Saturday, October 15, 2016

Breath Becomes Air by Paul Kalanithi

As an adolescent, Paul Kalanithi was concerned with the central question: what gives life meaning? For an answer, he turned to literature, earning a BA and MA in English literature. Then, he studied another love, science, because he wanted to know how a brain – just an organ - makes the mind possible. Finally, at 34, within reach of the official title of Stanford University neurosurgeon-scientist, he reads his own test results, finds his body riddled with cancer, “lost in a featureless wasteland of his own mortality”, yet finds the wherewithal to write this extraordinary, powerful, heart-wrenching book. Twenty-one months later, with a newborn daughter, he dies at the age of 36.

When Breath Becomes Air stopped me in my tracks. It made me see the world with fresh eyes, appreciate it with every breath, and realize the difference between breath and air, brain and mind, body and soul, balance and ambition.

Kalanithi understood the science behind his cancer, but it was his relationship to literature and other people that soothed and sustained him in the end. His love of language as “an almost supernatural force,” and his use of it to forge this book ensures his legacy. He underscores that we are more than matter, biological organisms, numbers and graphs.  One of my favorite lines is: “It occurred to me that my relationship with statistics changed as soon as I became one.” Kalanithi superbly identifies the limits of science: “The paradox is that scientific methodology is the product of human hands and thus cannot reach some permanent truth. . . Science is based on reproducibility and manufactured objectivity” and makes claims about matter and energy, but that kind of scientific knowledge is “inapplicable to the existential, visceral nature of human life.” No reader of Kalanithi’s book can remain immune to the importance of the “A” (Arts) in STEAM or to the imperative of keeping it there as an equal in any child’s curriculum.

No one acting as an agent in medicine or as a patient should let this book slip away, for Kalanithi leaves a treasure of insights about how all of medicine “trespasses into sacred spheres;” how “the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.” He pursued medicine “to bear witness to the twinned mysteries of death, its experiential and biological manifestations, at once deeply personal and utterly impersonal.”

This is a must-read for medical personnel because they face “heroic responsibility amid blood and failure” and must resolve them every day. For Kalanithi, medicine was not a job but a calling, full of moral responsibility, holding everything that mattered to him: life, death, identity, and meaning: “Neurosurgery requires a commitment to one’s own excellence and a commitment to another’s identity. . . . My highest ideal was not saving lives—everyone dies eventually—but guiding a patient or family to an understanding of death or illness.”

Debilitated by cancer, Kalanithi poignantly describes how it felt for him to flip from neurosurgeon to patient, from the subject, the agent, the cause of medical actions to the direct object of them, as “something to which things happened.” With courage, we are mind, spirit, and soul. That is what makes us human, and the sharing of them is what makes life meaningful. Kalanithi’s wife, Lucy, finishes the book, which is: “a chance for this courageous seer to be a sayer, to teach us to face death with integrity.”

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