when breath becomes air

from my IB English A: Language and Literature, HL essay

by Asta

TO WHAT EXTENT DOES PAUL KALANITHI ESTABLISH THE LIMITATIONS CREATED BY ACCEPTING ONE’S MORTALITY IN HIS MEMOIR WHEN BREATH BECOMES AIR?

Paul Kalanithi’s memoir, When Breath Becomes Air (2016), is about his life and path towards death after being diagnosed with stage IV metastatic lung cancer. His book delves deep into his journey with literature and biology, a road that finally led him to the constant search for ‘what makes a meaningful life’. Thus, becoming a renowned neurosurgery resident at Stanford brought Kalanithi nearer to answering this question, as experiencing life and loss up close revealed the ultimate powerlessness one has over death. Kalanithi actively engages with the reader, asking questions he does not yet have the complete answers to and forcing the readers to ask the same and hopefully, someday, find the answers themselves. Therefore, this essay aims to explore how far Paul Kalanithi communicates the burden of facing mortality when life and its prospects are stripped away.

In Part I of the memoir, the readers are introduced to Jeff, Paul Kalanithi’s friend and former colleague, who he’s always shared a wonderful and enjoyable friendship with (Kalanithi 82). Unfortunately, to much surprise, Jeff commits suicide after “a difficult complication and his patient died”, so the intense sense of remorse and self-condemnation arising from the failure to preserve life was a limitation for this character (Kalanithi 114). The acknowledgement that, as Kalanithi remarks, “death comes for all of us” is what made “the overwhelming guilt, like a tidal wave” fester within Jeff (Kalanithi 114). The proximity to death did not eradicate Jeff’s fear of it, nor did the acceptance of a patients’ imminent death, as understood by most successful surgeons, hold Jeff back from taking his life - in fact, it is that acceptance of the inability to save a person every time that awakened an irreversible and all-consuming shame that ultimately led to the death of Kalanithi’s friend. Therefore, Kalanithi establishes the danger of spiraling into despair, a limitation resulting from accepting one’s mortality.

Furthermore, this limitation is best expressed when Kalanithi, soon after hearing of Jeff’s death, writes - “We had assumed an onerous yoke, that of mortal responsibility” (Kalanithi 114). In this sentence, Kalanithi purposefully uses a first person voice by saying “we”. The inclusive language immediately makes a greater connection between the persona and reader to the imagery present later in the sentence, while building a strong pathos derived from the consequences of such a pressurizing vocation.

The reader is further pulled into the harrowing experiences of neurosurgeons when Kalanithi chooses to use the word “assumed”. Instead of such intense responsibility being enforced or demanded, Kalanithi clarifies that it was “assumed”, which connotes to taking up this mantle willingly and as a decision unregretted. It also makes the reader think of Kalanithi, Jeff, neurosurgeons in general, being molded into whatever shape required for them to do their job - they become what is necessary to become to save lives, assuming a role of sheer power grasped voluntarily regardless of the cost.

Then, we see that the shape they take is that of an “onerous yoke”. Alone, the word “onerous” compels no mental picture in the reader's mind, only alluding to an unexplainable oppressive force of some sort. However, when coupled with “yoke” it is clear that Kalanithi aims to communicate the exhaustion of an overwhelming weight endured by neurosurgeons, as he creates a vivid picture of a tough wooden beam and comparison between the hardship faced by animals and workers in his profession. Such abstract diction and visual imagery combined help create the phrase “onerous yoke” even more metaphorical to “mortal responsibility”.

The phrase “mortal responsibility”, written in italics, clarifies and encapsulates Kalanithi’s overall message about the drive and purpose of a neurosurgeon, finally giving a name to the “yoke” that has the power to drag down people like him when they fail and can’t stay afloat. The limitation of fitting perfectly into a given role and maintaining the balance between life and death at all costs is thereby presented by this sentence Kalanithi wrote after Jeff’s suicide.

According to an article presented in the fifth UAD TEFL International Conference, death constructs peoples “worldly perception and identity” and there are both negative and positive attitudes towards death (Triyoga and Putri 182). The recognition of death can lead to certain negative attitudes defined by the fear of things like the “impact on survivors, fear of punishment, fear of not being, and fear of the death of others”, all of which can take form after accepting one’s mortality as well (Triyoga and Putri 183). This is applicable to the example of Jeff’s suicide and proves that such acceptance may be an unexpected limitation.

