I read “When breath becomes air” because I had heard so much about it, and because I am studying the art of writing memoir. I’ve published a memoir which I think should be rewritten from scratch. I finished a second one, but I am rewriting it from scratch.

So I turned to Dr. Paul Kalanithi for wisdom and inspiration. Boy, did he deliver.

"When Breath Becomes Air" is a memoir we can learn from. It is the story of a life of hope, joy and expectation abruptly cut short by Cancer. This review analyses the "writerly" aspects of the book. In the process it reveals much of the story, so if you intend to read the book you may want to stop here.

The biggest challenge in such a book is that the reader knows the end. It’s on the blurb, and in every single book review. With that critical piece gone, how do you still engage the reader? Paul does so by taking us along on his difficult journey. We live his life, share his love, joy & pain. We experience utter despair in his book – I wept more than once. His skill as a storyteller makes us his fellow traveler.

Chronology is the first thing one notices. The book is mostly linear - it starts with Paul's diagnosis and ends with his death. He goes back into his youth where he describes his love for literature and medicine. He talks about human experiences as a medical student and a doctor. He makes you appreciate the sensitive nature of the work of a neurosurgeon - you understand the huge burden it carries. He touches upon his relationship with Lucy, his wife. He then brings the story back to the present. He moves across different times in his life and is able to tie all the pieces together into a single coherent narrative.

The story covers two aspects of his life: professional and personal. Paul shares his angst over his career - and how his goalpost shifts with his life expectancy. His work defines his identity, but what work he chooses depends upon how long he has to live. If he has 10 years, he would continue as a neurosurgeon. If only two, a writer. His decision to finish his residency is an act of hope - that he may continue as a neurosurgeon. But despite completing it, he is unable to attend his own graduation because of a relapse. That is cruel, but he is matter-of-fact about it. Rarely does any self-pity come through.

The story effortlessly entwines his personal and professional life. He talks about his love for Lucy. He shares the trouble in their marriage before his diagnosis, and how the cancer makes their relationship stronger. The decision to have a baby is particularly touching. He mentions his conversation with his wife where she says

"Dont you think saying goodbye to your child will make your death more painful?"

And he replies "Wouldn’t it be great if it did?"

The reader forms a mental picture of him without having the traditional “Character description”. His whole persona is built up one spare detail at a time. His smooth skin turns up only when the blood thinning drugs cause acne and bleeding. He is obviously fit because he hikes and runs and cycles.

A similar picture of Lucy would help. She is obviously a beautiful human that the reader learns to love, respect and empathise with. But a physical description would help a lot. A reader wants to see the characters. But we cannot not see Lucy because she has no physical being. The reader doesn’t know if she is Caucasian or black. Blond or Brunette. We can guess she is tall because “they fit so well” but that’s pretty much all you get to work with. She remains a concept in the story – lacking any physical form. Another small peeve was the use of the word "attending" as a noun. At first glance it comes across as a typo. After coming across it again and again, the reader realizes that it is a short form for "Attending Neurosurgeon". Medical jargon never explained. 

But this is nitpicking,

The story deals with much bigger questions - our mortality and the meaning of life. Paul believes god is important. That god matters. He accepts the fallibility of science. There is one scene towards the end when he is with his Oncologist Emma, and she tell him "You have a good five years left". And he says "She pronounced it, but without the authoritative tone of a true oracle, without the confidence of a true believer. She said it, instead, like a plea...like she was not so much speaking to me as pleading, a mere human, with whatever forces and fates truly control these things".

Paul is a writer with great dexterity. One cannot help but marvel at his determination to not do an average job. He wrote late into his disease, but the book isn't just text piled on more text. He has worked hard to edit the story down to the bone to make it flow with clarity and grace.

There is a certain humility with which Paul writes. Even when he talks about his successes - which are many - it comes across as humble, not boastful. As you read through the book, you get to like and respect Dr Paul Kalanithi. That is because he always comes through as human. I could relate to him. I empathize with him. And that is the sign of a great Memoir.

Note : In March 2020, the Himalayan Memoir Writers Retreat will be hosted by Alex Lemon & Chetan Mahajan.. The retreat will be hosted at the Himalayan Writing Retreat in Satkhol Village, Uttarakhand, India, For more details, and to apply, please visit https://www.himalayanwritingretreat.com/memoir-writers-retreat-spring-2020/ .  

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