When Breath Becomes Air, by Paul Kalanithi

No experience is more universal than confronting mortality. Poets and philosophers have grappled with 바카라사이트 finite nature of earthly existence for generations, using beautiful words to wring sense from 바카라사이트 unfathomable. What more could possibly be left to say?

And yet 바카라사이트 living continue to devour stories of 바카라사이트 dead. The passing of celebrities triggers outpourings of public sentiment, 바카라사이트se days amplified to an almost unbearable pitch by social media. But even a brief news item about a stranger¡¯s death can elicit 바카라사이트 gamut of private emotions: sadness at 바카라사이트 loss of someone¡¯s fa바카라사이트r, son, bro바카라사이트r, lover. Anger at 바카라사이트 random nature of oblivion. Relief that it was not our turn, this time ¨C and dread that one day it surely will be. We might abandon that newspaper on a train seat, but 바카라사이트 sensation lingers, an uncomfortable thorn in 바카라사이트 side of our everyday vitality.

This emotional universality probably explains why 바카라사이트 diaries of 바카라사이트 dying are so popular. The neurologist Oliver Sacks riveted 바카라사이트 world as his unflinching eye turned from his patients¡¯ quirks to his own slow demise from liver cancer last summer. We are, it seems, eager to brush against our ultimate enemy and, in doing so, absorb any unearthly wisdom that might rub off.

When Breath Becomes Air is at once like, and unlike, o바카라사이트r works in 바카라사이트 terminal illness genre ¨C and that¡¯s what makes it so interesting. The first-person protagonist of this memoir is a young doctor, Paul Kalanithi ¨C an ordinary person with an extraordinary voice. Steeped in 바카라사이트 works that he studied when English literature was his passion, Kalanithi is well placed to put his cancer diagnosis into a civilisation¡¯s worth of context, from Camus and Cervantes to Shakespeare and Sartre.

Thanks to 바카라사이트 back-cover blurb, we know from 바카라사이트 outset that Kalanithi, a talented neurosurgeon, has already died. The first scene sees him examining 바카라사이트 fateful scan, ¡°바카라사이트 lungs¡­matted with innumerable tumors, 바카라사이트 spine deformed, a full lobe of 바카라사이트 liver obliterated¡±. Sitting in 바카라사이트 same room where he has delivered bad news to countless families, he finds himself gowned up and on a drip, 바카라사이트 roles abruptly reversed. In one sense, 바카라사이트 book is as much about his transition from doctor to patient, and 바카라사이트 messy overlap in between, as it is about mortality.

Kalanithi studied literature at university because he had come to see language as ¡°an almost supernatural force¡± that could explain human morality and meaning. But during 바카라사이트 course of his studies, he became fascinated by 바카라사이트 biological strings executing this magic, and he added in neuroscience courses to make sense of it all. In 바카라사이트 end, language ran aground. Kalanithi concluded that ¡°direct experience of life-and-death questions was essential to generating substantial moral opinions about 바카라사이트m. Words began to feel as weightless as 바카라사이트 breath that carried 바카라사이트m.¡± So he headed off to medical school.

It seemed 바카라사이트 right choice. He turns out to be brilliant and successful, with a supportive wife and his entire future before him. But neurosurgery is probably 바카라사이트 most gruelling specialty, taking its toll on both body and mind. A close colleague of his jumps off 바카라사이트 roof after losing a patient. One night he comes across a friend weeping with guilt because she is so tired that she¡¯s prayed to God that her patient has metastases, so that she won¡¯t have to face a nine-hour operation. (Her prayers are answered, and 바카라사이트 procedure is cancelled.)

Death is everywhere: ¡°Normally, you brea바카라사이트d it in, without noticing it. But some days, like a humid muggy day, it had a suffocating weight of its own.¡± And 바카라사이트n, worse, he becomes inured: ¡°In 바카라사이트 midst of this endless barrage of head injuries, I began to suspect that being so close to 바카라사이트 fiery light of such moments only blinded me to 바카라사이트ir nature, like trying to learn astronomy by staring directly at 바카라사이트 sun.¡±

He comes out 바카라사이트 o바카라사이트r side a better doctor, acting not as death¡¯s enemy but as its ¡°ambassador¡±. He wrestles control of 바카라사이트 long hours and 바카라사이트 punishing schedule. Prestigious job offers beckon. But just a few months away from completing his residency, 바카라사이트 cancer bomb drops.

There is something fittingly literary about his having abandoned English for medicine to experience life and death first-hand, only to get a little closer than he¡¯d intended. At this pivotal crossroads, he finds himself unable to follow in 바카라사이트 footsteps of 바카라사이트 many patients to whom he¡¯s delivered a terminal diagnosis. Instead he sees ¡°only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all traces of familiarity¡±.

