Tag Archives: Neurosurgery

When Breath Becomes Air by Paul Kalanithi: Bearing witness

Cover imageSo much has been said about Paul Kalanithi’s account of the twenty-two months from his diagnosis with lung cancer to his death at the age of thirty-six that I’m not sure what I can add of any value except to tell you emphatically to read it. This week sees its paperback publication in the UK. There will be piles displayed on tables in every bookshop you’re likely to enter. Don’t shy away from it because it’s winter, because you think it might be depressing and or because it feels like the world’s going to hell in a handcart: read it and be uplifted by Kalanithi’s eloquence, courage and the beauty of his writing.

Kalanithi’s account begins with his diagnosis then takes us back to his teenage years when he was convinced that he’d turn his back on the medicine much of his family practices and become a writer. Kalanithi was one of those rare people – equally at home studying the arts or sciences, only coming to medicine after taking a Master’s in literature. An epiphany led him to realise that only through medicine would he be able to come to an understanding of life and its meaning: he saw it as a calling not a job. He takes us through his training – the bone-deep exhaustion, the struggle between empathy and self-preservation and the difficulty of maintaining relationships while engaged in such emotionally, mentally and physically draining work. He and his wife, also a surgeon, are both open about the strains on their marriage. Half-way through the book, the doctor becomes a patient. Kalanithi describes the path his illness takes, the difficulty of being a patient and his wise oncologist’s insistence that he turn away from prognosis statistics and decide what meaning he wants to give to the life remaining to him. He and Lucy decide to go ahead with having a child – something they had planned to do in a few years – a decision which brings them both great joy. Kalanithi died on March 9th, 2015 when his beloved daughter Cady was just eight months old.

It’s not possible to write about Kalanithi’s book without remarking on the beauty and clarity of his writing, both in sentiment and description. When recounting dissecting his first cadaver he talks about the difficulty of separating its humanity from what he’s about to do then describes his first cut: ‘the scalpel is so sharp it doesn’t so much cut the skin as unzip it’. That struggle with empathy and the mechanics of what a surgeon must do is a dilemma Kalanithi returns to constantly, eventually electing to gently lead patients and their families towards the treatment that suits them, a world away from the scalpel-at-the-ready surgeons we see in TV hospital dramas. His priority is to find a meaning in life, to try to understand what that might be for each patient, then for himself when his own time comes. All this is amplified through anecdote, often expressed in lyrically beautiful prose: premature twins are born looking more like ‘preparatory sketches of children than children themselves’. Kalanithi’s humanity, compassion and courage shine out from every page, his concern for his patients palpable and his deeply probing thoughts about life and its quality enlightening. He was unable to finish the book he spent his last year writing but his wife has added an epilogue of equal thought and eloquence, tender yet clear-eyed. In it she says that Kalanithi was utterly determined to write a book which would engage his readers in understanding death and facing their mortality. That he has done, and done it with an admirable grace. Please read it.