A dying Paul Kalinithi and his daughter Cady
Tuesday
Paul Kalanithi’s When Breath Becomes Air is an account by an English major-turned-neurosurgeon who looked to both literature and science to find meaning in life and then in his own death. Kalanithi wrote the book when he was dying of terminal cancer at 37.
I’ve written about how Kalanithi moved from literature to science and then back to literature as he grappled with his questions. At one point he saw language
as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion.
When literature didn’t seem experiential enough, he turned to hands-on medicine to get closer to these brains, only to turn again to literature again in his dying months when science itself came up short. In today’s post I look at the various works of literature he mentions to see the role that they play.
Here he is turning back to literature, specifically to those writers who focus on mortality:
Lost in a featureless wasteland of my own mortality, and finding no traction in the reams of scientific studies, intracellular molecular pathways and endless curves of survival statistics, I began reading literature again. Solzhenitsyn’s Cancer Ward, B. S. Johnson’s The Unfortunates, Tolstoy’s Ivan Ilych, Nagel’s Mind and Cosmos, Woolf, Kafka, Montaigne, Frost, Greville, memoirs of cancer patients—anything by anyone who had ever written about mortality. I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again. The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language. Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward.
Baron Brook Fulke Greville, an Elizabethan poet, gave Kalanithi the title of his book. “Caelica 83” focuses on the moment when breath becomes air—which is to say, when bodies with souls becomes mere materiality:
You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
Reader! then make time, while you be,
But steps to your eternity.
Kalanithi several times quotes T. S. Eliot, who is also drawn to this fateful moment. In “Whisper of Immorality” Eliot cites Jacobean playwright John Webster as sharing his own obsession:
Webster was much possessed by death
And saw the skull beneath the skin;
And breastless creatures under ground
Leaned backward with a lipless grin.
Eliot’s articulates the same contrast in The Wasteland with his allusion to Andrew Marvell’s “To His Coy Mistress”:
But at my back in a cold blast I hear
the rattle of the bones, and chuckle spread from ear to ear.
Although he talks at one point about his Christian faith, Kalanithi never uses the spiritual language that shows up in, say, Death of Ivan Ilych. For much of the book, he turns to existential questioning and sometimes to the theater of the absurd. For instance, Kalanithi is comforted that someone like Samuel Beckett voices his sense of being lost. Here’s a passage from Waiting for Godot that comes to his mind when he hears about a pair of twins dying soon after being born prematurely:
One day we were born, one day we shall die, the same day, the same second….Birth astride of a grave, the light gleams an instant, then it’s night once more.
Meanwhile Krapp’s Last Tape, also by Beckett, helps him with his own dying:
And so it was literature that brought me back to life during this time. The monolithic uncertainty of my future was deadening; everywhere I turned, the shadow of death obscured the meaning of any action. I remember the moment when my overwhelming unease yielded, when that seemingly impassable sea of uncertainty parted. I woke up in pain, facing another day—no project beyond breakfast seemed tenable. I can’t go on, I thought, and immediately, its antiphon responded, completing Samuel Beckett’s seven words, words I had learned long ago as an undergraduate: I’ll go on. I got of bed and took a step forward, repeating the phrase over and over. “I can’t go on, “I’ll go on.”
At one point he quotes one of the great absurdist quotations from King Lear:
As flies to wanton boys are we to th’ gods.
They kill us for their sport.
This, however, takes him to a nobler framing of his situation. He comes to see us as heroes in a Greek tragedy rather than Beckett’s theater of the absurd. This is to say that, while we don’t have control over our fates—a modern notion—we can choose how we respond. Kalanithi arrives at this conclusion after his oncologist says something that seems oracular:
From the Enlightenment onward, the individual occupied center stage. But now I lived in a different world, a more ancient one, where human action paled against superhuman forces, a world that was more Greek tragedy than Shakespeare. No amount of effort can help Oedipus and his parents escape their fates; their only access to the forces controlling their lives is through the oracles and seers, those given divine vision. What I had come for was not a treatment plan—I had read enough to know the medical ways forward—but the comfort of oracular wisdom.
“This is not the end,” she [his oncologist] said, a line she must have used a thousand times—after all, did I not use similar speeches to my own patients?—to those seeking impossible answers. “Or even the beginning of the end. This is just the end of the beginning.”
And I felt better.
This broader acceptance–the sense that we don’t have to be in control–helps explain why Kalanithi is no longer quoting absurdist passages by the end of the book. Though he has earlier turned to the dark passages from Eliot’s Waste Land, now he is quoting the sense of peace that Eliot achieves by the end. This peace comes with giving oneself over to a higher power. “Damyata” means to have self control:
Damyata: The boat responded
Gaily, to the hand expert with sail and oar
The sea was calm, your heart would have responded
Gaily, when invited, beating obedient
To controlling hands
It is in this spirit of acceptance that the final passage in the book can be read. Upon hearing that he had terminal cancer, Kalanithi and his wife decided to have a child, and in his final weeks Kalanithi gives himself over to the love of this child. He concludes When Breath Becomes Air with a note to Cady:
When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.
Literature doesn’t provide Kalanithi with an answer, as he thought it would when he wrote a Master’s thesis about Walt Whitman trying to resolve the “Physiological-Spiritual split.” Rather, it provides him with a language and a framework for the line between breath and air. Because of that language and that framework, even as he is dying of cancer he is able to experience a deep joy.
Added note: I very much identify with Kalinthi’s obsessive reading after he learned he was going to die. After I lost my eldest son, I couldn’t stop reading elegies, including Milton’s Lycidas, Shelley’s Adonais, and, above all, Tennyson’s In Memoriam. Every day when I would get back from work, I would dip randomly into Tennyson’s poem and see what it had to teach me that day.