Mortality, Courage, and Meaning

Note: I started writing this post on November 10th, a week after I read When Breath Becomes Air. I had some trouble finishing the post and abandoned it. Recently I have been thinking that I ought to write about the CAA, NRC and the Modi government’s appalling crackdown on student protesters, especially in Jamia Millia Islamia and Aligarh Muslim University. However, my understanding of politics is rudimentary and others have said it far, far better than I ever could (but I am trying and maybe someday). Suffice it to say, it is horrific, and whether you are Indian or not, you should educate yourself on what is going on. Eventually, perhaps, I will do a round-up of resources on what is happening. In the meanwhile, here are my reflections on mortality, inspired by Kalanithi’s moving and ruminative book. 

Our connection with life is tenuous at best. We don’t know when our time will come; we don’t know when our loved ones will be taken from us. Despite our incredible advancements in medicine and infrastructure, in spite of all our ingenuity, we can still never really predict when and how we’ll go. And yet we live as if we are totally ignorant of our mortality, as if our bodies are not fallible, as if our pretended oblivion might temper our fates. This unconcern is built-in, really; apart from a primordial survival instinct, we don’t tend to spare much thought for the larger existential question of our mortality. This too, is a matter of survival, I think; were we to become overly obsessed with the fragility of our lives, going on with our affairs on a day-to-day basis might become rather difficult, might, indeed, even seem entirely pointless.

I can attest to that. My quiet struggles with futility, meaning, and the purpose of suffering set me apart very early on. And I noticed quite quickly that most people seemed not to be crippled by these existential questions, that in fact there seemed to exist some shield that allowed them go about their lives with tolerable contentment, and that the few of us not blessed with this protective mechanism were raw, exposed, searching, not able to make do.

So mortality is a subject that holds great interest for me (Atul Gawande’s Being Mortal is a huge favourite. If you haven’t read it already, I highly recommend it).

When suddenly faced with the prospect of a too early death, how do you react?

Paul Kalanithi, a promising young neurosurgeon with an illustrious career ahead of him (and an already impressive list of accomplishments behind him), wrote When Breath Becomes Air after he was diagnosed with terminal lung cancer. Paul is about to graduate residency with plans to start a family and job offers from reputed universities; the diagnosis comes as a cruel blow at what should have been a high point in his life, the beginning of what surely would have been an incredible journey.

The book opens with Paul struggling with excruciating back pain and tiredness. On top of this, his backbreaking schedule and preoccupation with work have put a strain on his marriage with Lucy, also a doctor (she’s an internist – a specialist in internal medicine). His suspicions are proved correct when the lab tests come back positive.

Paul knows that he will die – much sooner than he could have anticipated – but for the most part, it is still uncertain exactly how much time he has left. The uncertainty is heart-wrenching. For someone as ambitious as Paul, it means that he is forced to choose between his dreams – to pick what he can achieve in the time he has left. He chooses to graduate (he is so close when he receives the diagnosis!) and to write the book (if not the subject matter) he always wanted to write.

I read ‘When Breath Becomes Air’ practically in one sitting last weekend.

I’ve been wanting to read it ever since it came out, but held off because I was afraid it would be rather heavy. It was, and it did make me sad; but it was also poignant, thoughtful, and philosophical, an aching reflection on how limited our time is and how best to give that transience meaning, and endurance.

Kalanithi never got to finish his manuscript. To some extent, ‘When Breath Becomes Air’ is the result of a loving, painstaking sewing together by Lucy Kalanithi (Paul’s wife) and his editors. There are brilliant stretches and portions that don’t seem quite finished. And yet, it is an engrossing and affecting read.

Kalanithi is an adventurer and a philosopher. He has great dreams and chases meaning and understanding with tenacity, intelligence, and a flexibility that I find astounding. When one path proves not to be the answer, or the complete answer, he is ever ready to to upend everything and head in another direction; something that requires not only tremendous courage but tremendous humility and true intellectual curiosity. He is honest and brave and unflinching in the eye of the storm. And a doctor-writer-philosopher who combines knowledge and passion for medicine with a deep humanity and an appreciation for the Arts and Literature – my favourite kind (of the same ilk as Atul Gawande and Oliver Sacks – what a breed)! A unique vantage point from which to attempt to uncover the mysteries of life, the mind and the universe.

What a loss for humanity.

A tough, but worthwhile read.