When Breath Becomes Air

When Breath Becomes Air Posts

On “Dying” and “In Gratitude”

I’m writing a memoir, a form that in my mind plays hide-and-seek with the truth. It contains what I imagine and what I remember being told. Absolute veracity is what I am after.

Jenni Diski In Gratitude

Two women writers, Jenni Diski and Cory Taylor, are diagnosed with cancer and its inoperable. Trying to come to terms with the doctor’s grim prognosis is not easy. Suddenly time takes on a different meaning. Jenni Diski began a column for the London Review of Books once her cancer was diagnosed. It was a series a essays that were published reflecting on her life, her birth family, her writing, her school and most significantly her complicated relationship with the Nobel Prize winner, Doris Lessing, who took fifteen-year-old Jennifer Simmonds under her wing. The Australian writer Cory Taylor too spends a while in her memoir, Dying, remembering her mother and the choices she made. In both the memoirs what comes across clearly is that the two dying writers are reflecting upon their past but are also hugely influenced by and acknowledge the presence of the women who made the writers what they are. Jenni Diski had always nursed a desire to be a writer but had not been very focused about it till she met Doris Lessing and was introduced to her world of writers and other creative minds who always made interesting conversation and had ideas to offer. Cory Taylor discovered that her mother had had a dream to be a writer but never achieved it. She writes in Dying : “Writing, even if most of the time you are only doing it in your head, shapes the world, and makes it bearable. …I’m never happier than when I’m writing, or thinking about writing, or watching the world as a writer, and it has been this way from the start.” Three Australian writers including Benjamin Law wrote a beautiful obituary for Cory Taylor in the Guardian terming Dying as a “remarkable gift” for providing a vocabulary and invitation to speak about that “unmentionable thing”, a “monstrous silence” — death. ( 6 July 2016, http://bit.ly/2dPq0Mx ) These sentiments on writing and the gift of the memoir can probably be extended to Jenni Diski and In Gratitude too.

Apart from Jenni Diski’s and Cory Taylor’s preoccupation with writing and their evolution as writers what comes through strongly in both memoirs is the tussle between secular and religious modes of coping with death and its rituals. Also how ill-prepared a secular upbringing makes an individual in understanding burial rites or managing one’s grief once a loved one departs. How does one mourn? The structures of religious rituals seem to take care of the moments of sorrow. There is much to do. Yet the challenge of speaking of death and the process of dying is not easy. Cory Taylor had even contemplated euthanasia and ultimately passed away in hospice care.

In Gratitude and Dying: A memoir put the spotlight on the magnificent leaps medicine and technology have made, in many cases it has prolonged life but with it is the baggage of ethics — whether it is possible to go through the agony of pain while dying a slow death or to end it all swiftly by assisted suicide or euthanasia. These are critical issues not necessarily the focus areas of both books although Cory Taylor confesses in having contemplated euthanasia. While reading the memoirs innumerable questions inevitably arise in a reader’s mind.

Some of the literature published recently has been seminal in contributing to the growing awareness and need to discuss death increasingly in modern times when advancement in medical technology seems to prolong human suffering. Also in an increasingly polarised world between the secular and religious domains bring to the fore the disturbed confusion that reigns in every individual on how to deal with the dying, the finality of death, disposal of the mortal remains and the despair it leaves the distraught survivors in. Some links are:

“Daughters of Australian scientists who took their own lives reflect on their parents’ plan” http://bit.ly/2dDfvc8 ( Jan 2016)
Amitava Kumar’s essay “Pyre” published in Granta ( https://granta.com/pyre/ ) and recently republished in Best American Essays 2016, edited by Jonathan Franzen.
Atul Gawande’s Being Mortal ( 2015)
Paul Kalanithi’s When Breath Becomes Air ( 2016)
Aleksander Hemon’s moving essay on his infant daughter’s brain cancer ( “The Aquarium: A Child’s Isolating Illness” JUNE 13 & 20, 2011 ISSUE http://www.newyorker.com/magazine/2011/06/13/the-aquarium )
Randy Pausch’s The Last Lecture ( 2008, https://www.youtube.com/watch?v=ji5_MqicxSo )
Andrew Solomon’s essay on his mother’s decision to opt for euthanasia ( “A Death of One’s Own” 22 May 1995 http://www.newyorker.com/magazine/1995/05/22/a-death-of-ones-own )

In Gratitude and Dying are strangely comforting while being thought provoking in raising uncomfortable questions about mortality, importance of time, maintenance of familial ties and doing that which pleases or gives the individual peace. Both the memoirs have a confident writing style as if by capturing memories in words the writers are involved a therapeutic process of facing their mortality while the urgency to their writing has an unmistakable strength to its tenor as if no one will have the time to dispute their published words.

Read these books.

