'When breath becomes air' by Paul Kalinthi
Paul Kalinthi’s ‘When breath becomes air’ is one of few books I read twice – it came highly recommended as utterly wonderful, as an insightful book about a doctor facing his own demise from cancer.
It’s a book that delights repeatedly with beautiful language, the clarity of thought, the insight. Yet, it also made me angry, oh so angry. This bright young man decided early in life he did not want to be a doctor as he saw its toll; his doctor father was barely available for his family. Paul studied English Literature and completed his Master’s thesis on Whalt Whitman.
To get closer to that junction between life and death he studies medicine, and neuro surgery, after all. The book opens when Paul is in the last year of training as neurosurgeon. He works insane hours. He gets sick. He stops working. He gets better. He returns to work, only for a little bit. Yet, to finish his qualification, he has to go back to full schedule, to punish his body, to work those ridiculous hours; without completing a full schedule he cannot graduate. He works, he dies.
The book shows the struggle for identity. Who are you if you’re close to the goal you’ve been striving to achieve, now the final stretch. That question is not only asked by the patient / author, but also by the people closest to him – his wife, his colleagues, his doctor.
The title could have been ‘killed by medical training.’ You’re either fully in, or you’re out. Paul Kalinthi was killed by cancer, yet the cancer could thrive in a body that was weakened by lack of care, lack of sleep, of food, of insane work hours. One of Paul’s close friends and colleagues killed himself as he could not deal with the relentless demands and the absence of support in the life of a young doctor.
Kalinthi is a scientist and a writer. In some scenes he seems to hide behind those identities: when he ends up in hospital rather than at a wedding he wanted to attend he discusses the treatment plan with the emergency doctor – a way of not dealing with disappointment, fear, loss. It fills that prejudice that, in science, emotions are useless, not to be discussed, best not to notice as they are too painful.
This is a fabulous book for numerous reasons. It contains food for thought, its various layers to be discovered in more than one reading. Yet, I don’t love it as it’s a reminder of how unhealthy the life of a doctor is, how modern medicine, with its demanding work schedules that leave no room for sleep, food or relaxation for young doctors, kills its best; the people that trained and battled so hard against their personal needs and in the end fall victim to suicide, depression, cancer, caused by exhaustion and the desire to help others.