“The Perfect Gift”: Paul Kalanithi, When Breath Becomes Air


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?

I wanted to read When Breath Becomes Air almost as much as I hadn’t wanted to read Atul Gawande’s Being Mortal. In both cases it was about me more than about the books–about my fear of death, my preference for not facing it. “Most lives are lived with passivity towards death,” Kalanithi points out; “it’s something that happens to you and those around you.” I have no urge to do as he did, “to actively engage with death, to grapple with it.” While Gawande’s book prompted avoidance, though, because it sounded (and is) so pragmatic and thus confrontational about the realities of death, Kalanithi’s sounded like (and, to some extent, is) a book that looks past death, showing by its very existence but also through Kalanithi’s own insights that there are ways to mitigate its finality. Being Mortal is ultimately a very prosaic book about death: When Breath Becomes Air promises even in its title to find the poetry in it.

When I say that I did not, in the end, find When Breath Becomes Air particularly transcendent, I don’t mean to depreciate its power or poignancy as a memoir. It is smart and gripping, told with tremendous and highly affecting sincerity as well as urgency. Its brevity speaks implicitly to the race Kalanithi was in against time; the speed and compression with which he chronicles his many years of education and training take on unexpected pathos precisely because the narrative sometimes seems so rushed. He is clear about the deep questions he longs to find answers to: in his earlier years, about the connections between mind and brain, between who we are and what we’re literally made of; after his diagnosis, about what it means for life that death is its inevitable end. Who should we be, knowing (as we must know but usually pretend we don’t) that one day we won’t be?

These are, indeed, the ultimate questions, and as Kalanithi eloquently argues as he traces his own educational path through literary studies to medicine and neuroscience, neither science nor literature can, on its own, answer them fully–though it was interesting to find him, as his illness progressed, “finding no traction in the reams of scientific studies, intracellular molecular pathways, and endless curves of survival statistics”:

I began reading literature again: Solzhenitsyn’s Cancer Ward, B. S. Johnson’s The Unfortunates, Tolstoy’s Ivan Ilyich, Nagel’s Mind and Cosmos, Woolf, Kafka, Montaigne, Frost, Greville, memoirs of cancer patients–anything by anyone who had ever written about mortality. I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again.

kalanithi2The choices he finally makes reflect–perfect, maybe–the choices he had made throughout his life. He returns to work for as long as he can, finding purpose in his “calling,” and he wrote this book, which his wife tells us in her Epilogue he “wrote relentlessly,” committed to “help[ing] people understand death and face their mortality” in a different way than he had done so often as a surgeon.

I think When Breath Becomes Air achieves that goal, but not because Kalanithi ultimately has anything astonishing to say about death, or the meaning of life. If you want philosophical revelations, or profound human insights, you’re probably better off reading Woolf and Montaigne and Tolstoy for yourself. More than showing what it means to live or to die, for me Kalanithi’s book conveys what it is like to live and to die–to live, in particular, an examined life, in which choices are significant because they have moral as well as practical consequences; to strive to make whatever time you have as valuable as possible, to yourself, to the people you love, and to the wider community you inhabit; to feel, as he does, your imagined future “evaporate”; to suffer; to persist. He finds strength in quoting Beckett: “I can’t go on. I’ll go on.”

Kalanithi writes with wonderful, tactile specificity about his life. The many anecdotes of surgery, in particular, are equal parts inspiring and terrifying to someone who has never had that kind of awesome responsibility, or that level of life-giving skill. It’s very beautiful, too, to read about the decision he and his wife make to have a child, and about the joy he gets from the all too brief months he has with his daughter. For me, though, the book faltered when it wandered into metaphysics, when Kalanithi tried to explain the gap he perceives between scientific theory and whatever it is exactly that, for him, religion represents. “If you believe that science provides no basis for God,” he proposes, “then you are almost obligated to conclude that science provides no basis for meaning and, therefore, life itself doesn’t have any.” There are some skipped steps in there, not least of which is the one that takes us from the presumed metaphysical neutrality of science to the meaninglessness of life. Though here too he is unimpeachably sincere, his belated invocation of some kind of inaccessible capital-T “Truth” both seemed a bit intellectually fuzzy and struck a false note for me. His whole memoir, I think, is a testament to the ways that our own actions, choices, and relationships imbue life with meaning.

The book actually has a cover blurb from Atul Gawande: “Dr. Kalanithi’s memoir,” it says in part, “is proof that the dying are the ones who have the most to teach us about life.” When Breath Becomes Air is a moving and thought-provoking memoir–it is indeed “heartbreaking,” as Gawande says, because Kalanithi was young and kind and brilliant, full of promise he wasn’t able to fulfill. We can certainly learn from his experience and his example. Understandably enough, though, Kalanithi can hardly provide transcendent, universal answers to the big questions he asks. His life doesn’t (and probably shouldn’t) tell us how to live our own, except that we should do so consciously, aware of the words of the poem that gave him his epigraph:

Reader! then make time, while you be,

But steps to your eternity.