When Breath Becomes Air

Author: Paul Kalanithi

Reviewed by David Freedman

The reviewers of Dr. Paul Kalanithi’s extraordinary book are unanimous: powerful and poignant; devastating and spectacular; life affirming; filled to the brim with joy, humour and meaning. Yet it is the words of the New York Times reviewer – “finishing this book and then forgetting about it is simply not an option”- that truly resonated with me.

Dr. Paul Kalanithi seemed to have it all. He was a gifted writer with a B.A. and M.A. in English literature, an M.A. from Cambridge and an MD from Yale. With multiple career offers, he was completing his residency in neurosurgery at Stanford when diagnosed with metastatic stage IV lung cancer. He turned to writing this book, which consists of two parts: Part I. “In Perfect Health I Begin”; and Part II: “Cease Not till Death.”

In Part I, we follow the education and career path of a man who was a gifted doctor and writer, both of which he pursued with compassion and brilliance. Talking to a patient terrified of brain surgery, he calmly presented the options, meeting her “in a space where she was a person, instead of a problem to be solved.” Elsewhere in the book, he comments that before operating on a patient’s brain “I must first understand his mind: his identity, his values, what makes his life worth living and what devastation makes it reasonable to let that life end.” How can one not be moved when Dr. Kalanithi puts forward: “the physician’s duty is not to stave off death or return patients to their old lives but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face and make sense of their own existence.”

Part I ends and Part II begins without transition. Paul and Lucy are lying in a hospital bed, crying, with the CT scan images still glowing on the computer screen. Yet Part II is not as sad as might be expected. It is full of hope and warm family moments. It is authentic in addressing the important decisions to be made while Paul is still alive.

Dr. Kalanithi died at age 37 before completing his book and the extremely moving epilogue is written by his wife, Dr. Lucy Kalanithi. If you choose to read this book, and remain composed through Parts I and II, Lucy’s epilogue is the ultimate challenge. Do not even try to hold back the tears. Just rejoice in the fact that you have come through an exceptional autobiographical and literary experience that, while heartbreaking, is heartwarming and full of life.