"For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living? 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 naïve 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. Advance praise for When Breath Becomes Air "Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi's memoir is proof that the dying are the ones who have the most to teach us about life."--Atul Gawande "Thanks to When Breath Becomes Air, those of us who never met Paul Kalanithi will both mourn his death and benefit from his life. This is one of a handful of books I consider to be a universal donor--I would recommend it to anyone, everyone."--Ann Patchett"-- "At the age of 36, on the verge of a completing a decade's worth of training as a neurosurgeon, Paul Kalanithi's health began to falter. He started losing weight and was wracked by waves of excruciating back pain. A CT scan confirmed what Paul, deep down, had suspected: he had stage four lung cancer, widely disseminated. One day, he was a doctor making a living treating the dying, and the next, he was a patient struggling to live. Just like that, the future he and his wife had imagined, the culmination of decades of striving, evaporated. With incredible literary quality, philosophical acuity, and medical authority, When Breath Becomes Air approaches the questions raised by facing mortality from the dual perspective of the neurosurgeon who spent a decade meeting patients in the twilight between life and death, and the terminally ill patient who suddenly found himself living in that liminality. At the base of Paul's inquiry are essential questions, such as: What makes life worth living in the face of death? What happens when the future, instead of being a ladder toward the goals of life, flattens out into a perpetual present? When faced with a terminal diagnosis, what does it mean to have a child, to nuture a new life as another one fades away? As Paul wrote, "Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnosis, I knew that someday I would die, but I didn't know when. But now I knew it acutely. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live." Paul Kalanithi passed away in March 2015, while working on this book"-- On the verge of completing a decade's worth of training as a neurosurgeon, Kalanithi was diagnosed with stage IV lung cancer. Just like that, the future he and his wife had imagined evaporated. Kalanithi chronicles his transformation from a naïve medical student 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.
3 1/2 stars
The author was a young neurosurgeon who learned he had metastatic terminal cancer when he was 36, just finishing his training. Throughout his life, Kalinithi sought to understand what it meant to live a meaningful life. This book represents the work he did, in his final year of a life cut tragically short, to convey as much as he could of what he learned. In the process, he shows us the dying that is part of living, not shrinking into the avoidance of death that is so prevalent in our faux-immortal culture that glorifies youth and vitality.
This is a beautiful work, a remarkable accomplishment were he not so ill, and yet no doubt not possible without the felt immediacy of his situation. Kalinithi managed to grieve, to fear, to lose, and still to love, to have courage, and to face reality with open eyes and steadfast clarity. He put a lifetime of thought and struggle with ideas into this book, and it fails him to try to summarize, other than to say that he squeezed every bit of meaning and purpose he could muster into his life and his remaining time. His love for his wife, his friends and his service through doctoring helped to sustain him. And in no small measure so did his infant daughter, conceived after his diagnosis. In his words, and though these are his final thoughts in the book, I think it is worth quoting them here because they will tell you much about him and about whether this is something you may want to read:
"There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past.
That message is simple:
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."
I am much the better for having read this.
The demands placed upon a medical student are tremendous. They are described in detail with a beautiful prose style that blends reality with metaphor in a seamless way. These demands are nothing compared to the demands that Paul placed on himself as he traversed the difficult course toward his twin goals of neurosurgeon and neuroscientist. His residency is described as a breathless experience, yet one that allowed him eventually to breathe a little as he observes, "By this point in my residency, I was more experienced. I could finally breathe a little, no longer trying to hold on for my own dear life." (p 88)
He describes the tension when operating on the brain or near the spinal cord; where minuscule movements can make the difference between life and death or, even worse, life without some necessary brain function. The suspense of these moments is palpable for the reader.
After being diagnosed with lung cancer and beginning to undergo treatment that, perhaps, might extend his life enough to provide at least the possibility or part of the life he had originally planned, he underwent periods of pain that made his life incredibly difficult. One thing from his earlier life became a life-saver, however temporary, for him. It is a moment when he shares, "Lost in a featureless wasteland of my own mortality, and finding no traction in the reams of scientific studies, intracellular molecular pathways, and endless curves of survival statistics, I began reading literature again: Solzhenitsyn's Cancer Ward, B. S. Johnson's The Unfortunates, Tolstoy's Ivan Ilyich, Nagel's Mind and Cosmos, Woolf, Kafka, Montaigne, Frost, Greville, memoirs of cancer patients--anything by anyone who had ever written about mortality." (p 148) He was trying to make sense of death and find a way to begin to define himself with a vocabulary that was meaningful and helpful. It was a vocabulary that would help him understand his own experiences. It was a process that worked as he concluded, "And so it was literature that brought me back to life during this time. . . I got out of bed and took a step forward, repeating the phrase over and over: 'I can't go on. I'll go on.' [Beckett]" (p 149)
He was able to return to work for a period of time. Not at the level he had been at when first diagnosed, but at a level that allowed him to contribute and attempt to be the surgeon he once was. But the joy was gone, and eventually the cancer returned. Paul writes eloquently of the final days with his wife and new-born baby. Yet his life did not have the longevity that his words would. His life, his breath, allowed him to share a story of fortitude and courage, becoming an inspiration for his family, friends, and all who have the honor to read his memorable memoir.
