Most of the books that I read don’t come my way because of recommendations from others or through online search. They come via browsing Barnes & Noble or Booktowne, when a promising looking book (or two or three or more) compels me to sit down and let my eyes digest its author. It will be a difficult adjustment for me if brick & mortar ever go away.
Booktowne’s motto is “Where Good Friends Meet Good Books”, but I’m not an overly sociable guy. My take on bookstores is that they’re a place “Where Good Books Become Good Friends”. Such was the case last week when the New Release table at B & N drew me to a short stout book with the breezy title, “When Breath Becomes air”, by Paul Kalanithi. The back jacket cover has two glowing endorsements, one by Atul Gawande (among my favorite medical writers) and the other by the novelist Ann Patchett. Patchett’s comments dispel any suspense about what happened to Dr. Kalanithi. He died, but in sharing his ascension to the top of the training phase of his profession as a neuroscientist/neurosurgeon, and then how cancer robbed him of the rest of his life, he fulfills his promise as a writer.
Abraham Verghese, a fellow Stanford physician, writes in his foreword to the book:
“In a world of asynchronous communication, where we are so often buried in our screens, our gaze rooted to the rectangular objects buzzing in our hands, our attention consumed by ephemera, stop and experience this dialogue with my young departed colleague, now ageless and extant in memory. Listen to Paul. In the silences between his words, listen to what you have to say back. Therein lies the message.”
Paul and Lucy, his wife and former Yale Medical School classmate, were students at Yale when Shep Nuland was still lecturing about How We Die. Descriptions like Nuland’s convinced Paul that such things could only be known face-to-face. Lucy wrote the epilogue to Paul’s book, and the passage that she quotes applies equally to writing as it does to neurosurgery, the context in which he wrote:
“ You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving”.
Everything that Paul writes brims with brutal honesty, ranging from the marital tension that he and Lucy experienced during Residency, to the pearls and perils of medical training. He has done for young dying physicians on the cusp of greatness what Randy Pausch did for lay persons in The Last Lecture. And there are striking parallels in the determination of Lucy Kalanithi to honor her husband without having that define her (“My Marriage Didn’t End When I Became A Widow”), much as Jai Pausch transitioned from caretaker to dream maker.
Paul’s plight first came to light in an essay he wrote for the New York Times two years ago pondering how much time he had left. It resonated with thousands of people, an effect that surprised even him, as he related in this interview. I have a hunch, though no first-hand knowledge, that this may have emboldened the incomparable physician/writer Oliver Sacks to be as candid as he was in the year prior to his death.
The sense of time reportedly warps as we approach death even at age 37, and Paul was able to document this in a piece he wrote for Stanford Medicine, Before I Go. Embedded in that piece is a compelling audio and video interview.
Lisa Rosenbaum captured the essence of When Breath Becomes Air in her Medicine and Society column in the New England Journal of Medicine.
“Although few of our patients can achieve the final act that Paul Kalanithi has, all of them can leave a legacy. The nature of prognostication means we will sometimes be wrong. And the nature of disease means we will often have no cure to offer. But the nature of hope requires a sort of empathy that is not about feeling what our patients feel, but instead about seeing in them what they can be. Sometimes that means refusing to fall, but sometimes it means falling a bit together.”
You will experience many emotions as you read through this powerful book. You will nod in agreement, you will feel empathy and you will well up and probably shed a tear or two. Ultimately you’ll feel like you’re riding on Paul’s shoulders, accompanying him as he walks through the valley of the shadow of death. And it will take your breath away.
PostScript 02/14/16 – When Breath Becomes Air #1 on NY Times Bestseller list second consecutive week.