My sister requested this review, and I might as well share.
The structure of As Breath Becomes Air reminds me of the theory of the split brain giving rise to the bicameral mind, although a neurosurgeon would probably not hold this theory in high esteem. The basic idea is the balance between the small and large perspectives, which are colloquially delegated to the left and right hemispheres. The small picture handles detailed technical judgments, whereas the large picture handles value judgments. Kalanithi notes these perspectives are decoupled and delegated to the doctor and patient, to the point that doctors often lack empathy for the patient’s role in their own recovery.
He gives some pathological examples of this, then uses his experience to showcase the beauty of medical practice when both parties in the exchange apply both perspectives. For example, he describes entering a flow state while performing neurosurgery at a level of mastery, and later his own doctor encourages him to focus on his values rather than the technical details of his disease. Having earned his trust this way, he’s able to trust her to “be the doctor” when his mind becomes muddled by the cancer. But as the title suggests, the book is actually a meditation on mortality and what it means to be alive, which uses the dual experience of doctor and patient as metaphor for his own attempts to answer these existential questions within both perspectives.
I think that, by the end, he concludes that it’s an impossible dream to defeat death this way, and takes this existential angst and physical suffering as fuel for empathy with his fellow man. After all, mankind has a common understanding in the fear of death. So he concludes, I believe, by exhorting his daughter to understand his death as an imperative to act in love toward others. The common human experience is perhaps nothing more than to live, and then to die, leaving nothing behind except the date markings on a tombstone (and even these erode to nothing eventually). So it stands to reason that a person ought to live as best they can in the meantime, having literally nothing better to do. And I would add to this that we ought to be assured of our inevitable failures to live well, and struggle anyway, because the wages of sin are the inevitable destruction of the mind and body and the redemption of this sin is the Lord’s business, not ours. I think Kalanithi would have agreed with me on this point.
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