When Breath Becomes Air

Beautifully written and very insightful

Beautifully written and very insightful

I am supposed to be writing a short piece about skiing in the Japanese Alps east of Tokyo. A self-indulgent vehicle for some spectacular POV skiing videos and a smug record of my transition from social media workhorse in Singapore to international bon viveur and adventurer. Life just doesn’t work like that though. Months of planning my post-resignation ski odyssey, my “fourth ski season” with guided adventures, and endless powder didn’t add up to anything.

I was supposed to wave goodbye to Singapore on the morning of January 29th and fly to Tokyo sipping Champagne in SIA economy plus. Instead I was flying to Manchester in KLM economy with a bleeding 2.8 cm deep, 3 cm diameter, surgical wound in my upper thigh and a ringing (literally he called me just before I headed for the airport on the evening of January 28th) endorsement from a surgeon that the suspected post-op diagnosis was a disease called Melioidosis, and that I should seek immediate treatment.

So instead of a cosy Ryokan in a snowy wonderland, I’m in isolation room J14, infectious diseases ward J3 in North Manchester General Hospital, approximately 11 miles from where I grew up. It started as these things do with a minor irregularity, a cut that wouldn’t heal that I noticed over Christmas. Through January, my health spiralled downwards and gradually, disbelievingly, I realized that this was going to be no extended ski holiday and I was heading into a medical whirlygig.

Bearding up in ward J3

Bearding up in ward J3

Without going into extravagant detail, the treatment consists of regular intravenous antibiotics, combined with poking, prodding, scans and encouraging words. So I’m left with hours to fill and reading is my way of escape. Currently a bestseller in the US, “When Breath Becomes Air” is the memoir of a late, eminent neurologist & neuroscientist Paul Kalanithi who was diagnosed with lung cancer at 36 years old and died in March 2015, 8 months after birth of his first child at 37. “Couldn’t you read something more cheery?” queried my Mum who is worried about my mental state. Well actually when I’m plunged into a new situation (first general aneasthetic, first hospitalization, first time anyone’s said “this is treatable, the prognosis is good”) my first reaction is to read up. I have suddenly developed an interest in medicine, illness, and death that is completely at odds with my distaste for the subject as recently as the “Call the Midwife” Christmas special.

The first thing about this is it isn’t a conventional cancer memoir, detailing every stage of his illness, treatment and decline. It’s much more about the man’s life, his struggle to become a brain surgeon, and the experience of having his dream snatched away just as he stood atop his professional mountain. There are countless reviews of this book online, most much more insightful than this but I have a few observations. Firstly, it’s beautifully written. As much as anything this man was a writer and I recommend it just on the basis of that. Secondly it is very moving, but only in the sense of being a frank unsparing memoir, not in a schmaltzy, glib “Scrubs” kind of way.

My fascination is really with the chapters about how he decided to become a neurosurgeon and the struggle that ensued. I would find the responsibility of making decisions on a person’s immediate physical future virtually impossible I think, and it’s reassuring to know that, despite medicine being his “calling”, Dr Kalanithi took years to come to terms with it. Secondly, although it sounds macabre, the descriptions of operating, are fascinating, better than any diagram, you get a feel for what he actually did as a surgeon.

Lastly the theme of this book is death and it gives lie to the myth that Doctors are some kind of omnipotent force, with a black and white line between treatment and decline. He freely admits that physicians are necessarily working in a grey area where they make frequent but unavoidable mistakes. They simply cannot know the outcome of any particular course of action, and just rely on judgment and instinct based on an exhaustive education and experience. The religious dogma that life is sacred and that the physician is always working to extend it is completely undermined by the complexity of treating serious injuries and chronic disease. Even in his own final days this reality is clear with his and his doctors’ rejection of a ventilator to help him breathe in favor of morphine and a more peaceful and necessarily quicker death. If that isn’t a form of voluntary euthanasia I don’t know what is. It happens every day all over the world and I hope the dignity of this choice is extended beyond cancer to other conditions like MS or locked-in syndrome where people live in a kind of excruciating limbo for potentially years.

For my part, despite my current affliction I didn’t find it depressing at all. Kalanithi’s real insight is Hemingway-esque in that he decides it is the struggle that’s the stuff of life. Bad things will happen to you and, within reason, you just have to suffer through, just as you should enjoy the good times. Not much help? Well, that’s reality for you.

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