When Breath Becomes Air(2)

But here’s the thing I must come back to: the prose was unforgettable. Out of his pen he was spinning gold.

I reread Paul's piece again and again, trying to understand what he had brought about. First, it was musical. It had echoes of Galway Kinnell, almost a prose poem. (“If one day it happens you find yourself with someone you love in a café at one end of the Pont Mirabeau, at the zinc bar where wine stands in upward opening glasses…” to quote a Kinnell line, from a poem I once heard him recite in a bookstore in Iowa City, never looking down at the paper.) But it also had a taste of something else, something from an antique land, from a time before zinc bars. It finally came to me a few days later when I picked up his essay yet again: Paul’s writing was reminiscent of Thomas Browne’s. Browne had written Religio Medici in the prose of 1642, with all its archaic spellings and speech. As a young physician, I was obsessed with that book, kept at it like a farmer trying to drain a bog that his father before him had failed to drain. It was a futile task, and yet I was desperate to learn its secrets, tossing it aside in frustration, then picking it up again, unsure that it had anything for me but, in sounding the words, sensing that it did. I felt that I lacked some critical receptor for the letters to sing, to impart their meaning. It remained opaque, no matter how hard I tried.



Why, you ask? Why did I persevere? Who cares about Religio Medici?

Well, my hero William Osler cared, that’s who. Osler was the father of modern medicine, a man who died in 1919. He had loved the book. He kept it on his nightstand. He’d asked to be buried with a copy of Religio Medici. For the life of me, I didn’t get what Osler saw in it. After many tries—and after some decades—the book finally revealed itself to me. (It helped that a newer edition had modern spellings.) The trick, I discovered, was to read it aloud, which made the cadence inescapable: “We carry with us the wonders, we seek without us: There is all Africa, and her prodigies in us; we are that bold and adventurous piece of nature, which he that studies, wisely learns in a compendium, what others labour at in a divided piece and endless volume.” When you come to the last paragraph of Paul’s book, read it aloud and you will hear that same long line, the cadence you think you can tap your feet to…but as with Browne, you will be just off. Paul, it occurred to me, was Browne redux. (Or given that forward time is our illusion, perhaps it’s that Browne was Kalanithi redux. Yes, it’s head-spinning stuff.)



And then Paul died. I attended his memorial in the Stanford church, a gorgeous space where I often go when it is empty to sit and admire the light, the silence, and where I always find renewal. It was packed for the service. I sat off to one side, listening to a series of moving and sometimes raucous stories from his closest friends, his pastor, and his brother. Yes, Paul was gone, but strangely, I felt I was coming to know him, beyond that visit in my office, beyond the few essays he’d written. He was taking form in those tales being told in the Stanford Memorial Church, its soaring cathedral dome a fitting space in which to remember this man whose body was now in the earth but who nevertheless was so palpably alive. He took form in the shape of his lovely wife and baby daughter, his grieving parents and siblings, in the faces of the legions of friends, colleagues, and former patients who filled that space; he was there at the reception later, outdoors in a setting where so many came together. I saw faces looking calm, smiling, as if they had witnessed something profoundly beautiful in the church. Perhaps my face was like that, too: we had found meaning in the ritual of a service, in the ritual of eulogizing, in the shared tears. There was further meaning residing in this reception where we slaked our thirst, fed our bodies, and talked with complete strangers to whom we were intimately connected through Paul.



But it was only when I received the pages that you now hold in your hands, two months after Paul died, that I felt I had finally come to know him, to know him better than if I had been blessed to call him a friend. After reading the book you are about to read, I confess I felt inadequate: there was an honesty, a truth in the writing that took my breath away.



Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words. In a world of asynchronous communication, where we are so often buried in our screens, our gaze rooted to the rectangular objects buzzing in our hands, our attention consumed by ephemera, stop and experience this dialogue with my young departed colleague, now ageless and extant in memory. Listen to Paul. In the silences between his words, listen to what you have to say back. Therein lies his message. I got it. I hope you experience it, too. It is a gift. Let me not stand between you and Paul.





PROLOGUE




Webster was much possessed by death



And saw the skull beneath the skin;



And breastless creatures under ground



Leaned backward with a lipless grin.



—T. S. Eliot, “Whispers of Immortality”



I FLIPPED THROUGH THE CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.