The neurosurgeon who turned his fight with terminal cancer into a heartbreaking book
He was bizarrely, uniquely ready to write this book,’ says Lucy Kalanithi of When Breath Becomes Air, the remarkable memoir written by her husband, a brilliant neurosurgeon named Paul Kalanithi, in the months before he died, aged 37, from lung cancer. ‘He had these big existential questions that were not theoretical any more, swirling around.’ We are sitting at the kitchen table of her friend’s apartment in Brooklyn, the thin January light filtering through the window. In New York for the memoir’s promotional tour, she is fulfilling a promise she made to Kalanithi when it became clear he wouldn’t live long enough to see his words in print. ‘The end came so fast, he deteriorated very quickly, so we basically had this period of 12 hours to make decisions about his death and exchange some words. One sentence of it was, “Can you publish my book?”’ Lucy says, her voice faltering.
It is less than a year since Kalanithi passed away, surrounded by family, in a hospital bed in the intensive care unit at Stanford University in California, where he had been chief resident in neurological surgery mere months before. For his 36-year-old widow, time seems barely to have passed.
‘I will say a year is nothing; I’m shocked. At first the grief was so crushing I thought, I cannot believe this is part and parcel of being human.’ Tall and willowy, with a lovely, intelligent face, her blue eyes fill up intermittently throughout our conversation. ‘Someone said the book was “crackling with life”, and I loved it because… ’ She pauses and swallows hard. ‘This is going to bring tears to my eyes, but even when Paul was wasted [with cancer] and looked like an old man he was totally crackling with life. His mental state was alive. He didn’t die until he died.’
Kalanithi wrote When Breath Becomes Air in the last 22 months of his life and what he has left behind is a luminous, revelatory memoir about mortality and what makes being alive meaningful. Life, birth, disease and death are examined with the observational power of the doctor-philosopher, bringing to mind Atul Gawande’s Being Mortal and Oliver Sacks’ The Man Who Mistook His Wife for a Hat, to name literary classics by just two physician- writers. But it is his voice that compels you to take notice – lyrical, intimate, insistent and profound. Kalanithi had the mind of the polymath and the ear of a poet, and when he speaks about what matters most, it brings you up short.
‘Everyone succumbs to finitude,’ he writes, his cancer metastasising in his lungs. ‘Most ambitions are either achieved or abandoned; either way, they belong to the past. The future, instead of the ladder toward the goals of life, flattens out into a perpetual present. Money, status, all the vanities the preacher of Ecclesiastes described hold so little interest: a chasing after wind, indeed.’
Neither Lucy nor Kalanithi had any idea he would write a testimonial to mortality. In the dark, dis-orientating period following his diagnosis of stage IV lung cancer, Kalanithi grappled with the question of what he should do with his time, now illimitably precious. Still ambitious to finish his residency, he returned to work when his cancer responded to chemotherapy and the third-line drug Tarceva, battling through immense pain in order to complete his arduous neurosurgical training [see extract below].
"He always had this dream of being a writer and he had just seen his medical career come crashing down before his eyes"
