What would you do if…..?

What would you do with one year left to live? Paul Kalanithi chose to write. The fruition of his choice is his first and only book: When Breath becomes Air.

The book is a memoir of his life journey from literature graduate to neurosurgeon, and from doctor to patient after a diagnosis of inoperable lung cancer. It has become an international bestseller since its publication after the author’s death, aged 37, in 2015.

I’d seen it around, the cover depicting the dove-blue gowned back of an operating surgeon. Then a patient in my Creative Writing Group at Maggie’s Cancer Care Centre waved her copy at me: ’Have you read this? It’s brilliant!’ she enthused, before warning me that the more medically-explicit surgical passages might not suit everyone’s stomach.

Drawn by her enthusiasm, the book’s title – derived from the Elizabethan poet Fulke Greville’s Caelica – and suitably primed, I opened its pages.

Inside was a book and a person who eluded categories. Kalinithi himself observes he was no neat fit, his sense of vocation an intertwining of art and science.

His quest for what gives life meaning led him to study literature at Stanford University, but then re-train as a neurosurgeon. He felt that ‘literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.’  Kalinithi envisaged a career of two halves: twenty years as a brain surgeon followed by two decades as a writer. It was not to be.

The root of the word disaster, Kalinithi comments, comes from the splitting of stars. With his cancer diagnosis, life’s familiar constellations were shattered. He felt disorientated, unable to plot a path through the uncertainties of terminal illness towards its inevitable outcome.

And yet he has to find a way. His approach is to express his feelings alongside an unflinchingly honest gaze at the facts of what he faces. This delicate dance between heart and head served him well as a neurosurgeon. There he learned that in order to operate on a patient’s brain, he needed to understand their mind: their sense of identity, values and what made their life worth living.

Now he has to embrace the shift of identity that life-changing diagnosis brings, becoming a patient and discovering first-hand the pain and vulnerability on the other side of the Consultant’s desk.

Now he learns that living with terminal illness means a constant re-examining and re-adjusting of values. He faces the difficulty of making plans without knowing what time he has left: ‘Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases.’

He contemplates survival-rates, realising his relationship with statistics has changed now he is one. But here, too, he applies the creative balance he once applied to his patients: In any prognosis, be accurate, but leave some room for hope.

He maintains the spaces of hope in his own life, living, rather than dying, with cancer. In his final year, Kalinithi became a father of a baby girl, and also birthed the book itself – its last poignant chapter completed by his wife Lucy after his death. Her tribute to their relationship is that ‘one trick to managing a terminal illness is to be deeply in love – to be vulnerable, kind, generous and grateful.’

The writing of When Breath Becomes Air  itself is quite an achievement: informative, a lucid balance between clinical elegance and emotional authenticity, a reflective testimony to human resilience.

For those experiencing, or close to, those with a terminal illness, it offers the encouragement of a fellow-traveller. For all of us, though, this book invites us to reflect. As Kalinithi notes, he always knew that he was going to die; the challenge came in the timing and upending of plans.

The book’s Prologue urges the reader to listen to its author and then, ‘In the silence between his words, listen to what you have to say back.’

What would you do if you had one year left to live? Two years? Ten years?

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    Julia
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