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‘When Breath Becomes Air’: Young doctor’s last words of wisdom, hope

Paul Kalanithi, M.D. at the Stanford Hospital and Clinics in 2014. ( Norbert von der Groeben/Stanford Hospital and Clinics )

Paul Kalanithi's memoir, "When Breath Becomes Air," written as he faced a terminal cancer diagnosis, is inherently sad. But it's an emotional investment well worth making: a moving and thoughtful memoir of family, medicine and literature. It is, despite its grim undertone, accidentally inspiring.

In 2013, Kalanithi, a 36-year-old neurosurgeon, was found to have lung cancer. A nonsmoker who enjoyed reading and the outdoors, Kalanithi was rising through the ranks at Stanford University School of Medicine when weight loss and severe back pain sent him hobbling to the doctor. Kalanithi knew what was coming even before the CT scan results revealed multiple tumors. In that single moment, he writes, “the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.” Now, he’d wear a light blue hospital gown instead of a surgical one. The diagnosis stole not only his future, but also his identity. “Who would I be, going forward, and for how long?” he asks.

Paul Kalanithi reflects on being a physician and a patient, the human experience of facing death, and the joy he found despite terminal illness. (Video: Stanford/YouTube)

Before I go: A Stanford Neurosurgeon’s parting wisdom

Kalanithi's diagnosis is both a death sentence and an opportunity — albeit an unwanted one — for the kind of introspection that many of us claim to want but that never seems possible unless forced by tragedy. Raised on a steady diet of literature — Sartre, Twain, Thoreau — assigned by his mother when he was a boy in Arizona, Kalanithi is a deeply philosophical sort (his master's thesis in literature at Stanford was "Whitman and the Medicalization of Personality"). His book, adapted parts of which appeared in the New York Times and The Washington Post, showcases his learned background, his contemplative disposition and his kindness. His decision to go to medical school, he writes, was an effort "to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay."

Kalanithi writes in great detail about his years of training, and in these parts of his memoir, you might forget for a minute that you are reading the words of a dying man. You're drawn in — as you might be by the work of Atul Gawande, Oliver Sacks or Jerome Groopman — learning about the cases, the patients, the dilemmas.

Watch Kalanithi talk about his life and family

Courtesy of YouTube

But Kalanithi is also one of those patients, a position that gives him special insight. “It occurred to me that my relationship with statistics changed as soon as I became one,” he writes. He ponders the times when “I had pushed discharge over patient worries, ignored patients’ pain when other demands pressed. The people whose suffering I saw, noted, and neatly packaged into various diagnoses, the significance of which I failed to recognize — they all returned, vengeful, angry, and inexorable.”

His words are bracing for their honesty. He also writes beautifully about the philosophical aspect of medicine, neurosurgery in particular: “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.”

Kalanithi's health improved for a while, allowing him to go back to work and to write more. He persevered through chemotherapy treatments, and when typing became painful, he wore "silver-lined gloves that allowed use of a trackpad and keyboard," his wife, Lucy — also a doctor — writes in the epilogue. In 2015, though, things took a turn, and Kalanithi died before he completed this work. Lucy, with the book's editor, finished the manuscript, sometimes piecing together emails and other documents into the narrative. It's a seamless collaboration — even the hurried, somewhat disjointed final pages feel like an authentic reflection of Kalanithi's physical decline. Lucy's epilogue and a foreword by Abraham Verghese add perspective to the first-person account.

In one of the book’s most poignant moments, Kalanithi lies on a cot in the same hospital room where his wife is giving birth to their daughter, Cady. Holding his child for the first time, he writes, “The possibilities of life emanated before us.” A few pages later, however, he is confronting yet again the certainty of death. “Everyone succumbs to finitude,” he writes. “I suspect I am not the only one who reaches this pluperfect state.” Only memory and words — in his case, those in this very book — “have a longevity I do not.”

Read them and, yes, weep.

Nora Krug is a Book World editor.

Read more:

The best books of 2015

Oliver Sacks’s posthumous gift: ‘Gratitude’

How a long-lost manuscript changed one writer’s life

When Breath becomes air

By Paul Kalanithi

Random House. 228 pp. $25

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