Friday, February 12, 2016

When Breath Becomes Air

Title:  When Breath Becomes Air
Author:  Paul Kalanithi
Publication Information:  Random House. 2016. 256 pages.
ISBN:  081298840X / 978-0812988406

Book Source:  I received this book as a publisher's galley through NetGalley free of cost in exchange for an honest review.

Opening Sentence:  "I flipped through the CT scan images, the diagnosis obvious:  the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated."

Favorite Quote:  "If the unexamined life was not worth living, was the unlived life worth examining?"

Paul Kalanithi (1977 - 2015) has quite a history. A second generation immigrant. A Stanford graduate with a Bachelors in Biology and a Bachelors and Masters in English. A Cambridge graduate with a Masters in the History and Philosophy of Science and Medicine. A Yale medical school graduate. A Stanford resident in neurosurgery. Winner of the highest award given for research by the American Academy of Neurological Surgery. A son. A brother. A colleague. A friend. A husband. Sadly, Also a patient diagnosed with stage IV lung cancer at age 35. Even more sadly, Paul Kalanithi died in 2015 at the age of only 37.

What can I possibly say about a book that comprises the final words of a dying man? I tear through the book because the writing conveys to me a sense of urgency. I pause, reread and reflect. I furiously underline passages because, if you will excuse the phrase, they take my breath away. And I cry. I cry for him. I cry for his family. I cry for the questions this book asks about life. I cry because that could be any one of us. I cry because this book brings me face to face with mortality - his and my own.

Many books take on the topic of death and end of life. Atul Gwande's Being Mortal brings the conversation of about end of life decisions, both in terms of pragmatic advice and in its application to his own family. The Death Class by Erika Hayasaki looks at death through the safety of an academic discussion of a college class. Hospice Voices: Lessons for Living at the End of Life by Eric Lindner adds the perspective of volunteers who make the journey maybe just a little easier. Many memoirs such as H is for Hawk and Wild speak to a family member's experience with the death of a loved one.

Dr. Kalanithi's book brings together two different perspectives. The first is that of a member of the medical profession examining his own profession. This is not an look at the pragmatic details of medicine - cost, insurance, statistics, hospital management, etc. This is a philosophical dialogue on what it means to be a doctor and on the sacred trust that doctors must take on to truly care for their patients. The fact that he deals with neurosurgery makes that examination all the more philosophical. Written through the lens of his own diagnosis, his commentary on his work becomes even more reflective. "Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and their family, ideally with a doctor as a guide, to answer this question:  What makes life meaningful enough to go on living?"

The second perspective, of course, becomes that of the doctor turned patient, a patient who knows better than most what is happening to his own body and where it may lead. Again, this is not a description of the practical details of his care; the fact that he is treated at the very hospital at which he works and the fact that he is also a colleague to his physicians make his journey different than that of other patients. However, this perspective again is of the emotional, mental, and again, philosophical journey, which transcends all practicalities. This perspective is one of resiliency, of determination, and even of hope. Yes, the book is even about hope for Dr. Kalanithi's journey becomes a journey of life for "even if I'm dying, until I actually die, I am still living."

Paul Kalanithi expected to leave a legacy to the world through his medical research. He expected to run a research lab and may indeed have changed the course of medicine. Cancer changed the course of his life. However, the world does indeed have a legacy of his work - his words and his lesson about death and about life. My recommendation - Read it, and then perhaps read it again. It will leave you changed.

Please share your thoughts and leave a comment. I would love to "talk" to you.


  1. Excellent summary that captures the beauty,emotion and gift of Dr. Kalanithi's book.

    1. Thank you for stopping by. Dr. Kalanitihi's book is definitely one of the most moving and thought provoking books I have ever read.