When Breath Becomes Air - A Review
I was completely in 2 minds of whether to write this blog piece but here we go... A little bit different today's article is about a book review. I had picked the recommendation up from following Jim O'Shaunessey who is quite a famous fund manager and whose Fidelity story features in 'The Biggest Risk to your Investments' episode. The book is a US bestseller written by Paul Kalanithi and is a first-hand story of a neurosurgeon who discovers he has inoperable lung cancer. As I knew I would be specialising in planning with medical professionals and have found myself immersed in career paths and retirement structures, I thought it was worth a read.
The book starts recounting Paul's early life from growing up in the Arizona desert with his brother. To his first passion takes him to Stanford University studying English Literature which also explain why the book is so well constructed. It's the type of book which stays with you for weeks and months after and you find yourself lost in thought recounting while going about your day. The stories of his experiences, the successes and failures of treatments he's been part of and the life-changing or ending consequences. Perhaps this is just because of the matter-of-fact nature of life and death that medical professionals face on a daily basis but the often tragic element of life and illness is brought into clear focus.
What makes this book incredible is that Kalanithi not only has an incredible story but is also an incredible writer. His use of prose will stay with you. Describing the conflict he had when he was younger trying to decide to pursue a life of exploring writing and the literary arts compared to following the structured and demanding path of neuroscience. The question of whether to dedicate his life to distant artistry reflecting on life and death or to experience it first hand as a surgeon. Opting that despite being drawn to the beauty of writing and poetry, understanding that a life of reflection on this cannot compare to the real experience he would gain through experiencing this by becoming a surgeon:
'If the unexamined life isn't worth living...
Is it worth examining an un-lived life?'
The topics of what it is to live a meaningful life are revisited at various stages and the book takes you through his treatment and slow acceptance of a terminal illness which you're left wondering whether a professional of his standing had diagnosed months in advance but failed to accept? Then the first-hand experience of the doctor/patient relationship being reversed on him and described his desire to try and find a semblance of control in the face of the uncontrollable. The choice during treatment of whether to have a child with his wife knowing that he would almost certainly not seem them grow up. The sort of choices that humble our everyday concerns to complete irrelevance.
The book may feel as if it ends abruptly. Paul's cancer worsened and his ability to write reduced. The penultimate chapter draws you as the reader in, sort of willing there to be a continuation of the story. Somehow tragically overoptimistic faced with the reality. The subtle message that seeps through these final pages is a stark reminder on the cruel nature of illness. That even if you have time, you may not be able to be yourself in the time you have left....The final chapter written by Paul is to his recently born daughter:
'I don't know what this girl will be like when she is 15. I don't even know she will take to the nickname we have given her. There is perhaps just one thing to say to this infant who is all future, overlapping briefly with me whose life barring the improbable is all but past. That message is simple - when you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been and done and meant to the world. Do not, I pray, discount that you filled a dying man's days with a sated joy. A joy unknown to me in all my prior years. A joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.'
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So why do I feel it appropriate to bring you down to talk about such a heavy topic? I guess it's because it's left me reflecting somewhat that I think especially in the UK we seem to suppress, which is the very real feelings of our own mortality. Perhaps it's the 'stiff upper lip' nature of our society or perhaps is just a more human element that I'm naively trying to paint with British exceptionalism.
What I love about this book is the thing that makes Paul such an interesting character and such a perfectly placed author. Someone who has an exceptional grasp of poetry as well as an intensely scientific area of neurology. This provides the perfect counterbalance between science, faith and meaning that we all encounter when considering our own mortality. During his treatment, Paul begins his journey almost obsessively focusing on a structured scientific approach to considering his life through Kaplan Meier estimates. (Apparently a medical predictor of life expectancy.) To being treated by an excellent doctor during his treatment whose focus was not on mathematical probabilities but maintaining meaning in the face of a terminal illness.
“What patients seek is not scientific knowledge that doctors hide, but existential authenticity each person must find… the angst of facing mortality has no remedy in probability.”
If there is one theme that flows through this book it is that despite incredible feats of modern medical science there are such areas of life, death and meaning they cannot answer. While acknowledging though poetry and spirituality can provide a level of comfort and reflection, it is often humbled by our human condition.
I also often wonder if in that - we do a disservice to the grieving as well as ourselves in not confronting the reality of our own mortality? From what I found in doing so is that if you do read this book despite the tragic story you will put the book down completely uplifted. You can read the book because it's a beautiful story, or read the book because of the excellent writing but most of all - read it to be reminded that in the end, all stories about death are really stories about life.
