When Breath Becomes Air by Paul Kalanithi

Posted by Mrs Giggles on March 18, 2016 in 4 Oogies, Book Reviews, Nonfiction

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When Breath Becomes Air by Paul Kalanithi
When Breath Becomes Air by Paul Kalanithi

The Bodley Head, £12.99, ISBN 978-1-847-92367-7
Memoir, 2016


Paul Kalanithi, I’m afraid, is never going to write another book again. He passed away last year from advanced, inoperable lung cancer. When Breath Becomes Air chronicles his thoughts on his life, the past as well as the present, until the birth of his daughter. This book is, in a way, unfinished, as Dr Kalanithi eventually became too ill to write, but then again, this book is about real life. In real life, we don’t always get the complete picture, and sometimes, such as in this case, the story becomes even more poignant.

Now, reviewing memoirs is very tricky, which is why I don’t make a habit of doing it. Okay, I don’t make a habit of reading them either. The trouble is that, when it comes to memoirs that are written by people who have since moved on, any bad thing I say, even something that is just a little bit negative, is going to make me look like the unwashed rear end of a baboon. Well, I am going to save everyone the trouble and admit right now, yes, I am that part of a baboon’s anatomy. Clear the room if you are going to get dry heaves at any hint of negativity, because you know me, I can’t lie and pretend that everything is sweet and sunny all the time.

Now, when it comes to When Breath Becomes Air, you may be wondering why this particular person was so special to get a book like this. Obviously, it is because he had an agent, duh. But yes, so many people get cancer every day, and not everyone will recover, and even when one recovers, often one seems to be on borrowed time as there is always the possibility of a recurrence. And yes, when it comes to lung cancer, it’s one of the toughest cancers to treat. Most of the time, when you discover that growth in a lung, often because you go to the hospital when the symptoms finally show, the cancer is already at an advanced stage, has spread here and there and everywhere, and hey, if you get lucky at some clinical trials, here’s a few more years. If unlucky, well, let’s just live life day by day and make arrangements as to when the plug should be pulled when the road has reached its end. Many people go through this every day. So… why this dude, why should you care about his story?

Well, on paper, just by telling you who he was when he was alive, I suspect that it may be a hard sell as the story of Dr Paul Kalanithi is actually pretty boring if we take away the whole cancer is coming to get him angle. He was born to an affluent family, and like most Asian-American kids, he conformed to the stereotype of being an overachieving all-rounder. He was hot – just look at the photos of him when he was younger and healthier – and he knows it (“a part of me that identifies as handsome”). His academic achievements were off the scales, and he was also a great athlete who could run half-marathons and bike up hills and mountains without much effort. Even when he was on treatment, he kept getting amazing job offers from people who were willing to even chip in on the cost of his treatment. His oncologist (a woman), according to his wife, “likes him”. As a neurosurgeon, his techniques were praised for bending the rules to make things better. His colleagues clamored for him to be their boss. Oh, and whenever Mr Kalanithi mentioned the folks that were from the same year as he in medical school, they either died in car accidents or committed suicide, the implication being that no one from his year could match him in terms of achievements and all-around awesome.

Without the cancer, you may think that this is one guy whose life story would be as interesting as sawdust to read, and I don’t think I disagree. I mean, he was loaded, he didn’t seem to suffer from financial woes and the painful spillover of cancer into family life and relationships (in fact, his marriage became stronger because of cancer), so people looking for sweeping tales of suffering and pain made noble and heroic are going to be disappointed with this one. Even at his most ill, Dr Paul Kalanithi was in a more privileged position than the average lung cancer patient, so it can be hard to relate to his story.

So why should you read this story? The first reason, a very subjective one, is that Dr Kalanithi was in some ways a more literate and insightful modern day version of Dr Victor Frankenstein – minus the body stealing, of course. He had always wanted to be a writer, as he was a big litfic-groupie – a scene with an ex-girlfriend shows that he believed “lowbrow” books were beneath his time and attention – and, my goodness, he did have an innate gift of using words to craft poetic sentences that seem profound rather than pretentious. His sensitive perception of the world drove him to seek for insight as to how to make sense of the world, from books mostly written by now long-dead people, and his fascination with life, death, and how the human brain seemed to be at the center of all these complex mysteries of life eventually led him to medicine. Neurosurgery.

