Famous Last Words

Three memoirs of mortality suggest that even for the terminally ill, universal truths are elusive.

Natalie Matthews-Ramo

Natalie Matthews-Ramo

“When a man knows he is to be hanged in a fortnight,” Samuel Johnson remarked, “it concentrates his mind wonderfully.” The same can be said of the terminally ill. Johnson’s word, concentrate, suggests why the rest of us often seek wisdom from people facing this terrible sentence. Nothing feels more fleeting than concentration in this buzzing, scattered information age, when you can conclude a day of nonstop media consumption still worried that you haven’t thought or done anything that really matters. And while no one envies late-stage cancer patients their fate, surely they, among all of us, must be experts at winnowing the essential from the ephemeral?

Books like Randy Pausch’s The Last Lecture and Paul Kalanithi’s When Breath Becomes Air spend weeks on the New York Times best-seller list (115 for the former, and for the later, 60 and counting), in part for their promise to share some of the clarity their authors earned in the hardest possible way. Writers have always contemplated their own deaths, of course, most famously Michel de Montaigne, the first modern essayist, whom Kalanithi quotes: “To study philosophy is to learn to die.” But most authors, like the rest of us, don’t get around to thinking about it until late in their lives. Neither Pausch nor Kalanithi were known as writers before they set out to chronicle the approach of their own deaths (from pancreatic and lung cancer, respectively), although Kalanithi, a neurosurgeon, had literary aspirations. Both men were young (46 and 36) when they received their terminal prognoses, as was the late Nina Riggs, author of the lovely new memoir The Bright Hour. Riggs, a poet, wrote a blog about living with stage 4 breast cancer, as well as personal essays on the subject, before her death just as The Bright Hour was going to press earlier this year. Taken together, these three books suggest that universal truths, even in extremis, are elusive. Perhaps they don’t exist at all. We die the way we live, idiosyncratically.

The Last Lecture is organized around a speech Pausch, a computer science professor, delivered as part of an ongoing series at Carnegie Mellon University in which noted scholars are asked to offer a talk presenting the pith of everything they have learned. Pausch called his lecture “Really Achieving Your Childhood Dreams,” and it is as much pep talk as pedagogy. (He also explains at the end that he intended the speech as much for his own children as its original audience.) Pausch describes growing up loving Captain Kirk, Disneyland, and winning stuffed animals in amusement parks, passions seamlessly transmitted to his adult life. To call Pausch a big kid would be no exaggeration, and in his eyes, no insult. He longed to experience zero gravity and become an Imagineer. (Few have ever adored the Disney-industrial complex more wholeheartedly.) He got both. The book’s insistent “follow your dream” refrain is in perfect concert with the upbeat self-actualization mantras of American popular culture, as is the promise that not only do you never have to grow up—that is, gracefully accept your own limitations—but you shouldn’t even want to.

At times, Pausch comes across as an optimism machine. “I don’t know how not to have fun,” he writes. “I’m dying and I’m having fun.” The Last Lecture is a scrubbed-up, apple-pie version of the showdown with mortality, a promise that it can be done without fear or despair, with a song in your heart even—probably “When You Wish Upon a Star.” Without a doubt, Pausch’s native buoyancy and determination carried him far in life, but they are also a pair of blinkers, a willful refusal to acknowledge some of the world’s less chipper realities. Pausch was disappointed that more of his students didn’t recognized the photo of Jackie Robinson he hung in his office. One of the things he admires most about the first black player in Major League Baseball, he writes, is the athlete’s motto: “Don’t complain, just work harder.” In fact, Robinson’s contract prohibited him from complaining, even if teammates or fans spit in his face, but the possibility that this was a strategic decision in response to virulent racism rather than a rule to live by doesn’t seem to occur to Pausch.

Inspirational writing is, even at its best, like Robinson’s silence: a tactical lie. It’s made of the stuff we tell ourselves to help us keep going; whether it represents the whole truth matters less than how useful we find it. The Last Lecture, for all its likability, for all the comfort it has brought to many people, falls within this category. When Breath Becomes Air, on the other hand, is a testimonial. Like all real literature, it aims above all to tell a truth, however roughly it goes down. Kalanithi often struggles with this task, particularly when it comes to writing about his most intimate relationships, or what he calls “human relationality.” Those parts of his memoir can feel remote and stilted. He has a tendency, when faced with some imponderable question, to light out for his bookshelf and come back with a quotation from Beckett or T.S. Eliot. What makes this moving is less the content of those passages than the force of the longing behind them. A great reader from childhood, Kalanithi had mapped out a life for himself that would begin with a brilliant surgical and academic career, then finish with a second, equally impressive literary act. In When Breath Becomes Air, he is trying as hard as he can, using the tools he has cherished for decades, to tell us what it is like to have your life knocked savagely off course.

Part of the allure of When Breath Becomes Air is that it is written by a doctor, and not only a doctor, but a surgeon, a godlike (or at least magelike) figure in the eyes of many—including surgeons themselves. The best writing in the book is Kalanithi’s account of his work, his meticulous descriptions of the tissues where selfhood in all its mysteries resides and what it feels like to manipulate them, to be millimeters away from obliterating a patient’s identity in the act of saving his life. Kalanithi makes no effort to hide the formidable self-confidence required to do such a thing. Anyone who has ever huddled in a waiting area, waiting for a verdict from someone like him, can’t help but be fascinated by how such a powerful figure copes with the same vulnerability and confusion that ordinary mortals bring to his doorstep.

