When Breath Becomes Air

“Doctors, it turns out, need hope, too.”

– Paul Kalanithi

One of the phenomena that has characterised the past eighteen months is the emergence of a small bundle of encapsulated RNA, the coronavirus – a blight that has swept over the earth and brought with it the incorporation of ‘social distancing’, ‘self-isolating’ and ‘lockdown’ into modern day lexicon. Against the backdrop of this pandemic, and during the last six months in particular, one of the books I have found myself returning to time and time again to finish is that of Kalanithi’s. What was it about the growing number of Covid deaths that led me to read about his?

The easy answer of course is that Kalanithi’s writing offered a stark contrast to the stories making the headlines: of cancer patients left without treatment, of entire families unwell and in intensive care, of those with the virus rapidly deteriorating and dying alone. Written pre-pandemic, ‘When Breath Becomes Air’ tells ultimately of a life lived well and with meaning, and a death of which the same is true. With the different treatment options afforded him, and both the emotional and physical support his loved ones were able to offer, Kalanithi’s memorable voice lends hope in this dark age of a return to normality, and in sharing his narrative with the reader, he transcends mortality statistics at the same time.

An additional and integral factor in the resonance of his story, particularly at present, lies in its content – a journey through medicine. Perhaps due to the (almost) universal nature of healthcare, impacting on every individual life both directly and indirectly, forays into writing from people on the delivery side have lately been well received. From earlier titles like Henry Marsh’s ‘Do No Harm’ to Adam Kay’s ‘This is Going to Hurt’, doctors turned writers have spawned a new genre of book detailing their experiences, filling a previously untapped niche and going on to produce material that seems to fly off the shelves. ‘When Breath Becomes Air’ is no exception. We learn about Kalanithi’s beginnings, his own early introduction to doctors and life in healthcare through his father, and the road he takes to eventually enter into that world himself. Part of the appeal, in the case of both his narrative and that of a similar ilk that came before, is down to the amalgamation of the recognisable with the alien, as those used to receiving healthcare are placed in the shoes of those who deliver it. Kalanithi writes of familiar concepts like hospitals, imaging, and pregnancy, and intersperses this with details of crash calls, patient loss, and cadaver dissection, granting the reader entry into the elusive medical sphere. In doing so, he chips away at the often God-like image of its inhabitants and reveals them to be just as fallible and human as everyone else; in a time like today where they have been, the world over, applauded as heroes, it is even more important to mark the burden of expectation and remember this.

And yet. This insight and reminder is not all ‘When Breath Becomes Air’ has to offer. There is something different, something more, in Kalanithi’s magnum opus that I have yet to encounter in other books that too share the umbrella of the same genre. Maybe it is the marriage of his philosophical musings with his keen interest for literature which tastes different as he tells of remembered moments pre-medical school. Perhaps his patient stories take on a more meaningful hue knowing from the start, as the reader does, that it isn’t long before Kalanithi will be walking in their shoes himself. Or could it just be his particular style of writing that creates a melody both familiar to the ear and foreign all at once? Whatever it is, the overall effect is of a narrative that actively stimulates introspection in the audience, as Kalanithi posits the concept of mortality at its core using his unique acquaintance with it to do so.

And therein lies the other answer to the book’s relevance today. In searching for the meaning of life, reflecting on death, and confronting the crossroads between the two with candour, Kalanithi brings to the fore questions which are often buried and forgotten – and which a raging virus has unearthed all too brutally. The sudden loss of so many so soon has culminated in global mortality figures disparate to anything ever seen in both the twenty first century and across recent generations alike. In a western society where ageing, and consequently death, is hardly embraced, the result has been an atmosphere of panic as many were left wondering who and how badly would next be infected, and increasingly sober dawned realisations from Franklin’s old adage: the only thing certain in life is death (and taxes). The grim figures, coupled with Kalanithi’s relentless quest to decipher existence and identity, one night before bed prompted a count of those I’d certified, their names scrolling through my mind as I lay in the dark. With it, almost as if asked by Kalanithi himself, came the question, what makes a good death? In this his own example loomed in response – expected, comfortable, surrounded by loved ones – harking to a time that has not yet fully returned. For the wider public, and in an area where more control can be exercised, thoughts of mortality have lent themselves to querying what makes a good life, as lockdown has redefined relationships previously integral to the answer. With the absence of foreign travel, outdoor fine dining, and in-person social interaction so too has emerged the question, can an existence without the aforementioned still be defined as ‘good’? What, if anything, about our time on this earth, makes it meaningful?

As Kalanithi grappled with these uncertainties in his youth, his search led him first to literature, then to medicine and later, neurosurgery where he continued to seek purpose in the neural pathways that make up who we are. His transition from doctor to patient is referenced throughout his writing, presenting a new lens through which he explores mortality. And as both the book and his life draw to a close, and Kalanithi does not rage against the dying of the light, he leaves behind him an optimism that, though every soul will taste death, maybe we’ll find the answers before we do.