The Clouds are the
Floating
The Flowers are the
Blooming
When Breath Becomes Air is a book written by Paul
Kalanithi, a neurosurgeon who died of non-small cell lung cancer (NSCLC) 22
months after the diagnosis at the age of 36. His wife described the book as a cogent
powerful tale of living with death.
“The Clouds are the Floating; The
Flowers are the Blooming.” are two verses written by Thich Nhat Hanh, a master in Zen Buddhism, in
his poem The Great Lion’s Roar. They are mentioned in his new book The
Art of Living, in which he
explores the questions about life and death. As always, he teaches mindful breathing,
through which there is concentration and insight. And there, lies the way.
Paul was born in New York, but he
spent his teenage in Kingsman, a desert valley in Arizona, 100 miles south of
Las Vegas. His father was a
cardiologist. He moved the family to the
desert town when Paul was 10 so as to establish a regional cardiology practice
of his own. Although his father and his
uncle were doctors, Paul had made up his mind to study English literature and
to become a writer. He was the diligent
and serious type of student. He entered
Stanford University and majored in English literature and biology. As with many adolescents and great thinkers
alike, Paul was haunted by the myth of live and death. He wondered “where biology, morality, literature and philosophy intersected”. He came to the conclusion that reading or
writing alone would not give him an answer. “Direct
experience of life-and-death questions was essential to generating substantial
moral opinions about them.” After
his first degree from Stanford and a degree in history and philosophy of
science and medicine from Cambridge, he went to Yale for medical school. He “was
pursuing medicine to bear witness to the twinned mysteries of death, its
experiential and biological manifestations: at once deeply personal and utterly
impersonal.”
Ironically, during his years as a
neurosurgical resident in Stanford, he was designated the chance to experience
death directly, not as an observer or an intervener. He was diagnosed to have NSCLC at the age of
36. The chance of having lung cancer at
36 was 0.0012. The cancer turned out to
be EGFR positive and responded well to target therapy with Tarceva. At that time, he started to write his book. He diligently rehabilitated himself and was
able to continue his neurosurgical residence work 18 months later. Paul and his wife, Lucy, his medical school
classmate and a physician, planned to have a baby. With IVF, Lucy was soon pregnant.
Paul faced cancer and death
head-on. He realized that nothing had
changed. He was uncertain both before
and after he had cancer when he would die. At the same time, he was certain both before
and after he had cancer that he would die. As a doctor, he was trained to focus on the future.
But in reality, only the present day
counted.
Paul did not finish his book, at
least as the way he planned to. The last
chapter was written by Lucy. Soon after
he resumed his duty, the cancer got worse. A new focus with no mutation gene (and thus
not responsive to target treatment) appeared. Chemotherapy failed because of intolerable
side effects. He was said to die in
peace and satisfaction (despite leptomeningeal carcinomatosis and respiratory
failure) with her 8 months old daughter in his lap. He saw continuation in her.
Thich Nhat Hanh coins the word “inter-being”
to explain that one exists not as a self, but as an inseparable part of the
whole universe. There is continuation in
our off-springs, in our siblings, in our spouses, in our ancestors, and in
mankind. He observed that when a cloud
floats, the cloud and the floating are in fact inseparable. The cloud is the floating. He gives a profound view on death in his book:
“People need to break free from 3 wrong
views before they can be liberated from suffering. The first wrong view is that we are a separate
self cut off from the rest of the world. This self is born at one moment and must die
at another, and it is permanent during the time we are alive. The second is that when we die, we cease to
exist. The third wrong view is that what
we are looking for- whether it is happiness, heaven, or love- can be found only
outside us in a distant future.” Targeted
to overcome these 3 wrong views, he introduces the practice of concentrations
on emptiness, signlessness, aimlessness, impermanence, non-craving, letting go,
and nirvana. One of the ways to attain
insight through such concentration practice is mindful breathing. Thich Nhat Hanh has always been teaching
mindful breathing. The essence is to concentrate
on in-breaths and out-breaths in relax and peaceful manner.
When Breath Becomes Air is not a pleasant book to read, especially for us doctors. Paul had no choice but to face his cancer. He described his life as sowing without
reaping. I do not know whether he
finally got the answer to his questions about life and death. He roamed into philosophical quotes before he
could finish his book. However, he did
give first person experience on how to focus on the present moment bravely. As a patient, he witnessed how important the
doctors’ attitude and accurate but compassionate communication were. “When
the scalpel fails, the neurosurgeon is left with his words.”
I wonder how many readers would
attain enlightenment after reading The
Art of Living. Non-self,
impermanence and nirvana are said to be profound and beyond description. Practicing mindful breathing might sound too
simple, yet it might take your whole life time before you can bravely face
inevitable sufferings that pop up now and then. But at least, there are ways that might help,
as it is advocated. As the subtitle of
the book says, the art of living is peace and freedom in the here and now.
Breathing in, I enjoy the harmony
of my in-breath. Breathing out, I enjoy
the harmony of my out-breath. When
breath becomes air; the breath is the air.
