When Death Comes: Lessons from When Breath Becomes Air

February 5, 2016

Paul Kalanithi's When Breath Becomes Air

Paul Kalanithi’s When Breath Becomes Air

I had been wanting to read Paul Kalanithi’s When Breath Becomes Air after reading a thoughtful review on the Brainpicking’s website.  It was a poignant experience, knowing that its author was dealing with a diagnosis of terminal lung cancer while he was writing it, and that he died before seeing its publication. Somehow we think that these messages from dying people and from beyond the grave will be wiser than the thoughts of ordinary people like us who are so often mired in rote routines of daily living.  We forget that life is always a terminal diagnosis.  Books like this are a good reminder.

Kalanithi says, “I began to realize that coming in such close contact with my own mortality had changed both nothing and everything.  Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when.  After the diagnosis, I knew that someday I would die, but I didn’t know when.  But now I knew it acutely.  The problem wasn’t really a scientific one.  The fact of death is unsettling.  Yet there is no other way to live.”

Life is full of wake-up calls — chronic and acute illnesses, betrayals, divorces, deaths of friends and family, losses of jobs and homes, etc.  One cannot minimize how disorienting and dislocating such blows can be.  Kalanithi says, “Severe illness wasn’t life-altering, it was life-shattering.  It felt less like an epiphany — a piercing burst of light, illuminating What Really Matters — and more like someone has just firebombed the path forward.”  He goes on to describe what this was like for him:  “I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced.  The lung cancer diagnosis was confirmed.  My carefully planned and hard-won future no longer existed.  Death, so familiar to me in my work, was now paying a personal visit.”

The most obvious lesson from coming face to face with one’s own mortality is to focus your remaining days and hours and minutes on what is most valuable to you.  But making a meaningful life is often a struggle even for those of us in good health.  Understanding what makes life worth living is a slow, incremental process, filled with the consequences of choices, blockages, and starting over again and again.  Imagine working through these choices — to build on an old life or find a new one — while facing your own death and while grieving the loss of the future you had planned:  “Grand illnesses are supposed to be life-clarifying. . . . The way forward would seem obvious, if only I knew how many months or years I had left.  Tell me three months, I’d spend time with family.  Tell me one year, I’d write a book.  Give me ten years, I’d get back to treating diseases.  The truth that you’d live one day at a time didn’t help: What was I supposed to do with that day?”

Well-meaning colleagues would say to Kalanithi, “Shouldn’t you be spending time with your family?”  He wondered, “Shouldn’t you?”  And that’s the rub.  We should all be spending time doing what is most important to us.  Every day.

And here’s another lesson from Kalanithi’s book:  what is most important to us changes.  It changes with time and again when time is running out.  “The tricky part of illness is that, as you go through it, your values are constantly changing.  You try to figure out what matters to you, and then you keep figuring it out. . . . Death may be a one-time event, but living with terminal illness is a process.”

I loved how Kalanithi found solace in literature as he struggled with how best to live even while he was dying.  ” . . . I began reading literature again. . . . I was searching for a vocabulary with which to make sense of death. . . . I needed words to go forward.  And it was literature that brought me back to life during this time.”

I have no doubt that had Kalanithi been cured and gone back to work as a doctor/writer/scientist, he would have become more understanding and empathetic with his patients.  He was fortunate in having an oncologist whose advice was repeatedly to figure out what was most important to him.  His own experiences taught him an important lesson:  “. . . I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”

May we all face death with such grace.







6 Responses to “When Death Comes: Lessons from When Breath Becomes Air”

  1. Rose Says:

    Wow! The excerpts you have shared here were breathtaking and thought provoking for me. They also invite one to seek a fresh perception of death, one not so frightening.
    I must buy the book.
    Thank you for sharing.

  2. kittybluhm Says:

    What a gift this is, Rosemary. it’s uncanny how your entries often augment thoughts I am having . . . Thank you.

  3. Carl Gansen Says:

    I’d also recommend starting with this simple book.

    1,000 Marbles: A Little Something About Precious Time
    Jun 15, 2001
    by Jim Davis and Jeffrey Davis

    It is not as philosophically deep but it lays out a process and a plan of action that you may consider before life threatening illness sets in.

  4. Carl Gansen Says:

    Thanks Rosemary,

    Now that you reminded me of my reading and thinking along these lines, here is another book that has had a lasting effect on me along with friends and relatives as well. We were introduced to the poem during the eulogy to a departed friend. Linda Ellis wrote a poem called “The Dash” and has followed it up with a supporting book. Both are worthy of consideration.

    The Dash: Making a Difference with Your Life
    by Linda Ellis

    • Rosemary Says:

      I was familiar with the poem, but not that there was a book. Our library does not carry either of the titles you recommended. Thank you for your suggestions though.

  5. shoreacres Says:

    I thought this was most interesting: ““Grand illnesses are supposed to be life-clarifying…” But what of those who have no “grand” illness? What of those who only wind down, slower and slower, until they fade away? How are they to cope? We tend to heap accolades on the “brave,” those whose diagnoses are dramatic: sudden and terrifying. But I wonder — I’m only pondering the question — about the others.

    Now and then, I come across someone who asks, “What would you do, if you knew you were going to die?” I always smile a bit at that. We’re so good at setting aside the question.

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