When Breath Becomes Air – Paul Kalanithi

If you ever needed a reminder that life is short and you never really know what’s coming, When Breath Becomes Air is it. This memoir details how neurosurgeon Paul Kalanithi’s life was “catastrophically interrupted” by a metastatic lung cancer diagnosis at the age of 36. He wrote this book in the late stages of his illness, and it was published posthumously in 2016.

Kalanithi is in the last year of his residency at Stanford University when he notices a few odd symptoms. At first, he thinks they could all be attributed to age, or the stress of the job: weight loss, back pain, that kind of thing. His marriage is also on the precipice of breaking down, so he has a lot of stuff competing with the aches and pains for his attention.

When the symptoms don’t abate, Kalanithi’s medical training kicks in. He suspects cancer long before he receives the Official diagnosis. His wife is a doctor too, and she is equally concerned.

Kalnithi checks into the hospital where he works, and he’s sitting in the very room where he had examined patients for years when he becomes one himself. In the blink of an eye, his life span has radically shortened (though his oncologist is reluctant to say by just how much), and he’s undergoing a barrage of treatments that may ultimately make him sicker than the cancer itself.

The question at the heart of When Breath Becomes Air – “what makes life meaningful enough to go on living?” (page 71) – is one that Kalanithi first considered as a curious undergraduate, studying philosophy and literature. The question took on new layers as a neurosurgeon-in-training, learning how to make life and death decisions for his patients, and then again, as a patient himself, making his own decisions about what his life could be with terminal cancer.

In Kalanithi’s account, he was already an unusually empathetic doctor with a deep understanding of philosophy and regard for personal values prior to his cancer diagnosis. Still, he’s forced to reckon with a massive shift in perspective as the one wearing the hospital gown. “It occurred to me that my relationship with statistics changed as soon as I became one,” he notes, on page 134.

When Breath Becomes Air offers a unique perspective on medicine and mortality, one I’ve not encountered in any other memoir, and though it’s heartbreakingly sad, it’s also oddly motivating. Kalanithi’s account of the end of his life prompted me to have conversations with my loved ones – all thankfully alive and well, for the moment – about what they expect from end of life care, and what they value enough to fight for. I’m rarely that earnest, so it’s a testament to how moving I found this book.

Read When Breath Becomes Air on audiobook via Libro.fm here.

My favourite Amazon reviews of When Breath Becomes Air:

• “Bottom line is guy handles uncurable cancer well (especially when his almost-estranged wife returns) and tells you how wonderful he was about the experience. Too many memoirs are just to toot the author’s horn.” – A
• “Dr. Kalanithi obviously did not know much about nutrition—having lunches of diet coke and ice cream sandwiches—does not seem very healthy.” – aop
• “This is a dream book with a dream logic that the somnambulist public accepts uncritically. It is billed as nonfiction, but like the usual fiction book, it has no index. It is a medical narrative, but it has no glossary.” – Bernard M. Patten