“When Breath Becomes Air”: A call to life before death

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“Go, go, go, said the bird: human kind
Cannot bear very much reality.” — T.S. Eliot, Four Quartets

whenbreathbecomesairI picked up When Breath Becomes Air (hardback; ebook; audiobook) at about 10pm on the first day of spring by a recommendation from the inimitable Jesse Kornbluth. From his and other reviews, I roughly knew what the book was about: death. What better time to meditate on death than on the very cusp of Earth’s re-awakening?

In one sitting, it was read. It’s a tonic against the unreality that assaults us in the world today — politics, entertainment, advertising, broken promises, missed meetings — because it’s the most real book I’ve read in recent memory. Paul Kalanithi is 36 years old, and chief neurosurgery resident at Stanford Medical School. Every day, he opens up people’s skulls with a drill and saw, dissecting through the dura and meninges to get to a tiny tumor in the cerebellum. One false move of his scalpel by 2mm, and instead of a productive career and fatherhood, his patient is fully paralyzed for life. This is not about shifting around some spreadsheet numbers or holding meetings with middle management about shareholder value, folks. Kalanithi’s work is at the interface between thriving and withering, life and death, every day.

And then, Kalanithi’s life takes a turn for the even more real: he himself is diagnosed with lung cancer. At that point, he has to decide whether he will be spending the remainder of his time on Earth dying or living — a span of 1 to 10 years, depending on disease progression. He chooses to live: to rehabilitate himself and go back to full-time surgical practice in spite of his exhausting chemotherapy regimen; to repair his marriage; to have a child; and to write this book. I am very glad he made that decision.

It turns out that Kalanithi’s time on earth was much closer to the lower end of the predicted range, which makes his story even more poignant and the creation of this book even more heroic. Between 100hr weeks at the hospital, mind-fogging chemotherapy, and a newborn, when did he write?

This is a book that stays with you. It’s a lucid exposition from a consummate insider on the practice of medicine and work of healing. When can doctors heal? What do they tell patients when they can’t? How do they react when a patient dies? How do they convey that news to the family? Is life always worth living?

Paul’s days were numbered, and he knew the number was small. But so are ours. If you’re 25, that number is 18,000 to 20,000. If you’re 45, it’s closer to 13,000. If your light plane crashes, or you have a mountaineering accident, or have a freak untreated food poisoning, that number could be much smaller, like it was for my three friends who died in the past year, all under the age of 35.

So the bad news is that we’re all going to die, folks. Especially you. The good news is that every moment that you live is a gift. You can have that fact impressed upon you by a terminal diagnosis. Or you can read When Breath Becomes Air. Let that inform your days, and you just may infuse every moment of your existence with greater meaning, purpose, and joy.

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