The Spiritual Aspect of Memoir: How We Find Stories in Our Quest to Find Meaning

PART THREE of three

Hello beloved reader, below is the third and last part of my VCFA lecture. You may click here for Part One and Part Two.

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Now to examine one of the most riveting memoirs of the more than 70 memoirs I’ve read to date.

When Breath Becomes Air was written by a physician who received a diagnosis of Stage IV lung cancer at the age of 36. While it’s true that this memoir has been on the New York Times bestseller list since its publication in January 2016, [I gave this lecture at VCFA in July 2017] I have encountered some reverse snobbery around this book. How could it be a literary memoir if it’s on the New York Times bestseller list?

Well, perhaps I’ve learned about myself that I’m more interested in commercial memoirs than I am in literary memoirs—although as I mentioned earlier, my MFA experience has included reading plenty of literary memoirs as well.

But Kalanithi’s memoir is both literary and commercial: perhaps the secret sauce to the kind of literature that I enjoy. Kalanithi is so gifted in his ability to engage the reader on the page, I finished my first reading of it in two sittings.

Within any engaging memoir we will find a central question.

A question which is the author’s obsession.

In Kalanithi’s When Breath Becomes Air, I would offer that his central question revolves around how do we, as human beings, find meaning in our lives.

And as he knows that his life will finish sooner rather than later while writing this book, this question becomes even more poignant.

After a Prologue in which he describes his cancer diagnosis, Kalanithi launches into a description of his teenage years where he writes on page 19:

“I knew with certainty that I would never be a doctor.”

But by page 30 he writes,

“A few years later, I hadn’t thought much more about a career but had nearly completed degrees in English literature and human biology. I was driven less by achievement than by trying to understand, in earnest: What makes human life meaningful?”

As I have the Kindle edition of the book, I was able to search for the word “meaning” and it appears 54 times throughout his narrative.

He goes on to write,

“I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain. Meaning, while a slippery concept, seemed inextricable from human relationships and moral values.”

Considering the connection between searching for meaning and spirituality, it’s a surprise to me that in his memoir, Kalanithi never took a deep dive into his own spiritual nature. Instead he focused on “moral values.”

The only times he mentions anything about his spirituality, is first on page 24 when he writes about his parents’ religious conditioning:

“They had eloped, in love, across the world, from southern India to New York City (he a Christian, she a Hindu, their marriage was condemned on both sides, and led to years of familial rifts…)”

Then about three quarters of the way through the book, on page 168, he writes: 

“Although I had been raised in a devout Christian family, where prayer and Scripture readings were a nightly ritual, I, like most scientific types, came to believe in the possibility of a material conception of reality…”

He writes that he goes through a period of atheism, then goes on to say,

“Yet I returned to the central values of Christianity—sacrifice, redemption, forgiveness— because I found them so compelling.”

So it seems that he found some meaning in his life by returning to his early Christian conditioning.

Even though we are here at VCFA to study literature and the craft of writing, I am not only interested in a memoirist’s writing choices, I’m also interested in their life choices—this is because as writers of memoir, our life choices reflect how we find meaning.

Kalanithi described in detail how grueling his schedule was as a neurosurgeon, and he described how physically weakened he had become with terminal lung cancer. Then he described the relief and respite he experienced with a new drug.

As a reader I was rooting for him to take time away from his work and enjoy the remaining time he had left to live.

Yet he made the choice to go back to the grueling schedule of a neurosurgeon.

So the question I would ask about his life choice here is:

Do you think his Christian conditioning may have affected that choice?

And if yes, do you think he was aware of how his Christian conditioning affected his choice to go back to such a grueling schedule when he had such a limited time left to live?

Looking at our own religious conditioning and biases may provide insights in our quest to find meaning as we write our own memoir.

As Victor Frankl, the Holocaust survivor, Austrian neurologist, psychiatrist, and author of Man’s Search for Meaning wrote,

“We have absolutely no control over what happens to us in life,
but what we have paramount control over is how we respond to those events.”

