When Breath Becomes Air

dr paulDr. Paul Kalanithi is a brilliant young neurosurgeon in the midst of his residency when he is faced with a terminal cancer diagnosis. When Breath Becomes Air is his memoir, his exploration and examination of what makes life worth living. And indeed, this harrowing yet exquisite account of his life and musings as he shuffles ever closer to his inevitable death is well worth reading.

Educated Americans love nothing more than a doctor who can write and Dr. Kalanithi is one of those rare souls who excelled both in the operating room and on the page. In the first part of his story, we learn about his upbringing and his genius – he has a master’s degree in English literature and one in philosophy and considered being a writer before opting to take the more difficult path of becoming a surgeon. In his own words, “The call to protect life – and not merely life but another’s identity; it is perhaps not too much to say another’s soul – was obvious in its sacredness.”

It was not a decision taken lightly and he throws himself into his training with eyes wide open. As he writes, “The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”

What is remarkable is that Dr. Kalanithi continues his residency while undergoing harrowing treatments for his cancer. The grueling training required to succeed in one of America’s most prestigious hospitals (Stanford) would be impossible for most high functioning, healthy individuals. Paul has unfathomable grit and tenacity and keeps inching towards his goal even as his body deteriorates and betrays him.

This book is not for the faint-hearted. Tears rolled down my cheeks at many moments, especially as he enters his final days at the tender age of 37, just months after his baby daughter is born.

Dr. Kalanithi passed away before finishing his manuscript (oh and he was also writing this book in addition to everything else) and the last part is pieced together by his wife, Lucy who is also a doctor. In the epilogue she writes, “Although these last few years have been wrenching and difficult – sometimes almost impossible – they have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love.”

Indeed, one of the most heartfelt aspects of the book is how Dr. Kalanithi navigates the uncertainty of his predicament and how he must recontextualize his life and the way he must now improvise given so much uncertainty. As Janet Maslin writes of the book in the New York Times: “There is so much here that lingers, and not just about matters of life and death: One of the most poignant things about Dr. Kalanithi’s story is that he had postponed learning how to live while pursuing his career in neurosurgery. By the time he was ready to enjoy a life outside the operating room, what he needed to learn was how to die.”

The tragedy of this story is of a brilliant man who is unfairly and senselessly taken far too soon (although is there any other way?), leaving behind a grieving wife and eight month old daughter. The beauty of the story lies in Dr. Kalanithi’s ability to express in words his experience, to take charge of his own narrative even as he has so little control and power in the face of his own death. I, along with millions of others, am eternally grateful to have been able to bear witness to his life and death through his writing.


Grace and Grit (& perspective)

grace and gritThe memoir Grace and Grit by American writer and philosopher Ken Wilber is a sprawling account of his late wife’s, Treya, grueling fight against the cancer that ultimately kills her. Although under Ken’s name, the book was the brainchild of both of them and before her death, and Treya gave permission to Ken to use her very personal diary entries, letters she wrote to loved ones and conversations they had during this time, so her voice is very present. Treya’s journey is a constant reminder of how, even when our body is giving up, our heart and mind must remain strong. The need to have grace and grit, not just for survival but for growth and meaning, is ever present.

From the beginning, we learn that Ken and Treya are well-educated intellectuals and immersed in various ‘transpersonal’ spiritual traditions, making the memoir sweeping in its scope. Questions about the meaning of life and death hover over every page, as well as inquiries into what it means to be fully human, to truly love someone, and the risks and costs of these endeavors. The themes of sacrifice, faith, freedom, science, medicine, and devotion feature prominently.

I recently completed my third reading of this cathartic book. I file it under ‘bibliotherapy/memoirs of catastrophe’ – one of those books you return to when you are going through a hard time and need some perspective, some comfort, a vicarious experience of suffering and triumph.

Through Treya’s own words, we get a sense of her world and where she’s at in her life as the book opens with her and Ken’s very fast courtship and wedding. She is young (mid-30’s), vibrant and adventurous. She is deeply spiritual, having spent some years living in a remote spiritual community. Although accomplished in her own right (degrees from prestigious universities, well-travelled, multilingual, involved in myriad spiritual and environmental causes), she reveals her insecurities – that before she met Ken she was resigned to a life of being a single woman who was unsure of her life’s purpose or daemon. She is relatable because like many women, she struggled with self-criticism and feeling unworthy of love. She died in 1989 and in many ways, was ahead of her time in her pursuit of independence and self-sufficiency.

