Written by Dalia Ismail

What’s a breath when you’re no longer breathing…? (Photo by Richard Legner/Getty Images)

All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances,

Shakespeare – As You Like It (Act II, Scene VII)

We, mortals, ache at the thought of “the” ending scene, the closing curtain, and the empty stage. This is what Paul Kalinthini does in ‘When Breath Becomes Air.’

Paul was already living his life’s legacy: he had already taken great strides towards graduating from residency and earning a respectable annual salary at the age of 36.

However, like leukemic Amina in the 2017 TV series Halawet El Donia , Paul, a mid-thirties fellow mortal, accepts the bold fact that his growing lung cancer, has all but dramatically decreased his life expectancy. At a Stanford neurosurgery graduates’ meeting, he thought: “I was surrounded by success and possibility and ambition, by peers and seniors whose lives were running along a trajectory that was no longer mine, whose bodies could still tolerate standing for a gruelling eight-hour surgery.”

His illustrious career no longer stretching many years ahead, Paul started asking what makes life worth living.

On the Title:

When read aloud the title is a fluid and elegant arrangement of words that, for lack of a better word, sounds airy. Grammatically, the title is a dependent clause awaiting a meaningful complement. If you, like me, try wrapping your head around it, you’re tempted to ask, well, what happens when breath becomes air? The answer’s logic is simple: Breath is breath because it’s air vented out of a living being’s nasal or oral passage.

By the same token, breath ceases to be dubbed ‘breath’ when its subject stops showing vital signs of living, such as inhaling and exhaling: breathing. When breath becomes air, it is a confirmed state of infirmary.

Role Exit

In general, the hardest struggle the terminally-ill undergoes is what sociologists would term their forced ‘role exit’. These patients usually feel as if they ‘lost their identities’ because an integral part of their character gets stripped away. At one point, they are at the steering wheel, driving their own car to wherever their heart desires; the next they are strapped to the passenger’s seat, being driven to a one-way destination. It’s especially hard for young patients whose natural expectation to live beyond a certain age violently crashes when their once-healthy-bodies start wilting.

Involuntarily, Paul exited his role as a renowned neurosurgeon ready to earn his residency and build an ebullient future. When he could no longer stand for long hours to perform his life’s calling – brain surgeries -, he realized that becoming a cancer patient automatically added to his “role set” the unexpected and undesired role of a dependent, needy patient.  A sociologist would say Paul exited the defining feature of his character, lost forever to cancer, in exchange for other roles he didn’t expect. It seemed as if the playwright decided to re-cast the hero on stage, mid-play.

Stage Time

Among the inevitable changes an altered role brings, is a new sense of time. Paul openly shared that his sense of time had gone haywire; soon after his diagnosis, his psychological experience of time gets directly affected by how he abruptly transitioned from a hectic pace of life interspersed with several surgeries and cases to a relaxed, uneventful one, apparently void of action.

This crucial insight implies that, alongside their painful role exits, patients struggle to adjust their experience of time – that fragile path between life and death that shrinks and stretches with every treatment and setback. I find it impossibly complex to think outside time and self. Yet, the terminally-ill have no choice but to accept that they can neither give up their new role with its strange time inaccuracies and fluctuations; nor retain their old role with its defined time measurements.

Kalanithi with his daughter in 2015 (Photo by Gregg Segal)

The Play’s Hero

It is extremely unlikely that readers would find Paul anything short of charmingly ambitious, sharp yet amiable, and inquisitive. Being the polymath that he was, Paul wasn’t only a skilled neurosurgeon, but one with a sensual flare for literature and philosophy. He is the guy you would see climb up the career ladder in a couple of jumps. He’s also the guy you would want to sit next to on the bus, because he would be an interesting one to talk to and chat with about life, death, and what lies in between and afterwards.

I believe Paul inadvertently advertised for the kind of hero/ine we too would wish to be like when our final chapter comes along. Alive in his readers’ minds and in his family’s memories, Paul could live beyond his feeble mortality. He may not have been able to rewrite the final scene, but at least he made sure it would earn a standing ovation.

Taking Control of the Script

While reading, I was haunted by feelings of compassion for a friend who battled cancer but lost in the end. In the 8th grade, one of my classmates was diagnosed with cancer. She was only 14-years-old, with a beautiful soul, active, sharp, and very amiable. Within months of her treatment, I was always perplexed and amazed by how she sent us messages that were pain-free and so normally sounding. At the time, I didn’t realize that the terminally-ill becomes emotionally healthy and aware, overnight.

When her mother and grandmother paid a visit to our school some months after she passed away, they said her maturity and resilience inspired them: they remarked that she led a playful, joyful life despite the cruelty of chemotherapy. Their words were a proof that although cancer irrevocably changes its host’s life, its host can nonetheless control at least how those changes are registered.

 “Each day, we wake slightly altered, and the person we were yesterday is dead, so why… be afraid of death, when death comes all the time?”

Paul, the neurosurgeon, recognized that his old self was quickly demolished by cancer. It struck me that I had traversed the five stages of grief (Denial  →  Anger  → Bargaining  → Depression →  Acceptance), but in reverse!

You can read Oliver Sacks’ article here and Paul’s here in the NYTimes.

Your Thoughts?

What do you think of Paul’s book? If you were him, would you pay tribute to your loved ones by sharing your last chapter?