For a while after his diagnosis, Kalanithi went back to work, but eventually his strength failed him, and at some delicate intersection, never quite pinpointed in When Breath Becomes Air, his need to prove that he was still a brain surgeon came into conflict with his patients’ well-being. Like Pausch, he held a sense of himself defined by his ability to do almost anything he set his mind to. He was, however, far more willing to look the destruction of that self in the eyes. Kalanithi never completed When Breath Becomes Air, but the book we have still ends authentically, with the once-driven doctor, now almost stilled, holding his infant daughter in his arms. He is resigned to the fact that they will never really know each other, hoping only that some day she’ll understand that she was the greatest joy of his last hours, “a joy that does not hunger for more and more, but rests, satisfied.”

When Breath Becomes Air and The Last Lecture assure their readers that remarkable men have the same hopes and troubles as the rest of us, that death is both a great leveler and chance for them to prove their mettle. Nina Riggs, who died at age 39, was a published poet, but not especially celebrated or influential in the world beyond her family and friends before she got sick. She was already much like the rest of us, with the exception of being Ralph Waldo Emerson’s great-great-great-granddaughter. Hers is one of those haute-WASP families whose fortunes have petered out over the generations, the grandparents’ estate sold piecemeal and the grandchildren applying for disability. One thing she does appear to have inherited is cancer, which has ridden roughshod over both branches of her ancestry; even her paternal grandfather had breast cancer. Riggs’ distress over her own illness was cruelly compounded by the fact that her mother died of the disease during Riggs’ treatment.

Yet The Bright Hour is not a gloomy or brooding book. Perhaps Riggs’ life as a poet taught her to reconcile herself to transience, frustration, and the unlikelihood of achieving renown. She quotes Montaigne even more than Kalanithi does, but to her, he is not a marmoreal Great Writer, but a companion, the chatty, brilliant, worldly friend at her elbow. The havoc chemo wreaks on her appetite makes her sympathize with his kidney stones and his doctor’s prohibition on eating oysters, a treatment Montaigne considered almost as bad as the illness. Pausch and Kalanithi inform us that impending death whets their appreciation of everyday life, but Riggs shows us what that life is, bathed in the incandescence of anticipated loss. Her husband, John, and her sons, Freddy (10) and Benny (7), emerge as distinct, eccentric individuals in The Bright Hour. Early on, Riggs has a fight with John when he tells her, “I just can’t wait for things to get back to normal.” This, to Riggs, is a betrayal of the biggest challenge she has ever faced. “I have to love these days the same way I love any other,” she tells him. “There might not be a ‘normal’ from here on out.”

The Bright Hour hits many of the established beats of the cancer memoir: mourning for lost hair and eventually a lost breast. What it’s like “when your new hair emerges sleek and orderly from a shoebox.” The ink-black humor Riggs shares with the friends she makes in waiting rooms and support groups. Complaints about the military language often used to describe cancer treatment and how exhausting this language can be to a person whose energies are wholly consumed in making it through the day. Riggs is funny and frank, confessing that she only pretended to admire her transcendentalist ancestor’s work as a teenager, secretly caring “way more about what was happening in the Baby-Sitters Club series and what I could do to my bangs with a curling iron.” She describes the paradoxically disorienting experience of a respite in her treatment. “I make sense there somehow,” she writes of the cancer center. “A lot more sense than I make at the gym or the elementary school or the grocery story or work meetings— or all the other places I’ve sat outside of for too long in my car taking deep breaths as I attempt to return to civilian life.”

“Dammit,” Riggs’ mother jokes. “I can’t believe I’m going to die right when you’re in the middle of all this. It’s killing me.” But her family also gets a new dog, sends her sons off to summer camp, goes to Harry Potter World, shops for a new couch on the internet. She shrugs off the notion of a bucket list. “I want all of it,” she writes, “all the things to do with living—and I want them to keep feeling messy and confusing and even sometimes boring. The carpool line and the backpacks and light that fills the room in the building where I wait while the kids take piano lessons.” She is also lucky to be married to the kind of man who comes home from work and says, “Do you want to go get in bed together and stare at the ceiling?” They seem a near perfect match.

Riggs takes Montaigne as her melancholy example on how to approach the end of life: “I am making myself ready to lose it, without regret, but as a thing that is lost by its very nature.” She remembers without bitterness the days of her young motherhood, days that seemed to go on forever, as she and her friend pushed strollers to the park and fumed over “our lives—so small and long.” She and another dying woman plot to give their relatives the passwords to their email accounts so that they can use them to send “a direct ‘mother is watching’ email” to misbehaving children. She wonders what it would be like to fall asleep while riding on the back of her father’s motorcycle and thinks “maybe it wouldn’t be so bad to fall into that, to loosen the grip at the waist, let gravity and fate take over—like a thought so good you can’t stop having it.”

But The Bright Hour is not without its terrors. In the memoir’s most extraordinary chapter, Riggs describes heading off to a retreat center run by Catholic nuns, to take a few days alone to write. After the kids head off to school, she packs, thinking that she is “readying myself to leave them. I am practicing. … This is just practice.” The moment she sets foot in the retreat, despite the peaceful surroundings, she has a panic attack: “I can feel that John and the kids are out there—their world spinning along. And I am here—separate, cut off, alone.” This moment, this sudden encounter with nothingness, is as close as a dying memoirist can come to fingering the edge of the knife about to cut her throat. Fear is strangely absent from the most popular books of this kind, and perhaps The Bright Hour is too raw to join their numbers. But Riggs’ willingness to include that darkness is what gives her last work its surpassing radiance.

The Last Lecture by Randy Pausch. Hachette.

When Breath Becomes Air by Paul Kalanithi. Vintage.

The Bright Hour by Nina Riggs. Simon and Schuster.

Read all the pieces in the Slate Book Review.