Arun Sharma
“You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.” (Baron Brooke)
Shattered dreams, deeply moving relationships of a brilliant scientist/ surgeon’s heart undulating on the waves of turbulence and facing life’s enormities; love and sorrow, peace, joy and tears, intense agony sealed inside deep silence of a pained heart staring devil of death on the mirror!
“I found compassion where I thought only mechanism occurred. I found hope where I thought only shadows reigned. I found a soul struggling to make sense of life’s meaning in the face of death. And is not that the story of humanity?” Paul Kalanithi questions!
Abigail Blessing writes: “Fear, sorrow, joy, confusion, peace enveloped me in waves. Can the presence of death cause such a contrast of emotions? His words dispelled the silence of death, filling it with moving anecdotes from his personal and medical experience.” When Breath Becomes Air opens a window into the life of Dr. Paul Kalanithi.
Paul died on Monday, March 9th 2015! Lucy his wife writes: he told me, “I want everyone to know that even if I don’t see them, I love them.” Inside emergency room “he turned towards me and whispered , “This might be how it ends, his voice soft but unwavering, I’m ready. Ready, he meant to start morphine to die. With my heart breaking, I climbed into the last bed we would share. Paul’s decision to look in the eye was a testament not just to who he was on the final hours of his life but who he had always been.”
About life he wrote, “One day we are born, one day we shall die! The light gleans an instant then it’s night again.”
Paul grew up in Kingman, Arizona days immersed with nature, literature, and unquenchable thirst for knowledge. After earning a B.A. and M.A. in English literature and a B.A. in human biology from Stanford, Paul received MPhil in History and Philosophy of Science from Cambridge. As he wanted “direct experience” in life; “it was only in practicing medicine,” he writes, “that I could pursue a serious biological philosophy.” Through medical career he hoped to answer “the question of what makes life meaningful, even in the face of death and decay until the last breath is heroic saga of his memoir When Breath Becomes Air!
In high school in Kingman, one of his friends was counselled by his teacher; “ You should join the Army”, the biggest dream in rural Arizona. When Paul said he was destined for Harvard, Yale or Stanford no less, his classmate Leo remarks (on joining Army); “Fuck that if you are going to Harvard or Yale then I’m too!” While Leo got into Yale and Paul to Stanford he remarked, “I don’t know I was happier when I got into Stanford or Leo into Yale.” He finds: “The most intoxicating thing I’d experienced was the volume of romantic poetry.” Avid reader of everything he could lay his hands on, his High School girl friend suggested him, “You are always reading such high culture crap- why don’t try something low brow for once.”
Searching for meaning, he goes to Yale and becomes a neuro-scientist. He writes: “I’m driven less by achievements than trying to understand, in earnest: what makes human life meaningful ? I still felt literature provided the best account of the life while neuroscience laid down the most elegant rules of the brain.”
He cites Nabokov making us aware how our sufferings can make us callous to the pain of others. Literature, provided the “richest material for moral reflection. His urge: “to fuse and strengthen the human relationship that formed meaning.”
“Humans are organisms, subject to physical laws, alas, the one that says entropy always increases Disease are molecules misbehaving: the basic requirement of is metabolism and death is its cessation.”
“ I thought virtue required moral, emotional, and physical excellence.”
A neuro-trainee surgeon examining a set of images from a CT scan (Paul’s) . The diagnosis is straightforward: “Cancer, widely disseminated.”
He worked hundred hours a week trying to excel. On the verge of qualifying as a coveted neurosurgeon after a decade of training, and planning to start a family with his wife, Lucy, he found himself confronting not only a terminal illness, but also profound identity crisis: having aspired to be “the pastoral figure … I found myself the sheep, lost and confused”. The account of transition from doctor to being patient within a year or so prior to his death, he was 37 and his daughter, Cady, was nine months old. He had inoperable and deadly lung cancer. He faced a certain death staring at him!
Paul’s had life full of exceptional achievements. Tired of sitting around reflecting on the meaning of life – he wanted action and real responsibility, “answers that are not in books”. He was drawn to neurosurgery by its “unforgiving call to perfection”.
