When Breath Becomes Air (Kalanithi)

Book #2, read July 2018

When Breath Becomes Air (2016) made a huge splash, becoming a NYT bestseller, etc. Even Bill Gates read (and reviewed, and loved) it. In it, Dr. Paul Kalanithi basically tells his life’s story in two main threads: how he came to choose, learn, and practice medicine, and how he’s fighting late-stage lung cancer in only his mid-30s. The situation has (had…) all the makings of a kind of hero’s journey, and no wonder it grabbed people’s attention. A superstar young doctor dying of lung cancer right after bringing home a new baby, imagine that.

But as far as I can tell, the Paul Kalanthi described in the book would want me to write an honest critique of his work, and I can’t be 100% positive. I have no problem with the lofty philosophical bits, but many other prospective readers will. Kalanithi seems to think that his decision to study medicine is deeply interesting (he studied literature first, and first bristled at the thought since there were doctors in the family). But I didn’t care so much – who among us hasn’t changed their college major or master’s program once or thrice? Depending on your existing worldview, you’ll either find Kalanithi’s ultimate choice of neurosurgery as either inspired or eye-rollingly hubristic.

Kalanthi is interested in the mind-body problem, and I know that he would have studied it specifically. But, disappointingly, he can’t muster much more to say about it than platitudinous rhetorical questions (“There must be a way, I thought, that the language of life as experienced – of passion, of hunger, of love – bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats.”)

For someone who decided (years ago, as a student) that “human relationality” “undergirds meaning,” it’s a little rich that Kalanithi had become estranged from his wife prior to his diagnosis and then barely mentions her pregnancy in passing. I do believe it’s noble that Kalanithi tried to relate to his patients on a human level, especially seeing as how he operates on what he takes to be the seat of their souls. But readers are just as likely to feel alienated by Kalanithi’s focus on strangers to the detriment of those close by. It’s like an overdone character in a book: doctor too busy caring for patients to care for his own wife, oops! The very last paragraphs Paul wrote are about his infant daughter Cady, and the joy she brought him as he died. But that’s why those bits seem a little surprising. Perhaps, due to Kalanithi’s increasing frailty, the part of the journey that turned him from arrogant doctor into sated family man simply went mostly unwritten.

To be clear, producing a single book that encapsulates everything someone with a full professional and personal life might want to say is a totally Herculean task (especially to undertake while already critically/terminally ill). It’s certainly no surprise that When Breath Becomes Air isn’t completely satisfactory in that regard. You don’t have to be a perfect person to write a good book, either. But since this is a book review…

The highlight reel of Kalanithi’s life doesn’t make you feel especially connected to him, but you feel obligated to preemptively develop some empathy because you know what’s coming next. His experiences training as a doctor are sort of depressing and cliched: start ambitious, end desensitized. His experiences as a student shouldn’t have to be that significant. But because his life is turning out to be rather short and he was a student for most of it, they become forced into significance. I don’t know exactly what I’d want anyone, dying or not, to say about “human relationality” vis a vis meaning in life (personally, I don’t think there’s any such meaning to be had, but the question comes up often enough that there has to be something to say).

Throughout, Kalanithi’s writing is alternately beautiful and cringe-worthily heavy-handed (“in taking up another’s cross, one must sometimes get crushed by the weight”). It’s clear that he’s trying to find a comfortable writing voice (while also grappling with the weightiest possible subject matter), and under such pressure. What a shame that he got only an ill-fated Titanic crack at writing a book. If this material had spanned a few decades instead, who knows how it could have come out.

I did especially enjoy (???) the section on glioblastoma, from a neurosurgeon’s point of view. It helped me to more fully envision the events that unfolded around my family member’s recent diagnosis. The epilogue, by Paul’s widow Lucy Kalanithi, is quite beautiful (a number of Amazon reviewers like it better than the rest of the book). It helps to drive home that Paul is gone, his life’s previous work (doctoring), new work (writing), and would-have-been-future-work (parenting) all left unfinished. She too must find her voice for this task under immense pressure, kudos for that. I have only begun to dip a toe into the mental fog of grief and it’s enough to make you forget how to brush your teeth, let alone how to write something huge numbers of strangers would want to read.

All of the above notwithstanding, I read the book very quickly and definitely cried at the end.

Read this book if you’re interested in how a doctor thinks about his own death and if you don’t mind stories without silver linings.

Don’t read this book if you’re very put off by arrogance or intellectualism.