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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. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naive medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father 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. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.
Praise for When Breath Becomes Air
"I guarantee that finishing this book and then forgetting about it is simply not an option. . . . Part of this book's tremendous impact comes from the obvious fact that its author was such a brilliant polymath. And part comes from the way he conveys what happened to him--passionately working and striving, deferring gratification, waiting to live, learning to die--so well."--Janet Maslin, The New York Times
"An emotional investment well worth making: a moving and thoughtful memoir of family, medicine and literature. It is, despite its grim undertone, accidentally inspiring."--The Washington Post
"Possesses the gravity and wisdom of an ancient Greek tragedy . . . Kalanithi] delivers his chronicle in austere, beautiful prose. The book brims with insightful reflections on mortality that are especially poignant coming from a trained physician familiar with what lies ahead."--The Boston Globe
"Devastating and spectacular . . . Kalanithi] is so likeable, so relatable, and so humble, that you become immersed in his world and forget where it's all heading."--USA Today
"It's Kalanithi's] unsentimental approach that makes When Breath Becomes Air so original--and so devastating. . . . Its only fault is that the book, like his life, ends much too early."--Entertainment Weekly
"Split my head open with its beauty."--Cheryl Strayed
Publishers Weekly® Reviews
- Reviewed in: Publishers Weekly, page .
- Review Date: 2015-11-02
- Reviewer: Staff
Author and physician Kalanithi had nearly completed his residency in neurosurgery at Stanford when he was diagnosed with Stage lV lung cancer at the age of 36. Despite the stubborn progression of his disease, Kalanithi was able to write, work, and delve into a number of profound issues before the end of his life, documented here (his wife provides the epilogue). As a youth in Arizona, Kalanithi was unsure whether he wanted to pursue medicine, as his father did, or if literature and writing were his calling. This inspiring memoir makes it clear that he excelled at both. Kalanithi shares his career struggles, bringing readers into his studies at Yale (including cadaver dissection), the relentless demands of neurosurgery, and the life-and-death decisions and medical puzzles that must be solved. After he begins cancer treatment, Kalanithi strives to define his dual role as physician and patient, and he weighs in on such topics as what makes life meaningful and how one determines what is most important when little time is left. He also shares the challenges of colleagues: an oncologist who walks a tightrope between hope and honest reality; a fellow doctor who commits suicide after losing a patient; Kalanithis wife, also a doctor, bearing witness to her husbands decline even as she gives birth to their child. This deeply moving memoir reveals how much can be achieved through service and gratitude when a life is courageously and resiliently lived. (Jan.)
A doctor confronts his dying days
Although Paul Kalanithi dreamed of becoming a writer, he first planned to spend 20 years as a neurosurgeon-scientist. Tragically, however, in 2013—during his last year of residency at Stanford—the nonsmoking 36-year-old was diagnosed with stage IV lung cancer.
Soon after, he wrote a powerful New York Times op-ed piece, “How Long Have I Got Left?,” describing his diagnosis and struggle to make the best use of his remaining time. “Tell me three months,” he wrote, “I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases.”
In the months before his death in March 2014, Paul managed to do all three. He received treatment, continued to perform surgery as long as feasible, spent precious moments with his wife and family, became a father for the first time, and wrote a thought-provoking memoir about his life, illness and mortality, When Breath Becomes Air.
“He was working really hard,” recalls his widow, Lucy Kalanithi, a Stanford internist who met Paul while the two were in medical school at Yale. “He was suffering physically and of course emotionally. But he was very, very tough and thoughtful, and somehow coped and kept going.”
She describes her husband as “unbelievably smart, and, to top it off, the funniest person I’ve ever met, while at the same time, soft-spoken and subtle.” The couple often sat or lay side by side during his illness and Lucy’s maternity leave, with Lucy sometimes reading Paul’s words as he wrote. His manuscript afforded the couple a natural opportunity to communicate about what was happening and how Paul was feeling.
“It was exhausting, but we were having a really good time,” Lucy says. “It was very purposeful; we loved each other and we loved Cady [their daughter]. We knew that Paul’s time was limited and we were in pain . . . but it was kind of an amazing time. It’s a weird word to use, but also very fun.”
Lucy notes that her husband was “uniquely positioned” to write this book, and that she, as a physician, was also uniquely positioned to help take care of him, along with their families and friends.
“And it still took everything I had,” she says.
In the book’s foreword, Stanford physician and author Abraham Verghese aptly describes Paul’s writing as “stunning” and “unforgettable,” noting: “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.”
Paul thought deeply before he wrote, and then his words flowed; his wife recalls that he wrote his op-ed piece during an airplane flight. “He wrote very quickly,” Lucy explains, “and didn’t spend a lot of time going back over it, partly because he didn’t have a lot of time and he knew it. Literally, he was racing to finish.”
The beauty of his prose is hardly a coincidence, because Paul earned graduate degrees in English, history and philosophy before turning to medicine. Early in the book he declares, “I knew with certainty that I would never be a doctor.” Pages later, he eloquently traces his unforeseen career trajectory, explaining, “I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context.”
Paul didn’t expect to face his own intersection so soon. Summing up his transformation from physician to patient, he writes: “Shouldn’t terminal illness, then, be the perfect gift to that young man who had wanted to understand death? What better way to understand it than to live it? But I’d had no idea how hard it would be, how much terrain I would have to explore, map, settle. I’d always imagined the doctor’s work as something like connecting two pieces of railroad track, allowing a smooth journey for the patient. I hadn’t expected the prospect of facing my own mortality to be so disorienting, so dislocating.”
The book was nearly complete when Paul died. “One of the last things he said to me was ‘Please get this finished,’ ” Lucy remembers. She explains that all the words in the book are his: His editor occasionally supplemented his manuscript with passages written elsewhere in essays, his book proposal and lengthy emails to friends.
Lucy also penned a powerful epilogue describing Paul’s last days in a sad but elegant coda to the book. “I’m not at all a writer like Paul was,” she admits. “But writing that epilogue—I just loved it. It was the most meaningful thing I’ve ever written.”
As she works part time at Stanford (planning to return full time in March), Lucy finds the grief process to be “unexpected and unpredictable.” She rejoices in every milestone of their daughter Cady’s life. “Paul would have loved that her first word was ‘dog,’ ” she says. “There are all these little things that are just so bittersweet because he’s not here.”
When Breath Becomes Air closes with Paul’s heartbreakingly beautiful words to Cady, who brought him so much happiness during his dying days. “I’m so happy that he wrote it for her,” Lucy says. “That passage is my prized possession. I haven’t memorized it. I didn’t even try. I’ve just read it so many times.”
In the midst of her grief, Lucy remains excited about the book’s publication. “I’m keeping a promise that I made to Paul, which feels really important and makes me feel purposeful.”
“I’m very happy about sharing him with the world,” she adds. “This book will be on people’s bookshelves. I can’t believe it. Paul really wanted to be a writer. We worked so hard to make it happen.”
Nonetheless, she can’t help but lament: “I’d give anything for you to be talking to Paul rather than me.”