At its most interesting, the late Paul Kalanithi’s bestselling memoir When Breath Becomes Air (Random House, 2016) is a book about language. It is not, as many reviews would seem to indicate, an introduction to medical humanities, lacking both a primer’s organization of ideas and an author’s inclination to educate the reader. Rather, the book presents readers with the startling idea (to those uninitiated in the field) that science and humanities can be linked, can inform each other, can benefit both patient and practitioner in so applied and grimly pragmatic a field as neurosurgery. This it achieves through its harrowing narrative and by repeatedly contemplating the miraculous powers of language, “an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion” (39).
Always interesting, at times gut-wrenching, When Breath Becomes Air is an account of a surgeon’s life and training bracketed by a diagnosis of his cancer and death, and ending with an epilogue by his wife, Lucy. The proximity of the two ideas—the healer stricken, the health-giver succumbing to illness—sets up the parameters for our reading of the life; we are constantly aware that this is a narrative race against time and, as though we were hearing a deathbed confession, that knowledge prepares us to read with sympathy and extra awareness. Without such expectations, Kalanithi’s early memories and even his tone might convey only a dully impressive catalog of achievements. He seems alternately to overlook and foreground a voice of privilege in his recounting of juvenile literary interests (“Hamlet bore me a thousand times through the usual adolescent crises” ), college preparatory experiences, acceptance into Stanford. The young student, sipping whiskey and chatting with authors, roaming the English countryside while part of a History and Philosophy of Science program at Cambridge, finds himself “increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them”; eager for such direct experience, he says, he was heading back to the States and “going to Yale for medical school” (43). It’s hard not to be aware of the irony: the young acolyte hungering for life-and-death reality, ensconced in systems and experiences that seem to shield him from those realities.
Yet Kalanithi punctures and subverts such apparent earnest cluelessness both directly, with his accounts of eye-opening experience, and indirectly, with his alternate interrogation of and reliance upon language, “the surgeon’s only tool” when the scalpel fails (87). His experience with a crisis pregnancy during an ob-gyn rotation reveals both narrative reckonings. Faced with the judgment call about performing an emergency C-section, Kalanithi is shocked into epiphany: “What a call to make. In my life, had I ever made a decision harder than choosing between a French dip and Reuben?” (66). In his search for both skill and wisdom as a developing doctor and surgeon, he discovers both the power and limitations of language: “What possible sense could be made” of the crisis for the parents, “what words were there for comfort?” (65). Throughout When Breath Becomes Air, it is Kalanithi’s sincere willingness to explore the sciences and humanities simultaneously—“not saving lives” but “guiding a patient or family to an understanding of death or illness” (86)—that continuously enlivens and enlightens the memoir. His is an iconoclastic self-portrait that can be startling for any reader inclined to see the doctor as an impersonal, godlike being by design and necessity. With a voice awash in empathy (“How little do doctors understand through which we put patients”), the author’s quest for enlightenment becomes most profound when, as the narrative’s structure prepares us to expect, the illness and death become personal. Here we find Kalanithi the patient and sufferer clinging to the coldness of language as a barrier from pain, “naming each muscle as it spasmed to stave off tears: erector spinae, rhomboid, latissimus, piriformis…” (12), yet pondering with breathlessness the inability of diagnostic terminology to confine the idea of hope: “Is that what hope was? Could we divide the curve into existential sections, from ‘defeated’ to ‘pessimistic’ to ‘realistic’ to ‘hopeful’ to ‘delusional’?” (134).
When Breath Becomes Air will make, has made, its most dramatic impression on readers who are strangers to narrative medicine. But the scholar within the field cannot help but be inspired by his account of crumbling oppositions between doctor and sufferer, and between the “twinned mysteries of death…at once deeply personal and utterly impersonal” (53).
Tom Bragg is an Associate Professor at the University of South Carolina Salkehatchie. He is the author of Space and Narrative in the Nineteenth-Century British Historical Novel (Routledge, 2016).