Book 24: When Breath Becomes Air

When Breath Becomes Air (2016) by Paul Kalanithi is not your usual autobiography. It’s a real life version of the “if you’re reading this, it’s too late..” messages. The author passed away before the book was published, and he wrote the book knowing that would be the case. Our posthumous protagonist is a neurosurgeon who was suddenly thrust into the role of a patient, and whose days were abruptly limited just as he was primed to reach the apex of his career.

“I lay there in the dirt, awash in sunlight and memory, feeling the shrinking size of this town.”

The book is split into two parts – pre and post diagnosis. In part one, I surprisingly found I had a lot in common with Paul – a childhood where you would actually hear the words “always check your shoes for scorpions” and they would be words you have to take seriously. One of my cousins when I was little walked into the bathroom at our farm only to find a scorpion on the toilet seat. Although, I never saw it with my own eyes so I can’t say for sure if it happened or if it was one of those “I saw a ghost” stories kids tell each other.

“Literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.”

I also related to his love for literature and reading. It’s amazing how he connects reading to neuroscience, in a way that I never would have thought of. His two aspects represent me and my brother perfectly – I’m books and Abdulaziz is medicine and it seems that Paul is the combination of the two. He saw literature and culture as almost a biological function of the brain. The heart beats for the body to survive, and the mind creates for humanity to survive and leave legacies. His love for both literature and science and his insistence on the overlap of the two reminded me of the Renaissance men. We are so quick to box people in as just business minded, or STEM vs the creative minds when many have the potential for both. Many med students I know are also artists, musicians and poets.

“Brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.”

The first part is about his life pre-diagnosis. As a resident we see that he was so immersed in life and death that he became inured. He’s seen death by alcohol and by moose attacks, he’s seen inexplicable deaths and more. And he writes this all as he lays dying which is such a unique perspective. The brief discussion on cadavers at university reminded me of Stiff by Mary Roach.

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

His moral responsibility as a doctor, his struggle with always bearing bad news and repeated mindful efforts to humanise his patients and guide them through as best he could were inspiring. He sees them at a clear divide between “life before” and “what remains of life after” in the moments of his diagnosis.

“How little do doctors understand the hells through which we put patients”.

I learned so much, like the idea of sending messages into the brain and the implications that might have like treating OCD. What makes rigorous treatments like chemo worth it just to continue living?

Time was a major theme throughout. He mused on the way time is on hold during surgery – something I’ve never thought of even with all the shows I watch.

“What kind of life exists without language?”

Not only do we need to live in terms of heart beating, lungs breathing – but we also need to live with our faculties about us. Not being able to understand, or not being able to speak a language would lead to a form of isolation that somehow makes life not worth living.

“The fact of death is unsettling. Yet there is no other way to live”

His narration is clear, pragmatic and no-nonsense, but also beautiful. He never rambles, is always to the point and is very sincere.

“my relationship with statistics changed as soon as I became one”

This book also forces us to reflect on what molds our identity: our bodies, what we do with our bodies, our strength, our pain, our looks & our language, our feelings.

“The angst of facing mortality has no remedy in probability”

Somehow, even though the subject matter and situation were sad, the book still managed to be uplifting. Especially with the arrival of his daughter, he timed an ending with a fresh beginning.

“Every tiny increase in strength broadened the possible worlds, the possible versions of me”

The epilogue was written by his wife and this is the part where I finally burst into tears.

“I was his wife and a witness”

It was interesting reading this during Ramadan – a time where you naturally think a lot about the meaning of life, where u think of the have and have-nots and where you read the Quran and think about why we’re here and how we’re all so different. Different skins, different luck, different paths, different futures and languages and opportunities and thoughts. Kalanithi taught me that it is important to take time when reflecting on your life. He went to so many lengths just to acquire the vocabulary with which to articulate his feelings. He was noble in the curve-ball life through his was and I admire him for that.

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