The demands of the training were challenging : working more than 100 hours a week, operating in which the difference between life and death could be a “matter of millimeters” inside brain. Late one night, as he cuts into a tumor deep inside a patient’s brain, his supervisor asked him what would happen if he increased the incision by two millimeters. Double vision, guesses Kalanithi. “Locked-in syndrome”, came the reply.
As cancer weakens Paul’s body, forcing him to abandon his heroic self-image, writing gathers strength. He knows: something is wrong, but not confirmed. Plagued by terrible back pain, weight dropping fast, discovers his fears only when she picks up his phone and finds “frequency of cancers in 30- to 40-year-olds” typed into a medical search engine. He continues to work, dosing himself up on Ibuprofen and putting in 36 hours at the operating table. But then, what else can he do? Beckett’s lines: “I can’t go on … I’ll go on” motivates him to go on to give his body and soul to patients. His terminal diagnosis changes everything and nothing: “Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when.”
A planner by nature (40-year career plans), he wants to know how long he has: if it’s three months, he will spend time with his family; one year, he will write a book; 10, and he will go back to medicine. The averages and probabilities, while useful to a doctor in deciding on treatments, have little meaning for a patient. “What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find on her own … the angst of facing mortality has no remedy in probability.” Lacking certainty in destiny, all he can do is assume he is going to live a long time. Once symptoms subside, he heads back to the operating theatre, performing his duty with devotion and dedication.
During his treatments, “Don’t you think saying goodbye to your child will make your death more painful?” asks Lucy. Paul responds: “Wouldn’t it be great if it did?”
The book eloquently describes life : we are all confronting our mortality every day. The question we face, is not how long, but rather how, we will live – and medical textbook don’t answer. Then he is drawn to the books of poetry he left gathering dust when he entered medical school.
Facing certain DEATH, he guides readers through scenes of profound loss and quiet hope: “Paul sets the stage for his own tragedy.” When the results arrive, a glaring image of stage IV lung cancer, Paul is under death’s shadow, grappling with his mortality through the words he weaves.”
Kind and compassionate to his patients, yet, he felt that he was “on the way to becoming Tolstoy’s stereotype of a doctor… focused on the rote treatment of disease — and utterly missing the larger human significance.” Words and statistics cannot heal the wound of fearful uncertainty; healing lies in the relationship between doctor and the patient. “Before operating on a patient’s brain, I must first understand his mind,” Paul concludes: the patient is not just an object, but a soul, a being in possession of an “identity,” “values,” and knowledge of “what makes his life worth living, and what devastation makes it reasonable to let that life end.” Technical excellence without relationality is like a stained-glass window without light. Paul urges the world to view humanity as a group of individual beings, not mere collection of data.
Battling with his own cancer, Paul writes:
“I realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis now I knew it acutely.”
He viewed death as inevitable but not imminent. Death’s shadow following him all around, was ignored amidst achievements, dreams of happiness, success and a sense of immortality. But encountering the fatal disease lurking inside, he felt the tremor. At the peak of his career, Paul was confronted with his finality of reality that blew away his dreams of life he cherished!
His response?
To see one’s mortality in the mirror is to acknowledge time’s transience and life’s impermanence. Facing eventuality, Paul searches for what is significant and what is meaningful. His decisions: to have a child and to write this book.
“If human relationality formed the bedrock of meaning, it seemed to us [he and Lucy his wife] that rearing child added another dimension to that meaning.” The memoir’s message: life’s meaning is rooted in relationality. Paul found value in his relationships with his patients, his family, his friends, the world, and God.
When Breath Becomes Air is practical and deeply personal. It’s guide to life and a love letter to his daughter as well. Death is an ultimate reality! Like his life, the book was half-finished; his wife and editors worked to publish it posthumously in 2016. Through life experience he tells; “how to live and find meaning when breath is still breath.” Memoir radiates with life’s connection with a purpose with compassion. Paul quotes Samuel Beckett, “birth astride of a grave.” The book is full of poignant reflections and in the promise of his child’s life, death and life are intertwined in the memoir!
When Breath Becomes Air offers readers a new perspective on mortality and offers deeply rooted meaning in Life!
(Arun Sharma is a writer and an engineer)