Of course, he was brilliant, amazing, et cetera. But forget all that. It is his account of his struggles to balance distance and concern when it came to his patients that could hurt the heart the most. Most people look at medical specialists and saw only how much money they are earning, and they are very convenient scapegoats for our frustrations at the failures of modern medicine – we pay through our throats for healthcare, and yet, these overpaid people would still push us through all these treatments with tubes and scalpels that gave us so much pain; worse, we learn that most of them would never put themselves through the same treatments they force on us when they catch the same cancers – they would tell their colleagues not to resuscitate them, and some would even refuse chemotherapy – the same ones they push onto their patients as they insist that these drugs would do a whole world of good. What is not always known is that some of these doctors and specialists do all these things to their patients because of protocol, out of necessity to avoid a lawsuit, and more. Sometimes, their hands are tied, and they thank whatever deity out there that they are, at least, able to avoid putting themselves through what they have to put their patients through.

This memoir gives an outsider to the medical system an insight of this internal struggle experienced by these doctors and specialists. Dr Kalanithi wanted to save all his patients, but he couldn’t, of course, and this slowly ate away at him. He struggled daily to maintain his equilibrium – when you are exhausted after what seems like an interminable operation, and your nerves are raw, try telling the parents of a baby that the baby is born without a brain and with practically zero chances of surviving. He knew that some of his colleagues resorted to treating their patients as problems to work through, these patients’ problems an inconvenience, and he tried so hard not to do that. But it wasn’t easy. Dr Kalanithi’s sensitive prose brings to life his internal struggles so vividly, it can be quite painful for me to read this book. Memories of my own time back in those days, the long hours… I eventually opted to go out because I knew I couldn’t deal with the constant heartbreaks, and I could only give Dr Kalanithi a mental salute for being able to stay that strong for so long. Were he to live and were we to meet, we wouldn’t have much to talk about, I suspect, as his personal interests and lifestyle were so different from mine, but I couldn’t help respecting him as I read this book, for him being so human yet so capable of confronting his own weaknesses and attempting to overcome them.

Even when he was diagnosed with cancer, there was so self-pity evident in his words here. There was bargaining with God for more time, insecurities and fears for the future and for himself, and perhaps anger and some shame for not being able to do the things he once took for granted, but he never asked for the reader’s pity. Instead, he treats the reader as an equal, sharing his thoughts on his life, his philosophies, his questions about the nature of life itself, and more.

So that is the second reason to read this book – it’s a fascinating, if somewhat one-sided, conversation with an intelligent man with an impressive mix of  quiet curiosity, elegant poetry in his words, and a stoic ability to embrace life even when it hands him nothing but lemons after lemons.

The reason I didn’t give this book an extra oogie may earn me some evil side-eyed glance from other people, but hey, it has to be said: the foreword and the epilogue. The epilogue, written by Dr Kalanithi’s wife, Dr Lucy Goddard Kalanithi, offers closure and an account of his final days as well as the quiet aftermath. I can see why this may be considered a necessary inclusion, but the tone of this epilogue is more of a Reader’s Digest tearjerker special. This, I feel, cheapens a bit the quiet dignity and poise that permeated her late husband’s chapters.

But worse – the worst – is the foreword by Abraham Vergese, who claims to know Dr Kalanithi “most intimately” only after his death, and yet he could still find so many words to describe Dr Kalanithi’s everything – from his smile (“wry, gentle, a hint of mischief there”) to his writing, which, according to Mr Vergese, “had echoes of Galway Kinnell, almost a prose poem” (and here he drops in a few lines of a poem to show that he’s not just picking up names from a Wikipedia list). And he goes on and on, like that someone at a funeral who barely knew the deceased but insisted nonetheless on hogging the stage to deliver some overlong, delirious eulogy that made people wonder what this fellow was overcompensating for. I personally feel uneasy when people automatically equate someone having cancer to some courageous act of heroism (as if the cancer patient had any choice in the matter, snort), and Mr Vergese makes me super uneasy by practically pulling himself and spewing his joy all over the foreword. “I KNOW THIS DEAD GUY WHO HAD CANCER AND WAS SO AWESOME, AND I UNDERSTAND HIS GENIUS, Y’ALL, BECAUSE I AM GENIUS TOO AND I LOVE POETRY… LEMME SAY A FEW LINES… I… OH… OHHH…. OHHHHH PHWOAR!”

Still, that thing is easily skippable, so there’s that.

Anyway, if you have any interest in the way doctors work and think, When Breath Becomes Air may be worth a look. Dr Kalanithi did not want to make you sob or cry, instead he just wanted to talk, share his thoughts, because he didn’t have much time left and this was all he could do, having let go of his dreams and plans for the future. A part of me is glad that I get to be his audience, and I like to think that he’s glad, too, that I, and hopefully a few more people out there, would like to think of him as a person rather than merely another entry in the exploitative cancer memoir market.

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