At Janelle's suggestion, my November book has been Paul Kalanithi's When Breath Becomes Air. This being November 6, a person might raise eyebrows at the pace of this read-through. Quite simply, it is the kind of book the reader is likely to have trouble putting down, and sticks in one's mind at other times, drawing the reader back in whatever spare moments can be found. It is also not a tremendously long book, and though well-written is not so especially dense as to require concentrated perusal or paragraph re-reads in order to make meaningful sense of it. In fact, that is a testament to how well it is written: its important message is articulated clearly and simply even in its nuance.Dr. Kalanithi was a freshly minted neurosurgeon when he died of lung cancer in his late thirties. This is the memoir of his life and illness.
The basic story line (kid grows up, pursues ambitions, falls in love, almost realizes ambitions, dies of cancer), while as gripping as all tragedies are, would not be that interesting in a lasting, universal sense but for Dr. Kalanithi's history as Paul, the intellectual, fun-loving livewire of a child who seemed to live the essence of a youth trying to understand his situation on this planet. What does it mean to exist? It may be impossible, he seems to hint, to ever really know, but the attempt to know will not be fruitless. He followed each sign to the next. In academia and on his own time he voraciously romped through philosophy and literature, eventually almost begrudgingly admitting that the signs he responded to most authentically were pointing him to science, particularly the science of the human brain. Where better to explore conscious existence than in the seat of consciousness?
And why a doctor? It was not exactly a desire to "help" or "heal" people. It was more theatrical for him: he craved the theater of encounter with existence, the coming face to face with personhood, and the decision-making surrounding it. How could he understand existence without engaging it fully, and how to engage it fully without being in situations where it was in jeopardy? He dearly wanted to be an agent of understanding for self and others, and eventually found himself pulled in two directions: to become a doctor and to pursue writing.
His plan for his career had been straightforward enough (if punishingly challenging): spend twenty years as a doctor and researcher of the highest skill and attention, learning all he could about human encounters with the gaining, the losing, the regaining, the holding on to, the giving up of life, consciousness, and death, and making sense of those processes, then spend the next twenty writing about it. We all stood to gain much from that plan, and I for one am sorry to see it cut short.
Or perhaps compressed. Because in a way his deadly encounter with lung cancer brought him arguably closer to his goal of understanding existence and its loss than those twenty years of clinical and research work ever could have, and the urgency he felt in facing a shortened lifespan prodded him to put words together for us in the form of this book. He does not talk about himself as courageous or selfless, but both of those character traits are obvious; he has left us in his debt.
Part of the reason this was a timely read for me was because of events in our neighborhood. Two neighbors have been contending with cancers, both of them valued friends of ours. I picked this book up to read as we were waiting for news as to whether one of them was going to make it out of the ICU after his encounter with an experimental treatment at the National Institutes of Health. The treatment, intended to assault his cancer probably had that effect. But the side effects were so severe that he experienced compromises to all his major organ functions, including his brain, and had to be hooked up to life support for immediate survival. Even if he did wake back up, it was unclear whether the severe damage would be reversible. He did make it back to consciousness, and by all reports he was lucid and coherent when he requested that all treatments be stopped, and that he be returned to his home to await death with his family. This was consistent with his stated priorities and values dating from the time of his diagnosis, so the doctors and his family honored his request. A few days ago he came home. Early this morning he died. We are lucky to have known him and to have been his friends and neighbors; our minds will be partly used in thinking of his family for the next while.
So the issues of existence and consciousness that were raised in When Breath Becomes Air have been pretty close to home, in all senses. What was it like for our neighbor to know so clearly that the end of his life was so clear and so near? How did it feel to risk an experimental treatment, knowing it could kill him or cure him (that's what he wanted...one or the other), then be woken up to find that he was living in exactly that third option he most wanted to avoid? What did he most need in the days and hours living up to that fateful choice, and did he get it? How were we or were we not the friends to him that he needed us to be; how could we have been better at it?
These questions are not the garden-variety self reflection after loss of a friend; the other neighbor is likely to be in some kind of similar straits sometime in the next several years, though cancers and their progress are so variable and treatments are evolving so fast right now that time estimates are not all that helpful. I have been at a bit of a loss for how to talk about his illness with him. In those few times I have been able to visit with him, I have simply attempted to let him take the lead; if he wants to talk about tough decisions, encounters with doctors, existential issues, what have you...I have been operating as if he will bring them up. Certainly I have no wish to bring things to the forefront of his mind that he might not want to dwell on. But I worry a bit that a timely, gentle question, well placed and worded, could be just what he might need to open a window that needs opening, and that I might lose my chance to make that needed connection if I don't take it soon. Do I lack the courage? I hope not, but I do lack the questions. Perhaps what would make the most sense would be for me to ask, next time we are together, whether there is anything he would like to talk about, and let him know that I am available to him if so, and there is nothing I am too afraid to talk about with him. It feels lame to ask the person how I can help them...we all love those stories of the people who seem to automatically know, and who swoop in at just the right moment with just the right words or intervention. I am not that person.
And I am not Paul Kalanithi. I do not feel that same existential drive to help people interpret conscious existence (and am not nearly so qualified to help them do so), though I, in my own way, have devoted a considerable chunk of my life to trying to reckon my place in the world, and love to help people ponder theirs. Perhaps the most disquieting element of the book was when he, the accomplished scientist who has taken time to delve into realms I never will, concludes the same thing I do: "Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue. Between these core passions and scientific theory, there will always be a gap" (Page 170).
In other words, science cannot save us from ourselves. If life is going to have meaning, it is up to us to make it for and with ourselves and each other. Good courage to us all in the making of it, and gratitude to the likes of Dr. Paul Kalanithi and our neighbor, R, for demonstrating it.
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