Jenni Diski In Gratitude Bloomsbury, London, 2016. Pb. pp. 250 £12.99

Cory Taylor Dying: A Memoir Canongate, London, 2016. Pb. pp. £12.99

24 Oct 2016

Paul Kalanithi – ” When Breath Becomes Air”

01 02 , 2016 No Comments

“…I found myself increasingly often arguing that direct experience of life-and-death questions was essential to generating substantial moral opinions about them. Words began to feel as weightless as the breath that carried them. Stepping back, I realized that I was merely confirming what I already knew: I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action. ( p.43)

Paul Kalanithi’s When Breath Becomes Air is an account of his being diagnosed with cancer, the birth of his daughter, rediscovering religion (though his parents were Christian and Hindu) and his death, as narrated in an epilogue by his wife, Lucy. It is a heartbreakingly beautiful book written with surgical precision and an objective insight that only a doctor can possess. It comes across throughout the book but is evident when Paul Kalanithi is recalling a terribly acute back spasm he had while at a railway station. As he lay on the hard wooden bench to manage the pain he was reciting the name of every single muscle that was paining. In Jan 2014 he wrote an essay for the New York Times called, “How long have I got left?” ( http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html ) and it went viral. Subsequently he wrote/interviewed for Stanford Medicine in Spring 2014 called, “Before I go” ( http://stanmed.stanford.edu/2015spring/before-i-go.html ).

Paul Kalanithi was a voracious reader when he was a child. His father and his elder brother were doctors but when Paul applied to university, his first preference were the literature and history courses. But before leaving his then girlfriend in Arizona encouraged him to read a “low brow” book that she had enjoyed instead of the “high culture” reading he was constantly immersed in. This brow book influenced Paul considerably. It talked about the importance of the mind and the brain. After finishing the book, he browsed through the courses being offered at Stanford and began to explore some of the biological science classes too. He turned out to be an exceptional student who would survive the 88-hour week and more, plus study and remained top of the class. Unfortunately cancer intervened in the eighteen months of his residency. This put immense pressure on his marriage to Lucy who was also at Stanford. But despite the hiccups, Lucy and Paul were together through the first phase of his treatment. At this point he did not require chemotherapy as the cancer began to respond to the oncologist’s treatment. So much so, Paul returned to work a few months later, although on a lighter schedule. Within days he had returned to his full workload of surgeries and was in the OT every day. Unfortunately soon the cancer returned. This time far more virulently. He read his own scans at the end of a long day at work. Here is a very moving excerpt from the book published in the New Yorker on 11 January 2016 where Paul recollects his last day at work — “My last day as a surgeon”. (http://www.newyorker.com/books/page-turner/my-last-day-as-a-surgeon )

Paul left the manuscript incomplete on his computer. He requested his wife to complete it. Lucy Kalanithi has written a heartrendingly poignant essay as the epilogue to the book. Like her husband, Lucy too is a medical professional, but there is marked difference in their writing styles. Unlike her husband who brings in his love for literature with his passion for medicine to write crisply and objectively, Lucy writes gently, calmly, but the pain at losing her much beloved husband is unmistakable. She completes the book by describing his last day, holding his eight-month-old daughter for the last time, the funeral, the memorial service and his grave. ( I was weeping by the time I finished reading the essay.) On 6 January 2016, Lucy Kalanithi wrote in the New York Times, “My Marriage Didn’t End When I Became a Widow”. ( http://opinionator.blogs.nytimes.com/2016/01/06/my-marriage-didnt-end-when-i-became-a-widow/) It describes some of the memories she recounts in the epilogue.

When Breath Becomes Air would be better seen as having been written by husband and wife. The tragedy that befell such a young family where the couple had promising careers ahead of them can only be experienced by reading the book in one sitting, reading/hearing Paul at first and then closely followed by Lucy’s voice grieving at the loss of a much loved husband, companion, friend, father, son, brother and surgeon. His memorial service in Stanford was attended by his family, friends, colleagues and patients.

I have often wondered what it must be like for a doctor to realise they are ill and their mind analyses, evaluates every stage while they are sick. When Paul kept prompting his oncologist for some idea of the realistic time it would require him to recover, she kept evading his question. At one point in the book he has an epiphany when he realises it is sometimes best to stop being a doctor and looking after oneself but be treated by others, instead of second guessing their treatment.

When Breath Becomes Air is a very moving book and should be read by everyone.

( The images used to accompany this article are from the Internet. I do not own the copyright to them at all. If anyone knows who owns them, please let me know and I will acknowledge the source.)

Paul Kalanithi When Breath Becomes Air ( Foreword by Abraham Verghese) The Bodley Head, an imprint of Vintage, Penguin Random House, London, 2016. Hb. pp. 230 £ 12.99

1 February 2016