May 31, 2016

When Breath Becomes Air

When Breath Becomes Air by Paul Kalanithi
Nonfiction - Memoir
2016 Random House
Finished on February 4, 2016
Rating: 3.5/5 (Good)

Publisher's Blurb:

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 Kalanitihi'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 faces 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.

I read Paul Kalanithi's touching memoir over the course of three days. I enjoyed the first half of the book quite a bit more than the second half, which became more heavily focused on his philosophical views about death and the meaning of life. The first half was more about his youth and career path to becoming a neurosurgeon. The epilogue, which is written by Paul's wife, Lucy, is beautifully articulated and extremely touching, as is the foreword, which is written by Abraham Verghese.
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 hands, 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 silences between his words, listen to what you have to say back. Therein lies his message. I got it. I hope you experience it, too. It is a gift. Let me not stand between you and Paul.
On Books:
After I was caught returning at dawn from one such late-night escapade, my worried mother thoroughly interrogated me regarding every drug teenagers take, never suspecting that the most intoxicating thing I'd experienced, by far, was the volume of romantic poetry she'd handed me the previous week. Books became my closest confidants, finely ground lenses providing new views of the world.
On a Life Worth Living:
While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability--or your mother's--to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand's function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?
On Neurosurgery:
Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death. I had thought that a life spent in the space between the two would grant me not merely a stage for compassionate action but an elevation of my own being: getting as far away from petty materialism, from self-important trivia, getting right there, to the heart of the matter, to truly life-and-death decisions and struggles... surely a kind of transcendence would be found there?

Final Thoughts:

I had such high hopes for this memoir. Overall, I thought it was pretty good and I'm glad I read it, but I didn't find it to be quite as amazing as other readers have stated. It's a sad story, but not one that brought me to tears. Atul Guwande's Being Mortal had a much stronger impact on me. But to be fair, they aren’t really all that similar. Being Mortal is about the care of our aging community (whether that be in a nursing home or staying within the family home), as well as hospice care and the death of loved ones. This resonated strongly with me as my parents, while healthy and active, are both in their 80s. Discussions about their wishes for their future care is an important topic and Gawande’s book helped shed light on issues I hadn’t considered. When Breath Becomes Air is about a young man’s career as a neurosurgeon and his untimely death to cancer. I was fascinated with the medical segments of the book, intrigued by neurosurgery and the treatment of diseases associated with that area of expertise. However, I grew frustrated with the author’s desire to continue working when he was so ill. Not only did I feel that he was putting his patients at risk, but also that he was robbing his wife and daughter of valuable time together with him in his final months. And yet, to compare the two books is the proverbial comparison of apples to oranges. Both are worthwhile and stand on their individual merits.


  1. Think I enjoyed (if that's the word) this more than you did. I was sobbing while listening to the end. Being Mortal is the better book in my opinion, but they are so different... both 5 stars for me.

    1. JoAnn, I wonder if I would have had a different reaction to the audio version. Hearing the words spoken, especially the epilogue, might have had me sobbing, too.

  2. I've heard many good things about When Breath Becomes Air and do want to read it but I don't think I'd like the philosophical parts either.

    1. Kathy, it's been a hit with so many readers. I think you'd probably enjoy it.

  3. "Being Mortal" it is then. I've been tossing around which one to read and I can only read so many books at a time on the subject.

    1. Lisa, I'll be interested to hear your thoughts once you've read the book. Being Mortal is pretty much what made me and my husband decide to move to Oregon next year. We want to be closer to my mom as she ages since she's alone. We're really looking forward to being able to help her with her day-to-day activities.


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