Magazine article The Human Life Review

When Breath Becomes Air

Magazine article The Human Life Review

When Breath Becomes Air

Article excerpt

WHEN BREATH BECOMES AIR Paul Kalanithi (Random House, 2016, $25.00, 228 pp.)

On a spring evening in 2015, Paul Kalanithi died at the age of 36 of metastasized cancer. Not, however, before composing this poignant and in many ways elegant autobiography prompted by his diagnosis. Kalanithi was a gifted and driven young neurosurgeon with a hunger to achieve excellence and a meaningful life. A lover of great literature who earned his master's in English Lit before zeroing in on medicine for a career, Kalanithi naturally turned to the written word to help him better comprehend his abbreviated life and to convey to others its major epiphanies and concentrated lessons.

The result lingers in the mind both because of what it tells us about Kalanithi and what, in the end, it does not. This is a difficult book to grasp, in the sense of knowing where the author is going, how he envisioned the effect of his writing, and how different it might have been if he had lived long enough to complete and edit it. (It cuts off several months before his death. An epilogue, written by his wife, describes this last period of his life and details his final hours, surrounded by extended family that included the eight-month-old child they determined to conceive knowing he would be likely to die before she could walk.)

It is Kalanithi's skill as a writer that delayed my realizing how unfinished, structurally, his book is, and that even now makes me wonder whether some of what appear to be gaps or internal contradictions are not intended, are not in fact meant to represent unresolved questions or enlightening examples of cognitive dissonance.

Take his description of his father, a cardiologist who was dedicated to his job and determined to send his three bright sons to top colleges:

When we did see him, late at night or on weekends, he was an amalgam of sweet affections and austere diktats, hugs and kisses mixed with stony pronouncements: "It's very easy to be number one: find the guy who is number one and score one point higher than he does." He had reached some compromise in his mind that fatherhood could be distilled, short, concentrated (but sincere) bursts of high intensity could equal... whatever it was that other fathers did. All I knew was, if that was the price of medicine it was simply too high.

Of course, even as we read this, we already know from the foreword and prologue that he will ultimately not only choose to become a doctor, but to zero in on neurosurgery and neuroscience, hugely labor-intensive and attention-deflecting as they are. In addition, he and his doctor wife will choose to have a baby daughter destined (and this part was certainly not his choice) to grow up with her father completely absent.

It is hard not to wonder-and to feel that he wondered too, or felt we would be right to wonder-how different a father he would have been. And whether "different" necessarily means better. Kalanithi's father features sparsely but significantly in the rest of his son's book: Once when his now medically trained son follows him on his rounds and watches him engage with his patients; later, after the dire cancer diagnosis and the first rounds of treatment are succeeded by a resurgence of the cancer, when he erupts with helpless love against the idea that there is no hope; and finally at his son's deathbed. Is this small but important collection of scenes simply a record of the pluses and minuses of their relationship? Is it the view of a younger person vs. an older one? Is it the bare bones of what, if Kalanithi had had more time and, in the last months, strength, would have been a profound and nuanced reflection on fatherhood, family, sonship, legacy? At this and every other point in the book where the reader is left wondering where to come down, we experience the hole left by the author's untimely departure. He died too soon to answer all of his own questions and ours too. Which can perhaps be said, to a greater or lesser degree, of most of us when we die. …

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