When Breath Becomes Air
When Breath Becomes Air
You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone;
Till time end bodies, but souls none.
Reader! Then make time, while you be,
But steps to your eternity.- Baron Brooke Fulke Greville
My head, leaned back on my mother’s shoulder; my eyes, gazing outside at my four-year old, Zaynab, speaking in the air as she played in the garden. Someone was being scolded, I could tell, from the way she held her hands on her waist. I have faced her wrath.
“How much of this will I remember?” I asked.
“How much of what?” my mom replied, pouring us tea.
“This. Zaynab. Our time together.” I went on: “We pour so much love and energy into our kids and they bring us so much happiness. How much will I remember of these moments when I’m older? How much do you remember of us?”
I could tell not much. She summed my entire childhood in six minutes. The few stories lacked any detail. There was only a sense of what Jawad was like. Her day-to-day striving, outpouring, and receiving… forgotten. It made her slightly uncomfortable, I felt. That was not my intention.
“What does it mean?” I wondered. “What’s the point?”
Next morning, I picked up a book from my shelf that I had been meaning to read for a while: When Breath Becomes Air, an intimate memoir of a young doctor with great ambition who comes face-to-face with his own mortality. In a letter to a friend, the author writes, “That’s what I’m aiming for, I think. Not the sensationalism of dying, and not exhortations to gather rosebuds, but: Here’s what lies up ahead on the road.” I felt drawn to its premise.
Passionate about science and writing, Paul Kalanithi majored in English and biology at Stanford and went on to pursue a master’s degree in philosophy from Cambridge, before graduating from the Yale School of Medicine. He was interested in discovering where “biology, morality, literature and philosophy intersect,” and so he chose neurosurgery, the most difficult specialism of all, drawn by its “unforgiving call to perfection.”
I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death. I had thought that a life spent in the space between the two would grant me not merely a stage for compassionate action but an elevation of my own being: getting as far away from petty materialism, from self-important trivia, getting right there, to the heart of the matter, to truly life and death decisions and struggles… surely a kind of transcendence would be found there? I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful?
And then, at age thirty-six, at the peak of a career bursting with potential, the unthinkable happens. Paul finds himself a patient at the very hospital where he works as a neurosurgeon, diagnosed with stage IV lung cancer. He doesn’t know it yet, but he has 22 months left to him. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, he struggles, while facing his own death, to rebuild his old life—or perhaps find a new one. His whole sense of identity is shaken. “My carefully planned and hard-won future no longer existed.”
As a doctor, I had had some sense of what patients with life-changing illnesses faced—and it was exactly these moments I had wanted to explore with them. Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle. I’d always imagined the doctor’s work as something like connecting two pieces of railroad track, allowing a smooth journey for the patient. I hadn’t expected the prospect of facing my own mortality to be so disorienting, so dislocating… looking into my own soul, I found the tools too brittle, the fire too weak, to forge even my own conscience.
Lost in a featureless wasteland of his own mortality, and finding no traction in the realm of scientific studies, it was literature that brought Paul back to life during this time.
The monolithic uncertainty of my future was deadening; everywhere I turned, the shadow of death obscured the meaning of any action. I remember the moment when my overwhelming unease yielded, when that seemingly impassable sea of uncertainty parted. I woke up in pain, facing another day—no project beyond breakfast seemed tenable. I can’t go on, I thought, and immediately, its antiphon responded, completing Samuel Beckett’s seven words, words I had learned long ago as an undergraduate: I’ll go on. I got out of bed and took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” That morning, I made a decision: I would push myself to return to the OR. Why? Because I could. Because that’s who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I’m dying, until I actually die, I am still living.
After much deliberation, Paul and his wife, Lucy, decide to have a child. “Don’t you think saying goodbye to your child will make your death more painful?” she asks. He responds, simply, “Wouldn’t it be great if it did?”
As he nears the end, Paul comes to believe that life is about striving, not about avoiding suffering. And that life’s meaning, its virtue, has something to do with the depth of the relationships we form. “Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them.” That’s what makes life worth living, even in the face of death and decay.
Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed. We are never so wise as when we live in this moment.
Paul died on 9 March 2015, aged thirty-seven, with these final words for his nine months old daughter, Cady.
When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.
As I put the book down, I was filled with an awareness blunted through the daily distraction of living: Death comes for all of us. Yet we never suspect our own fragility. And so it is with my darling Zaynab, all I have with her is the present moment. That is an enormous thing.