When Breath Becomes Air by Paul Kalanithi: A Book Review

Death has fascinated humanity since time immemorial. In his book Being Mortal, Atul Gawande writes about, how making life meaningful, instead of merely prolonging it, should be the goal of doctors. Joan Didion, in The Year of Magical Thinking writes, “A single person is missing for you, and the whole world is empty… I know why we try to keep the dead alive: we try to keep them alive in order to keep them with us. I also know that if we are to live ourselves, there comes a point at which we must relinquish the dead, let them go, keep them dead.”

When Breath Becomes Air is a memoir written by the late neurosurgeon Paul Kalanithi, in which he contemplates about death and life, faith and doubt. Kalanithi was at the beginning of his journey as a neurosurgeon, when he was diagnosed with stage IV metastatic lung cancer, and his promising life was cut short by the cruel hands of fate. What happened to Paul was tragic, but he himself was not a tragedy. He lived fully, sought the meaning of life, & wrote a life-affirming memoir for the posterity.

What is the option before us, when one day we discover that the future we’ve been planning for is no more there? Should we cry and curse our fate? Should we do what we always wanted to do in the time left? Shall we wait for death? What is death? What is the meaning of life? Where do biology, morality, literature, and philosophy intersect? This little, pithy book provides answers to these questions and more. Kalanithi was on the threshold of a life, for which he had prepared long and hard. He had multiple degrees from Stanford University, in English Literature, Human Biology and Philosophy. He attended Yale School of Medicine. He returned to Stanford for his residency training and fellowship in neurosurgery and neuroscience. Kalanithi was married to a fellow doctor Lucy Kalanithi. He discusses how the heartbreaking cancer diagnosis, which derailed his carefully planned future, saved his tottering marriage.

“I can’t go on. I’ll go on,” he promised himself to stave off the monolithic uncertainty of his future. Despite his body (and health) reduced to a mere shadow, Kalanithi decided to continue with his career as a neurosurgeon. “Even if I’m dying,” he writes, “until I actually die, I am still living.” For Kalanithi life wasn’t about avoiding suffering. He strove to achieve what he could achieve in the little time left with him.

In this book, he discusses his life before and after cancer. He shares his fears and his successes as a doctor. He talks about the sudden and painful transition from being a doctor to becoming a patient. “As a doctor, I was an agent, a cause; as a patient, I was merely something to which things happened.” Despite the unsettling fact and certainty of his death, he strove to achieve excellence. Life is fragile; howsoever prepared you are, you can’t prepare for the uncertainties of life. Sometimes potential goes unrealized, sometimes we miss success despite our meticulous planning. We can identify with Kalanithi’s state of mind after that dreadful cancer diagnosis, when he found himself lost and confused, as if someone had firebombed his path forward. But we find him later, having emerged stronger and fiercely determined to achieve something which he was always meant to do, writing this memoir where he peels off the absurd layers from the human condition. The book is an audacious attempt to solve the conundrum of human existence. Kalanithi talks about faith and death; he discusses the uncertainties of life; he talks about the dilemmas faced by the neurosurgeons. Death is a cruel, and a magnificent enemy, it always wins; yet, we can strive to be immortal through our equally magnificent deeds.

The book is an honest take on the dying moments of an extraordinary doctor. At times it becomes repetitious, with all those descriptions of the neurosurgery episodes, yet it is life-affirming. The book goes into those authentic moments, rarely witnessed by us mortals, when life and identity are under threat of being wiped out or extinguished. The book is mostly written with a scientific detachment, though there are some passages which choke you, like the one where Kalanithi discloses to his wife about his cancer the first time or the one where he leaves a message for his little daughter. The book has an abrupt ending, same as Paul’s life. The Epilogue of the book is penned by Lucy Kalanithi, and it achieves a poignancy seldom seen. Despite its poignancy and pathos, the epilogue is full of hope, and life itself. Ultimately, the book is a triumph, and not a tragedy. It teaches us to live in the moment because “We are never so wise as when we live in this moment.” The book gives us a message that:

“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

Read the book for its thoughtful contemplation of mortality.

Similar books:

  1. Being Mortal by Atul Gawande
  2. On the Move by Oliver Sacks
  3. The Diving Bell and the Butterfly by Jean-Dominique Bauby
  4. Saturday by Ian McEwan
  5. The Year of Magical Thinking by Joan Didion

© 2017, Bhupendra Singh

One comment

  1. I read this book and found it humbling as a healthcare professional myself. To be forced to live the life of the patients you treat everyday is enlightening and horrifying. Great piece. Enjoyed your review.

    Liked by 1 person

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