Book
Review: WHEN BREATH BECOMES AIR by Paul Kalanithi 2016
Penguin/Random Publishing
As
a boy growing up in the desert town of Kingman, Arizona, Paul
Kalanithi was certain he would never become a doctor like his father
or so many others in his family. His father was never home until late
at night. Friendly, offering brief encouragement or advice, but
hardly ever available. If asked what he wanted to study in college,
Paul was vague---maybe writing; maybe something about life's meaning
. . . something about the mind . . .
During
his senior year in college, his class visited a home for people who
had had severe brain injuries. The place was a storehouse, really; a
place for those whose families had long ago given up visiting them, a
place to exist, but not to live. “Only later would I realize that
brains give rise to our ability to form relationships and make life
meaningful. Sometimes, they break.”
Some
of his classmates graduating from Stanford headed for New York to
pursue life in the arts, but that didn't quite seem to fit him. He
couldn't let go of the question: Where did biology, morality,
literature, and philosophy all come together? The answer came to hm,
“Set aside the books and practice medicine.” It would take him a
couple of years to make up for the lack of chemistry and physics in
his previous studies, but he gained admission to a whole new world at
Yale Medical school.
Many
books have been written about the medical school experience and the
exotic diseases the student may encounter. Kalanithi's visit to 'the
home for broken brains' apparently stuck firmly in his mind. He
thought he might become a psychiatrist, studying diseases of the
mind.
But
he saw that the brain was the physical engine that operated the mind,
and he resolved to become a neurosurgeon. Speculation on theories of
psychiatry gave way to what he called the 'moral mission of medicine'
which is fixing what is wrong. “The patient is more important than
the paperwork.”
The
training period for a brain surgeon is among the most demanding and
lengthy that a medical school graduate can undergo---six to eight
more years beyond the four years of college plus the four years of
medical school. Increasing responsibility of the senior surgical
resident requires twelve- to fourteen-hour days on duty, regardless
of fatigue. Speed and technique are not the only things that matter.
Talking with the patient and family at the right pace; always leaving
room for hope, takes time and empathy. It almost destroyed his
marriage. He and Lucy met in first-year med school---she entered
internal medicine--- and they were very much in love, but she was
beginning to feel the strain of his continual duties in the hospital,
and suggested marriage counseling.
During
the last year of training – chief neurosurgical resident – he
experienced chest pain and weight loss. He and Lucy have a rare
afternoon taking in the sun at a San Francisco park. Lucy glimpses
his phone screen displaying some search results: “frequency of
cancers in thirty- to forty-year-olds.” He didn't want to discuss
it. She didn't accompany him on a trip a few days later; said she had
some things she needed to sort out. He began suffering intolerable,
screaming-in-pain back spasms; cut his trip short. Back at home he
told her he had cancer. She knew. The distance between them vanished.
“I will never leave you,” she promised.
Paul
was admitted to the hospital as a patient. His new doctor, Emma
Hayward, came into the room to introduce herself to him and his
family (most of them doctors too.) He supposed she could tell him
about survival statistics.
“No,”
she said, “Absolutely not. We can talk about treatment later. And
about going back to work, too, if that's what you'd like to do. I'll
see you Thursday after the tests I've ordered are back.” His
family contacted many of their fellow doctors to find out the best
treatment for him. To their surprise they found that most recommended
Dr. Hayward as not only world-renowned, but compassionate, knowing
when to push and when to hold back.
And
with that, the future Paul and Lucy had anticipated for so long
evaporated. But his curiosity and intellect remained fully active.
Some conditions are universal; one he had always seen and accepted
was that death comes to each one of us. What is it that makes my life
worth living? he asked. Dr. Hayward laid it out for him: What do you
want to accomplish?
There
were several things. He had already begun healing his marriage by
opening his thoughts to Lucy. They discussed whether to have a
child. Whether to return to the practice of surgery, or to take a
professorship. Above all, he wanted to write this book, to encourage
people to not give up living just because of a diagnosis. “A
diagnosis is not the end,” to quote Dr. Hayward, “or even the
beginning of the end. It is just the end of the beginning.”