However, positive attitudes towards death are prevalent too. The article highlights that people can take a hopeful, progressive and meaningful stance towards death, resulting from “a willingness to feel the comfort or submission to mortality” (Triyoga and Putri 183). In his memoir, Kalanithi himself approaches death through multiple perspectives, one of which is the limitations of accepting death as investigated above, another is the freedom and power emerging from surrendering to mortality. While the writer expresses the agony of anticipating death, he also goes to great lengths to show the reader the rewards of coming face to face with mortality. Kalanithi explains how, as a neurosurgeon, “you’re always thinking about what you’ll be doing five years down the line” instead of being in the present (Kalanithi 197). To him, cancer was a way to finally understand that “it’s not all that useful to spend time thinking about the future” and placing excessive value on “money, status, all the vanities” that distracts oneself from their ultimate objective (Kalanithi 198).

Kalanithi establishes the stability and clarity brought about by acknowledging approaching death when he plainly states - and without passing judgement - that “the future, instead of a ladder toward the goals of life, flattens out into a perpetual present” (Kalanithi 198). This sentence placed near the end of the memoir captures how the author led the rest of his life, prompted by the fact that he could die within a span of a few weeks or months or years. Such unexpectedness contrasts with his view of the future, which is represented by “a ladder”. This acts as a metaphor for an imagined future, one that extends upwards, straight and sturdy, having rungs to support the climber along the way. The end of the ladder symbolizes “the goals of life”, which Kalanithi was steadily moving towards considering his many years of education, studying English literature and human biology across Stanford University, University of Cambridge and Yale School of Medicine… all leading up to his residency training (Yale School of Medicine).

Moreover, the visual imagery of “flattens out” makes the reader envision the action of collapsing, signifying Kalanithi's future reaching a plateau. This seems like quite a pessimistic prospect especially when coupled with the phrase “perpetual present”, a plosive that emphasizes on a sense of repetitive tedium and looped time. Nonetheless, his tone in this sentence is that of acceptance and this lack of denial results in future desires being washed away, with any residue becoming a part of the present. Therefore, such an epiphany is not a limitation of accepting mortality.

Similarly, by portraying how a terminal illness like cancer can make a person detached from the future, Kalanithi also communicates the ‘seize the day’ attitude arising from a dynamic view on death. This takes the form of Cady, Kalanithi’s infant daughter born eight months before his death, who not only took away the “empty wasteland” of Kalanithi’s future, but offered “a blank page on which I [Kalanithi] would go on” (Kalanithi 196).

Proof that accepting mortality is not a limitation is depicted by how Kalanithi’s proximity to death made him treasure his time with his daughter, as Cady gave him “... a joy that does not hunger for more and more but rests, satisfied” (Kalanithi 199). Here, emotive diction of “joy”, “rests” and “satisfied” show in the simplest terms how “the possibilities of life emanated before” a father, who though dying, still received precious moments of bliss that can be experienced only by a parent (Kalanithi 195). This contrasts with “hunger”, and not having so highlights Kalanithi’s gratitude for having such joy in the first place, the scale of which was amplified and only realized because he had accepted that his time was short and shouldn’t be squandered. The absence of greed, and not wanting “more and more” of that satisfaction meant that accepting mortality was not a limitation at all, but quite the opposite - for it made a man confront that which meant the most to him.

To conclude, Kalanithi certainly establishes different outlooks of death, especially by revealing the dire consequences of the onus placed on neurosurgeons. Although, Kalanithi communicates this to a lesser extent since the advantages of acknowledging mortality and focusing on his daughter were bigger features of his story. Kalanithi thus conveys the limitations and benefits of accepting one’s mortality primarily by the use of visual imagery, abstract and emotive diction, supported by metaphors, tone and inclusive language.

Works Cited

Kalanithi, Paul. When Breath Becomes Air. The Bodley Head, 2016.

Triyoga, Arilia, and Apriyana Putri. “The manifestation of death as seen in Paul Kalanithi’s When Breath Becomes Air: A psychological approach.” UAD TEFL International Conference, vol. 2, 2021, p. 182.

Yale School of Medicine. “Dr. Paul Kalanithi Award for Professional Excellence in Neurosurgery.” Yale School of Medicine, 28 May 2020, https://medicine.yale.edu/neurosurgery/education/residencyprogram/awards/kalanithi/. Accessed 03 Oct 2021.

[subject to plagiarism]