When Breath Becomes Air by Paul Kalanithi
My rating: 5 of 5 stars
Summary (adapted from Goodreads)
At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. Just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi’s transformation from a naïve medical student, into a young neurosurgeon at Stanford, and finally into a patient and a new father to a baby girl, confronting his own mortality.
What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.
Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing mortality and on the relationship between doctor and patient, from a gifted writer who became both.
This is one of those books that is so hard to review because there is just no way that you can do it justice. The author says it all absolutely perfectly, precisely, and poetically, so any words on my part are like fluorescent lights compared to the perfect gold of autumn sunshine. However, there is so much Truth and beauty to process and internalize from the pages of this book that I must attempt a review regardless of the inadequacy of my words. There were several passages though, that resounded with such power that I will quote them directly.
It seems almost an oxymoron to say that a memoir written by a dying cancer patient is one of the most powerful, positive, uplifting, and hopeful records of life that I have ever read, but it is the truth. Paul Kalanithi’s grasp of the meaning of life and death is so full, nuanced, and inspiring; he so eloquently describes his life journey as a son, reader, student, friend, philosopher, doctor, husband, and finally patient and father. All of it motivated by his desire to live a meaningful life and to discover what makes a life meaningful.
His interest in and search for meaning was sparked by literature. He felt like a bosom friend when I read, “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, has something to do with the depth of the relationships we form. It was the relational aspect of humans that undergirded meaning…Literature not only illuminated another’s experience, it provided, I believed, the riches material for moral reflection.”
But Paul Kalanithi didn’t just stop at reflection. He wrote, ““If the unexamined life was not worth living, was the unlived life worth examining?” And so he lived. He challenged his mind and body, he formed relationships, he worked hard and played hard.
His reading also introduced him to an idea that stuck with him through many years and that ultimately led him to choose neurosurgery as his career path over literature and writing:
“The mind was simply the operation of the brain, an idea that struck me with force…Of course it must be true – what were our brains doing, otherwise? Though we had free will, we were also biological organisms – the brain was an organ, subject to the laws of physics, too! Literature provided a rich account of human meaning; the brain, then, was the machinery that somehow enabled it. It seemed like magic…I began to see all disciplines as creating a vocabulary, a set of tools for understanding human life in a particular way. Great literary works provided their own set of tools, compelling the reader to use that vocabulary….I couldn’t quite let go of the question: Where did biology, morality, literature, and philosophy intersect? [Medical school] would mean setting aside literature. But it would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.”
I was completely fascinated by his experiences and descriptions of medical school. He illuminates the ironies and conflicts in balancing science and sensitivity in the practice of medicine. One of my favorite descriptions related to working on cadavers: “You would think that the first time you cut up a dead person, you’d feel a bit funny about it. Strangely, though, everything feels normal. The bright lights, stainless steel tables, and bow-tied professors lend an air of propriety. Even so, that first cut, running from the nape of the neck down to the small of the back, is unforgettable.”
I would describe Paul Kalanithi as a hero, but that’s certainly not what he was going for. However, his integrity and sincerity are truly bold and valiant in today’s world of instant gratification and self-interest. His words give the best sense of his convictions:
“Words began to feel as weightless as the breath that carried them…Moral speculation was puny compared to moral action.”
“I was pursuing medicine to bear witness to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal.”
“The heroic spirit of responsibility amid blood and failure. This struck me as the true image of a doctor.”
“In my life, had I ever made a decision harder than choosing between a French dip and a Reuben? I still had a a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn’t enough; moral clarity was needed as well.”
“The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.”
I went back to teaching this year after 10 years as a stay-at-home mom. There have been feelings of doubt, guilt, euphoria, and everything in between. I have had to make decisions and judgment calls regarding how to prioritize my time, how to balance my family and my students, how to keep and strengthen relationships with my children while also being effective as a teacher – both situations in which I can impact lives for good or ill. It was cathartic to read and relate to Kalanithi’s struggle to find the same balance in his life between medical school, family, research, and then ultimately illness and death. He wrote, “Putting lifestyle first is how you find a job – not a calling.” Both Motherhood and Teaching are my callings; this book has inspired me and strengthened my resolve that I can bring meaning to my life and to others through doing what it takes to fulfill my callings, no matter the sacrifice and inconvenience to myself.
Most powerful was the feeling of kinship Kalanithi inspires not just between him and his readers, but between the human race as a whole: “…it cannot be doubted that each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer and eighth, the Indian beggar a ninth, the pastor a tenth. Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them.”
All of this wisdom and Truth Paul Kalanithi shares as his body and mind are attacked and destroyed by cancer. It brings such an urgency to his message, while at the same time his words are full of peace and dignity even in the face of death. He is honest and open about his struggles in each stage of his life, including at the end, but that just makes his message and decisions to put others above himself more inspiring. The epilogue written by his wife solidifies the beauty of the love that they shared as a family and that they now share with the world.
Please read this book. No matter your life circumstance or experience there is something in these words for you.
Age Recommendation: This book deals with the theme of death beautifully, respectfully, and with reverence; however, some of the facts may be too emotional for younger readers. For that reason, I would recommend this book for 17 and older.
Appropriateness: There is some swearing in the book, but not a distracting or disturbing amount. Some vague, mild, reference to sex, but nothing graphic or disturbing. There is some medical procedures and description, but it’s all scientific so even when described in some detail the intent is not to be disgusting. There are emotional themes which ought to push us out of our comfort zones a little, but the intent is pure and good. If any of these aspects would deter you from reading the book, please don’t let them. This is a “must-read.”
Book Club Discussion: There are so many topics and questions that could be discussed in relation to When Breath Becomes Air including the importance of literature, doctor and patient responsibilities, terminal illness, dealing with death, sacrifice for goals, and finding balance.
Other book recommendations: If you are interested in When Breath Becomes Air then I think you would also likeThe Alchemist by Paul Coelho, The Perfect Mile by Neal Bascomb, The Guernsey Literary and Potato Peel Pie Society by Mary Ann Shaffer, Unbroken: A World War II Story of Survival, Resilience, and Redemption by Laura Hillenbrand, Everything on a Waffle by Polly Horvath, Anne of Green Gables by L.M. Montgomery, The Little Prince by Antoine de Saint-Exupery, and A Tree Grows in Brooklyn by Betty Smith.