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'When Breath Becomes Air' Contemplates What It Means To Live — And Die

By all outward appearances, Paul Kalanithi had it all. Trained at a top medical school, his long years of residency nearly complete, the career he’d long dreamed of as a neurosurgeon was so close he could touch it. He spent his days among the sick and dying, but he had long ago come to terms with this, bringing to bear his training and skilled hands on those he could save; offering mercy to those he could not.

Cover for 'When Breath Becomes Air' (Courtesy Random House)
Cover for 'When Breath Becomes Air' (Courtesy Random House)

In his powerful memoir, “When Breath Becomes Air,” Kalanithi details his climb to the near-summit of the medical profession, as well as his all-too-fast descent due to the lung cancer that claimed him at 37. He spent his last year writing about his life on both sides of the doctor-patient divide, and we are the better for it. (The book is the top nonfiction seller on The New York Times lists.)

Kalanithi’s career in medicine began like many others, with necessary distancing that comes naturally to most of us. He indulged in the turning away and in the black humor that people in white coats sometimes embrace as a way to deal with the tragedies they must confront. Yet Kalanithi was better than that, and he knew it. A man who regularly turned to the greats of literature, from Montaigne to Eliot, he hewed to a higher moral code. Life, for him, could not be reduced to a punchline, and he knew that even if running away from someone else’s tragedy might save his sanity, it left in its wake a world of suffering.

As death became a regular companion during his years of residency at Stanford University’s hospital and clinics, Kalanithi didn’t coarsen. He wanted to know it inside and out from the perspectives of both doctor and philosopher. It was the kind of perfection that drove him to be a neurosurgeon, a line of work with little room for error but where one could save lives, salvage damaged minds and perhaps come to a greater understanding of one’s fellow man.

“Every operation on the brain is, by necessity, a manipulation of the substance of ourselves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact,” he writes. Through knowing his patients inside and out, Kalanithi sought to learn “What really matters in life.” During his residency — with days lasting sometimes 16-plus hours with hardly any time off — Kalanithi tried to see illness through the eyes of his patients and their families. At the time of his diagnosis, he was well on his way to becoming the doctor we all wish was in our corner when bad news arrived.

The cancer struck as Kalanithi was nearing completion of his medical training. For a man of such learning and seemingly innate wisdom, who by this point in the book the reader has come to respect and admire, it is a humbling moment. “[T]he future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated,” he writes.

Paul Kalanithi at the Stanford Hospital and Clinics, February 2014. ( Norbert von der Groeben/Stanford Hospital and Clinics )
Paul Kalanithi at the Stanford Hospital and Clinics, February 2014. ( Norbert von der Groeben/Stanford Hospital and Clinics )

Thus begins Kalanithi’s transition from doctor to patient. His wrestling with mortality was for naught, yet something pivotal was gained. He finally learned what was important by living it, and he did his best to share it with the rest of us. Nearly every page of “When Breath Becomes Air” has an underline-able turn of phrase or an aphorism you’ll want to commit to memory. Ruminations on time, the meaning of life and the nature of being fill these pages, and do so with an easy grace that belies the writer’s desperate straits at the time of composition.

Throughout the last half of the book, readers go along on Kalanithi’s rough ride, as he endures chemotherapy, enjoys a short remission, and battles to graduate from Stanford University School of Medicine, and even perform the neurosurgery that had once meant so much to him. After these victories, it is doubly heartbreaking to watch him quickly fade, as his cancer comes back with a vengeance.

Hence, the unknowable remains so. “When Breath Becomes Air” reminds us that this doesn’t mean we should spend our lives looking away from it.



John Winters works and teaches at Bridgewater State University. He is working on a biography of Sam Shepard which will be published next year by Counterpoint Press.

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