Ste­fanie Marsh

The Weekend Australian - Review - - Books -

You can imag­ine the young Paul Kalanithi. An am­bi­tious achiever at an elite univer­sity, a vig­or­ous allrounder with a plan. His love of English lit­er­a­ture points to a writ­ing ca­reer, un­til he dis­cov­ers his call­ing: neu­rol­ogy. To be one of the world’s great neu­rol­o­gists be­comes his life’s goal. By his mid-30s, Kalanithi is within grasp­ing dis­tance of ev­ery­thing he has worked for. Then he gets can­cer and ev­ery­thing changes. If you were told to­mor­row you had 18 months or so to live and they would be a time of rapid, painful and ir­re­versible phys­i­cal de­cline, what would you do? From his wheel­chair, Kalanithi de­cides to write his mem­oir.

He died last March and 10 months later When Breath Be­comes Air was pub­lished in the US, where it has been No 1 on The New York Times’ best­seller list since.

“A dy­ing doc­tor writes” is al­ways likely to cap­ture the read­ing pub­lic’s imag­i­na­tion, es­pe­cially when the doc­tor in ques­tion is al­ready a ris­ing star in neu­ro­surgery, prob­a­bly the world’s most com­pet­i­tive field. Kalanithi, one de­tects, knew this more than any­body; there’s still in his writ­ing some­thing of the clever boy at school des­per­ate to prove him­self.

So how is a highly com­pet­i­tive, goal-ori­en­tated man whose iden­tity is wrapped up in his ca­reer ac­com­plish­ments go­ing to cope with be­ing told by his doc­tors that he is too sick to work? By work­ing, of course. Mem­oir writ­ing is a side­line. Kalanithi — his body a wreck — re­sumes his ca­reer at full speed.

The first symp­toms come in the form of back spasms. That was in 2013. Ig­nor­ing them, and also his wife Lucy’s re­peated re­quests for greater in­ti­macy in their mar­riage, he trav­els alone to see friends in New York state. Half­way through the jour­ney, he col­lapses on a bench with pain — and is mis­taken for a va­grant by a po­lice­man.

“I knew about back pain but I didn’t know what it felt like,” he writes. It won’t be the last time that the Yale and Stan­ford-ed­u­cated neu­rol­o­gist finds him­self in a hor­ri­fy­ingly ed­u­ca­tional role re­ver­sal; learn­ing about medicine as a pa­tient. He spends the rest of his hol­i­day bedrid­den. Back home in Cal­i­for­nia in May 2013, a chest X-ray re­veals that “my lungs, in­stead of be­ing clear, looked blurry, as if the cam­era aper­ture had been left open too long. The doc­tor said she wasn’t sure what that meant. She likely knew what it meant. I knew.” Stage IV metastatic lung can­cer.

“My life had been build­ing po­ten­tial, po­ten­tial that would now go un­re­alised. I had planned to do so much, and I had come so close. I was phys­i­cally de­bil­i­tated, my imag­ined fu­ture and my per­sonal iden­tity col­lapsed, and I faced the same ex­is­ten­tial ques­tions my pa­tients faced.” Al­most ev­ery­thing — his health, his mar­riage, his ca­reer path — changes. With the ex­cep­tion of that burn­ing, des­per­ate am­bi­tion of his. His am­bi­tion is what this mem­oir is re­ally about.

Kalanithi’s can­cer is a stealthy and ag­gres­sive crea­ture. It will soon re­duce him to a sap­less, bone-thin, bald­ing shadow, too weak to lift a When Breath Be­comes Air By Paul Kalanithi Bod­ley Head, 228pp, $32.99

Paul Kalanithi de­cided to write his mem­oir af­ter a ter­mi­nal can­cer di­ag­no­sis

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