Monday, June 12, 2017

book review: When Breath Becomes Air

title: Paul Kalanithi
author: When Breath Becomes Air
publisher: Random House
year: 2016

"I was pursuing medicine to bear witness to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal."

Paul Kalanithi was, by all accounts, an excellent neurosurgeon, with the potential of being a true guiding force in medicine and science. He spent most of his early adult life seeking knowledge on multiple fronts, from literature and science to philosophy and ethics. When he finally decided to pursue a career in neurology, he wasn't just content to be a doctor—he wanted to understand and identify with his patients fully, to help them and their families adjust to whatever their new reality would be following a diagnosis, an accident, a surgery.

At the age of 36, Paul Kalanithi, with a BA and MA in English Literature, a BA in Human Biology, an MPhil in History and Philosophy of Science and Medicine, and was completing his residency in Neurological Surgery and a postdoctoral fellowship in Neuroscience was diagnosed with Stage IV Lung Cancer. 

The transition from doctor to patient is not easy for anyone. While he and his internist wife Lucy are prepared for the worst, Paul's oncologist has hope, and doesn't allow him to wallow in his diagnosis. If he wants to stop being a neurologist, she tells him, it has to be because he doesn't want to continue or wants to pursue something else—his cancer won't stop him.

As he struggles with thoughts of his future, however long that might be, he ponders how to fill that time. Should he continue working in a field that has so richly given back to him, and given him the chance to touch so many lives? What gives a life value, and how can that value be measured? 
What obligations does he owe his family, his friends, his wife, his infant daughter?

"At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living."

When Breath Becomes Air is an intellectual and deeply emotional memoir, written by a young man with so much promise, so much heart, so much empathy. It is both a reflection on coming face-to-face with one's own mortality and a commentary on the responsibility doctors have to help their patients and their families through that same reflection, whether it happens with some warning or suddenly. It is also a love story, of a man and his wife, a man and the child he will never truly know, and a man and his career.

We know from the very start of Abraham Verghese's introduction to the book that Paul lost his battle with cancer, yet the end of his life, and the epilogue written by Paul's wife still feel like sucker punches. You mourn a man you probably never knew, but you feel truly blessed he chose as one of his final acts to share his life, his death, and his thoughts with the world, because we are all better for them.

"'The thing about lung cancer is that it's not exotic,' Paul wrote in an email to his best friend, Robin. 'It's just tragic enough and just imaginable enough. [The reader] can get into these shoes, walk a bit and say, 'So that's what it looks like from here...sooner or later I'll be back here in my own shoes.' That's what I'm aiming for, I think. Not the sensationalism of dying, and not exhortations to gather rosebuds, but: Here's what lies up ahead on the road.' Of course, he did more than just describe the terrain. He traversed it bravely."

This is a beautiful book, truly a work of art that I won't soon forget. I book I recommend to anyone working in any aspect of the medical profession. Thank you to the Kalanithi family for this opportunity to catch a glimpse into Paul' journey. 

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