"When Breath Becomes Air" by Paul Kalanithi

When Breath Becomes Air is my second entry in "possible books to teach at school." I was drawn to Kalanithi's book primarily because it's short, nonfiction, and modern. I was also drawn to it because of its clear hook, the undoubtable reason it's become so popular and has over 16,000 Amazon reviews: the author's--a neurosurgeon--tragic death at age 36 of lung cancer.

We have a grand sense of "fairness" in the world--what deaths are tragedies, and what deaths are acceptable to our understanding of the modern universe. Kalanithi's death challenges that sense of fairness. He's young, for one, and he dies just months after the birth of his first child, but even more importantly, he's incredibly successful in one of the most challenging fields most of us can imagine. In a country that prizes professional success and academic recognition, Kalanithi reached the absolute top, only to be toppled by a unconquerable disease. Plenty of that irony also carries the book. Kalanithi is a doctor, yet his medical training offers no respite from his cancer; he has access to the best doctors and treatments available, yet we're reminded that modern medicine can't save all.

I say all this preamble to note that much of what sustains When Breath Becomes Air is its premise. It makes it hard, then, to separate out the compelling premise from Kalanithi's writing. Is the writing good? Is the book good? Or does the story simply pull too many strings of human belief to look away?

I don't know. I found myself pulled in by Kalanithi, but was I pulled in by his prose or his credentials? Surely a Stanford neurosurgeon is to be listened to, regardless of what he says! Plus he faced death in a way most of us (I'm the age he was when he died, I note with a shudder) would find unimaginable. I think, though, I ultimately would have preferred a more honest book. Kalanithi spends the book primarily exploring his life's work, his search for philosophical meaning in the scientific practice of medicine. He speaks in grand (and, perhaps, vague) pronouncements and metaphors about the ephemeral nature of life itself; of our search for purpose. But he doesn't really talk about ambition. About the single-minded pursuit of a demanding profession that nearly broke up his marriage (it's saved by his cancer diagnosis). I don't mean to belittle Kalanithi's philosophical meditations or his desire to help others, but you don't become a neurosurgeon because of philosophy or out of altruism. The cost is simply too high. Becoming a neurosurgeon is a result of ambition, a drive for success and recognition at the highest possible levels. 

I don't fault this pursuit--it's one imminently respected by Americans--but it's not a pursuit without cost emotionally and socially. It's an individualistic pursuit, one that precludes a priority on family, for example. I don't mean that as a criticism. Platitudes about "family is the most important" aren't useful. But I would have appreciated more awareness of the fact that, to succeed as Kalanithi does, the self--via the actualization of his work as a surgeon--comes first. When faced with his cancer diagnosis, Kalanithi chooses to keep working, despite his limited time left. Again, I don't fault that choice. Given his life's work, it's the most obvious and natural choice to make. But it does make his romantic statements at the end about the joy his young daughter brings him ring hollow. He acknowledges this joy is "a joy that does not hunger for more and more but rests, satisfied" (199), but we never see that criticism of medicine earlier in the novel. That pursuing professional (or academic or athletic) success means pursuing an unachievable joy.

Nevertheless, while I might have wanted more brutal honesty about his profession, there's plenty of compelling material, both about the work of top doctors and surgeons and about the limitations of modern medicine. 

I wrote the above after finishing Kalanithi's portion of the book, assuming the epilogue by his wife wouldn't substantively impact the memoir. Surprisingly, Lucy's epilogue is essential to the book as a whole and actually changes my opinion somewhat. Lucy's description of their final months is heartbreaking and intimate in a way Paul's writing is not. It was in her section that I found myself quietly crying, even though I was reading in the middle of class with a bunch of teenage boys in the room. While Paul focuses on philosophical questions of the body and mind, she focuses on the love of family--something Paul practically ignores (he acknowledges his family's support but offers few details, spending far more time on his relationship with his oncologist; Lucy's pregnancy--undertaken only because of Paul's short time left--is mentioned in passing). She notes, too, the limitations of Paul's story: "Paul's voice in When Breath Becomes Air is strong and distinctive, but also somewhat solitary. Parallel to this story are the love and warmth and spaciousness and radical permission that surrounded him.... He wrote with a clear voice, the voice of someone with limited time, a ceaseless survivor, though there were other selves as well" (220).

After reading the epilogue, I can see more value in When Breath Becomes Air, and see it more of a story of the many-faceted life one lives, even near death. I'm still not sure if this is the book I'm looking for to use in the classroom, as my students might find the more philosophical portions dry, but it would be an interesting shift from the material we more commonly teach.