And I would offer that writers of memoir are writing about exactly that—“how we respond to those events.” Those events being the “snocksnarls and clusterfucks” again to quote Sue Silverman.

And again, how we respond may be largely dependent on our spirituality or our religious conditioning, which is worth investigating.

While Kalanithi does not explore his own spiritual nature in depth in his memoir, he does recognize that his study of human meaning is somewhat monastic, as shown when he writes on page 31,

“Throughout college, my monastic, scholarly study of human meaning would conflict with my urge to forge and strengthen the human relationships that formed that meaning. If the unexamined life was not worth living, was the unlived life worth examining?…

I could either study meaning or I could experience it.”

He goes on to write about how those experiences gave his life meaning,

“This was summer at Sierra Camp, perhaps no different from any other camp, but every day felt full of life, and of the relationships that give life meaning.”

At this point, to break up my lecture a bit, can someone please volunteer to read these quotes that show Kalanithi’s obsession with meaning?

QUOTE 1:

“I studied literature and philosophy to understand what makes life meaningful, studied neuroscience and worked in an fMRI lab to understand how the brain could give rise to an organism capable of finding meaning in the world, and enriched my relationships with a circle of dear friends through various escapades.” (page 35)

In other words, Kalanithi found the joy of living life and building relationships was part of what made his life meaningful.

QUOTE 2:

“As graduation loomed, I had a nagging sense that there was still far too much unresolved for me, that I wasn’t done studying. I applied for a master’s in English literature at Stanford and was accepted into the program. I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion. A word meant something only between people, and life’s meaning, its virtue, had something to do with the depth of the relationships we form. It was the relational aspect of humans— i.e., “human relationality”— that undergirded meaning.” (Page 39)

Kalanithi weaves this idea of “human relationality” throughout his memoir. Much later in the book (on page 142) after his cancer diagnosis when he and his wife consider having children, he even writes,

“If human relationality formed the bedrock of meaning, it seemed to us that rearing children added another dimension to that meaning.”

QUOTE 3:

“Medical school sharpened my understanding of the relationship between meaning, life, and death. I saw the human relationality I had written about as an undergraduate realized in the doctor-patient relationship.” (page 51)

Here he offers the doctor-patient relationship as another example of human relationality that adds more meaning to his own life.

QUOTE 4:

“And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context.” (Page 70)

Here I disagree with Kalanithi when he says that these questions around meaning “usually arise in a medical context.” I would offer that these questions intersecting life, death and meaning, often may occur in a medical context, but there is a trifecta:

these questions around meaning often occur through a crisis either in love, money or health.

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So now we have explored some of the sections that show Kalanithi’s quest to find meaning, let’s look at how he manages to write such an engaging memoir—what craft elements can we explore and analyze?

The structure of his book begins with a foreword by physician and author Abraham Verghese where he writes,

“It occurs to me, as I write this, that the foreword to this book might be better thought of as an afterword. Because when it comes to Paul Kalanithi, all sense of time is turned on its head. To begin with—or, maybe, to end with—I got to know Paul only after his death. (Bear with me.) I came to know him most intimately when he’d ceased to be.”

Employing a structure that encompasses such an engaging foreword written by another well-known doctor and author, effectively hooks a reader’s interest. 

Then we read Kalanithi’s 13 page prologue describing when he first suspected he had cancer and his eventual diagnosis.

The structure for the rest of the book is chronological and split into two parts plus an epilogue:

PART I: In Perfect Health I Begin: 100 pages that tell the story of his teenage years up through college.

PART II: Cease Not till Death: 83 pages. The poignancy of Kalanithi’s situation comes to a head, as he dies before he finished his book.

So his wife, Lucy Kalanithi wrote an EPILOGUE of 25 pages.

