Home > When Breath Becomes Air(7)

When Breath Becomes Air(7)
Paul Kalanithi

This was summer at Sierra Camp, perhaps no different from any other camp, but every day felt full of life, and of the relationships that give life meaning. Other nights found a group of us on the dining room deck, sipping whiskey with the assistant director of the camp, Mo, a Stanford alum taking a break from his English PhD, and discussing literature and the weighty matters of postadolescent life. The next year he returned to his PhD, and later he sent me his first published short story, summing up our time together:

Suddenly, now, I know what I want. I want the counselors to build a pyre…and let my ashes drop and mingle with the sand. Lose my bones amongst the driftwood, my teeth amongst the sand….I don’t believe in the wisdom of children, nor in the wisdom of the old. There is a moment, a cusp, when the sum of gathered experience is worn down by the details of living. We are never so wise as when we live in this moment.

Back on campus, I didn’t miss the monkeys. Life felt rich and full, and over the next two years I kept at it, seeking a deeper understanding of a life of the mind. I studied literature and philosophy to understand what makes life meaningful, studied neuroscience and worked in an fMRI lab to understand how the brain could give rise to an organism capable of finding meaning in the world, and enriched my relationships with a circle of dear friends through various escapades. We raided the school cafeteria dressed as Mongols; created a full fake fraternity, complete with fake rush-week events, in our co-op house; posed in front of the gates at Buckingham Palace in a gorilla suit; broke into Memorial Church at midnight to lie on our backs and listen to our voices echo in the apse; and so on. (Then I learned that Virginia Woolf once boarded a battleship dressed as Abyssinian royalty, and, duly chastened, stopped boasting about our trivial pranks.)

Senior year, in one of my last neuroscience classes, on neuroscience and ethics, we visited a home for people who had suffered severe brain injuries. We walked into the main reception area and were greeted by a disconsolate wailing. Our guide, a friendly thirty-something woman, introduced herself to the group, but my eyes hunted for the source of the noise. Behind the reception counter was a large-screen television showing a soap opera, on mute. A blue-eyed brunette with well-coiffed hair, her head shaking slightly with emotion, filled the screen as she pleaded with someone off camera; zoom out, and there was her strong-jawed, undoubtedly gravel-voiced lover; they embraced passionately. The wailing rose in pitch. I stepped closer to peer over the counter, and there, on a blue mat in front of the television, in a plain flower-print dress, was a young woman, maybe twenty, her hands balled into fists pressed into her eyes, violently rocking back and forth, wailing and wailing. As she rocked, I caught glimpses of the back of her head, where her hair had worn away, leaving a large, pale patch of skin.

I stepped back to join the group, which was leaving to tour the facility. Talking with the guide, I learned that many of the residents had nearly drowned as young children. Looking around, I noticed there were no other visitors besides us. Was that common? I asked.

At first, the guide explained, a family will visit constantly, daily or even twice a day. Then maybe every other day. Then just weekends. After months or years, the visits taper off, until it’s just, say, birthdays and Christmas. Eventually, most families move away, as far as they can get.

“I don’t blame them,” she said. “It’s hard caring for these kids.”

A fury churned in me. Hard? Of course it was hard, but how could parents abandon these kids? In one room, the patients lay on cots, mostly still, arranged in neat rows like soldiers in a barracks. I walked down a row until I made eye contact with one of them. She was in her late teens, with dark, tangled hair. I paused and tried smiling at her, showing her I cared. I picked up one of her hands; it was limp. But she gurgled and, looking right at me, smiled.

“I think she’s smiling,” I said to the attendant.

“Could be,” she said. “It can be hard to tell sometimes.”

But I was sure of it. She was smiling.

When we got back to campus, I was the last one left in the room with the professor. “So, what’d you think?” he asked.

I vented openly about how I couldn’t believe that parents had abandoned these poor kids, and how one of them had even smiled at me.

The professor was a mentor, someone who thought deeply about how science and morality intersected. I expected him to agree with me.

“Yeah,” he said. “Good. Good for you. But sometimes, you know, I think it’s better if they die.”

I grabbed my bag and left.

She had been smiling, hadn’t she?

Only later would I realize that our trip had added a new dimension to my understanding of the fact that brains give rise to our ability to form relationships and make life meaningful. Sometimes, they break.

As graduation loomed, I had a nagging sense that there was still far too much unresolved for me, that I wasn’t done studying. I applied for a master’s in English literature at Stanford and was accepted into the program. I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion. A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form. It was the relational aspect of humans—i.e., “human relationality”—that undergirded meaning. Yet somehow, this process existed in brains and bodies, subject to their own physiologic imperatives, prone to breaking and failing. There must be a way, I thought, that the language of life as experienced—of passion, of hunger, of love—bore some relationship, however convoluted, to the language of neurons, digestive tracts, and heartbeats.

At Stanford, I had the good fortune to study with Richard Rorty, perhaps the greatest living philosopher of his day, and under his tutelage I began to see all disciplines as creating a vocabulary, a set of tools for understanding human life in a particular way. Great literary works provided their own sets of tools, compelling the reader to use that vocabulary. For my thesis, I studied the work of Walt Whitman, a poet who, a century before, was possessed by the same questions that haunted me, who wanted to find a way to understand and describe what he termed “the Physiological-Spiritual Man.”

As I finished my thesis, I could only conclude that Whitman had had no better luck than the rest of us at building a coherent “physiological-spiritual” vocabulary, but at least the ways in which he’d failed were illuminating. I was also increasingly certain that I had little desire to continue in literary studies, whose main preoccupations had begun to strike me as overly political and averse to science. One of my thesis advisers remarked that finding a community for myself in the literary world would be difficult, because most English PhDs reacted to science, as he put it, “like apes to fire, with sheer terror.” I wasn’t sure where my life was headed. My thesis—“Whitman and the Medicalization of Personality”—was well-received, but it was unorthodox, including as much history of psychiatry and neuroscience as literary criticism. It didn’t quite fit in an English department. I didn’t quite fit in an English department.

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