Intersectionality is a theory of how various social identities, such as race, gender, sexuality, and class, and their overlap contributes to the specific type of systemic oppression and discrimination experienced by an individual. While Paul Kalanithi does not express feelings of being affected directly by the oppression and discrimination that intersectionality can cause, he does exhibit a struggle with his own identity in his novel, When Breath Becomes Air. Paul struggles to let his various identities coexist and instead shows great difficulty accepting more than just one identity. Paul changes the way he chooses to identify himself through the progression of his diagnosis and treatment, from physician, to cancer patient, to finally, simply a writer and a father.
Paul Kalanithi begins telling his story in the years of his residency when his identity was simple, and straightforward. Paul was a physician, and he was born to do the work of a neurosurgeon. For Paul, the security of this identity was threatened when cancer came into the picture. The identity he feels most comfortable in is no longer secure for Paul. In fact, from the moment Paul’s cancer diagnosis is confirmed, he struggles with the existence of his former identity, “Lying next to Lucy in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician—my identity—no longer mattered” (119). For reasons only Kalanithi can truly understand, he feels that his new identity cannot coexist with the identity as a physician that he’d grown faithful to for so long. “Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death, to rebuild my old life—or perhaps find a new one” (139). In an effort to “face his own death” Kalanithi decides he must move on and start a new life as a cancer patient instead of feeling like an outsider in his old identity. Paul comes to better understand the complexities of this new illness identity towards the end of his novel. He is able to acknowledge that his current identity must consist of a gentle compromise between his previous identities and his future ones.
Some of the difficulties Paul experienced were due to the fact that before his illness, Paul’s view of medicine was extremely one-dimensional. He understood illness as a problem that needed to be looked at scientifically and solved rather than a journey that must be accepted and lived through. While he was able to understand and empathize with his patients, he was never able to truly respect their perspective having not experienced it. Paul still had worries that he “was on the way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focused on the rote treatment of disease—and utterly missing the larger human significance” (85). Part of Kalanithi’s growth was realizing that while a physician’s role is more than just enabling healing and practicing medicine, it is so important to remember the patient is “a person, instead of a problem to be solved” (90). Kalanithi becomes a better, more well-rounded physician by experiencing illness first-hand. He is also as a better patient because he understands the difficult vocabulary and implications of medicine. However, his ability to recognize this and balance comes gradually, as he begins to accept his new illness identity and appreciate how it has helped him grow.
Kalanithi’s role as a patient affects every aspect of his life, and it is a new element of identity over which he has no control. He expresses, “As a doctor, I was an agent, a cause; as a patient, I was merely something to which things happened” (141-42). Paul is faced with an inability to act on his true passion saving the life of his patient, because he can’t save himself. He certainly tries to maintain control over his medical care by letting his “doctor-self [remain] responsible for [his] patient-self” (183). When his oncologist suggests that he release himself from the responsibility of being the doctor, Paul admits he “hadn’t ever considered that [he] could release myself from the responsibility of [his] own medical care” (182). Much of Kalanithi’s text is thus focused on how he navigates this tenuous line between patient and physician: sometimes he separates them from one another; at other times, he simply can’t.
