Richard, a friend of mine, gifted me Paul Kalanithi’s posthumously published memoir, When Breath Becomes Air, for secret santa. As a young neurosurgeon faced with his own mortality in the form of lung cancer, Paul reflects on his life, his experience as a doctor, and confronting mortality. When I was reading his account, I found myself thinking most about Paul’s musings about the relationship between language and humanity.
This subject surfaces time and time again. At one point, he raises the question,
What kind of life exists without language?
Paul briefly mentions one patient that he had—someone whose words had turned into code.
He recited another series of numbers, this time with urgency. There was something he wanted to tell us, but the digits could communicate nothing other than his fear and fury.
I am deeply saddened by such an existence—the thought of being unable to express myself to others scares and frightens me. For some inexplicable reason, I am and have been inclined towards language as my medium of experiencing the world and expressing my own experiences. Paul seemed to suggest that his interest in literature and language propelled him to study neuroscience and become a doctor. As he writes, when he was younger, he thought that
Literature provided a rich account of human meaning: the brain, then, was the machinery that somehow enabled it.
But for him, reading about death was not good enough to understand them—despite the richness that language affords.
Moral speculation was puny compared to moral action. Descriptions like Nuland’s convinced me that such things [like death] could be known only face-to-face.
It strikes me now that Paul does not expect that his own account of his own confrontation with cancer to lead people to understand, let alone prepare for, cancer. Indeed, his personal account is not at all like Atul Gawande’s Being Mortal or Checklist Manifesto, in which Gawande makes recommendations, at least implicitly.
In high school, I participated in debate. One of the things I remember from that experience was that words don’t mean the same things to everyone. In debate, this was for good reason. If you concede an opponent’s definition of a key term or phrase, then your own arguments no longer resonate with the judge. I recognize that language is not a perfect medium of human expression. It is subject to interpretation, at whims to the context it’s placed in, relevant only to those who can parse it. But personally, language is the cheapest method of powerful expression. Words can build worlds and change how people see themselves and others. Paul certainly recognized this quality.
[One of my patients] would likely refuse surgery if I launched into a detailed spiel detailing all the risks and possible complications. I could do so, document her refusal in the chart, consider my duty discharged, and move on to the next task. Instead, with her permission, I gathered her family with her, and together we calmly talked through the options. As we talked, I could see the enormousness of the choice she faced swindle into a difficult but understandable decision. I had met her in a space where she was person, instead of a problem to be solved.
Certainly, the exact words that we choose may not be as important as the way we say them. But on a page, be it in RAM or made of trees, words may still stand on their own, carrying with them the humanity that went into their arrangement, even when the breath that might have uttered them as since ceased.
Paul, despite coming to a full understanding of death, turned again to literature for a different reason.
I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again. The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language. Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward.
Understanding alone did not give Paul the ability to write about it. Perhaps this disconnect is the biggest sign that language and humanity are not deeply intertwined. Perhaps it doesn’t matter. Perhaps having spent so long with literature—thinking about it, talking about it, practicing it—language has come to offer Paul a way to touch others. Instead of helping others understand mortality, perhaps Paul has helped others understand his humanity.
Words have a longevity I do not. I had thought I could leave [my daughter] a series of letters—but what would they say? I don’t know what this girl will be like when she is fifteen; I don’t even know if she’ll take to the nickname we’ve given her.
Paul, perhaps your words will help her meet you in a space where she is a person and you are a person. Perhaps that is the ultimate test of language’s relationship to humanity.
I cannot make promises that I can compel myself to make changes to my life or my values after reading When Breath becomes Air. But at the very least, I will try to make it a goal that my writing find its way to accomplish something.