Paul Kalanithi, the author of When Breath Becomes Air, majored in literature in college and then decided to go into medicine. He chose to become a neurosurgeon and neuroscientist, which involves some of the most difficult academic and residency training possible. For him it was not about finding a lucrative career, but rather a calling to be able to serve humankind in the best way possible. When he was six years into his residency training, he was diagnosed with a lethal form of lung cancer. The doctor was forced to become a patient. He died just after finishing his residency at the age of thirty-six. He wrote this book in the last months of his life, when it was evident that he would be unable to go back to his work as a surgeon and the drugs and chemotherapy he was undergoing were proving ineffective.
Like another memoir I read not long ago, Between Two Kingdoms: A Memoir of a Life Interrupted by Suleika Jaouad, about a twenty-two-year-old diagnosed with leukemia and the trauma she underwent in the medical system in efforts to save her life, this would seem to be an agonizingly painful read. And Kalanithi’s book does have its difficult, intense passages, but overall it evokes a feeling of hope and triumph rather than despair. Remember that Kalanithi trained in literature before he trained in medicine and had at one point considered becoming a writer. His language throughout the book is intense, poetic, and insightful.
What elevates the author’s account of his medical training is his ethical focus. He was deeply concerned about the patients in his care. For their sakes he was willing to forego an easier lifestyle and put in grueling hours of work. Because he had the capacity to help, he felt the obligation to do so. As a neurosurgeon he looked forward to a lifetime of service to those in need, and as a neuroscientist he looked forward to discovering new and better methods of treating brain injuries and illnesses.
This all came to a crashing halt when he began to suffer unbearable pain and was diagnosed with stage IV metastatic lung cancer. Before he began treatment and would be unable, he and his wife decided to have a child. Their daughter was born eight months before he died. She brought him joy and a sense of completion before the end.
This book confronts the dilemma of facing unexpected death; but then, for most of us, regardless of our age or the state of our health, death is unexpected and unwelcome no matter when it arrives. It was one thing for Kalanithi to confront the reality of dying patients, but quite another when the roles were reversed and he was the one contemplating the realization of his own mortality. I think it is good to sometimes remind ourselves that one hundred percent of us will experience death at some point. There are no exceptions. There is no escape from this truth. We can try to prolong our time in these fleshly bodies, but sooner or later we will die one way or another. Knowing this can help us evaluate our lives and make decisions that can imbue the time we have with significance. It is a reminder we all need now and then.