In his posthumously published "When Breath Becomes Air," Paul Kalanithi gets straight to the sudden turning point in his life: the day the Stanford neurosurgery chief resident looked at a scan showing he had advanced cancer and likely little time left.
What follows is a poignant account of his life, his quest to find meaning, his efforts to retain his humanity in the grind of becoming a doctor and, ultimately, his thoughts on dying.
As he and his wife, Lucy, grapple with whether to become parents in their remaining time together, she asks him: "Don't you think saying goodbye to your child will make your death more painful?"
He replies: "Wouldn't it be great if it did?"
The heart-rending exchange captures Kalanithi's full-throttled approach to living.
In Kalanithi's childhood and college years, one can see the seeds that created this ethos.
When Kalanithi's family moved from New York to a desert town in Arizona, his mother — fearing for her children's educational prospects — obtained a "college prep reading list," which then-10-year-old Paul began to tackle.
"Books became my closest confidants," Kalanithi writes, explaining the profound themes, rich lexicon and literary quotes peppered throughout his writing.
One summer while in college, he applied for an internship at a research center as well as a job at a lakeside camp; he was accepted at both and had to choose. "In other words, I could either study meaning or I could experience it." He picked the latter.
Back on campus, Kalanithi summarized his dovetailing interests: "I studied literature and philosophy to understand what makes life meaningful, studied neuroscience and worked in an fMRI lab" — functional Magnetic Resonance Imaging — "to understand how the brain could give rise to an organism capable of finding meaning in the world."
It is no surprise, then, that Kalanithi chose the incomparably demanding field of neurosurgery. His reflection on the practice, responsibility, idealism and fallibility of medicine is a must-read for those in the field and those touched by it.
When facing brain surgery, "the question is not simply whether to live or die," Kalanithi writes, "but what kind of life is worth living." Would you trade your right hand's function to stop seizures? Would you trade your ability to talk for a few extra months of mute life?
In the gravest of cases, Kalanithi writes: "I had to help those families understand that the person they knew — the full, vital independent human — now lived only in the past and that I needed their input to understand what sort of future he or she would want."
The book is full of sage dictums: "A tureen of tragedy was best allotted by the spoonful. Only a few patients demanded the whole at once; most needed time to digest."
Despite his close contact with death, it was a dizzying change from doctor to patient.
"As a doctor, you have a sense of what it's like to be sick, but until you've gone through it yourself, you don't really know. It's like falling in love or having a kid," Kalanithi writes.
When cancer struck, he went back to literature to understand his experience and make sense of death. Ultimately, he made a decision: "Even if I'm dying, until I actually die, I am still living."
He worked on building his strength to go back to the operating room. While working 16-hour days, he battled "waves of nausea, pain, and fatigue." But his calling as a neurosurgeon was a strong draw. "Moral duty has weight, things that have weight have gravity, and so the duty to bear mortal responsibility pulled me back into the operating room."
A reader can't help but feel deep regret that Kalanithi — the unusually introspective doctor, the intellectually driven scientist and the compassionate humanitarian — no longer walks this Earth, sharing his gifts. His book is faint consolation. Doctors ought to learn from his compassion for patients; all of us ought to learn from his passion for life.