February 15, 2018

Revisiting a great book

I wrote this review of "When Breath Becomes Air" when it was released in 2016. I picked it up again the other day, reread it and decided its story deserved to be told again. 

Meet Dr. Paul Kalanithi, author of When Breath Become Air. He was a 36-year-old neurosurgery resident when he first viewed the MRI clearly revealing his own lung cancer. He later admitted that until his illness, he knew a lot about pain but he didn’t know what it felt like.
Yes, it’s about dying, but half of this little book focuses on Paul Kalanithi before the cancer, living a life unknowingly crammed with preparatory steps. He got his master’s degree in English literature prior to medical school; his plan had been to spend 20 years in surgery and then 20 years as a writer. Instead, he spent seven years in residency and a few months feverishly authoring this book, which is not just well written but seriously literary. His relentless search for what makes life meaningful even in the face of death and decay had begun with his college admissions essay, in which he argued that happiness is not the point of life. In his brief career as a surgeon, he labored to save what made a patient’s life worth living, if possible, or to allow the peace of death, if not. It was an ideal he adopted for himself when his oncologist counseled that the first step in the medical decision making process is to find one’s values. Dr. Kalanithi passed away eight months after he was told, “You have five good years left,” but as the author graciously allowed, “Doctors, as it turns out, need hope, too.”
We like it when doctors write books. We know they play an extraordinary role in the theater of life and we want a peek from their vantage point. Among the best are Dr. Atul Gawande’s Being Mortal, which gave us a candid view of the healer’s role in shared decision making; I’m still here: Living Long and Loving Life at Age 90, written by Des Moines area cardiologist Dr. David Lemon, filled with his witty and wise patients’ observations on the pageantry of life; and the unique and inspiring stories of hospice care in Dr. Ira Byock’s The Four Things That Matter Most. But Dr. Kalanithi’s book trumps them all because he is not just contemplating the end of life, he is contemplating the end of his life. Part memoir, part condensed treatise on the meaning of life, part manual for the soon-to-be-dying, When Breath Becomes Air is very nearly flawless.
Is there reason to believe that physicians deal firsthand with illness and dying differently than their patients? I don’t think so. We all learn the tough lessons of being a patient when—and not a moment before—we become one. As doctors age, I believe their odds of understanding that no longer treating the disease is not the same as no longer treating the patient are about the same as for the rest of us. And, like the rest of us, the ones that figure it out will be better equipped to practice shared decision making and to accept the inevitability of life’s end. Because, as Dr. Kalanithi recognized soon after his terminal diagnosis, “My relationship with statistics changed as soon as I became one.”