Both Worlds: The Personal Journey from Doctor to Patient in ‘When Breath Becomes Air’

At one point in Paul Kalanithi’s life he somewhat let go of his love for literature and decided to commit himself one hundred percent to medicine. He had started on his path to become a neurosurgeon and to discover the answer to a question that has lingered with him since his undergraduate years: What “makes human life meaningful, even in the face of death and decay?”(42). He wanted to find the answer that he couldn’t discover in books through experiencing meaningful relationships with the dying. This meant sacrificing his older priorities and continuing in classes required for medical school to begin his process of understanding the most complex organ in our bodies, the brain. Paul’s words throughout part one of his memoirs, When Breath Becomes Air, gives the reader an insight from his childhood ventures all the way through to his sixth year of residency. If there was one thing Kalanithi knew about life before his journey, it was that everyone is born and everyone will die.

As a medical student after two years of intense studying, he started in the labor and delivery ward where he witnessed his first birth, as well as his first death. The reality of being in charge of making such imperative “judgement calls” struck Paul during a scenario where the burden of deciding whether it was best to deliver twin babies early, or wait longer to deliver was being made. Kalanithi wondered how he would ever make such decisions in his life since to this point a hard decision for him was “choosing between a French dip and a Reuben”. (66) Before he knew it he became responsible for calling the shots and making decisions at times for his patients, such as whether or not their life was worth living, if surgeries were worth performing, and weighing out the pros and cons of possible side effects of brain surgeries which were life changing to not only the patient but also the patients’ families. Would his patients be able to still value the quality over quantity of their lives? Different parts of the brain are responsible for the different ways we act, perceive, think, control our actions/movements, functions, and so much more. Paul’s job was now to educate and help his patients and their family members answer the questions that lingered with him and would continue to do so throughout his career. Daily examples of tough decisions for his patients include whether or not they would “trade … (their) right hand’s function to stop seizures?” and “How much neurologic suffering would you let your child endure before saying that death is preferable?” (71) In the process of evaluating quality of life over quantity each patient has his or her own philosophies behind the meaning of his or her life.

Kalanithi did not fully escape his love for literature because, “when there was no place for the scalpel, words were the surgeon’s only tool.” (87) His skills learned from literature enabled him to gently break life changing news to the patient and their loved ones. In talking through choices with his patients, he helps them to learn to accept pain and reshape their identities. Roles changed when Kalanithi himself discovered he was dying of lung cancer. He was now standing in his patient’s shoes and had to experience and live through the process of answering his questions dealing with a devastating diagnosis himself. He is initially overwhelmed by the news of his cancer and is forced to take into consideration the advice recommendations of his oncologist. Although his doctor is unable to give an estimate of life expectancy in terms of years, just as Kalanithi was also unable to do with his own terminally ill patients, she did estimate that he had about an 80% chance of dying from his cancer. Kalanithi ponders “If I had two years, I’d write. If I had ten, I’d get back to surgery and science.” (137) As far as his family was concerned, Paul and his wife coped by consulting a therapist as well as go to a sperm bank to weigh out their options. Paul also had the chance to return to the work which he worked so hard towards all his life.

Paul’s writing gives a valuable lesson to all of his readers as his words continue to live on and spread from reader to reader, even though he passed away during his last year of training. His book shows he chose quality of life, over quantity of time. Even though Kalanithi knew his life was coming to an end, he continued to write his book since writing was something he truly loved to do. He proved living means more than just staying alive. It means accepting suffering regardless of the body losing its ability to live.