has very clearly stated the difference between a job and a calling. His career choice was his calling. According to him
Putting lifestyle first is how you find a job—not a calling. As for me, I would choose neurosurgery as my specialty.
The author shares his struggle of becoming doctor and how he faced various cases of his patients as a neurosurgeon. The author has explained why he chose the field of neurosurgery in his words as:
While all doctors treat diseases, 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.
I was compelled by neurosurgery, with its unforgiving call to perfection;
Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death.
He expresses the state of the patients in the following words:
The brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability—or your mother’s—to talk for a few extra months of mute life?
The author constantly tries to understand and implement how to deal with a terminally ill patients and how to convey about his illness to him and his family. The various cases discussed by him clearly shows his deep sensitivity and attachment to his patients.He discusses the long and tiring working hours of being doctor and his journey from busy to super busy going through his triumphs and failures. He also discusses about his love life briefly and his marriage.
The Part II is what is more cherishable by the reader. During his stint of his residency he is diagnosed with Lung Cancer. He shares his moment of his grief with his wife in the hospital.The second part narrates his emotional and physical journey from the moment of his diagnosis till his final acceptance of his illness and how he embraces his death.
The journey towards his death takes a lot of twists and turns of his treatment. The author has very clearly shared his vulnerabilities , his emotions and his pain with his readers. He quotes
Only 0.0012 percent of thirty-six-year-olds get lung cancer. Yes, all cancer patients are unlucky, but there’s cancer, and then there’s CANCER, and you have to be really unlucky to have the latter.
The readers can understand how he must have felt when he swapped his role from being Doctor to being patient. During illness he says
One of the early meanings of patient, after all, is “one who endures hardship without complaint.”
I had learned something, something not found in Hippocrates, Maimonides, or Osler: 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.
He struggled to control his treatment and finally left to the judgement of his doctor by letting go of his being doctor. The most touching part is when he is unable to attend his own graduation of Residency for which he had struggled for his entire life. He has chased his dream of neurosurgeon and finally achieved it to let it go in the end. There are moments in this book that you feel for this doctor that cannot be described in words. The doctor had stated his struggle as
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.
Life wasn’t about avoiding suffering.
When cancer hit him so hard the doctor found solace in these words
Samuel Beckett’s seven words, words I had learned long ago as an undergraduate: I’ll go on. I got out of bed and took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.”
One of the critical decision the doctor takes after his diagnosis is to become a father. He and his wife were undergoing marital problems but when he is diagnosed with this illness the grief brought back the couple together and bond them further intricately that they decide to bring another life in the world so that the child will be reminder of their love even if the author does not exist.
It was the desire of the doctor to pen his journey and he has written this book in his last days till the moment he cannot write. Ultimately the lung cancer spread so rapidly that in his final days he was diagnosed with tumors in his brain. As a brain surgeon, imagine how he must have felt this irony. He completely understood his illness and bravely faced the consequences. As a layman we are fortunate that we are only aware of the symptoms but he as a doctor, not only understand the symptoms but understands all the consequences. The incomplete book is finally completed by his wife and she published this book so that people will be aware of Dr.Paul message.
He described his helplessness in following words:
The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget.
You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.
It struck me that I had traversed the five stages of grief—the “Denial → Anger → Bargaining → Depression → Acceptance” cliché—but I had done it all backward. On diagnosis, I’d been prepared for death. I’d even felt good about it. I’d accepted it. I’d been ready. Then I slumped into a depression, as it became clear that I might not be dying so soon after all, which is, of course, good news, but also confusing and strangely enervating.
The rapidity of the cancer science, and the nature of the statistics, meant I might live another twelve months, or another 120. Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die—but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell.
The way forward would seem obvious, if only I knew how many months or years I had left.
Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day?
I work my whole life to get to this point, and then you give me cancer?” And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.
The story of Dr Paul touched the core of my heart. Had he lived he would achieved a lot of milestones in his career and in the field of neurosurgery. He was so much sought globally that even after his diagnosis he received plenty of offers with all the amenities to deal with his cancer to work for the various renowned organizations. But Dr.Paul understood that the dream job at this stage of his life is nothing but mirage and finally gives up on his dream job to secure the remaining days and future life of his wife and his child.
You have to read the book to understand the Dr.Paul’s thinking process about reaching his decisions about the life and the death. He expresses:
Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist. If time dilates when one moves at high speeds, does it contract when one moves barely at all?
It must: the days have shortened considerably.
Graham Greene once said that life was lived in the first twenty years and the remainder was just reflection.
That message is simple: When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.
I think one can learn a lot from from this book. The Doctor emphasizes that
You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.The fact of death is unsettling. Yet there is no other way to live.