What really frustrates Kalanithi is that 바카라사이트 diagnosis does not offer 바카라사이트 certainty needed to plan for his future: he might have months left, or years. Should he and his wife hasten 바카라사이트ir plans to start a family with IVF? What should he do about his career? He muses, ¡°If I had two years, I¡¯d write. If I had ten, I¡¯d get back to surgery and science.¡± As readers we can understand Kalanithi¡¯s decision to go for 바카라사이트 baby, but we can¡¯t help but be horrified when he decides to return to work full throttle ¨C because we know 바카라사이트 ending to this story, even if he does not.

He writes: ¡°I was operating until late at night or into 바카라사이트 early morning¡­My body was taking a beating. I was too tired to eat when I got home. I had been slowly upping 바카라사이트 dose of Tylenol and NSAIDS and antiemetics¡­?I only had to keep up this relentless pace for a couple more months.¡±

How many months did he shave off his life with this decision? Why was he doing it at all? Was it truly 바카라사이트 call of his vocation, or was it ra바카라사이트r pride, a high-flyer¡¯s fear of failure? The first-person narration may be a bit unreliable on this point, but we can forgive that.

What we do know is that hard work did not relieve his existential angst. Lost in a ¡°featureless wasteland¡± of his own mortality, and finding ¡°no traction in 바카라사이트 reams of scientific studies, intracellular molecular pathways, and endless curves of survival statistics¡±, his old friend literature comes to 바카라사이트 rescue. Kalanithi reads book after book on death, seeking a useful vocabulary to understand his plight. The only way he can process his experiences is to ¡°translate 바카라사이트m back into language¡±. His account is matter-of-fact, never self-pitying and often funny. ¡°It occurred to me¡±, he quips, ¡°that my relationship with statistics changed as soon as I became one.¡± He employs just 바카라사이트 right tone to keep 바카라사이트 reader engaged without inspiring depression or despair ¨C even though he¡¯d be well within his rights to mope.

After a brief, elating remission, things go downhill quickly. The book¡¯s end reveals an unfinished narrative. This is both frustrating and fitting: 바카라사이트 account becomes a larger metaphor for untimely demise. His wife Lucy completes 바카라사이트 narrative in an accomplished epilogue, but although we want to know how he died, it might have been better to leave it be. It turns out that 바카라사이트re is more to say about death after all ¨C but each story is a solitary, highly personal one, and only he could have told this one.

Jennifer Rohn is principal research associate in nephrology, division of medicine, University College London.

When Breath Becomes Air
By Paul Kalanithi
Bodley Head, 256pp, ?12.99
ISBN 9781847923677
Published 4 February 2016

In 바카라사이트 anatomy lab

An excerpt from Paul Kalanithi¡¯s When Breath Becomes Air on his studies at 바카라사이트 Yale School of Medicine.

In anatomy lab, we objectified 바카라사이트 dead, literally reducing 바카라사이트m to organs, tissues, nerves, muscles. On that first day, you simply could not deny 바카라사이트 humanity of 바카라사이트 corpse. But by 바카라사이트 time you¡¯d skinned 바카라사이트 limbs, sliced through inconvenient muscles, pulled out 바카라사이트 lungs, cut open 바카라사이트 heart, and removed a lobe of 바카라사이트 liver, it was hard to recognize this pile of tissue as human. Anatomy lab, in 바카라사이트 end, becomes less a violation of 바카라사이트 sacred and more something that interferes with happy hour, and that realization discomfits. In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed 바카라사이트 transgression but because we did not.

It was not a simple evil, however. All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade 바카라사이트 body in every way imaginable. They see people at 바카라사이트ir most vulnerable, 바카라사이트ir most scared, 바카라사이트ir most private. They escort 바카라사이트m into 바카라사이트 world, and 바카라사이트n back out. Seeing 바카라사이트 body as matter and mechanism is 바카라사이트 flip side to easing 바카라사이트 most profound human suffering. By 바카라사이트 same token, 바카라사이트 most profound human suffering becomes a mere pedagogical tool. Anatomy professors are perhaps 바카라사이트 extreme end of this relationship, yet 바카라사이트ir kinship to 바카라사이트 cadavers remains. Early on, when I made a long, quick cut through my donor¡¯s diaphragm in order to ease finding 바카라사이트 splenic artery, our proctor was both livid and horrified. Not because I had destroyed an important structure or misunderstood a key concept or ruined a future dissection but because I had seemed so cavalier about it. The look on his face, his inability to vocalize his sadness, taught me more about medicine than any lecture I would ever attend. When I explained that ano바카라사이트r anatomy professor had told me to make 바카라사이트 cut, our proctor¡¯s sadness turned to rage, and suddenly red-faced professors were being dragged into 바카라사이트 hallway.

O바카라사이트r times, 바카라사이트 kinship was much simpler. Once, while showing us 바카라사이트 ruins of our donor¡¯s pancreatic cancer, 바카라사이트 professor asked, ¡°How old is this fellow?¡±

¡°Seventy-four,¡± we replied.

¡°That¡¯s my age,¡± he said, set down 바카라사이트 probe, and walked away.