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When Breath Becomes Air Hardcover – Deckle Edge, January 12, 2016
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BOOKS FOR A BETTER LIFE AWARD FINALISTAt the age of thirty-six, on the verge of completing a decade?s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi?s transformation from a naÃ?Â¯ve medical student ?possessed,? as he wrote, ?by the question of what, given that all organisms die, makes a virtuous and meaningful life? into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.
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Dr. Paul Kalanithi had every advantage in fighting his lung cancer (he was a nonsmoker). He had the best medical minds to advise him, plus a network of supportive friends and relatives, many of them doctors. At one point he’s offered a position at a hospital where the prospective perks include transportation (out of state) to and from one of the best cancer facilities in the country. We should all be so lucky.
I realize that it’s difficult to engage in total honesty in a memoir, But no one's life is as perfect as Dr. Kalanithi presents his to be. For example, we are told that his wife, Lucy, was getting ready to leave him when he got his diagnosis. But this is never explained or elaborated on. I thought it was a little odd that the person who wrote the Foreword had only met Dr. Kalanithi a few times. Why not have one of his many friends write it?
The disease proceeds to take its terrible toll. While Dr. Kalanithi faces his prognosis unflinchingly and with great courage, he doesn’t really offer any wisdom for the rest of us. He finds meaning in poetry and literature. He understands that death gives meaning to life. I found sentences like the following to be simply a statement of the obvious: “A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form.” Yes, relationships are important.
I did appreciate Dr. Kalanithi’s essay in the New York Times about the Kaplan-Meier curve and that material is incorporated here.
It’s clear that Dr. Kalanithi loves his family and friends. But as others have stated in some of the comments, he comes across as a bit self-absorbed and superficial, especially in the beginning. In that section, he enumerates some of the pranks he played when he was young and there’s a section on the treatment of cadavers by medical students.
The first few chapters were apparently written last, at a time when chemo brain was affecting Dr. Kalanithi’s ability to think and write clearly. The latter 3/4ths is much more gracefully written. The book is really a long essay and can be read in one sitting. But I guess I'm wondering why a long essay merits the price of $13.00 (kindle).
The part that brought tears to my eyes, was the epilogue written by Lucy Kalinathi, Paul’s wife. I can’t help but think that she’s the real writer in the family. How lucky he was to have such a loyal, empathetic partner!
If your goal is to learn more about the life of a neurosurgeon, DO NO HARM, STORIES OF LIFE, DEATH, AND BRAIN SURGERY by Henry Marsh is an outstanding choice. For a more thoughtful consideration of mortality, read Anne Lamott, Andrew Solomon, or Atul Gawande. All of them write with depth and nuance about the complexities of life and death--more so than Dr. Kalanithi.
When Breath Becomes Air details Dr. Kalanithi's life as a neurosurgeon and his fight against advanced lung cancer. Even in his short life he achieved noteworthy recognition as a scholar, a surgeon, a scientist and now - posthumously - as a writer. The book is a tale of tribulations and frank reflections. Ultimately there's not much triumph in it in the traditional sense but there is a dogged, quiet resilience and a frank earthiness that endures long after the last word appears. The tribulations occur in both Dr. Kalanithi's stellar career and his refusal to give in to the illness which ultimately consumed him.
The first part of the book could almost stand separately as an outstanding account of the coming of age of a neurosurgeon and writer. Dr. Kalanithi talks about his upbringing as the child of hardworking Indian immigrant parents and his tenacious and passionate espousal of medicine and literature. He speaks lovingly of his relationship with his remarkable wife - also a doctor - who he met in medical school and who played an outsized role in supporting him through everything he went through. He had a stunning and multifaceted career, studying biology and literature at Stanford, then history and philosophy of medicine at Cambridge, and finally neurosurgery at Yale.
Along the way he became not just a neurosurgeon who worked grueling hours and tried to glimpse the very soul of his discipline, but also an eloquent writer. The mark of a man of letters is evident everywhere in the book, and quotes from Eliot, Beckett, Pope and Shakespeare make frequent appearances. Accounts of how Dr. Kalanithi wrested with walking the line between objective medicine and compassionate humanity when it came to treating his patients give us an inside view of medicine as practiced at its most intimate level. Metaphors abound and the prose often soars: When describing how important it is to develop good surgical technique, he tells us that "Technical excellence was a moral requirement"; meanwhile, the overwhelming stress of late night shifts, hundred hour weeks and patients with acute trauma made him occasionally feel like he was "trapped in an endless jungle summer, wet with sweat, the rain of tears of the dying pouring down". This is writing that comes not from the brain or from the heart, but from the gut. When we lost Dr. Kalanithi we lost not only a great doctor but a great writer spun from the same cloth as Oliver Sacks and Atul Gawande.
It is in the second part of the book that the devastating tide of disease and death creeps in, even as Dr. Kalanithi is suddenly transformed from a doctor into a patient. It must be slightly bizarre to be on the other side of the mirror and intimately know everything that is happening to your body and Dr. Kalanithi is brutally frank in communicating his disbelief, his tears, his hope and his understanding of his fatal disease. It's worth noting that this candid recognition permeates the entire account. Science mingles with emotion as compassionate doctors, family and a battery of medications and tests become a mainstay of life. The painful uncertainty which he documents - in particular the tyranny of statistics which makes it impossible to predict how a specific individual will react to cancer therapy - must sadly be familiar to anyone who has had experience with the disease. As he says, "One has a very different relationship with statistics when one becomes one". There are heartbreaking descriptions of how at one point the cancer seemed to have almost disappeared and how, after Dr. Kalanithi had again cautiously made plans for a hopeful future with his wife, it returned with a vengeance and he had to finally stop working. There is no bravado in the story; as he says, the tumor was what it was and you simply experienced the feelings it brought to your mind and heart.
What makes the book so valuable is this ready admission of what terminal disease feels like, especially an admission that is nonetheless infused with wise acceptance, hope and a tenacious desire to live, work and love normally. In spite of the diagnosis Dr. Kalanithi tries very hard - and succeeds admirably - to live a normal life. He returns to his surgery, he spends time with his family and most importantly, he decides to have a child with his wife. In his everyday struggles is seen a chronicle of the struggles that we will all face in some regard, and which thousands of people face on a daily basis. His constant partner in this struggle is his exemplary wife Lucy, whose epilogue is almost as eloquent as his own writing; I really hope that she picks up the baton where he left off.
As Lucy tells us in the epilogue, this is not some simple tale of a man who somehow "beats" a disease by refusing to give up. It's certainly that, but it's much more because it's a very human tale of failure and fear, of uncertainty and despair, of cynicism and anger. And yes, it is also a tale of scientific understanding, of battling a disease even in the face of uncertainty, of poetry and philosophy, of love and family, and of bequeathing a legacy to a two year old daughter who will soon understand the kind of man her father was and the heritage he left behind. It's as good a testament to Dr. Kalanithi's favorite Beckett quote as anything I can think of: "I can't go on. I will go on".
Read this book; it's devastating and heartbreaking, inspiring and edifying. Most importantly, it's real.
I am not sure what I expected, perhaps something more profound about life and death and instead got endless descriptions of the brain, neurosurgery and how extremely rare and important beings neurosurgeons are in society. My late father was a surgeon and while he did not have the god complex, I met many of his colleagues who did and that is what came across to me here.
Of course is is tragic that a young man with much to offer was cut down in his prime. I was hoping this book would have something to offer me, and sadly it did not.