Fragile hopes

At age 36, on the cusp of embarking on a brilliant career in neurosurgery, a career that so far had already made room for achievement, fulfillment and renown, Paul Kalanithi was diagnosed with Stage IV lung cancer.

His journey from doctor to patient, from medical philosopher to struggling survivor, from super-busy achiever to a son, brother, husband and father desperate for more time with those he loved—is chronicled in the book “When Breath Becomes Air.”

On the surface, it is a memoir of one man’s last days on earth, and the compromises he must make to come to terms with his illness, and the future he will leave to his widow and daughter. But because Kalanithi is something of an artist and intellectual, his book is also a contemplation on the meaning of life and the nature of illness and survival, healing and health, humanity and science.

Paradoxically, Kalanithi has two abiding passions: literature and medicine. His love for the written word was kindled by his mother, who filled their home with books on the “college prep reading list,” a collection of works deemed necessary for a basic background on the classics meant to guarantee her three children’s entry into elite colleges, which would otherwise be denied them from a poorly rated high school district.

Though his father and a brother were doctors, Kalanithi was drawn to the medical field not so much by the science of it, as by the philosophy behind the calling to save lives. As he put it: “I was driven less by achievement then by trying to understand, in earnest: What makes human life meaningful? I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain. Meaning, while a slippery concept, seemed inextricable from human relationships and moral values.”

Much of the book is given to Kalanithi’s experiences with patients and colleagues, their fragile egos and even more fragile hopes. It takes years for Kalanithi to develop the formula for talking to dying patients and to their families. It is a delicate dance: providing the crucial details and the dismaying diagnosis without killing hope and dampening any remaining zest for life.

The irony is not lost on him when he receives his diagnosis, giving him a patient’s point-of-view when his turn comes to accept dismaying news, explore modalities of treatment, and wait for what he does not know.

A crucial decision he and his wife Lucy make after his diagnosis is whether to go ahead with their plans to have a child, even at a time when Paul’s health crisis is coming to a head. It would seem foolhardy, founding a family when death is an impending possibility. But for Paul and Lucy, the arrival of their daughter Cady signals a sense of continuity, and gives Paul as well a comforting sense of meaning in a life that is being so cruelly truncated.

The most moving part of the book for me are Paul’s final words in the book (Lucy provides a moving epilogue). Much of his time during his enforced idleness due to illness was given over to the writing of “When Breath Becomes Air.” But as the countdown begins, Kalanithi spends more and more time simply basking in the company of family and friends, Cady cradled in his lap, absorbed in the present.

“Everyone succumbs to finitude,” Kalanithi writes. “Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder towards 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.”

For Paul Kalanithi, the meaning of his life is reduced to this message to his daughter:

“When you come to one of the many moments in life where 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 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.”