Paul Kalanithi was on the cusp of a promising career as a neurosurgeon when, at age 36, he was diagnosed with stage IV lung cancer. In his memoir, “When Breath Becomes Air,” he writes, “severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany—a piercing burst of light, illuminating What Really Matters—and more like someone had just firebombed the path forward, and now I would have to work around it.” This fascinating memoir resists easy generalities or comforting platitudes; it is not a triumphant story of life over death. Instead, it chronicles Kalanithi’s improvised, provisional, and brave attempts to find workarounds to meaning.
Part of what makes this memoir so compelling is that Kalanithi writes about his illness as both a doctor comfortable discussing mortality and as a patient facing his own. He writes, “as a doctor, I knew not to declare “Cancer is a battle I’m going to win!” or ask “Why me?” (Answer: Why not me?)” But, just pages earlier, he writes as a patient: “Only 0.0012 percent of thirty-six-year-olds get lung cancer. Yes, all cancer patients are unlucky, but there’s cancer, and then there’s CANCER, and you have to be really unlucky to get the latter.” The tension between these roles—sober-minded doctor and terrified patient—illuminates the universal experience of dying from a unique perspective.
“When Breath Becomes Air” is also remarkable because its author was not just a doctor, but a fine writer. In vivid detail, he recounts his childhood, the immense pressure of medical training, and his lifelong commitment to literature. Early in the book, Kalanithi recounts his indecision over his future profession:
“…I hadn’t thought much more about a career but had nearly completed degrees in English Literature and human biology. I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful? I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.”
Kalanithi’s earnest pursuits and direct prose makes this book an unforgettable account of the life of the mind. The subject and literary sensibility at first suggested I might find a kind of first person version of Joan Didion’s bestselling “The Year of Magical Thinking” — a poetic and restrained memoir on loss. Instead, “When Breath Becomes Air” seems ultimately closer to psychologist Victor Frankl’s “Man’s Search For Meaning,” a title that could easily have been a subtitle to this book. As Kalanithi, his wife, and extended family make final decisions about whether to have a child or between different treatment options, we are forced to ask ourselves: Would I make the same decision? What makes my life meaningful?
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