Paul Kalanithi's When Breath Becomes Air

In his meditative memoir When Breath Becomes Air (Random House, 2016), Paul Kalanithi examines his life's striving for meaning, experiences, and an understanding of identity and death.



Although there are certainly a number of other excellent writers who are doctors with whom we might compare Kalanithi's brief volume (such as Abraham Verghese, who provides a foreword to the memoir, or Sanjay Gupta, whom Kalanithi references in his book), I found that Kalanithi's perspective called to mind most readily Vikram Chandra's Geek Sublime: Writing Fiction, Coding Software, another memoir in which novelist Chandra explores his experiences and perspective as a software engineer on his sense of narrative and fiction writing. In both Kalanithi and Chandra's memoirs, there is a deep sense of expertise and embeddedness in the vocabulary of a distinctly nonliterary worldview that nevertheless comes along with a deep love of literature, metaphor, and the cadences of poetic lines. Indeed, Kalanithi recounts in the first half of the book how he studied both literature and biology as a double major in college, pursuing a master's in literature as well before turning an undivided attention to medicine for the next decade of his life. For him, literature is what makes meaning of experiences in people's lives; still, he felt an urgent need also to have those experiences, to dive into the stuff of life more than simply reflect upon it and come to deeper understandings.

As he found himself drawn to medicine, Kalanithi settled into neurosurgery as the specialization that best encapsulated his sense of how science and modern technology seeks to make sense of the sublime emergence of identity and meaning from the very material substance of the brain. There is a little something too neat in his retrospective narration of his career trajectory.... but clearly this was the experience of a young man who knew what he wanted to do at each step of his life, even if longer term goals were not always immediately apparent.

There is a lot to say about this memoir, especially Kalanithi's utterly beautiful language. One sample:
Before operating on a patient's brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another's cross, one must sometimes get crushed by the weight.
These are lines not meant simply to convey a thought but also to reach for that ineffable power of poetic language, strings of words that mean more than what they say. Additionally, Kalanithi ruminates on the origins and valences of significant words that he uses—patient and disaster, for instance—along with careful framing of his words with literary epigraphs and references to canonical works of English literature (T.S. Eliot's The Waste Land makes a few appearances, for example).

And perhaps most powerfully for me, Kalanithi writes about the importance of compassion in the work of doctors. This is a topic that is big in the medical humanities, of course, but one that seems to be a source of constant stress for those in the medical field due to overwork and the workings of the mind that tend to dampen doctors' ability to connect emotionally with their patients, sometimes as a way of preserving the doctors' own sense of self and worth. Speaking with another resident who could not admit that he messed up, Kalanithi said:
"All you have to do," I said, "is look me in the eye and say, 'I'm sorry. What happened was my fault, and I won't let it happen again.'"
This ability to accept responsibility for mistakes was at the core of Kalanithi's conception of the good doctor. It is not enough to be an excellent technician or even to have the best bedside manner if doctors cannot deal with the fact that they themselves will slip up, and those mistakes will lead to serious consequences and death for some of their patients.

See also stephenhongsohn's review of Kalanithi's memoir.
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