Paul Kalanithi’s posthumous memoir, “When Breath Becomes Air,’’ possesses the gravity and wisdom of an ancient Greek tragedy. Kalanithi writes in the idiom of the modern, quoting Samuel Beckett and conjuring images of brain scans, but his story contains elements of that older form: A fate is foretold, bravely resisted, and we are left to watch the inevitable unfold.
Kalanithi, who died on March 9, 2015, at the age of 37, delivers his chronicle in austere, beautiful prose. The book brims with insightful reflections on mortality that are especially poignant coming from a trained physician familiar with what lies ahead.
The story opens with Kalanithi sitting on a hospital bed studying his own CT scans with his young wife, Lucy, also a physician. The two discuss the case, but the diagnosis is clear.
From there Kalanithi takes us back to his youth in Arizona and the somewhat unconventional path that would eventually lead him to Yale medical school, where he would meet his wife-to-be.
When Kalanithi learned of the lung cancer that would take his life less than two years later, he was completing his residency as a neurosurgeon at Stanford. He reflects on how he had looked into the faces of his own patients while delivering news of fatal brain cancers. “The root of disaster means a star coming apart, and no image expresses better the look in a patient’s eyes when hearing a neurosurgeon’s diagnosis,” he writes.
Suddenly he found himself in the position of a patient struggling against such total disintegration.
More than a decade of medical training had given him extensive experience with death and disease. But his own case understandably felt different, even unprecedented, and the prospect of dying struck him with a raw force. “Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I instead saw only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.”
Much of his memoir explores the difference between types of knowledge: academic and experiential, objective and subjective, clinical and personal. Kalanithi was already unusually qualified to bridge this divide before he became sick. As an undergraduate he studied literature and biology and was constantly searching for ways to reconcile their different languages. He discovered in both disciplines some of the same basic truths and questions about human nature, and he specialized in neurology because the brain was the physical locus of identity.
As his illness progressed, he became haunted by his own past failures of empathy, moments when he could have been more attuned to his patients’ needs. But a certain degree of detachment is also an inevitable part of working every day with the gravely ill. Some of the memoir’s most candid moments deal with the unavoidable callousness that doctors must actively work to resist. In one scene, he slips back into a trauma bay of the hospital to retrieve a melted ice-cream sandwich that he put down before performing an emergency operation. He was not able to save the patient, and he feels a sudden guilt when he notices that he still wants to save the melting treat.
His memoir prompts a subtle awakening of empathy for both doctors and patients. Kalanithi was clearly an exceptional neurosurgeon, but he also wrote with a moral wisdom that allowed him to see that behind the abstractions of medical statistics there is always some particular lived experience.
His own experience of life was rich and varied; the memoir covers everything from recollections of his childhood to falling in love and the birth of his daughter not long before he dies. The narrative voice is so assured and powerful that you almost expect him to survive his own death and carry on describing what happened to his friends and family after he is gone. And while this does not happen, the words of his deeply moving book constitute a kind of continuance.
WHEN BREATH BECOMES AIR
By Paul Kalanithi
Random House, 225 pp., $25
Nick Romeo is a journalist and cultural critic.