The Saturday Read – ‘When Breath Becomes Air’ by Paul Kalanithi

“I knew with certainty that I would never be a doctor.”  How many of us eliminated career options with such conviction in our final year of high school?

The Saturday Read is ‘When Breath Becomes Air’ by Paul Kalanithi. Although not intended as a ‘career’ book, the beautiful prose and compelling story will leave you reflecting on choices, time and values.

The book is a narrative revealed in two parts.

The first begins with the story of a college student making the most of his experience at Stanford, initially studying English literature, “…seeking a deeper understanding of a life of the mind” until his ultimate realization that “I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action…I was going to Yale for medical school.”

The unintended value of the book’s Part I is a tutorial on the process of career decision making: exploration, reflection, discovery, reality testing, trade-offs and identity.

“In the fourth year of medical school, I watched as, one by one, many of my classmates elected to specialize in less demanding areas…and applied for their residencies. Puzzled by this, I gathered data from several elite medical schools and saw the trends were the same: by the end of medical school, most students tend to focus on “lifestyle” specialties – those with humane hours, higher salaries, and lower pressures – the idealism of their med school application essays tempered or lost…Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job – not a calling.”

Part II, “Cease Not till Death” addresses an essential question of life and career, What happens when your sense of identity is shaken?

“Lying next to Lucy in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician – my identity – no longer mattered.

Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused.”

Before the book was published, Dr. Kalanithi wrote two articles a year apart. Elements of both appear throughout the narrative. The first, ‘How Long Have I Got Left?’ for The New York Times in January 2014 described his role reversal as he “traversed the line from doctor to patient” and reflected on his own mortality.

“I began to realize that coming face to face with my own mortality, in a sense, 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.

Faced with mortality, scientific knowledge can provide only an ounce of certainty: Yes, you will die. But one wants a full pound of certainty, and that is not on offer.”

The second article, ‘Before I Go’ was published in the Spring 2015 issue of Stanford Medicine. Here he writes about time and career as the future “flattens out into a perpetual present”. 

“Time for me is double-edged: Every day brings me further from the low of my last cancer relapse, but every day also brings me closer to the next cancer recurrence — and eventually, death. Perhaps later than I think, but certainly sooner than I desire.

Everyone succumbs to finitude. I suspect I am not the only one who reaches this pluperfect state. Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described, hold so little interest: a chasing after wind, indeed.”

In the end, his illness brought him back to his love of literature and writing. His remarkable life informs this brilliant memoir. It’s a book for the new year, when resolutions are carelessly disregarded. The words, and Dr. Kalanithi’s legacy, reconnect us with the fundamentals of humanism. 


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