Prologue to Paul Kalanithis When Breath Becomes Air Review
T his volume, already a bestseller in the United States, opens with a trainee surgeon examining a set of images from a CT scan. His highly trained eye takes in how the tumours are dispersed across the lungs, how the spine is plain-featured, how one lobe of the liver has been obliterated. The diagnosis is straightforward: "Cancer, widely disseminated." Only 1 thing makes this case unlike from the dozens he deals with each week: these are scans of his ain body.
The doctor in question was Paul Kalanithi, who discovered he had inoperable lung cancer at the age of 36. The platitude about someone having everything to live for could take been formulated for him: he was on the verge of qualifying as a neurosurgeon after a decade of training, and was planning to start a family with his married woman, Lucy. Instead, he found himself against non but a terminal disease, but likewise a profound identity crisis: having aspired to exist "the pastoral effigy … I establish myself the sheep, lost and dislocated". This account of his transition from dr. to patient was written in the year or then prior to his expiry early on terminal year, past which time he was 37 and his daughter, Cady, was 9 months old.
Prior to his disease, Kalanithi'due south life had been one of relentless striving and exceptional accomplishment. A medico's son in the Arizona desert town of Kingman, he was given a identify at Stanford University and went on to complete a postgraduate degree in English literature. But his scientific interests did not fit comfortably into an English language department (his thesis was on "the medicalisation of personality" in the work of the poet Walt Whitman), and, besides, he was tired of sitting around reflecting on the meaning of life – he wanted action, real responsibleness, "answers that are not in books". Then he enrolled in medical school.
For Kalanithi, medicine was never just a job, it was some other approach to the metaphysical questions he had taken aim at during his English language degree. In his 4th year he was puzzled when many of his contemporaries decided to specialise in areas, such as radiology or dermatology, which promised humane hours, high salaries and only moderate pressure level. Of such "egotistical" concerns, he tartly observes: "Putting lifestyle first is how you detect a job – not a calling." (I wondered at this bespeak whether, had he worked in England, he would have joined the striking junior doctors, but despite his interest in ethics he doesn't venture anywhere most the grubbier business concern of health policy).
He chose neurosurgery, the nearly difficult specialism of all, drawn by its "unforgiving telephone call to perfection". The demands of the training are almost unimaginable: he worked more than 100 hours a week, doing operations in which the difference betwixt life, decease and worse could exist a matter of millimetres. Late 1 night, as he cuts into a tumour deep inside a patient'south brain, his supervisor asks him what would happen if he increased the incision by two millimetres. Double vision, guesses Kalanithi. "Locked-in syndrome", comes the reply.
The least interesting part of When Breath Becomes Air is the section on neurosurgery, which suffers past comparison with Henry Marsh's wonderful memoir Practise No Harm. While Marsh applied the same intelligent disengagement to his own ego and insecurities as he did to the cases on his operating table, Kalanithi - at to the lowest degree in his incarnation as a doctor – doesn't go in for cocky-reflection or humility. I longed for him to dig a little deeper into what motivated his drive for perfection, even when information technology came at the expense of his own health and about destroyed his marriage, but his achievements are merely presented like so many trophies lined upwardly on the mantelpiece. Fifty-fifty the couples counsellor he and Lucy go to in the wake of his diagnosis, we are told, sees just excellence: "You 2 are coping with this better than whatsoever couple I've seen … I'1000 not sure I have any advice for you."
Simply equally cancer weakens Kalanithi's body, forcing him to abandon his heroic cocky-epitome, his writing gathers force. The odd limbo catamenia in which he is increasingly sure that something is wrong, simply hasn't yet had the tests to confirm it, is rendered in horrible detail. Despite being plagued by terrible dorsum pain, with his weight dropping fast, his wife just finds out nigh his fears when she picks up his phone and finds "frequency of cancers in xxx- to xl-year-olds" typed into a medical search engine. Even then he continues to piece of work, dosing himself upward on Ibuprofen and putting in 36 hours at the operating tabular array just days before his diagnosis. But then, what else can he do? Beckett's line comes back to him from his literature days: "I can't go on … I'll go on." Receiving the diagnosis changes everything and nothing: "Before my cancer was diagnosed, I knew that anytime I would dice, merely I didn't know when. After the diagnosis, I knew that someday I would die, just I didn't know when."
Kalanithi'due south first instinct on discovering he has cancer is to obsess about statistics and survival curves – afterward all, he knows simply besides well where to look them up. A planner by nature (he had a twoscore-yr career program), he wants to know how long he has: if information technology is three months, he volition spend time with his family; one year, and he will write a book; ten, and he will go back to medicine. But he finds that averages and probabilities, while useful to a doctor in deciding betwixt treatments, have petty meaning for a patient. "What patients seek is not scientific knowledge that doctors hibernate, but existential authenticity each person must find on her own … the malaise of facing bloodshed has no remedy in probability." In the absence of any certainty, he decides that all he tin can exercise is assume he is going to live a long fourth dimension. Once the drugs kick in and the symptoms subside, he puts on his scrubs and heads dorsum to the operating theatre, and he and Lucy commence on a form of IVF. "Don't you think maxim good day to your child will make your death more than painful?" asks Lucy. Kalanithi responds: "Wouldn't information technology exist great if it did?"
Whatever healthy person deciding to have a child might of class ask themselves that question, and come upwards with the same response. The power of this book lies in its eloquent insistence that nosotros are all confronting our bloodshed every twenty-four hours, whether nosotros know it or not. The real question we face, Kalanithi writes, is non how long, but rather how, we volition live – and the answer does not announced in whatsoever medical textbook. It brings him back, at concluding, to the books of poesy he left gathering dust when he entered medical schoolhouse.
Source: https://www.theguardian.com/books/2016/feb/03/when-breath-becomes-air-paul-kalanithi-review
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