Budgeting Life


This weekend, I picked up Dr. Paul Kalanithi’s extraordinary memoir When Breath Becomes Air.  I had bought it on a fire sale as an e-book before Christmas (thanks to this Stirrup Queens post) and when my lunch break rolled around, I thought I’d start on it.

Reading it at two in the morning, just down the hall from the ORs, wearing periwinkle blue surgical scrubs, a vital sign monitor on my desk that I needed to put away after my break made the story more real, and I was pulled in almost immediately.  It was not at all hard to imagine Dr. Paul Kalanithi as a physician, as a neurosurgeon, walking in and issuing his postop orders, doing the usual things surgeons do.

But of course, that is not the whole of the story, nor its most brilliant, poignant part: Paul Kalanithi was an undeniable genius, yes, clearly a gifted physician, yes, but he was also a patient.  The two personas, brought together in one who could clearly articulate the connections, tensions, and even find humor between them are what make this one of the most exceptional books I’ve read in a long time.

Kalanithi’s book was published posthumously and while it is absolutely about dying, it’s about more than that.  It’s about living within limits – unusually cruel tight ones in Kalanithi’s case – but limits are a fairly universal human experience.  I think what I found particularly instructive and lovely about When Breath Becomes Air is its acceptance of human limitation.  Kalanithi accepts that his cancer is terminal and seeks to live within that diagnosis – there’s no talk of “fighting” or being the exception or beating cancer.  Instead, he thoughtfully decides to live fully whatever time he has left.

It’s rare in this day and age where a relentlessly ‘positive’ mindset is stressed and the acknowledgement of the chance that an outcome might be anything less than miraculous restoration of health or a return to previous life is often met with “oh, don’t say that!” to see a treatise like this one.  Even outside of life and death situations, there’s a cultural notion about being able to accomplish anything with enough effort/investment – one with which I know much of the infertility community is intimately familiar.  I think the way this book challenges that is a central part of the appeal, or at least, it certainly was for me.  Kalanithi’s resolution to move forward by grieving his losses, knowing his death will come untimely early, and doing his best to both find and continue in what he valued until that death reads as far more positive than an empty promise to seek a ‘cure’ at any cost.

Personally, when confronted with limitations that truly grieved me, I’ve tended towards anger.  Maybe it’s because sadness and grief seem passive and anger gives the illusion that there’s something I can do, something that with enough force might change the distressing situation (even when I know better).  Kalanithi suggests a very different path.  He interrogates himself to find the values he wishes to cling to within the whirlwind.  And then he does it.  It’s not a denial of emotions or grief or putting a good spin on a tough situation, it’s a measured choosing of response.  “It felt like someone had taken away my credit card and I was having to learn how to budget” he writes.

There’s so much more to consider in the book – and hopefully write about – but that felt particularly resonant.  The next time I must budget my life, I know I’ll return to Kalanithi’s thoughts on doing so.

This post is a part of Microblog Mondays.  If you want to read more, head over to Stirrup Queens.  Thanks to Mel for originating and hosting.


5 thoughts on “Budgeting Life

  1. I read somewhere once that physicians look at life-altering diagnoses differently than most patients. Instead of taking the”we’re going to beat this!” approach, when the diagnosis is terminal their focus tends to be more on palatable care. Having floated through the cancer world, seen how taxing chemo and radiation are, I can appreciate this approach.

    Watching the decline of older members in my family, I’m reminded that living mindfully isn’t something most people prioritize. I think we’ve been trained not to do so from a young age, assuming that we can push off aspects of our lives (the good and the bad) till later. I think this is a major factor surrounding fear of death (or other major life transitions).

    Hence I really appreciate Dr. Kalanithi’s memoir. Thanks for the review

  2. I enjoyed this book, too, for similar reasons. I didn’t have a connection to the medical world piece, but I did love how he approached his cancer, the terminal diagnosis, and his plans to live out his unfairly shortened life. It’s not the same, but it made me wonder about doctors who become patients, and wonder about infertility nurses or doctors who find themselves in need of the services they offer. How weird it is to straddle both worlds, and to know what the words really mean that the doctors say.

    I read this two summers ago, and it was one of two memoirs about dying that had heartbreaking afterwords. The other was The Bright Hour by Nina Riggs, and that one read like poetry. It wasn’t a “positive thinking, fight fight fight” anthem either, and there was a lot of anger that came through, and brutal honesty, and it stuck with me. Both books were very sad, but also beautiful. Thanks for the review! (More proof that we are reading buddies!)

    1. After finishing “When Breath Becomes Air” I was poking around on the internet and discovered that Lucy Kalanithi (Paul Kalanithi’s widow) and John Duberstein (Nina Riggs’ widower) announced they were dating about a year ago. I’m putting The Bright Hour on my list.

      Definitely proof that we are reading buddies 😉 !

  3. I also think it feels good. It’s been on my To-Read list for a while, so thanks for giving me the kick along! This bit especially encouraged me to read it –
    “He interrogates himself to find the values he wishes to cling to within the whirlwind. And then he does it. It’s not a denial of emotions or grief or putting a good spin on a tough situation, it’s a measured choosing of response.”

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