When Breath Becomes Air by Paul Kalanithi
I’m not much of a memoir reader, so reading someone else’s personal history/confessional/testimony is always a bit of a gamble. I really do appreciate someone else’s voice giving me their story, but unless the writing is truly excellent and the tone is one that catches my attention/empathy, I’m not likely to be too moved by it. And such is the result with Paul Kalanithi’s book, When Breath Becomes Air.
First, a disclaimer: my dad is a physician. He went through the premed coursework, the MCATs, medical school, the match process, residency, and paying off his student loans through government service before landing his job with a family practice and finding a relative degree of comfort while being active member of his family and church. I was born his third year of residency. My mom is also an ER nurse/stay-at-home mom, so I cannot tell you how many dinner table conversations consisted of the most disgusting medical cases/phenomena that did not gel with casseroles and pasta for us. My brother once texted me, “Mom and Dad are currently talking about an infected penis! WHY???” Thus, while I’m not professionally familiar with medicine, it is something I’ve been intimately acquainted with my entire life.
I say this, because When Breath Becomes Air cross-sects two areas with which I have been long acquainted on both a personal and professional level: medicine and literature. Paul Kalanithi is a young scholar seeking to understand death and its philosophical aspects. As an English literature major, he decides that literature is not his calling and that the discipline does not help him understand the philosophy of death or the human body, so he goes into medicine and there discovers his calling. He is a successful neurosurgery resident in his last year, though in a rocky relationship with his wife, when he finds himself in horrible pain all the time. He discovers that he has terminal lung cancer and can only hope that experimental treatments will help him. He and his wife decide to have a baby, and then he shares his perspective of transforming from doctor to patient.
I feel kind of like a bad person for speaking ill of this book, particularly because Kalanithi died before it was finished. At the same time, however, his death and subsequent forward and epilogue by Abraham Verghese and his wife paper over some of the major flaws in the book (in my opinion). The forward is gushy and effusive. There’s no two ways about it. Verghese raves about Kalanithi’s courage and prose as if his writing were some magnificent revelation. Now, Kalanithi is a solidly good writer, but he’s not a Cheryl Strayed or Toni Morrison. And the book itself is awkwardly paced and rushed through towards the end.
The epilogue informs us that it was started during Kalanithi’s initial diagnosis, and as his cancer rapidly progressed, he rushed to finish it. Lucy Kalanithi finished his story with her longer epilogue, and the book was sent to press, without editing. This, I feel, really hampers the quality of the book. There are several turns-of-phrase, when Kalanithi talks about literature and the match process in residency, in which he comes off like an entitled asshole. He actually makes the statement that he saw many of his friends turn away from specialties (like neurosurgery) and denied their calling for the cushy and easy money of general practice. This is definitely true of some people, but let’s get real. You match where you are placed, and that’s the end of it. Not everyone who’s as smart or as gifted as he is gets their top match, and not everyone gets to be a neurosurgeon. Period. We won’t even discuss what he says about literature. The Chancellor tried to convince me that he wasn’t being an asshole, but I’ve got too much baggage from pre-med classmates trying to make me feel stupid for picking an “easy” major.
I realize I’m losing focus of this review quickly, so my ultimate point is this: if this book had been co-written or ghost-written and the prose cleaned up, Kalanithi could have told a really clear and touching story. As it was, the writing craft for me was lacking, and the voice held a pomposity I could not shake.
Read The Chancellor’s review for a different opinion. He really liked it, and you’ll see where our perspectives differ.