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What ‘when breath becomes air’ tells us about how to use our time

As a major bestseller published a couple of years ago, Paul Kalanithi’s When Breath Becomes Air probably needs little introduction – but just in case: it’s a powerful memoir about a top neurosurgeon in his mid-30s coming to terms with terminal cancer (the book was published posthumously and has an afterword from his widow, Lucy Kalanithi).

One of the passages that I found most affecting was a segment where Paul weighs what he should do, not quite knowing whether he has months or years to live:

The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out…

It struck me that I had traversed the five stages of grief – the ‘Denial -> Anger -> Bargaining -> Depression -> Acceptance’ cliché – but I had done it backward. On diagnosis, I’d been prepared for death. I’d even felt good about it. I’d accepted it. I’d been ready. Then I slumped into a depression, as it became clear that I might not be dying so soon after all…

The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with my family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: what was I supposed to do with that day?

At some point, then, I began to do a little bargaining…then, after the bargaining came flashes of anger…

And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.

This seems to me to capture succinctly some key facets of the human experience. It seems like we all (or at least those of us lucky enough to be young-ish and without a terminal illness) have to traverse the line between death being probably a long way away and the knowledge that death or disease could strike at any point in time. We have to acknowledge that the rug could be pulled out at any point in time whilst simultaneously believing that it’s nailed to the floorboards. Or, to put it another way, we have to build for a future we can reasonably expect whilst ensuring that our day-to-day life is lived well and meaningfully.

So on the one hand we have to plan for the future: our careers, our families, our ambitions, our homes, etc. Kalanithi had spent the majority of his adult life training to be a neurosurgeon. He had been motivated to devote this time because he reasonably foresaw a career that would be measured in decades. Although most of us probably don’t reach the pinnacle of achievement in our chosen careers in quite the same way that Paul Kalanithi did, nonetheless, the impetus is recognisable for all of us. We are ambitious, we are striving, we have goals we want to achieve that require some kind of sacrifice – in terms of time and effort spent doing things that aren’t immediately rewarding but which have a longer term payoff.

On the other hand we all face the possibility that things could change drastically, that our future horizons could shrink and we’ll have to ask ourselves: ‘have I used my time well?’ Kalanithi was in a reasonably good position to answer this – as a neurosurgeon he routinely saved and improved lives. I don’t really have any regrets about my life so far, but I’m not sure I could so surely point to what I’ve achieved in quite the same way Paul Kalanithi could. I suspect I’m not the only one.

It’s not that working towards a future outcome isn’t meaningful or worthwhile – it’s more that focussing purely on the future at the expense of the present is almost as bad as the opposite (carpe diem). It feels like the things we do on a day-to-day basis should strike a balance between longer-term striving (certainty in a reasonable future) and valuing the anonymous and often unglamorous seconds, minutes and hours that life is made of.

What does this mean in practical terms? I think it lies in knowing the different answers to the question ‘what should I do with my time?’ assuming the amount of time is measured in decades, years or months. What if you live to be 90? What if you have five more years? What if you have five more months? We can’t really experience what it’s like to actually face the latter questions until they become a reality, but the thought experiment isn’t just a trite exercise, it helps us think about the difference in what is important given different levels of urgency.

Kalanithi’s answers to these questions are a good guide. With three months left, spending time with those we love becomes important. With a year left, we tackle the passion projects (in Paul’s case, the book he always wanted to write) that we put on the back burner because we’re always too busy with something else. Both of these answers are important, whether or not we think we have decades of time rather than years or months.

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Cluniac monasticism and the power of institutions to create social change

I’ve been reading Larry Siedentop’s excellent Inventing the Individual recently. Siedentop argues that the origins of modern liberalism, with its emphasis on individual freedom, comes from the Christian tradition. In short, his argument is that the ideas of St. Paul, with their emphasis on individual salvation and an individual relationship with God, constituted a massive break with the Roman / Pagan focus on the family and innate social hierarchy. The revolutionary nature of these ideas and their implications for society and individual freedom were slowly brought to fruition by the medieval Catholic Church over a period of centuries.

There’s an awful lot in the book to think about and I’ll probably come back to this at a later date, but one thing that stood out for me was Siedentop’s description of the role of Cluniac monasticism as a vanguard for ethical reform in Western Europe:

In 910, with the foundation of the abbey of Cluny, Frankish monasticism turned the corner towards enduring reform… The founder, Duke William of Aquitaine, enabled the monks of Cluny to elect their abbots, free not only from interference by his own descendants but also from the local bishop. Cluny would be subordinate only to the authority of the papacy.

This was a big deal. Kings and nobles (not to mention the Frankish / German emperors) frequently treated monasteries (and the clergy) as parts of their domain, undermining the social role of these religious institutions and co-opting them into the ruling power structure.

By making institutional freedom an explicit part of the Cluniac movement, the monks were free to concentrate on reform relatively free of the corruption and nepotism affecting other parts of the Church. Siedentop describes what to me sounds awfully like the expansion of a kind of ‘franchise’ model of Cluniac monasticism:

The second abbot of Cluny, Odo, extended this reform by founding other monastic houses, which became ‘priories’ subject to the disciplines of Cluny. In this way a network of reformed monasteries spread throughout the Frankish domains, free from the threats of corruption assailing the Frankish episcopacy.

The success of this model was such that Cluniac priories became an important source of elected bishops – and once elected these bishops played a leading role in locally rooting out corruption and poor clerical behaviour. As such:

The indirect influence of Cluny was perhaps even more important. It restored the prestige of monasticism as representing a truly Christian life, an ordered life of personal dignity, work and self-government… The Cluniac reform movement raised the sights of the church inciting it to defend moral authority in a world apparently given over to mere power.

The reform movement went further, promoting the ‘Peace of God’ which argued that labouring and peasant classes – men, women and children – should be left undisturbed from the low level warfare and banditry of the aristocratic class. A new festival created in 994, the Feast of All Souls, celebrated the importance of the salvation of all people and the equality of the populace in God’s eyes. The symbolic changes were matched with an ‘extraordinary upsurge of new church building in the eleventh century’.

Lastly, Siedentop makes the point that by restoring a strong, independent monasticism this created ‘the opportunity for advancement through a career in the Church…[which] weakened the perception that social standing was entirely governed by fate’.

To me, this seems like a great example of how the institutions and incentive structures of organisations makes a huge difference. Prior to Cluny, it wasn’t as though there weren’t people throughout Europe who were appalled by the corruption and degradation of the feudal system, and the impact this had on local church organisation, but without an explicit guarantee of independence of action, it was difficult to marshal this sentiment into meaningful change.

In a 21st century context we would describe this as being heavily ‘disruptive’. Through an important innovation in the ‘business model’ of Western monasticism, the Church made key strides in a progressive (by the standards of the time at least) social agenda.

As above, there’s a lot more in Siedentop’s book, but this is a great example of how a small but significant institutional change can create a wave of social change.