Book Review: When Breath Becomes Air By Paul Kalanithi – What Makes Life Worth Living In The Face of Death?

Title: When Breath Becomes Air

Author: Paul Kalanithi

Publishing Date: January 12, 2016

Genre: Autobiography, Biography

Awards: Goodreads Choice Awards Best Memoir & Autobiography

‘When Breath Becomes Air’ is an eloquent, rattling, heartbreaking and powerful memoir of the neurosurgeon and writer, Paul Kalanithi. It is the story of his life, exploration of human identity, and struggle with inoperable lung cancer.

The Life …

Dr. Paul Kalanithi held degrees in English literature, human biology, history and philosophy of science and medicine from Stanford and Cambridge University before graduating from Yale School of Medicine. His reflections on doctoring and illness have been published in the New York Times, the Washington Post and the Paris Review Daily. He also received the American Academy of Neurological Surgery’s Highest Award for research. Kalanithi died in March 2015, aged 37. He is survived by his wife, Lucy and their daughter, Elizabeth Acadia (nicknamed, Cady).

The Foreword …

The book features a well-articulated foreword by Abraham Verghese, an Indian American physician-author, Professor for the Theory and Practice of Medicine at Stanford University Medical School and Senior Associate Chair of the Department of Internal Medicine. Abraham writes, “I reread Paul’s piece, again and again, trying to understand what he had brought about. First, it was musical. It had echoes of Galway Kinnell, almost a prose poem. But it also had a taste of something else, something from an antique land, from a time before zinc bars.”

Summing up the book, he marks, “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. In a world of asynchronous communication, where we are so often buried in our screens, our gaze rooted to the rectangular objects buzzing in our hand, our attention consumed by ephemera, stop and experience this dialogue with my young departed colleague, now ageless and extant in memory. Listen to Paul. In the silence between his words, listen to what you have to say back. Therein lies his message.”

The book is indeed a beautiful, yet poignant, read. I got to know Paul Kalanithi through his work – this book – and I am so pleased to know him and read his unique perspective about life and death. Despite the fact that the book is about his fight and flight with one of the most perilous diseases in the world and it has lots of heartbreaking moments, it is not dramatic or depressing. Instead, it offers hope, courage and unique insight into the life.

The book is divided into two parts:

  1. In Perfect Health I Begin
  2. Cease Not Till Death

The first part is about Paul Kalanithi’s career choices.

Paul was raised in a desert valley of Kingman, Arizona, ringed by two mountain ranges. While born in the family of doctors, Paul never imagined himself to be a doctor. He writes, “I knew medicine by its absence – specifically, the absence of a father growing up, one who went to work before dawn and returned to dark to a plate of pre-heated dinner.”

In his quest to understand the true meaning of life, Paul completed degrees in English Literature and Human Biology from Stanford University. He also worked in a fMRI lab to understand the working of the brain. He believed literature provided the best account of the life of the mind, while neuroscience laid down the most sophisticated rules of the brain.

“I had come to see language as 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 relationship we form.”

But soon after completing his thesis, Whitman and the Medicalization of Personality, as a course requirement in Ph.D., English Literature, he realized he didn’t quite fit in an English department. That was the moment he realized ‘medicine is the answer’ and that only the physician could truly understand ‘the physiological-spiritual man’.

The Turning Point …

That was the turning point in his life. He went to Yale for medical school. There, he embarked on a journey to get to know the true nature of the human mind, getting to the top of residency, his research received the most prestigious awards in medicine and neuroscience. He believed, “The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet struggle to win for your patients. You can’t even reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

The second part, titled ‘cease not till death’, is about the fight.

It is all about the transition in Paul’s life and those close to him. The heartbreaking news hit him and the diagnose was clear, Paul was suffering from inoperable lung cancer invaded into multiple organ systems, at the age of 36.

Only 0.0012% of thirty-six years old get lung cancer.

He writes “One chapter of my life seemed to have ended; perhaps the whole book was closing. Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused.”

With cancer progressing, Paul found himself growing weaker. But that didn’t stop Paul from living his life on his own terms. At one point, when his cancer became a little stable, Paul pushed back himself to the OR. He writes, “Because I could. Because that’s who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I am dying, until I actually die, I am still living.”

His wife, Lucy, supported him through thick and thin. Knowing that death is impending, Paul and Lucy chose to continue living, instead of dying, and decided to have a child.

The 5 Stages of Grief

Here is how Paul describes living with terminal illness in his book ‘When Breath Becomes Air’: “It struck me that I had traversed the five stages of grief – the “Denial – Anger – Bargaining – Depression – Acceptance” cliché – but I have done it all 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 slummed into a depression, as it became clear that I might not be dying so soon after all, which is, of course, good news but also confusing and strangely enervating. The rapidity of the cancer science and the nature of the statistics meant I might live another twelve months, or another 120. Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die – but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or year I had left. Tell me three months, I’d spend time with 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 with that day?”

He proceeds, “At some point, then, I began to do a little bargaining – or not exactly bargaining. More like: “God, I have read Job, and I don’t understand it, but if this is a test of faith, you now realize my faith is weak, and probably leaving the spicy mustard off the pastrami sandwich would have also tested it? You didn’t have to go nuclear on me, you know …” Then, after the bargaining, came flashes of anger: “I work my whole life to get to this point and then you give me cancer?” 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.”

On July 4th, Paul and Lucy welcomed Elizabeth Acadia into their life.

Paul Kalanithi with his daughter, Cady.

Paul led an unbelievable life in the face of death. He wanted to know what makes our life truly meaningful and he did get a chance to explore the answer as a neurosurgeon. Though his time was short in this world, his influence will continue to live, past death, through his book, his message and his legacy in the medical research.

When Breath Becomes Air: The Last Message.

Paul completes his memoir with this beautiful yet painful message:

“When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.”

The Epilogue…

Paul’s wife, Lucy Kalanithi, contributed the touching epilogue for the book. She writes, “Relying on his own strength and the support of his family and community, Paul faced each stage of illness with grace – not with bravado or a misguided faith that he would ‘overcome’ or ‘beat’ cancer but with an authenticity that allowed him to grieve the loss of the future he had planned and forged a new one.”

When Breath Becomes Air is one of those rare books that gives you realistic hopes about the life and death. Even while battling with a fierce disease, Paul followed his passion as a neurosurgeon and writer, regardless of physical collapse, he remained high-spirited, open to new possibilities, full of realistic hope and led a life full of purpose and meaning.

His message is life – with all its nastiness and horrors – is still worth living and celebrating in the days, weeks, months and years that are bestowed upon us.

Where to find the book?

Get your copy of ‘When Breath Becomes Air’ at Liberty Books.

Disclaimer: I will be reviewing books on this blog because I read a lot. But I am not a professional critic. Neither am I qualified to do book reviews. I am just an avid reader and I am happy to share my experiences with you. And I would love to hear your thoughts and recommendations too. So, feel free to comment or tweet me at @AyeshaAmbreen with your suggestions. Happy Reading!

Leave a Reply

Your email address will not be published. Required fields are marked *