Citations from “When Breath becomes Air” – Paul Kalanithi (2016).
I read this book in less than a day as I sat by my father in the hospital last month (April – May 2017), tubes going in and out of his frail, weakened body. Watching him fight and deteriorate during the last stage of cancer, I was pierced by indescribable pain, fear and sadness. None compared to that which he suffered continuously, a devastating heaviness of my own being all the same. I was in anguish not for myself, but because he was suffering. Seeing someone you love undergo such excruciating bodily and mental agony breaks open your soul and shatters it with inexplicable grief. I felt it as I sat by my father: in his cries for help in the middle of the night , his numerous sores and ulcers, his loss of coherence, his swollen legs, his blackened veins, his bony arms and his laboured breaths. And I felt it in Paul’s book. Like Paul, my father succumbed to his disease less than two weeks ago. In departing, he left me with a searing void that I must now replenish with a million memories and joys, with a celebration of his life but also a deep appreciation of life and the undeniable matter of death.
I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.
Life has to be lived; the collective knowledge and teachings of the scriptures, saints, intellectuals and philosopher-kings is put to one side and the task of daily existence, of living out this life becomes the supreme teacher. You need to experience this cusp firsthand, need to be jostled and tossed about by the winds of fate to know what any of this means. Paul writes more on this below.
…I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the air that carried them…Moral speculation was puny compared to moral action.
Paul quotes Samuel Beckett:
One day we were born, one day we shall die, the same day, the same second…Birth astride of a grave, the light gleams an instant, then it’s night once more.
Maybe life is merely an “instant”, too brief to consider.
What Paul had come to understand of life as a doctor :
Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death — it’s something that happens to you and those around you.
Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win for your patients.
Paul refers to the French philosopher, Michel de Montaigne (“That to Study Philosophy Is to Learn to Die“):
If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live.
Paul’s impressions on his mortality, after his diagnosis with terminal cancer:
The fact of death is unsettling. Yet there is no other way to live.
The word hope first appeared in English about a thousand years ago, denoting some combination of confidence and desire. But what I desired — life — was not what I was confident about — death.
The angst of facing mortality has no remedy in probability.
Why me? (Answer: Why not me?)
If you lost someone you loved, know someone who is diagnosed with a life-limiting disease, or are facing your own mortality : I want to reach out and hug you. I want you to know that your pain is shared and that, sometimes, weightless words can provide succour and solace. I give you my strength and love.