15. WHEN BREATH BECOMES AIR
All life is lived in the shadow of its own finitude, of which we are always aware — an awareness we systematically blunt through the daily distraction of living. But when this finitude is made acutely imminent, one suddenly collides with awareness so acute that it leaves no choice but to fill the shadow with as much light as a human being can generate — the sort of inner illumination we call meaning: the meaning of life.
That tumultuous turning point is what neurosurgeon Paul Kalanithi chronicles in When Breath Becomes Air (public library), also among the year’s best science books — his piercing memoir of being diagnosed with terminal cancer at the peak of a career bursting with potential and a life exploding with aliveness. Partway between Montaigne and Oliver Sacks, Kalanithi weaves together philosophical reflections on his personal journey with stories of his patients to illuminate the only thing we have in common — our mortality — and how it spurs all of us, in ways both minute and monumental, to pursue a life of meaning.
What emerges is an uncommonly insightful, sincere, and sobering revelation of how much our sense of self is tied up with our sense of potential and possibility — the selves we would like to become, those we work tirelessly toward becoming. Who are we, then, and what remains of “us” when that possibility is suddenly snipped?
generation after surgeon Sherwin Nuland’s foundational text on confronting the meaning of life while dying, Kalanithi sets out to answer these questions and their myriad fractal implications. He writes:
At age thirty-six, I had reached the mountaintop; I could see the Promised Land, from Gilead to Jericho to the Mediterranean Sea. I could see a nice catamaran on that sea that Lucy, our hypothetical children, and I would take out on weekends. I could see the tension in my back unwinding as my work schedule eased and life became more manageable. I could see myself finally becoming the husband I’d promised to be.
And then the unthinkable happens. He recounts one of the first incidents in which his former identity and his future fate collided with jarring violence:
My back stiffened terribly during the flight, and by the time I made it to Grand Central to catch a train to my friends’ place upstate, my body was rippling with pain. Over the past few months, I’d had back spasms of varying ferocity, from simple ignorable pain, to pain that made me forsake speech to grind my teeth, to pain so severe I curled up on the floor, screaming. This pain was toward the more severe end of the spectrum. I lay down on a hard bench in the waiting area, feeling my back muscles contort, breathing to control the pain — the ibuprofen wasn’t touching this — and naming each muscle as it spasmed to stave off tears: erector spinae, rhomboid, latissimus, piriformis…
A security guard approached. “Sir, you can’t lie down here.”
“I’m sorry,” I said, gasping out the words. “Bad … back … spasms.”
“You still can’t lie down here.”
I pulled myself up and hobbled to the platform.
Like the book itself, the anecdote speaks to something larger and far more powerful than the particular story — in this case, our cultural attitude toward what we consider the failings of our bodies: pain and, in the ultimate extreme, death. We try to dictate the terms on which these perceived failings may occur; to make them conform to wished-for realities; to subvert them by will and witless denial. All this we do because, at bottom, we deem them impermissible — in ourselves and in each other.