I bought this in hardcover form because I thought I would probably want to read it more than once, and I hope to have my kids each read it at some point. That made it much harder to save my favorite passages, though. I was stuffing little pieces of paper in it to mark pages, but sadly some of them fell out. But here are two short ones. One with some with humor:
"The good news is I've already outlived two Brontës, Keats and Stephen Crane. The bad news is I haven't written anything yet."
And one without:
"It occurred to me that my relationship with statistics changed as soon as I became one."
There is another I loved about hard decisions when one's loved one's quality of life has ebbed, but it is quite long and rather depressing. I might come back and add that later, or I might just keep that one to myself.
Paul Kalinithi was only 36 years old when an aggressive cancer took his life, a promising and talented neurosurgeon-neuroscientist. He somehow accepted his fate with grace and hard-won wisdom. Here are a few of his words -
"Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death - it's something that happens to you and those around you."
As someone who witnessed death on a regular basis, Kalanithi knew that "death always wins." It's a hard lesson to learn, but I think it's better to learn as much about it as you can. The closer you keep death in front of you during your life, the easier it might be to accept when your own time comes. One of the thing that Paul and his wife, now his widow, learned (and these are Lucy Kalanithi's words) -
"... we knew that one trick to managing a terminal illness is to be deeply in love - to be vulnerable, kind, generous, grateful."
Indeed. Lucy also shared this, in her Epilogue -
"At home in bed a few weeks before he died, I asked him, 'Can you breathe okay with my head on your chest like this?' His answer was, 'It's the only way I know how to breathe.'"
This is, no question, a very sad book, being about a talented young man's bright future cut short. But it's also a very brave book, full of wisdom, yearning, and love. Because Paul Kalanithi loved his wife, his new baby, his family, his work - life. But he left it bravely, and he left us this book, a resonating record of his last journey. Highly recommended.
- Tim Bazzett, author of the memoir, BOOKLOVER
"Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence – and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist."
To his infant daughter:
"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."
Well, this book was not what I expected. First off, I expected it to be a lot sadder. In fact, I didn't cry until the afterword, written by Kalanithi's wife. I also expected to be a bit terrified - frankly, when I read something that makes me think about the fact that one day I will cease to exist, I usually panic and cry and have to literally do everything I can to think about something else. Since this is a book written by a man facing a terminal cancer diagnosis, I expected to feel a lot of that existential terror. But I didn't, mainly because Kalanithi faced his death incredibly bravely and scientifically, which somehow made it less terrifying for me to think about. Obviously, I still don't want to die for a very long time, but now I hope that I could face it just a little bit better. Finally, I think this book makes clear that Kalanithi was a scientist above all else - if you're going into this expecting something about how to live your best life and not take things for granted, I think you'll be surprised. Yes, he does spend some time figuring out what he wants to spend his remaining time focusing on, but mostly, he focuses on the science of everything. A good read, if not quite the emotionally powerful one I expected.
In this memoir, he shares his thoughts about life, death, and suffering, both from a doctor's and a patient's perspective, and searches for meaning in his work, in literature, and in human relationships. It's deeply thoughtful, beautifully written, and poignant without ever being despairing. Looking mortality in the face is hard, but we all have to do it sometime, and I find I am rather grateful to Dr. Kalanithi for holding my hand for a moment and helping me take a good, long stare at it.
I think the world lost a good man when the author died, but I am very glad he took the time to share his story with us.
During his final year, Kalanithi completed his residency, had a baby with his wife Lucy, also a physician, spent long days in the OR performing complicated surgeries, and wrote this memoir. He learned to balance living and dying. Knowing that he did not have the time to pursue a career in research, yet pursuing his practice of neurosurgery while he was able.
Kalanithi’s first calling was writing. He graduated from Stanford with a B.A. and M.A. in English Literature and a B.A. in Human Biology, then earned an M. Phil in History and Philosophy of Science and Medicine from the University of Cambridge. In 2007, Kalanithi graduated cum laude from the Yale School of Medicine.
Kalanithi had the courage to enjoy the pleasure of time spent with his wife and baby daughter while knowing that his days were numbered and their future would be without him.
A sample of his wisdom and bravery is his advice to his infant daughter:
“When you come to one of the many moments in life when 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 story of Kalanithi’s life pulls you in right away. He begins with his diagnosis, and then backtracks to his childhood. All the while, he meditates on the meaning of life and death, particularly when he starts practicing medicine, and especially, when he is diagnosed with cancer:
“'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.'”
His writing is so intimate, so devoid of pretense and social distancing, that by the end, you will feel the devastation of having lost a very close friend, beyond regretting the loss to the world of a genuinely good person.
