When Breath Becomes Air

WHEN BREATH BECOMES AIR is a finely written, wretchedly beautiful account of one neurosurgeon’s struggle with lung cancer. By now, I’m sure you’ve heard the premise of this sensational book: Thirty-six-year-old Paul Kalanithi spends his whole life training to fulfill his destiny: to become a neurosurgeon. Different paths lead him to the profession – studies in English literature, philosophy, biology, and ethics bring him, eventually, to Stanford, where he’s poised to become one of the best neurosurgeons in the world.

And then his life changes: lung cancer just when things are finally starting to get good. Now the book becomes beautiful, truly shimmering. Death becomes not the enemy but the inevitable end, the thing which gives all else its meaning. And so what begins as a biography, a list of admirable milestones reached and challenges overcome, turns into something different, a story raw and yet perfectly controlled, a humble account of the time one young man faced his death.

For Kalanithi looks death straight in the eye. In the book’s tugging Epilogue, Kalanithi’s wife Lucy writes, “Paul faced each stage of his illness […] not with bravado or a misguided faith that he would ‘overcome’ or ‘beat’ cancer but with an authenticity that allowed him to grieve the loss of the future he had planned and forge a new one.”

Reminiscent of Jill Bolte Taylor's MY STROKE OF INSIGHT, Kalanithi’s descriptions of the mind – and his symptoms – are remarkable, and remarkably interesting. As a neurosurgeon, Kalanithi knows just where to press in the brain to make someone feel unutterably sad. He knows what makes people speak in numbers, not in words, and he muses upon the value of language to a life – what is living without words, for example? What does it mean to survive without the ability to listen – or to speak? When does death become a blessing? When does the doctor make the choice to pull the plug?

WHEN BREATH BECOMES AIR is a gift to the world. As Lucy writes in the Epilogue, Kalanithi would certainly have saved many lives had he lived. He would have comforted and cured and guided and grieved so many times, in a relationship “that sometimes carries a magisterial air and other times, like now, was no more, and no less, than two people huddled together, as one faces the abyss.”

With a mastery of language and an appreciation for the work that came before—explorations of prose by T.S. Eliot and Graham Greene, and even analysis of the Scripture itself—Kalanithi writes not only from a doctor’s perspective, a scientist’s, but also from that of an artist and a lover of beauty. The book, though considered unfinished, is nevertheless flawless, so tightly bound and emotionally wrought as to be unforgettable.

Most poignant about Kalanithi’s narrative is his examination of Lucy’s and his decision to have a child. Despite the death sentence of his cancer diagnosis, Kalanithi and Lucy conceive a daughter. Eight months after she’s born, Kalanithi dies. His final words – both to the reader and to his child – are these, which I’ll leave you with, dear reader:

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.

May we give thanks for every day, because each one is a gift, and we’ve only got so many.