71 pages • 2 hours read
Paul KalanithiWhen Breath Becomes Air
Nonfiction | Autobiography / Memoir | Adult | Published in 2016A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more. For select classroom titles, we also provide Teaching Guides with discussion and quiz questions to prompt student engagement.
Symbols & Motifs
The Wasteland by T.S. Eliot
Paul reads this book-length poem during his undergraduate program, as he studies English literature and biology. He says it “resonated profoundly, relating meaninglessness and isolation, the desperate quest for human connection” (31). It is an important poem because it holds so much potential for Paul.
Eliot began writing The Wasteland in 1919, in the wake of WWI. As one of the most famous examples of modernist literature, the poem has destabilized meter and structure, is thick with references (both accessible and not), and often ambiguously shifts perspective or voice. Eliot’s poem portrays a world in disarray, a world somehow elusive and incomprehensible to him.
That this poem resonates with Paul comes as no surprise, especially later in the book, when it crops up numerous times, both directly and indirectly. He recites the poem before the clinical trial and thinks of it before giving over control of his medical plan to Emma. Paul is also “lost in a featureless wasteland of his own mortality” (148). Eventually, however, “I saw not an empty wasteland but something simpler: a blank page on which I would go on” (196). This passage marks the birth of Cady. The poem becomes part of Paul’s DNA. Eliot’s language seeps into his own, and the images Eliot presents become engrained in the way Paul sees the world.
The Physiological-Spiritual Man
Paul writes his graduate thesis on Walt Whitman, who coined the term “Physiological-Spiritual Man.” Although the experience of the program discourages him from continuing the academic study of literature, it is this idea that pushes Paul into the practice of medicine.
The essence of the book is Paul’s attempt to reconcile literature and medicine, and the “Physiological-Spiritual Man” is explored more specifically when Paul recognizes that although science produces “organizable, useful data,” it cannot account for “the most central aspects of human life” (170). He seems to discover that the two disparate elements of Whitman’s phrase inevitably coexist in the reality of human experience.
Kaplan-Meier Survival Curves
Early on in his diagnosis, Paul becomes impatient with Emma’s unwillingness to share the Kaplan-Meier Curves. He seeks solace in statistics, a way of receiving organized, digestible information. Throughout the latter half of the book, this Curves become less and less relevant as Paul. He realizes that he cannot make his death date the focus of the rest of his life. Ironically, when Emma finally releases the information to Paul, it is no longer comforting. It does not offer a framework for Paul. She says it is “like a plea. Like that patient who could speak only in numbers” (193). When the time of certainty came for Emma, the statistic no longer held emotional relevance, which is perhaps what she had hoped for from the start.
Although the curve is a representation of controlled chaos, of trying to make sense of the unknown, it is also a very real answer to the very elusive problem of cancer.
The Language of Medicine
It comes as no surprise that a book about a neurosurgeon is laced with medical references and terms. But Kalanithi does not simply invoke the terms to describe surgeries and other procedures. Understanding the Wernicke’s part of the cortex or being presented with the image of a skull flap creates an empathetic bond between reader and writer.
Upon returning to the OR after his first treatment, Paul must “remove a generated disc from a patient’s spine” (155). After a shaky start, attempting the operation with various tools and racking his brain for his old skills, he quickly gets back into his old rhythm. His “hands relearn how to manipulate submillimeter blood vessels without injury” and his “fingers conjure up the old tricks they’d once known” (155). This language serves to show how surgery is not simply a step-by-step operation. The way an individual navigates the body is unique, and it is the highest of art forms.
Kalanithi understands, of course, what it means to be a confused patient. Thus, the language invites one into the OR; it makes scenes that only a surgeon can experience visceral to those with only the most basic understanding of medicine. As Kalanithi does not “avert his eyes from death,” he certainly does not think any reader too sensitive to become acquainted with the reality of what happens when we are ill (215).
