Every one of us will have to face death one day. Dr. Paul Kalanithi gives a stirring account of facing his own mortality in his recently-published, posthumous memoir When Breath Becomes Air. His insights about death and the interesting journey to his chosen profession of medicine make for compelling reading, filled with serious considerations.
In what at times are brutal details, Paul first gives an account of medical school and his early interactions with patients. He describes how he was taught to not consider the human aspect of medicine. Desensitization to all aspects of the human anatomy is the rule of the day. Patients are only the sum of their body parts when it comes to medical education.
All this changes when he is given the responsibility of seeing families through complex surgeries and making calls about life-saving operations. It becomes clear that Paul makes the change from medical technician to healer. His life-changing realization comes as a relief to the reader: it is more important to treat the soul than it is to treat the body.
Paul’s embracing the till-then missing human element leads to all manner of positive changes in his medical practice. No longer are his cases simply numbers or the notes on a chart. His grappling with ethical issues of the greatest importance comes as thought-provoking, to say the least.
At age thirty-six, he is nearly finished with his neurosurgeon residency and is looking forward to considering the best job offers in the country. Such plans are scuttled, however, when Paul is diagnosed with Stage-4 lung cancer. Faced with a long and uncertain journey, he refuses to take the easy way out. Just as he learned to see the spirit embodied in each of his patients, so his own spirit shines through as he faces the end of his earthly sojourn.
From the outset of his diagnosis, one thing that sets Paul apart is his embracing of suffering. Having known it in his most intimate interactions with patients, and witnessed firsthand the most tragic deaths, he faces his own challenge head-on. Today, when so many are pushing so-called “end-of-life” legislation, Paul’s personal account shows how disingenuous it is to suggest those dying should “take the easy way out” with suicide. His journey outlined in When Breath Becomes Air has much to teach about both living and dying.
The human element that Paul describes so well only goes so far. Paul makes the link between the physical and the metaphysical. He clearly understands the value of “hope, fear, love, beauty, envy, honor, weakness, striving, suffering, virtue.” These elements comprise the substance of what makes life worth living, showing the human condition to be so much more than a limited scientific experience.
However, the metaphysical, as crucial as it is to our humanity, can only take us so far. This becomes clear when Paul approaches his final days. He makes many worldly preparations: looking after his wife and newborn daughter, taking care of all funeral arrangements and expenses, and other such matters. He also spends much of his time reflecting, being together with his family and saying goodbye to friends old and new.
But what of Paul’s soul? Granted, the book was published posthumously, and such a question is far beyond the scope of a personal memoir.
Yet the thought is inescapable and left unaddressed. The human element is not enough when it comes to the end of our lives on earth. The physical and metaphysical have to give way to the supernatural and eternity. One’s life, no matter if it is cut short like Paul’s due to tragic illness, or one that ends in venerable old age, is short when compared with eternity.
Paul’s rediscovering of the human element truly transforms his life, filling it with meaning and purpose. Such a transformation is needed in every profession if the culture is to change.
More than anything, we also need to concern ourselves with eternity. Ultimately, we must give an account to God for our lives on earth. Saint Paul wrote centuries ago, “Eye hath not seen, nor ear heard, neither hath it entered into the heart of man the things which God hath prepared for them that love Him.” On the other side of the coin, Saint Robert Bellarmine suggests a paraphrase of this verse: “Eye hath not seen, nor ear heard, neither hath it entered into the heart of man the tortures and torments which God hath prepared for those who offend Him.”
The book suffers from the fact that there are a few rare uses of profanity and discussion favorable to in vitro fertilization. However, it does contain serious thoughts that demand attention and reflection.
In contemplating eternity, God becomes the ultimate standard by which we live and die. When Breath Becomes Air does not go so far as to make this explicit. However, Dr. Paul Kalanithi’s quote from Churchill concerning his own journey can be applied to the soul’s departure from the body: “Now is not the end. Nor is it the beginning of the end. But it is, perhaps, the end of the beginning.”