When Breath Becomes Air by Paul Kalanithi

My rating: 5 of 5 stars

My friend and colleague, Devin Manzullo-Thomas, warned me that he broke down weeping on a Chicago subway as he finished the book, to the consternation of his fellow passengers. I found it easier to weep discretely in a Barnes and Nobles cafe. As one might guess with a book that opens with the discovery of a young and hopeful and brilliant doctor at the beginning of his career that he has what by all accounts is an incurable cancer, death awaits. And awaits relentlessly. But the knowledge that the book ends in our common human destiny does little to steel the reader for the way the heart breaks against the stony shores of that certainty. We are not given the witness of his death; no autobiography could do that. But we are given the witness of his dying and are included in that process, one that is by turns, noble and wretched and then, in some sense, ennobling of the author, of those around him, and perhaps even of us as readers.

While focused on death, the book is not morbid. If it ends in tears, it is not even really depressing in any meaningful sense of that word. What we are given is the striving after understanding, and the effort to make meaning out of experience with the only tools we have been given to do it, through our language. The book is fascinating for its testimony to the difficulties of the life of the mind and the body, to the agonies of both surgery and uncertainty. Kalanithi began as a devotee of language and discusses his turn away from the study of literature and what might loosely be described as “the mind” and towards the study of the brain and the body in the attempt to understand more completely the physical mechanism by which, after all, we come to speak and conceive of ourselves as having something called a soul or a mind. Kalanithi does not go deeply enough into this transition away from literature and language for my personal taste, though he offers the throwaway line that he thought the study of literature had become too embroiled in the study of politics and was not leading him into the study of meaning. However, he also seems to think that the study of literature is too divorced from the world of action, of doing something in the world that makes a difference, a difference he thought he could make in the healing professions. Kalanithi’s book is not about a theory of literature, but if it were I would want to argue with him more forcefully here. There is, after all, nothing more thoroughly politicized in our day and age than the practice of medicine, though his book does not seem to take up the question of who gets to be there to have a chance at healing at a first rate medical center and why that might be. I might want to argue as well, as I have at other times, that the embrace of literature in particular, and of the humanities more broadly–indeed, education per se–is actually one part of the world’s healing, though we fail too often to recognize it as such. As Milton suggested, the purpose of education is to repair the ruin of our first parents (and perhaps the ruin of our own parents, and of ourselves, I might add).

But these are not the main points of Kalanithi’s book. He manages to make the beauty and power of the study of science, and especially the study of medicine real and persuasive. More broadly he shows convincingly that a life of intense study is a life worth living, that the life of the mind matters, even if that point is made more poignant by the fact that that life is cut off by a disease of the body that cannot be studied away and that as of yet remains beyond the realm of human comprehension and control. It is interesting to me that, in the end, Kalanithi returns to literature to make meaning of the death that he cannot, that none of us can, avoid. He makes mention of the fact, of his return to stories about living and dying, stories that tried to make sense of the fact of death. Some of his final memories are of sitting with his infant daughter on his lap, reading to her the words of Eliot’s “Waste Land”, a fact that might be comical were it not for the fact that it rings true for a father given over to the power of language to give meaning where meaning seems tenuous at best, were it not for the fact that I and other fathers I know in the English major set do or have done precisely the same thing.

Of course, he made his own story in the end. A story, to be sure, that could not have been written without his unimaginably deep engagement with science and medicine. But finally his story lives for us, tells us something about what it means to be human, because it lives for us in words.

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