When Breath Becomes Air by Paul Kalanithi

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I finished this book, exhaled, and flipped back to the beginning.

Reading the late Paul Kalanithi’s spectacular memoir When Breath Becomes Air, a meditation about love, literature and science in the face of a terminal cancer diagnosis was a strange experience

“The good news is that I’ve already outlived two Brontes, Keats and Stephen Crane,” Kalanithi wrote to a friend. “The bad news is that I haven’t written anything.” He was trying to be funny, using the kind of dark humor you get from people facing the unfaceable. But it also revealed Kalanithi’s tremendous ambition. He wasn’t content with only being a celebrated scientist and doctor. He wanted to leave a mark on the planet.

And in the short 22 months he had left, Kalanithi managed to produce a stunningly beautiful, heart-achingly unfinished, bittersweet record of his time on this planet. And lucky for us, we’re privileged enough to be allowed to read it.  It may sound stupid, but I felt like I owed it to Kalanithi to read his book slowly and savor every word. But I was too hungry for that, and kept flying through the pages. After catching myself for the third time, I devised a new solution-I would just read the book twice in a row. Seems reasonable enough. But I didn’t expect both reads to happen on the same day.

Kalanithi took a strange and winding road to become a surgeon. He never thought he would end up in medicine; after all, that was what kept his cardiologist father away from home. His first love was with the written word, and he devoured any book he could get his hands on. His mother, he wrote, worried about her child and drugs, “never suspecting that the most intoxicating thing I’d experienced by far, was the volume of romantic poetry she’d handed me the previous week.”

With the intellectual curiosity and restlessness that would define him, Kalanithi got a B.A. and a M.A. in literature at Stanford, followed by a Master of Philosophy at Cambridge. His love of words serves him well throughout this book. Even this title is paraphrased from a 17th century sonnet:

You that seek what life is in death, 

Now find it air that once was breath. 

New names unknown, old names gone: 

Till time end bodies, but souls none.

            Reader! then make time, while you be,

            But steps to your eternity.

Eventually, Kalanithi found his calling in neuroscience. His decision to go to medical school was an effort to “forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” Kalanithi would have been a great doctor. He was a great doctor, possessing a deep understanding and empathy for the patients he saw. But he soon found himself on the other side of the doctor-patient relationship.

At the age of 36, Kalanithi, about to complete his final year of residency, learned he had lung cancer. He knew what was happening even before he saw the CT scan revealing multiple tumors. In that instant “the future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.”

Kalanithi’s writing teems with urgency. He’d put so much of his life on hold in order to finish his residency. As he and his wife went through marital troubles, he even assured her that everything would be different once he was done with his residency. Now, as that time was upon them, he needed to learn how to die instead. He was frustrated by the fact that he didn’t know how long he had left. The day he learned his prognosis, both everything and nothing changed. “Before my cancer was diagnosed, I knew that someday I would day, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when.”  He didn’t know what to do with the time he had left. Should he remain a surgeon? Write? He and his wife were planning on having children. Should he become a father?

In fact, Paul did become a father, and his dying message to his baby girl was the thing that turned me into a sniveling mess in a public place. When he writes about his daughter, it becomes apparent who this book is for. It’s a record for his daughter of the father she wouldn’t remember, and his final message to her has lingered with me ever since I closed this book.

“When you come to one of the many moments in life when 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.” 

Read this book. Recommend it to your friends. Spread the word. You won’t regret it.

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