by Chandra Ganguly

“We cannot change the cards we are dealt, just how we play the hand.”

— Randy Pausch

In Paul Kalanithi’s memoir When Breath Becomes Air, we are faced immediately with the bane and challenge of any memoirist – how much do you give away of what you know and how soon? The question gathers a new grave importance when the outcome is a certain death, which in Paul’s story comes about with his diagnosis of terminal lung cancer early in the narrative. Paul, a neurosurgeon, is faced with the question of what he wants to do with his remaining days and he decides to write, to have a baby. He tries to practice medicine too for a while and must accede defeat to his fading body. What does a dying memoirist write about? About death, surely but more importantly what emerges is how a book about dying becomes a book about life and living and meaning. And isn’t that what we are all looking for? Isn’t that the purpose of our every day? Isn’t that our raison d’etre? A search for meaning?

Paul grappled early with meaning in his adolescence. He sought it out in literature and then channeled that search in medicine. Paul quotes Graham Greene, “Graham Greene once said that life was lived in the first twenty years and the remainder was just reflection.” (p.197) Paul spends his remaining time through the pain and treatments of his disease reflecting, trying to reflect even when his body and mind slowly gave way. These reflections at the center of his work is what makes this memoir so valuable to the readers he has left behind. Other than the insight he provides into the life of medical students and residents, which is engaging, what we as the reader are left with is a heightened awareness of our mortality and also an urgent sense of our need to give it meaning. “You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” (p. 155) What does Paul find at the end of his search? These are his final words in the book, addressed to his daughter, to a future he does not have, “When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years…”(p.200)