WHEN BREATH BECOMES AIR

when breath becomes air graphic poem

blue quotation-marksAt age thirty-six, I had reached the mountaintop; I could see the Promised Land… I could see a nice catamaran on the [Mediterranean Sea]. I could see the tension in my back unwinding as my work schedule eased and life became more manageable. I could finally becoming the husband I’d promised to be…

I flipped through [my] CT scan images, the diagnosis obvious… The future I imagined, the one just about to be realized, the culmination of decades of striving evaporated.Paul Kalanithi

Paul Sudhir Arul Kalanithi grew up in Kingman, Arizona. After graduating  from Stanford University in 2000 with a B.A. and M.A. in English Literature and a B.A. in Human Biology, he found himself caught between the worlds of literature and science; neither a perfect fit for him in his quest to discover the answer to the overwhelming question – what makes life worth living?  What is a meaningful life?

After deliberation, he set a goal to attend medical school, but not before he explored more fully the nature of thought and consciousness; how man makes decisions, defines consciousness, and rationalizes his existence. After attending the University of Cambridge where he earned a Masters of Philosophy in History and Philosophy of Science and Medicine, he turned to Yale University of Medicine where he graduated cum laude in 2007. Armed with years of theoretical education, he now focused on practical experience and hands-on patient care.  He returned to Stanford University to begin his residency training and ultimately fine-tuning his focus onto the field of neurology. In his sixth-year of a seven-year training program to become neurosurgeon, Paul learns he has stage-four lung cancer.

Now cresting at the top of his field, having struggled with the long duty hours, strains on his personal life, he feels he has a good grip on his personal identity. He will soon become a doctor, counselor and adviser to his patients. He has stumbled and made mistakes along the way to understanding that he must fully understand his patients as a whole to offer the best care.

And now he stands facing his own mortality. He knows he will never have that long sought after career as a neurosurgeon. He has become the patient. His world has come to a full-stop. “Who am I now?”, he asks.

In the end, he became the writer; an early life goal. A man determined to leave a lasting legacy. A man opening his whole life to the world in hopes that in revealing himself, others will learn to face their own mortality and fears; to live life fully, unafraid and ready when the end arrives. Paul, according to his wife, wrote feverishly, determined to lay bare his faults and strengths, his terrors and joys, and finally his acceptance and willingness to face death straight on in his own terms.

It is a hard book to read. The squeamish might want to skip through his cadaver training. And he is strongest when he openly discusses his weaknesses, his lack of empathy for his patients, and the moment he realizes what he has become and makes the change for the better. At times I felt like a voyeur as he shared painful moments in his marital life with his wife, Lucy. Paul’s terminal diagnosis impacted his family’s present and future.

Sadly, Paul never got to finish his book. Some reviewers have found the book rather cold and at times impersonal. It must be remembered that the book was compiled from his copious notes and essays. He undoubtedly would have edited the material had he the chance to do so making it sound less like a doctor’s chart dictation and more fully exposing the full range of his personality.

Lucy Kalanithi’s epilogue is riveting and more fully exposes the “whole” Paul. Lucy’s sharing of Paul’s final hours had me in tears.

Readers personally struggling with terminal illness and looking for ways to make decisions about their own care or caregivers seeking inspiration and help on behalf of a loved one are encouraged to view Paul’s videos and interviews online. In the end, you will never forget Paul; he did make a difference. He let us view the meaning of life as he lived it.

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