Life and Death, Time and Meaning


Book Review

When Breath Becomes Air

By Felice Katrina C. Trio-Ranche, MD, DPBO (ΜΣΦ 2004)

This year, I celebrate my 15th year as a physician. A decade and a half have flown by, hardly noticed because new chapters in life just replaced the ones before them without pause. In the mad rush of everyday things, I always look forward to pockets of silence, and often my moments of introspection are spent thinking about time – how much I’ve lost, and how little I have left.

Inevitably those thoughts return to time spent in the hospital as a medical student, in a veritable warp/war zone, where hours bled into days into weeks into something vaguely countable as five years. Against that frantic white noise of tasks and decked duties, urgent questions for my patients came first: which fluids to give, what medicine to push, how to explain what’s happening.

Meanwhile, questions for myself simmered silently: why am I alive, am I doing enough, and always the most difficult, how will I die. Will I negotiate a peaceful surrender, or will I refuse to go gentle into that good night.

Paul Kalanithi chose the latter. When Breath Becomes Air, a memoir posthumously published in 2016, chronicles his valiant struggle against cancer, all the while knowing that cancer would ultimately win. “When there’s no place for the scalpel, words are the surgeon’s only tool.”

Dr. Kalanithi was a neurosurgeon who stood on the cusp of a promising career at the time he was diagnosed. The first part of the book explores his life before medical school, his search for life’s rhyme and reason, and his love for the written word. He narrates arriving at the difficult decision to sacrifice immersing himself in the humanities, in order to train meticulously and relentlessly in pursuit of surgical excellence — only to realize along the way that the tender vines of literature, all these words and meanings and thoughts, were so subtly yet so firmly entwined among his interactions with patients and colleagues.

His internal conflicts about work and wants are familiar; surely every physician has grappled with the same questions. It is in contemplating them that he reveals his depth. Plunging into the pages was a poetic, transcendent experience for me, and I found myself enthralled by the earnest examination of life’s and death’s mysteries, resolved in the lyrical mingling of science and art.

“The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients.”

The entrance to the UP College of Medicine is graced by a replica of The Triumph of Science over Death, a sculpture by our national exemplar of the sciences and the humanities, Dr. Jose Rizal. In hopeful symbolism, a skull is on the ground, staring blankly with its cavities exposed to the elements, while a woman plants both feet on the calvaria and raises a torch, calling all physicians to battle against mortality.

Death is the inescapable end. But we must fight nonetheless. The struggles of our patients must also be our own; there is no his nor hers nor mine.

It was comforting to find a kindred soul in Mr. Kalanithi’s book. The second part describes his painful, but unwavering, journey to the end, with the mess of complicated turns punctuated once in a while by small mercies that lead to more questions. What is the point of fighting, I found myself asking again and again; knowing full well the malicious little tricks of death, why not choose a more comfortable end? What does it mean, to die with dignity?

My 23-year-old self, fresh from the grueling unrest of medical school, would have answered readily – it means dying quietly, with enough time to rest from my profession, and enough space to enjoy my own peace. Although this peace has remained the goal through the years, the path towards it is different now.

Serving here in the Philippines, apart from being its own sweet reward, has been the inexplicable antidote against my formerly complacent self. Every consultation and every surgery brought the expected fatigue, but also carried along with it the unexpected motivation to keep working, to aspire towards an ideal, and to spur others on as well. Every day, another step forward, another expansion of thought and spirit.

But what happens, what is the point of all this effort if we too shall pass? The epilogue of the book is perhaps the most inspiring part. After his death, his wife Judy closes the memoir with her own reflections. And this is the source of reassurance for me – after us, there will be others. Someone else will take up the fight, pick up where we left off, and continue the quest for healing, just as we have done for those who came before us.

I invite our readers to read this book, or rediscover it. It is a humble, honest homage to the practice of medicine, and what compels us to strive.

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