When Breath Becomes Air – A Reading Reflection
A couple of weeks ago, Pastor Ed preached a message on spiritual hunger (which he titled ‘The Tale of Two Rich Guys’), referencing two biblical figures — Zacchaeus and the Rich Young Ruler — who have different responses to the stirrings of their hearts. Both sense that there’s something more to life, but while Zacchaeus invites the truth, the Rich Young Ruler defers it. Near the end of his sermon, Pastor Ed recommended a book that addresses this very theme: When Breath Becomes Air.
When Breath Becomes Air is a stunning book about life and death, written by the late Paul Kalanithi, who, having grappled with death from multiple perspectives throughout his life, has much insight to share on the issue. Nearing the end of his rigorous training to become a neurosurgeon, Kalanithi gets diagnosed with lung cancer at the tender age of thirty-six. His memoir details his journey of setting out to answer perhaps the most important question anyone can ask: what is the meaning of life?
Before I dive deeper into the meat of my thoughts, I want to take a moment to applaud Kalanithi’s writing. It’s emotional, thoughtful, and witty — he writes with a confidence that is raw and honest, and really allows us to get into his head as he recalls various important experiences in his life. In preparing this piece, I realized that there are a billion things I’d love to touch on, but for the sake of time and brainpower, I’ll keep it to only the thoughts I found desperately important to share.
Life is a mist
The memoir begins with a short prologue that walks readers through several of Kalanithi’s memories (his back pains and anxieties) leading up to the diagnosis of his lung cancer. The section ends on a thought that seems to capture one of the biggest themes of the book.
“And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.”
Upon receiving his diagnosis, Kalanithi came to the startling realization that perhaps none of us have as much control over life’s circumstances as we often think we do. The future seemed to look bright for Kalanithi — he was almost done with his residency in neurosurgery at Stanford, having graduated medical school at Yale cum laude several years prior. In fact, things always looked optimistic for Kalanithi: he double-majored in English and Biology at Stanford in his undergrad years, earned an MA in English at Stanford following that, and even went on to get an MPhil in history and philosophy from Cambridge before going to medical school.
But then cancer happened. And it wasn’t because of anything he did (or did not do); in a swift moment, he seemed to have been unexpectedly robbed of his life. He explains it in this way: “My life up until my illness could be understood as the linear sum of my choices ... But now I lived in a different world ... where human action paled against superhuman forces.”
Isn’t it so common for us to live life with the illusion that we have control? I could resonate with this feeling deeply. Having been a student for most of my life, I hadn’t thought to consider much else besides school. Success as a student is simple to define: get good grades. When life feels confined to a series of hoops to jump through, controlling your fate feels simpler.
“And with that, the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.”
But the reality is that life is so much bigger than our grades and achievements. There’s love, purpose, and fulfillment to consider, and there’s the unexpected that will get thrown at every one of us at some point in our lives. It is upon the realization that we are fragile that we are often prompted to answer the deeper questions of life.
The certainty of death
In confronting death, Kalanithi not only had to think hard about what his life was going to be all about, but had to make concrete decisions to put his life on that trajectory. He makes a really interesting observation upon reflecting on his career as a neurosurgeon: “The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”
This is the reality of death: death is certain. Kalanithi realized that there’s more to life than simply staying alive; life must have meaning, and it is important for us to discover it. The sad truth is that many of us keep the thought of death at a distance, resulting in many lives being led without being grounded in purpose. The sadder truth is that we are often okay with it.
We tell ourselves that we’ll wait until we’re older to figure it all out, when death feels nearer and the urgency is greater. We don’t want to deal with what’s messy, so we’ll proceed with what feels more straightforward: getting good grades, climbing the ladder in our careers, enjoying cheap thrills of life.
The irony of it all is that being older or weaker doesn’t make death any more true than it once was, it simply makes it feel more real. Death is certain regardless of how close we are to it, which means that the question of purpose is a pressing one no matter where we are in life. It still needs to be answered.
