Paul Kalanithi’s When Breath Becomes Air opens with a trainee surgeon examining a set of images from a CT scan. His highly trained eyes take in how the tumours are dispersed across the lungs, how the spine is deformed, how one lobe of the liver has been obliterated. The diagnosis: “Cancer, widely disseminated.”
Only one thing makes this case different from the dozens he deals with each week: these are scans of his own body. The doctor in question was Kalanithi, who discovered he had inoperable lung cancer at the age of 36.
The cliche about someone having everything to live for could have been formulated for him — he was on the verge of qualifying as a neurosurgeon after a decade of training and was planning to start a family with his wife, Lucy.
Instead, he found himself confronting not only terminal illness but also a profound identity crisis. Having aspired to be “the pastoral figure … I found myself the sheep, lost and confused”.
This account of his transition from doctor to patient was written in the year or so prior to his death, by which time he was 37.
Cyril Diengdoh, Deputy Commissioner of South West Garo Hills, currently reading the book, says, “I discovered the memoir from a recommendation on Goodreads website and review in The Guardian Books page”.
“The book perhaps is about death, which is a universal truth we must all face. However, it is not a book about dying but rather the opposite — it’s about living. Courage, compassion, dignity and empathy are weighty words, difficult to write about. However, this book manages to inspire and that’s the reason it touched me,” says Diengdoh.
For Kalanithi, medicine was never just a job, it was another approach to the metaphysical questions he had taken aim at during his English degree.
In his fourth year he was puzzled when many of his contemporaries decided to specialise in areas, such as radiology or dermatology, which promised humane hours, high salaries and only moderate pressure.
He chose neurosurgery, the most difficult specialism of all, drawn by its “unforgiving call to perfection”. The demands of the training are almost unimaginable: He worked more than 100 hours a week, doing operations in which the difference between life and death was thin.
As cancer weakens Kalanithi’s body, forcing him to abandon his heroic self-image, his writing gathers strength. The odd limbo period in which he is increasingly sure that something is wrong but has not yet had the tests to confirm it, is rendered in horrible detail.
Despite being plagued by terrible back pain, with his weight dropping fast, his wife only finds out about his fears when she picks up his phone and finds “frequency of cancers in 30-to40-year-olds” typed into a medical search engine. Even then he continues to work, dosing himself up on Ibuprofen and putting in 36 hours at the operating table only days before his diagnosis.
Kalanithi’s first instinct on discovering he has cancer is to obsess about statistics and survival curves. A planner by nature, he wants to know how long he has. But he finds that averages and probabilities, while useful to a doctor in deciding between treatments, have little meaning for a patient.
“What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find on her own… the angst of facing mortality has no remedy in probability,” the author writes.
In the absence of any certainty, he decides that all he can do is assume that he is going to live a long time. Once the drugs kick in and the symptoms subside, he puts on his scrubs and heads back to the operating theatre, and he and Lucy embark on a course of IVF.
“Don’t you think saying goodbye to your child will make your death more painful?” asks Lucy.
Kalanithi responds: “Wouldn’t it be great if it did?”
Any healthy person deciding to have a child might of course ask themselves that question and come up with the same response. The power of this book lies in its eloquent insistence that we are all confronting our mortality every day. The real question we face, Kalanithi writes, is not how long, but rather how, we will live — and the answer does not appear in any medical textbook. It brings him back, at last, to the books of poetry he left gathering dust when he entered medical school.
“When Breath Becomes Air should be read because it is about courage, compassion and dignity which I believe will inspire many It is a wonderful read. I would like to recommend it to all,” says Diengdoh.
Reading suggestions for the week:
1. Love and Longing in Bombay by Vikram Chandra
2. Passion Flower by Cyrus Mistry