As one of her diary entries reprinted in the book states: “Sometimes I think my real problem is that I just don’t believe I could ever get really good at something, that I have an inflated idea of how good others are, and that maybe by the time I’m fifty that will have been cut down by experience to match reality and I’ll then know I could be good enough. And sometimes I think I just have to stop chasing my daemon long enough to let some space in my life for it to begin to show itself and grow. I want a full-blown plant right away and have been too impatient to nourish the small shoots enough to see which one I choose or chooses me.”

Treya is diagnosed with breast cancer just ten days after their wedding. This puts a lot of pressure on the young marriage and as the main caregiver and support person in Treya’s life, Ken is under a large amount of stress. He makes a lot of sacrifices to care for her and must deal with the consequences of this while riding the waves of hope and despair as Treya goes through several remissions and relapses, each relapse pushing her closer to death.

As time goes on, Ken finds it increasingly difficult to hold himself together, becomes depressed, ill and even loses his will to write. In his words: “I suppose the simplest and most crushing mistake I made was this: I blamed Treya for my woes, I had freely and voluntarily chosen to set aside my own interests in order to help her, and then when I missed those interests – missed my writing, missed my editorial jobs, missed meditation – I just blamed Treya. Blamed her for getting cancer, blamed her for wrecking my life, blamed her for the loss of my daemon. This is what the existentialists called ‘bad faith’ – bad in that you are not assuming responsibility for your own choices.”

In his darkest moment, Ken considers committing suicide. It takes a lot to pull himself out of that black hole, but he does so and is able to be stronger for himself and his wife. Their journey continues but with more support, more therapy, more spiritual practice, more medicine, more awareness of the pressure they are under.

As her physical health declines, Treya finds inner strength and faces her fears head-on. She has many epiphanies as she learns to surrender to the inevitable – that she will die. She overcomes her fear of being dependent and needy and her harsh judgement of herself and of others subsides. A new psychological landscape emerges in which she is more tolerant, relaxed and free.

From one of her journal entries: “I’m less critical of others. I don’t hold them to the standards of conventional or ‘doing’ success…I’m not only more tolerant of but genuinely interested in the various ways people choose to shape their lives, and a quick judgment isn’t waiting in the wings, ready to pop on stage at any time. I see all of life as more of a game, not quite so totally loaded with importance. It’s more fun, easier. I hold life more lightly.”

She develops a sense of self-trust and is able to let go of the harsh self-criticism and perfectionism that has plagued her most of her life. Her evolution is revealed in the following entry: “I trust myself more. I’m kinder to myself. I believe there is a wisdom guiding my life and that my life doesn’t have to look like anyone else’s to feel good and fulfilling and, yes, even successful.”

The last part of the book recounts Treya’s last weeks as it becomes evident that she will soon die. She makes a conscious decision of when to ‘let go’ and one of the most heart-wrenching moments in the book is when she tells Ken she is ready to die:

‘“Sweetie, I think it’s time to go,” she began.

“I’m here, honey.”

“I’m so happy.” Long pause. “This world is so weird. It’s just so weird. But I’m going.” Her mood was one of joy and humor, and determination.’

Ken writes about this experience of watching his dear Treya fade away and concludes that: “Real love hurts; real love makes you totally vulnerable and open; real love will take you far beyond yourself; and therefore real love will devastate you. I kept thinking, if love does not shatter you, you do not know love. We had both been practicing the wound of love, and I was shattered. Looking back on it, it seems to me that in that simple and direct moment, we both died.”

Although exquisitely written, the last days of Treya’s life as they are recorded cannot come close to the actual lived experience. Years after her death, Ken has spoken about the growth that occurred for both of them through that five year ordeal. If nothing else, the story of Ken and Treya can teach us about the profound transformative power of love. Treya’s own tenacious struggle can give us perspective, remind us of our own mortality and teach us to face our own dragons and challenges with grace and grit.