By Joelyn Suarez
Hope is not the typical remedy that doctors prescribe for medical illnesses, yet it is exactly what neurosurgeon Paul Kalanithi turns to when he is confronted with stage IV lung cancer. But what good is hope when all other scientific evidence points to an imminent end? Kalanithi’s memoir When Breath Becomes Air is about learning how to face death head on, while examining what it means to be alive. His definition of hope is not one that is unrealistic, or based on some miraculous intervention, but the very real possibility of leading a fulfilled life despite the amount of time one has left.
Kalanithi blurs the line between doctor and patient. When confronted with the initial diagnosis, Kalanithi throws himself into his work. He was a brilliant man who held two bachelors in English Literature and Human Biology, and an M.A. in English Literature from Stanford University, a Master’s of Philosophy from the University of Cambridge, then went on to graduate cum laude from Yale Medical School. He spent hours in the operating room, saving lives, while his body deteriorated in the months following his cancer discovery. In the twenty-two months between Kalanithi’s diagnosis and his death, he was able to accomplish something arguably more impressive than his degrees — he became a father, he focused his attention on his passion for literature, and he wrote a book that would serve as a legacy well beyond his physical life.
Kalanithi translates medical jargon with the poetic ease of a writer. Even more so after becoming a patient himself, he sees the human story beyond what is written on a clipboard. He asks himself the important questions: What is this person’s diagnosis? How aggressive is their illness? What is important to the patient, and what quality of life can they preserve? He believes in leaving a little room for hope as he stated:
What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find on her own. Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.
When Breath Becomes Air is an exploration of the seemingly minor moments that make up a lifetime and prepare a person for death. The memoir opens with a foreword by Abraham Verghese, and closes with an epilogue by Kalanithi’s wife, Lucy. Verghese prompts readers for what is to come:
Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.
Kalanithi’s perspective of death is unique; he battles it simultaneously on and off the clock. The stakes rise for Kalanithi knowing he will leave behind his wife, family, friends and colleagues. Through his personal experiences, dealing with patients and becoming one, Kalanithi interprets both sides of the conversation in his writing. He is not self-pitying and never asks, “Why me?” As a doctor, Kalanithi is versed in the science of death. As a patient, he is pragmatic.
When Kalanithi and Lucy decide to have a baby, despite his cancer, the narrative takes the biggest turn. He sees the future — rather than past ambitions or his current state — in his daughter, Cady. The memoir closes with a message to her:
When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.
To an extent, Kalanithi takes his own advice, and provides a ledger of what he has been and done in this world; however, his writing is not indulgent. He does not boast about what he has meant to the world or listed all the people whose lives he has saved as a doctor. Instead, Kalanithi shares his worries, his curiosities, his passions, and even his mistakes. The reader is left with Lucy’s epilogue to discover what Kalanithi meant to his family and friends. He was not only an extremely intelligent doctor, brave patient, eloquent writer, but also a loving husband, father, son, brother, and friend. When Breath Becomes Air is not an account of death, but a portrait of Paul Kalanithi’s life.
In Lucy’s epilogue we see a softer side to the highly intellectual man. She describes Kalanithi’s narrative voice as “strong” and “distinctive,” but also “solitary.” Death is solitary. Kalanithi’s life is the only one lost here. However, the grief is a shared experience — for Lucy, Cady, and even the reader. Lucy points to the other facets of her late husband’s character that were not spotlighted in the memoir:
Here he is as a doctor, as a patient, and within a doctor-patient relationship. He wrote with a clear voice, the voice of someone with limited time, a ceaseless striver, though there were other selves as well. Not fully captured in these pages are Paul’s sense of humor—he was wickedly funny—or his sweetness and tenderness, the value he placed on relationships with friends and family.
When Breath Becomes Air is indeed a success in terms of Kalanithi writing a compelling story. The theme of hope radiates off the page, and leaves the reader simultaneously fulfilled and saddened by the loss. But beyond Kalanithi’s skill, his ability to welcome readers into a world that is often unseen — whether it is the operating room or the psychological stages of terminal illness — success can be attributed to the loved ones who brought this book to light. When Breath Becomes Air has changed the landscape for medical narratives. It shows what one life looks like from the inside and out; one life that, for many, has changed the way life itself may be perceived.
Joelyn Suarez lives in San Diego, CA with her fiancé and son. She holds an MFA in Creative Writing from UCR Palm Desert. Her essays “Home” and “How To Cut a Lemon” have been featured in NoiseMedium and Brain, Child: The Magazine for Thinking Mothers. She is the Nonfiction Editor for The Coachella Review.