When Breath Becomes Air

When Breath Becomes Air is written by Dr. Paul Kalanithi. There is a good summary about this book on his website. There are also a lot of reviews that you can find online about this book as well. Here I share with you a couple of my own thoughts on reading When Breath Becomes Air. I was particularly taken by Paul’s courage to first strive for excellence, then to strive for living a meaningful life without self-pity, despite the tragedy.

Writing about his experience of watching the break of the dawn after hiking to the summit of Mount Tallac: You could not help but feel your specklike existence against the immensity of the mountain, the earth, the universe, and yet still feel your own two feet on the talus, reaffirming your presence amid the grandeur. His friend, the assistant director of the Sierra Camp, Mo, later wrote about the time spent together: Suddenly, now I know what I want, I want the counselors to build a pyre…and let my ashes drop and mingle with the sand. Lose my bones amongst the driftwood, my teeth amongst the sand…I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.

When finishing up his degree on literature, Paul found that one day the voice of “Take up and read” was confronted by the inner voice “Set aside the books and practice medicine” and he was commanded by the latter. He wrote: it would mean setting aside literature. But it would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay. I admire Paul’s courage and conviction tremendously for answering to that inner voice. Coincidentally, for two periods in the past decade, I heard that voice pulling me towards being a neurosurgeon. I did not follow it because being a real doctor (unlike the one I acquired, Doctor of Philosophy) seems to require one’s capability of shouldering greater amount of responsibility of others’ lives than any other professions and being a neurosurgeon most of all. The first time during my research on identifying the biomarkers that predict the stages of cognitive impairment and help to identify potential early treatment for Alzheimer’s disease, I was introduced to neurosurgical ways of alleviating the Alzheimer’s symptoms. The second period, I desperately wanted to be a neurosurgeon when my father was suffering from traumatic brain injury and I spent a lot time in ICU observing the devastation of many families whose loved ones were in one critical neural illness or another while exhausting every bit of myself to find ways to keep my father alive. It was during that time, my self-doubt was overwhelming. I questioned myself about my choice of profession and what I have learned all seemed so trivial and useless when it comes to curing dad’s illness. I examined every corner of my own life. What is the meaning of my life if I could not relieve the suffering from my beloved ones? How minuscule the impact of practising my profession is when confronted with the emotional and physical pains of a vast number of people daily? I was acutely angry with my incapability of doing more for my father and others for a long time. It came to my realisation that living a meaningful life and bringing goodness to others do not mandate that all should be trained to cure diseases. There are other channels that could be explored.

I struggled with minimizing the number of passages I wanted to quote from the book. Whether you are reading this book for its aesthetics, satisfying your curiosity of the process of becoming a neurosurgeon, an understanding of mortality and facing it, or its inspiration on the meanings in life and striving, it is not an exaggeration to say that this book has it all.

I began to see all disciplines as creating a vocabulary, a set of tools for understanding human life in a particular way.

I had spent so much time studying literature at Stanford and the history of medicine at Cambridge, in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me. Descriptions like Nuland’s convinced me that such things could be known only face-to-face.

Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that is the point. Putting lifestyle first is how you find a job – not a calling.

Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: what makes life meaningful enough to go on living?

Over the next seven years of training, we would grow from bearing witness to medical dramas to becoming leading actors in them.

Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life – and not merely life but another’s identify; it is perhaps not too much to say another’s soul – was obvious in its sacredness.

In taking up another’s cross, one must sometimes get crushed by the weight.

You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

If boredom, is, as Heidegger argued, the awareness of time passing, then surgery felt like the opposite: the intense focus made the arms of the clock seem arbitrarily placed. Two hours could feel like a minute. Once the final stitch was placed and the wound was dressed, normal time suddenly restarted. You could almost hear an audible whoosh.

I began to realize that coming in such close contact with my own mortality had changed both nothing and everything.

One chapter of my life seemed to have ended; perhaps the whole book was closing. Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany – a piercing burst of light, illuminating What Really matters – and more like someone had just firebombed the path forward. Now I would have to work around it.

It had occurred to me that Darwin and Nietzsche agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes. After so many years of living with death, I’d come to understand that the easiest death wasn’t necessarily the best….We would carry on living, instead of dying.

…acquiring rich experiences, then retreating to cogitate and write about them…

The monolithic uncertainty of my future was deadening; everywhere I turned, the shadow of death obscured the meaning of any action. I remember the moment when my overwhelming unease yielded, when that seemingly impassable sea of uncertainty parted. I woke up in pain, facing another day….I can’t go on, I thought, and immediately, its antiphon responded, completing Samuel Beckett’s seven words, words I had learned long ago and an undergraduate: I’ll go on. I got out of bed and took a step forward, repeating the phrase over and over: “I can’t go on, I’ll go on.” ….because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.

You have to figure out what’s most important to you.

Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them, where, as at the end of what Sunday’s reading: the sower and reaper can rejoice together. For here the saying is verified that “One sows and another reaps.” I sent you to reap what you have not worked for; others have done the word, and you are sharing the fruits of their work.

Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after wind, indeed.

Words have a longevity I do not…. When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.

My final word about When Breath Becomes Air: If you were to read only one book this year, it would be wise of you to pick this one.