When Breath Becomes Air is a recent book by Paul Kalanithi. It documents his experience living with terminal lung cancer and his transition from doctor to patient. I finished reading this book last night and cannot stop thinking about it so where better to write my thoughts down than here? This is unlikely to be a conventional book review and more like a jumbled mess of thoughts, feelings and opinions so bare with me! Also, I cannot guarantee that this will be free from plot spoilers!
At the age of thirty-six, on the verge of completing a decade’s training as a neurosurgeon, Paul Kalanithi was diagnosed with inoperable lung cancer. One day he was a doctor treating the dying, the next he was a patient struggling to live. When Breath Becomes Air chronicles Kalanithi’s transformation from a medical student asking what makes a virtuous and meaningful life into a neurosurgeon working in the core of human identity – the brain – and finally into a patient and a new father. What makes life worth living in the face of death? What do you do when when life is catastrophically interrupted? What does it mean to have a child as your own life fades away? (Waterstones)
I had wanted to read this book since seeing it multiple times in Waterstones covered in glowing reviews. I love anything medical so I was already interested, and read it now as preparation for writing my (second) personal statement. The book is split into four parts: prologue, part I (In perfect health I begin), part II (Cease not till death) and an epilogue written by the author’s wife. I was drawn into the book right from the start, where the reader is plunged straight into the story mid-diagnosis. I personally loved this part as it included so much medical information such as symptoms and diagnostic tests. We also meet the main characters, Paul and his wife Lucy, and learn about their relationship and lives. This part of the book was written very factually, as opposed to the rest of the book which is littered with thought spirals, reflections, insights and rhetorical questions.
Part I chronicles Kalanithi’s journey to becoming a doctor, working his way through the ranks of neurosurgery. I really liked reading about how he ended up in medicine, and found his thinking to be very erudite, his constant search for answers to his questions was interesting to observe and his intelligence was palpable through reading. I liked the way the writing was scattered with personal anecdotes (my favourites being his mother’s perseverance and Leo getting into Yale) as they added an additional dimension to the story. During this first part I really struggled to remember that Paul Kalanithi was a real person as opposed to a mere character. There were certain sections of text where I did a double take as I realised that this was his life, not just a plot line. However, this obviously made for very interesting reading!
Part II documents Kalanithi’s life post-diagnosis, as he struggles to find an identity away from ‘patient’ now that he has lost ‘neurosurgeon’. Throughout the whole book, one word I would use to describe the writing is ‘raw’. It is persistently unflinching and unfiltered. I found this particularly evident in the second half of the book (albeit in a more subtle way) as the author struggles with his mortality and his future. This was most tangible to me when he is offered the job in Wisconsin and realises he is trapped in an almost limbo- unable to confidently pursue a future yet also unable to accept an approaching end.
In a way, I found part II of this book reminiscent of The Fault in Our Stars by John Green. Paul Kalanithi and the fictional Augustus Waters both shared a near obsession with living a life that was worthwhile and meaningful. In the epilogue, Lucy (Paul’s wife) says ‘if he doesn’t have a chance of meaningful time…’ I’m still processing my feelings towards this idea. At the end of the day, is time only worth having if it is meaningful? And then meaningful to who? If Kalanithi was intubated and comatose would his family not still appreciate an extra week with him (therefore meaningful time) or would it be best for all involved if the remaining time spent together was mere hours when Kalanithi was still lucid and could participate? While a cynical part of me argues that the idea of meaningful time is pretentious (like Hazel says in TFIOS ‘There will be no one left to remember Aristotle or Cleopatra, let alone you.’), I am also aware that this idea is overwhelmingly human. If faced with my own mortality, I am almost certain that my mind would jump immediately to making sure I did worthwhile things and that my time was spent with purpose.
This book is one that forces you to evaluate your own morals as you read. It can be very easy to judge the author as he rescues his ice cream sandwich from the trauma bay, but it is written with such honesty that you are forced to contemplate whether you should rightly be on the moral high ground I felt I was on whilst reading. I loved the philosophical side of this book, and would like to explore some of the ideas in it in more depth.
In conclusion I loved this book and would recommend it to everyone. Lovers of medicine will enjoy the frontline perspective of both patient and doctor, and those reading for pure enjoyment will appreciate the poetic and thought-provoking writing (although warning: there is a lot of medical terminology in here!)
Let me know if you have read this book or plan on reading it, and if you have any recommendations that are similar!