Evaluation: How do we manage to look death in the eye and face death with integrity? Kalanithi not only tells us, but shows us through the way he lived his final two years after receiving his diagnosis. Many reviews laud this book as life-affirming, and it is. In addition, it is replete with thought-provoking meditations on the meaning of life that have the immediacy and poignancy of one who must answer that question right then, at that moment. The author riffs on literature, shows his sense of humor, and shares many moments of joy. I laughed a lot, but cried more; this book filled me with a profound sadness. Nevertheless, I consider this book to be a must-read, and highly recommend it.
"As a doctor, I had had some sense of what patients with life-changing illnesses faced--and it was exactly these moments I had wanted to explore with them. 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 imagine 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.
Friendships and relationships are important to Paul, but he also does let his work interfere with them as he finds himself drawn to the profession of medicine in spite of his youthful vow. Before entering medical school, as an undergraduate he studies literature, philosophy, neuroscience and biology. He earns a masters in literature from Stanford, but realizes that literature as a profession doesn't fit for him. He ponders "...where did biology, morality, literature, and philosophy intersect?" While waiting for the medical school acceptance process he travels to England, earning another masters degree in the history and philosophy of science.
At Yale, he meets his future wife Lucy, another med student, and upon finishing, they travel back to Stanford, both immersed in residency, but his extends longer and their marriage suffers. A key turning point is when Lucy learns he is worried about his health, yet not confiding in her. She plans to move out to ponder their future.
Frustratingly, it seems to take Paul too long to aggressively pursue a diagnosis for his symptoms. When he finally makes an appointment, he does not see his usual attentive physician, but a brisk, businesslike substitute who discourages him from getting the MRI that would have revealed his cancer. She dismisses this as too expensive, and recommends an X-Ray for his back pain, something that won't reveal cancer. Paul almost meekly accepts this, and that was difficult to understand. By the time he does get the required tests, his body is riddled with cancer.
The diagnosis of metastatic lung cancer brings Paul and Lucy back together as they discuss whether to have a child (they do). Various treatments allow a return to neurosurgery, but the pace of this work is grueling and physically difficult. His excellent oncologist works with him to enable continuation toward completion of is residency. He does complete residency, but by then he knows he will never practice, the hoped for professorship at Stanford will not be his.
Paul's final days are full of reflection and life with his family including his new daughter. After his death, Lucy completes the book. In the forward, Abraham Verghese says he did not really know Paul Kalanithi until he read the book. As a reader, one does get the sense of truly knowing Paul, his gifts and flaws, and how much we lost.
In the first half of the book, Kalanithi discusses his life before being diagnosed with cancer. From a young age, Kalanithi had a deep love for reading and literature. He found that literature contained powerful messages about human life, and did so in a way that was profoundly meaningful. In this quest for meaning, Kalanithi became fascinated with the brain and its role in the complexities of thought and emotion that makes us who we are. This led him to pursue degrees in both human biology and English literature and later go on to medical school.
Kalanithi writes a lot about the type of doctor he wants to be. As a doctor, he often encountered his patients in extremely vulnerable and private situations, and he felt a strong need to recognize the sacred in each individual. He recognizes the importance of being present and understanding what is important to his patients so he can be with them as they contemplate the unfathomable questions of what life becomes when a tumor or removal of a tumor alters the brain. Who do we become when the brain is changed in such a profound way that it affects personality, language, or impulse control? Is a life with a completely altered identity and limited function worth saving?
The book is incredibly well written and very moving. Kalanithi touches on a lot of very heartbreaking issues that are hard to think about. Patients confronted with losing their language abilities, parents watching their children diagnosed with brain cancer, parents losing their babies only days after birth. His own joys in holding his infant daughter, and the pain of knowing he would not be there to see her grow up. There is no shortage of tragic stories in this book and it is an extremely emotional read, but worth it for me. The book is probably not for everyone, it packs quite the emotional punch, so proceed with caution.
Dr. Paul Kalanithi is in the prime of his life and career when he is diagnosed with stage 4 lung cancer. A lifetime lover of literature, philosophy, this book is his final offering to the world. It is part memoir of his early family life and life as a neurosurgical resident. It is part musing on the meaning of life and how knowing of your impending death changes how one lives. Dr Kalanithi chose to continue living while he was dying; this is a powerful message for all who read this book. Dr Kalanithi is a beautiful writer. Just as lovely as his words are those of his wife Lucy who relates the end of her husbands life and how she keeps him alive. Reading this important work brought many tears, and sadness that the life of this vibrant and brilliant man was cut short.
Just before completing a neurosurgery residency and launching a promising career as scientist/surgeon, Paul Kalanithi is diagnosed with advanced lung cancer.
This is an amazing book. Imagine Hemingway as a Yale PhD, transitioning from Dr/expert to patient at the mercy of the merciless.
A few sentences, but really the entire work rings like a temple bell.
'Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death is its cessation.'
'Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnoses, I knew that someday I would die, but I didn't know when. But now I knew it acutely. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live.'
Describing his feelings, after years of distilling probabilities and odds to patients and families: 'It occurred to me that my relationship with statistics changed as soon as I became one.'
The afterward, written by his wife describing his final days, is equally significant. His end was heroic. I can't recommend this book enough.