And this struggle isn’t unique to young and healthy people either. Even Kalanithi, who at the time of saying this had already been battling cancer for quite some time, plunged into denial: “Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.” Thankfully he didn’t remain in denial for too long, but it is a tempting option. Instead, he confronted death for the beast that it is.
“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.”
The irony of it all is that being older or weaker doesn’t make death any more true than it once was, it simply makes it feel more real. Death is certain regardless of how close we are to it, which means that the question of purpose is a pressing one no matter where we are in life. It still needs to be answered.
Who is the captain of your ship?
Near the end of the memoir, Kalanithi has a strikingly memorable conversation with his doctor, Emma.
“You know how you offered to just be the doctor and I could just be the patient?” I asked. “I think that’s maybe a good idea. I’ve been reading science and literature trying to find the right perspective, but I haven’t found it.”
“I’m not sure that’s something you can find by reading about it,” she replied.
Emma was now the captain of the ship, lending a sense of calm to the chaos of this hospitalization. T.S. Eliot sprang to mind:
Damyata: The boat responded.
Gaily, to the hand expert with sail and oar
The sea was calm, your heart would have
responded
Gaily, when invited, beating obedient
To controlling hands
I leaned back in my hospital bed and closed my eyes. As the darkness of delirium descended again, I finally relaxed.
When it came to his health, Kalanithi found himself trusting his doctor — a leading expert in the cancer he was facing. Being a knowledgeable doctor himself, it wasn’t easy for Kalanithi to allow someone else to take the wheel. But when he did, knowing that Emma was the best of the best, he experienced great relief.
When it comes to our lives — when we are confronted with things unexpected, with what we cannot control — it seems clear to me where to place our hope. Who better to trust than the giver of life, the God of the universe, who orchestrates every detail of Nature and every ounce of creation?
And just as Kalanithi could “lean back in his hospital bed and close [his] eyes” upon trusting Emma, to trust God with your life is to receive restful peace. My favorite psalm speaks to this very matter.
Psalm 23:1-3
The Lord is my shepherd; I shall not want.
He makes me lie down in green pastures.
He leads me beside still waters.
He restores my soul.
He leads me in paths of righteousness
for his name's sake.
Hope
How do we decide what to place our hope in? In his reflections on hope, Kalanithi writes, “The word hope first appeared in English about a thousand years ago, denoting some combination of confidence and desire. But what I desired—life—was not what I was confident about—death.”
Hope is placed in what we both desire and are confident in. Kalanithi realized that he could not simply hope in this life alone, for although he strongly desired the fullness of it, he could not be confident in it prevailing against death. And this seems universally true; when we view life for what it is — a mist that vanishes upon the certainty of death — we simply cannot place lasting hope in the fleeting things of the world.
Christians find their hope in the promise that God makes. The promise that Jesus, by dying on the cross, has conquered death and given those who believe in him eternal life. That there exists a heaven; a home that we were made for.
1 Corinthians 15:54-57
When the perishable puts on the imperishable, and the mortal puts on immortality, then shall come to pass the saying that is written:
“Death is swallowed up in victory.”
“O death, where is your victory?
O death, where is your sting?”
The sting of death is sin, and the power of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ.
In the very same message that Pastor Ed delivered on the “Tale of the Two Rich Guys,” he referenced a verse that stuck with me. Proverbs 13:12 says: “Hope deferred makes the heart sick, but a desire fulfilled is a tree of life.”
Within every human heart is a desire for more than what this life has to offer — we know this from introspection and experience. It would be foolish to live life ignorant of this truth, or in other words, to defer hope. So contemplate your existence. For it is only when we live life with the purpose we were made for that we truly become alive.
Ethan is a junior studying Computer Science and Cognitive Science. He enjoys reading and making music, and is overly competitive when it comes to sports and board games.