A Cancer Memoir of Literature and Science

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Living With Cancer

Since a cancer diagnosis in 2008, I have always taken reading material with me on all hospital trips. For one visit, which took nine hours, my reading material included a posthumously published memoir: Paul Kalanithi’s “When Breath Becomes Air.”

Reviewers have emphasized the pathos of Dr. Kalanithi’s fate. On the threshold of a promising medical career, the 36-year-old resident at Stanford University received a diagnosis of Stage 4 lung cancer. His book spoke to me not only about cancer but also about the imperative, yet imperiled, connection between the arts, the humanities and the medical sciences. Dr. Kalanithi believed that the arts and humanities provide crucial tools for comprehending the body under siege.

Like many cancer memoirs, “When Breath Becomes Air begins with diagnosis: Dr. Kalanithi flips through CT images of his lungs matted with tumors. Then a flashback traces his childhood and education. In college and graduate school, Paul Kalanithi majored in English, although he went on to study philosophy and then to train in neuroscience and neurosurgery, earning high honors along the way. His background, along with his descriptions of the challenging lessons he learned during his medical training, serves as a startling retort to the dictum of the so-called “two cultures”: C.P. Snow’s idea that the humanities and the sciences remain deeply divided in Western intellectual thought and never the twain shall meet.

As a student, Dr. Kalanithi understood that “literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Words function as “an almost supernatural force,” bringing human beings “into communion,” but that process exists “in brains and bodies, subject to their own physiological imperative, prone to breaking and failing.” What was the relationship between the discourse of emotions and that of neurons?

Operating on regions of the brain that control language and therefore on “the crucible of identity,” neurosurgeons must consider “what kind of life exists without language” and “what kind of life is worth living.” Because Dr. Kalanithi needed to address these profoundly philosophical questions, he knew that “when there’s no place for the scalpel, words are the surgeon’s only tool.”

According to Dr. Kalanithi, science organizes empirical and reproducible data; however, it cannot “grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” Physicians need resources other than medicine to frame nuanced conversations, for scientific knowledge remains “inapplicable to the existential, visceral nature of human life, which is unique and subjective and unpredictable.”

After the cancer diagnosis, Dr. Kalanithi’s oncologist insisted on words, but he wanted numbers: “If I had two years, I’d write. If I had ten, I’d get back to surgery and science.” Yet he came to realize that “getting too deeply into statistics is like trying to quench a thirst with salt water.” Instead, he found in literature a vocabulary to ease the anxiety attendant upon diagnosis. A “seemingly impassable sea of uncertainty parted” when he recalled Samuel Beckett’s famous words: “I can’t go on. I’ll go on.” They convinced him that “even if I’m dying, until I actually die, I am still living.”

It makes perfect sense to me that Dr. Kalanithi completed a master’s thesis on Walt Whitman’s conceptualization of “the Physiological-Spiritual Man.” He knew that literature provides “the richest material for moral reflection.” Unfortunately, it also makes sense that one of his thesis advisers told him that it would be difficult to find a community in the literary world “because most English Ph.D.s react to science, as he put it, ‘like apes to fire, with sheer terror.’”

Is this one of the reasons the humanities are currently endangered?

Dr. Kalanithi’s memoir asks humanists pointed questions about what must be done to make their disciples supple in an engagement with science. Considering issues at the intersection of literature, philosophy and medicine, Dr. Kalanithi also underscores the importance of the medical humanities: a multidisciplinary field that involves artists, humanists, social scientists and scientists in issues related to wellness and sickness.

In the epilogue of “When Breath Becomes Air,” supplied by Dr. Kalanithi’s widow, Lucy, we are informed that his oncologist wanted him videotaped daily, doing the same task, so his deficits could be tracked. He decided to recite from T.S. Eliot’s “Waste Land,” setting the book facedown. We also learn that when his fingertips developed fissures from chemotherapy, he wore seamless, silver-lined gloves that allowed him to use his trackpad and keyboard. Composing “When Breath Becomes Air became his palliative therapy as well as the consummation of his love of literature.

The example of Dr. Kalanithi proves that we need more physicians who assimilate the arts and the humanities as well as more artists and humanists who assimilate the science of medicine. By connecting the empirical, reproducible data of cancer science to visceral, unpredictable and subjective experiences of the disease, “When Breath Becomes Air” points toward an approach that can mitigate the mutual incomprehension that baffles too many doctors and patients.

Dr. Kalanithi illuminates how the arts and humanities can help us negotiate that moment we will all inevitably confront: when our breath becomes the air others breathe.