Brow Beat

How a 16th-Century Poem Inspired the Clarity of the Prose in When Breath Becomes Air


Paul Kalanithi’s When Breath Becomes Air, a memoir by an unknown author, became a best-seller for an unusual—almost unheard-of— reason: the quality of its writing.

By “quality” I mean excellence but also a specific mode of narrative and meditation that Kalanathi achieves, a peculiar, calm intensity: a certain immediacy. No doubt that methodical intensity owes something to medical training. The book is, after all, a brilliant young neurosurgeon’s account of his own fatal illness. (His wife Lucy Kalanithi, also a physician, tells the end of the story in an epilogue.) A compelling subject, but the writing is crucial, in a way that derives from Kalanithi’s interest in poetry. Reviewers, including Anna Reisman in Slate, have justly praised the writing as “poetic,” but a poetry of understatement more than image, and precise abstractions—rather than heightened color—inform When Breath Becomes Air.

The title comes from a 16th-century poem by Fulke Greville that demonstrates that feeling of profound calm combined with immense urgency, concentrated into just six lines:

You that seek what life is in death,
Now find it air that once was breath.
New names unknown, old names gone:
Till time end bodies, but souls none.
    Reader! then make time, while you be,
    But steps to your eternity.

Finality, here, demands language this direct about its subject. The poem is also direct with the reader. Of the 41 words here, “You” is the first word and “your” modifies the last word. Greville’s poem gets right to its subject and speaks directly to its reader, with an exclamation mark, too. The second-person “you” also governs Kalanithi’s closing passage: a brief  farewell addressed to the couple’s infant daughter. “You filled a dying man’s days with a sated joy,” he tells her. That “sated joy”—“a joy that does not hunger for more and more”— is, Kalanithi’s writes, “an enormous thing.”

Greville’s brevity itself creates an extreme of understatement, so terse it is almost as if the poet allows himself to smile, sardonically, at the compression of life, death, and eternity into a few terse phrases. Extreme understatement, in a different way, characterizes passages like this, where the simplicity of Kalanithi’s prose summarizes realities of daily life and eternity, those extremes crammed together in urgent speech, almost to the point of laughter:

With the cancer having invaded multiple organ systems, the diagnosis was clear. The room was quiet. Lucy told me she loved me. “I don’t want to die,” I said. I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately.

In another, later passage, the understatement takes the form of intense abstraction:

If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: the days have shortened considerably.

The poem, Kalanathi’s epigraph, recalls another, longer 16th-century Greville poem, his elegy on the death of his friend Philip Sidney. This second poem begins with a line that consists, remarkably, of six abstract words:

     Silence augmenteth grief, writing increaseth rage—

The two verbs are almost synonyms, but “increase” appears hundreds of times in the King James Bible, meaning an increase in crops or procreation of descendants. “Augment” is a shade more abstract or more inward, and appears in the Bible just once, in the same sentence as “increase”:

And, behold, ye are risen up in your fathers’ stead, an increase of sinful men, to augment yet the fierce anger of the Lord toward Israel.
(Numbers, 32:14)

Caught between the blades of silence and writing, grief and rage, Greville suggests the need for a rhetoric beyond a hunger for “more and more.” Kalanithi’s prose, without striking images or drama, is in some way inspired to plainness by poetry—the closest possible thing to silence, defying silence.