posted on 27 Sep 2017

When Breath Becomes Air by Paul Kalanithi

I’ve written before about the new school of surgeon-writers currently producing work of astonishingly high quality (here, here and here) and I didn’t expect to be adding another related piece so soon. But then over the weekend I read Paul Kalanithi’s When Breath Becomes Air, and my assumptions about what to expect from this new and emerging surgeon-literature were utterly shaken.

When Breath Becomes Air is in many respects a profoundly different book to, say, Henry Marsh’s two wonderful memoirs. For the simple reason that with its publication, the school of surgeon-writers both gained – and lost – a new star: Paul Kalanithi died from cancer aged just 37 before even fully completing the book. It is unique, then, in that it shines a penetrating light not only on a neurosurgeon’s life, but also on his death.

In a relatively short book, Kalanithi describes his early years of study, the complex factors which made him choose a career in medicine (an attempt to reconcile science, literature and philosophy), the years of residency and training – workloads so punishing that they almost destroy his marriage – and his final achievement of full professorship. Everything is as it should be for a man of hugely driven ambition – except for the fact that he has excruciating back pain, is losing weight visibly by the day, and is sometimes too exhausted to get home from the hospital. He has cancer.

In reviewing the book, Henry Marsh said that Kalanithi describes clearly and without self-pity his progression “from innocent medical student to professionally detached and all-powerful neurosurgeon to helpless patient, dying from cancer.”

I disagree with Marsh in only one particular: that of Kalanithi’s helplessness. Because while it is true that Kalanithi’s illness is not a “battle” that can be “won”, nor a “challenge” that can be “overcome” – these are convenient clichés the book resolutely avoids – his refusal to become helpless, his resistance, is absolutely extraordinary. For instance, after initial treatment he does return to working full sixteen-hour days of surgery and post-operative care; he types his manuscript wearing special gloves to protect the fissured skin of his fingertips. Driven seems a scarcely adequate description.

The book bears witness, then, not only to the life of the surgeon – to the sometimes brutal detachment that surgery requires, its “mortal responsibility” – but to Kalanithi’s own decline. But it is also in some senses a love letter to the daughter he knows will have no memory of him: she is only eight months old when he dies.

While not, perhaps, as finely shaped nor as finely controlled as either of Henry Marsh’s memoirs – how could it be: it was written against insuperable odds as Kalanithi was dying – When Breath Becomes Air is the best book it could be in the circumstances and it is enormously powerful.

And it triumphs because it determinedly challenges – and perhaps even disproves – Rochefoucauld’s maxim: “Neither the sun nor death can be looked at steadily.” For this is precisely what Kalanithi does – and he does it for all who care to read, but especially for those he leaves behind: Lucy, the wife he almost lost during his early training, and Cady, the daughter who will know him – in full measure – once she too is old enough to read this extraordinary book.

Sometimes one reads books that are almost beyond criticism. There is little meaningful that one can say in reviewing them because they stand so far above – perhaps so far beyond – the usual run of literature, and offer insights into human situations of such extremity, that anything we might add begins to seem carpingly small almost before it is on the page. That is what When Breath Becomes Air made me feel.  It is a unique addition to the school of surgeon-literature – and one cannot imagine it being repeated. If you finish it without tears then you are made of sterner stuff than I am.

 

Alun Severn

September 2017