Living life in the ‘perpetual present’

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Living life in the ‘perpetual present’

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Imagine getting the degree you want. You have made it past the stages of preparation, of fine-tuning your skills so that you can contribute to the world, and when you finally get there, you are diagnosed with terminal cancer. It’s an unpleasant thought, but that’s exactly what happened to Paul Kalanithi, a sixth-year neurosurgery resident at Stanford University. In his final year of life, Dr. Kalanithi learned to live in a “perpetual present,” and he shared his experiences through rich prose in his first and only book, “When Breath Becomes Air.”

The dying man’s memoir is no novelty. Randy Pausch’s “The Last Lecture” in 2008 also captivated readers, as the dying often have more to teach than the living. Whereas Pausch was middle-aged and had already achieved his dreams, Kalanithi was just about to begin a promising career in medicine: “…[T]he future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.”

“When Breath Becomes Air” is divided into two parts: before and after diagnosis. In the first half, Kalanithi writes about his childhood, hobbies, interests, family and education. Fearing that he would fall behind in the less than stellar Arizona public school system, his mother introduced him to literature at a young age, which would become a lifelong passion. He read “1984” when he was ten years old. He went on to study biology and English at Stanford and receive a master’s in English literature. After receiving another master’s at Cambridge, he decided to follow in his father’s footsteps as a physician.

What’s remarkable about Kalanithi is his intense desire to find meaning. He studied subjects not with the intent of making a prosperous career, but to learn more about both the world around him and the purpose of human life. His search is what eventually lead him to medicine, as he sought to unify the lessons found in literature with the laws of the physical world. “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.”

After his diagnosis, Kalanithi found himself as the patient with all of the doctor’s knowledge. He fought for control of his treatment and learned that patients are sometimes treated as “just another case” instead of as people. The statistics used to measure a cancer patient’s lifespan became a constant source of worry, and he struggled with the thought that he could have anywhere from ten months to ten years left. Should he pick up the surgical tools once again, or should he write as he told himself he would do when he was sixty and retired? These thoughts are repeated throughout the book, and he begins to live with the thought that “even if I’m dying, until I actually die, I am still living.”

Quotes from the literature that Kalanithi praised are scattered throughout the book. The years of studying great writers must have seeped into his head and given him their skill. He handles the medical terminology in a way that is easily accessible, and his prose contains the same energy of the authors that he admires.

The book concludes with an epilogue from Kalanithi’s wife, which is equally as elegant as his own. “[The book] is, in a sense, unfinished, derailed by Paul’s rapid decline, but that is an essential component of its truth, of the reality Paul faced.” She addresses the future and the challenges of raising her child without Paul.

Some books change the way you live. This is one of those books.