The formation of meaning is a constantly evolving process, and from time to time, over the course of a life, things change, and these changes require that we pause and make sense of the experience. As COVID-19 infects our cities and communities, many of us have had to pull back from the lives we formerly led. Others have had to face the prospect of possibly losing loved ones, of possibly becoming sick ourselves. It is undeniable that these defining moments will change us; how we face these changes will define us. Nonfiction books and memoir can help us observe a writer making meaning while also doing the difficult work of living. In this book recommendation, I’ll explore how Paul Kalanithi’s When Breath Becomes Air offers a roadmap for making meaning.
At various points in my life, particularly in moments of profound change, I find myself returning to Paul Kalanithi’s When Breath Becomes Air. It is one of the few books I have read more than a couple of times. When he was 36 years old, about to finish his medical residency in neurological surgery, Kalanithi received a devastating diagnosis: terminal lung cancer. And just like that, Kalanithi found himself transforming from doctor to patient, from promising neurosurgeon to a man in search of the questions that had set him on the path to begin with.
The questions he is forced to face next are the questions we all ultimately face. What is the meaning of life? Or, in the words of Mary Oliver, “Tell me, what is it you plan to do with your one wild and precious life?” The answer for each of us is unique, shaped by our experiences in the world, by our goals, and by our values. Kalanithi reminds me, time and again, that I must not wait until the last minute to take stock, to pause, and to make sure that my values match my actions.
In this time of uncertainty, I find myself asking myself whether I am working on the projects I find most meaningful given life’s finitude. Am I working to build and nurture the relationships and love that makes life important? Am I giving of myself fully to each day, even if the day might itself be circumscribed by limits imposed by this pandemic?
Where does Kalanithi find meaning? In this nonfiction book, he finds it in literature, in his work as a neuroscientist, and in his relationships with other people.
“I studied literature and philosophy to understand what makes life meaningful, studied neuroscience and worked in an fMRI lab to understand how the brain could give rise to an organism capable of finding meaning in the world, and enriched my relationships with a circle of dear friends through various escapades.”
Kalanithi ultimately became a doctor to answer life’s most important question: “What makes human life meaningful?” He finds something of an answer in the marriage of literature and neuroscience. “…literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” In literature, Kalanithi finds “the richest material for moral reflection.”
And so, upon receiving his terminal diagnosis, Kalanithi turns to literature, choosing to spend his remaining time writing When Breath Becomes Air, a nonfiction book of such profound beauty it still takes my breath away, still leaves me weeping.
As Kalanithi navigates the ravages of terminal cancer, he finds meaning in his relationships. He reconnects with his wife, a relationship he describes as “deep in meaning, a shared and evolving vocabulary about what mattered.” In the midst of terminal illness, Kalanithi and his wife decide to have a child. His wife asks, “Don’t you think saying goodbye to your child will make your death more painful?” Kalanithi responds, “Wouldn’t it be great if it did?”
As a doctor, Kalanithi is forced to make split-second judgement calls that can mean the difference between life and death. He writes about twins delivered prematurely, who later die. The doctor chose to perform a C-section on the mother. Later, Kalanithi learns that the doctor had a choice: leave the babies in the womb, where they would likely die, or deliver them at 23 weeks—a few days short of viability. The doctor chose to deliver. Kalanithi asks the doctor, “Which is worse, being born too early or waiting too long to deliver?” The doctor explains that it is a judgement call. Up to that point, Kalanithi remarks, “In my life, had I never made a decision harder than choosing between a French dip and a Reuben?”
The judgement calls we make in life are often of the French dip and Reuben variety, but every so often, we are faced with choices so big, they are impossible to make. I believe the hardest choices in life are the ones most likely to get us stuck. Rather than making the hard choice, we so often choose to make no choice at all—which is itself the most dangerous choice we could make. Hard choices involve loss and tough decisions—leave the marriage or stay, quit the job or take the promotion, pursue the difficult, but passionate calling or choose the safe nine-to-five, move to the new city, say I love you. So often, we choose not to choose, and life chooses for us, not always in our best interests.
And even when we are making choices of the Reuben and French dip variety, we should do so always with the keen awareness that the sum total of those mundane choices eventually add up to form a life.
But how do we make choices, especially the tough ones? Kalanithi notes: “would knowledge alone be enough…? Surely intelligence wasn’t enough; moral clarity was needed as well.”
How do we make decisions with moral clarity? How do we approach life’s judgement calls with the resources to make a wise decision?
The answers we each give will be as unique as the lives we form in response. Some nonfiction books, however, can offer us a road map for living. Kalanithi’s book does just that.
Kalanithi’s search for authenticity is uncompromising. “Doctors in highly charged fields met patients at inflected moments, the most authentic moments, where life and identity were under threat; their duty included learning what made that particular patient’s life worth living, and planning to save those things if possible—or to allow the peace of death if not.”
The peace of death if not.
We live in the midst of a pandemic where doctors, right now, are being forced to make life or death decisions. Many of us are concerned for older loved ones, and for those with illness who may be vulnerable to this disease, whose course for some is so cruel.
Right now, socially distancing ourselves from one another is the best option we have as a society to save lives and stop the spread of disease. But, at some point, in the near future, we will need to ask ourselves what kind of society we want to build, what kind of world we’ll want to re-build, and more immediately, what kind of lives we want to live in the aftermath. It means defining our ongoing values as individuals and as a society. Fortunately, we can start to think about these things now. Life doesn’t stop in quarantine. We can sit and meditate on how we want to live our lives, to acknowledge that our answers will be imperfect. As a neurosurgeon facing life or death choices on the daily basis, Kalanithi knew this well: “The secret is to know that the deck is stacked, that you will lose, that your hands or judgement will slip, and yet still struggle to win… You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”
“…each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth… Human knowledge… grows from the relationships we create…”
Paul Kalanithi, When Breath Becomes Air
I think about nature, the power of waves crashing against rocky cliffs, the vulnerability of a bird bowing before a bowl of water, and the powerful wind that those wings make when they fly. I think about the importance and significance of full moons, clear oceans, mountains shrouded in clouds, and quiet woods. I think about the sound of clear streams, a tern flying over the sea, and the glimpse of a turtle coming up to breathe.
In the wake of tragedy and change, there is always a gap, a clearing, space made in a newly burnt forest after the fire. The old wood is gone. But there might be room to build a house, to plant a garden.
Kalanithi writes that he was searching in literature “for a vocabulary with which to make sense of death.” And through literature, he is “brought back to life.”
Through literature we are offered a glimpse of other perspectives. This is its gift. Kalanithi writes: “…each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth… Human knowledge… grows from the relationships we create…”
We are each tasked with this challenge: to find the vocabulary not only to make sense of our dying, but also our living. We must do the work, the sacred work of finding our way through life, of making up the meaning as we go.
About the Writer
Janice Greenwood is a writer, surfer, and poet. She holds an M.F.A. in poetry and creative writing from Columbia University.