The situation of the whole book is intriguing—an author who had studied literature and considered becoming a writer, but became a neurosurgeon, then is diagnosed with cancer, which both prompts him to write his first book and ultimately prevents him from finishing that book.

A la Vivian Gornick’s classic book about memoir, The Situation and the Story, Kalanathi succeeds in turning this unusual situation into an engaging story.

In Gornick’s The Situation and the Story: The Art of Personal Narrative, she writes,

“A memoir is a work of sustained narrative prose controlled by an idea of the self under obligation to lift from the raw material of life a tale that will shape experience, transform event, deliver wisdom.”

Shape experience.

Transform event.

Deliver wisdom.

Three of the key elements of memoir that Kalanithi achieves.

He shapes his experience/situation into a story that engages a reader on every page.

He transforms event by writing about the health crisis in his life and how it spurred him to examine his life and write about his obsession with his search for meaning.

He delivers wisdom through the many insights he offers throughout his narrative.

Verghese writes in his Foreword to When Breath Becomes Air,

“After reading the book you are about to read, I confess I felt inadequate: there was an honesty, a truth in the writing that took my breath away.

Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, see what it is to still live, to profoundly influence the lives of others after you are gone, by your words.”

This brings me to address the issue of how we write about others in memoir if we intend to continue to have a relationship with them. But Kalanithi didn’t have that concern as he knew his death was imminent.

It was up to his wife to write an epilogue and to read and edit what Kalanithi had written about her and their relationship. She didn’t change the fact that he wrote about the difficulty in their marriage before he had cancer. He had even written, “In truth, cancer helped save our marriage.”

In the epilogue his wife Lucy writes,

“Most of our family and friends will have been unaware, until the publication of this book, of the marital trouble Paul and I weathered toward the end of his residency. But I am glad Paul wrote about it. It’s part of our truth, another redefinition, a piece of the struggle and redemption and meaning of Paul’s life and mine. His cancer diagnosis was like a nutcracker, getting us back into the soft, nourishing meat of our marriage. We hung on to each other for his physical survival and our emotional survival, our love stripped bare. We each joked to close friends that the secret to saving a relationship is for one person to become terminally ill. Conversely, we knew that one trick to managing a terminal illness is to be deeply in love — to be vulnerable, kind, generous, grateful.” (p. 216)

Personally, I echo that sentiment. My own husband’s cancer did absolutely change our relationship, and launched us into a new chapter of the journey of our human experience as spiritual beings.

A crisis in love, money, or health, will often make you re-examine the choices you make in your life.

And through writing memoir, we get to integrate those changes in a way that will hopefully include an evolution of consciousness which most often happens when we look to make meaning from those snocksnarls and clusterfucks we survived.

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In conclusion, my subversive intention with this lecture has been to invite you to question how your own spiritual or religious beliefs may affect how you make meaning as you write memoir.

Thank you!

And now I’d like to give some time for a Q&A in addition to some time for a writing prompt. If anyone has any questions, please let me know and I can do my best to respond.

Otherwise, for the writing prompt, I invite you to write down a spiritual belief that you may have—whether it be a belief of reincarnation, or of heaven and hell, or of original sin, etc. And to brainstorm on paper about how that belief may affect how you find meaning as you write about the snocksnarls and clusterfucks in your life. [And for readers of this Substack, please feel supported and encouraged to write in the comments.]

And in case this may help you begin, you can play with the idea that as the Holy Rascal Rabbi Rami Shapiro said, “God is real. Everything we say about God is made up.”

And one more quote from American Buddhist nun, Pema Chodron for possible inspiration with your writing:

“People get into a heavy-duty sin and guilt trip, feeling that if things are going wrong, that means that they did something bad and they are being punished. That’s not the idea at all. The idea of karma is that you continually get the teachings that you need to open your heart. To the degree that you didn’t understand in the past how to stop protecting your soft spot, how to stop armoring your heart, you’re given this gift of teachings in the form of your life, to give you everything you need to open further.”