When Breath Becomes Air: A Conversation About Life, Death, and Humanity in Health Care
Illness and death are universal challenges, but not something we anticipate in our 30s. Kate Bowler and Lucy Kalanithi understand that any of us can confront these harsh realities at any time. Bowler was 35 when she was diagnosed with stage IV colon cancer. She tried to make sense of it in Everything Happens for a Reason: And Other Lies I’ve Loved. Kalanithi, an internal medicine doctor, completed her husband Paul’s manuscript, When Breath Becomes Air, after the neurosurgeon died of lung cancer at the age of 37. The two women discuss life, death, and the pursuit of humanity in American health care.
- 2018 Health
Kalanithi and Bowler begin by discussing the reasons behind their books. Kalanithi’s husband, Paul, was a voracious reader, and found some comfort in the final stages of his cancer by writing about it, naming it, trying to understand suffering through words. It was better than trying to seek comfort in statistics, Kalanithi noted. Bowler says she wrote her book to be honest about herself, not because she thought she was an important person with deep insight to share. But holding her “life up to the light” was intense and slightly uncomfortable, she admitted.
Bowler and Kalanithi discuss their reactions to the cancer diagnoses in their lives, and what it ultimately taught them. Bowler explains how her status in her family seemed to change when she became this “thing that happens to people,” and how it made her feel alienated. Kalanithi talks about her and Paul’s decision to have a child after he got sick, her worry for how the decision would increase his suffering, and how Paul reassured her.
Big IdeaThere’s so many things we do in our lives, that we don’t choose to do because they’re easy, but that we chose to do because they’re rich and meaningful and deep. And I’m not sure if there’s a point to suffering, except it connects you to all other human beings across time forever.Lucy Kalanithi
Bowler talks about how the language we use around someone who is sick or dying can make such a difference. She struggles with what she says is the American desire to always put things into perspective, to always have a lesson. But what she really needed from others during her intensive cancer treatments were the basics: help with errands, babysitting, food. “The best people realize there’s nothing special they’re going to bring,” says Bowler. “They just do a thing so that lifting this heavy weight doesn’t seem so heavy anymore.”
Bowler and Kalanathi discuss how they’re raising their children in the face of suffering and death.
Lucy Kalanithi: Can you tell us what it’s like to raise a child in the midst of this and what you’re teaching your son that maybe is different from what you would have? Or, just in general, what you feel like with your son, who’s four.
Kate Bowler: I thought my job before was to create the hamster bubble around him, and say we live in it here, and my job is to give you interesting hobbies and life enrichment and a vague but important sense of the problems of the world. But it’s my job to love you and let you grow in this perfectly insulated little ecosystem. Then I became aware that the worst thing in his life might be me, and that almost broke my heart.
Lucy Kalanithi: How old was Zach when you were diagnosed?
Kate Bowler: He was still one. And all my strongest memories of when I was the hospital, and I couldn’t pick him because of the surgical scars.
Lucy Kalanithi: And I’m sure you wondered whether he would remember you.
Kate Bowler: Oh my gosh, it was just the helplessness — exhausting. I think what I learned for myself and for Zach is that my job is not to pretend that I can use certainty or determination to solve every problem. But that if I can show him that the purpose of life is not to avoid pain but to find a way through, then I can raise the most compassionate softy in the world.
Lucy Kalanithi: I agree with that. I used to think, you try to raise a happy child. Now I’m like, no, you try to raise a resilient child.
Kate Bowler: Yeah. Brave in the face of reality.
Lucy Kalanithi: We talked earlier about the things that are important for your family to know about you and even your doctors to know about you. We talked about, what are the things you don’t ever want to give up? You only talked about Zach. You said, I would put up with a lot of suffering to be there for Zach, and you also talked about how you don’t want him to suffer. You yourself would make tradeoffs that would allow him to suffer less. I thought it was so lovely. I think it’s really important to know your own North Star.
Kate Bowler: Yeah, and that if fragility is a given, if we’re all paper sometimes, then the point is to choose between competing loves. I’m loving this life, but there are other things that I would trade a lot of things for. And thank god they happen to be the things that I chose in the first place.