When Breath Becomes Air by Paul Kalanithi (review)

When Breath Becomes Air is a book dedicated to the idea of time and mortality. It is both a devastating and comforting book from a man who spent the majority of his life grappling with how to live a meaningful life, and his book explores that necessary theme. Dr. Paul Kalanithi takes the reader on an emotional and moving memoir of family, medicine, and literature. When Breath Becomes Air brims with insightful reflections on mortality that are especially moving coming from a trained physician familiar with what lies ahead. Throughout his memoir, Kalanithi wrestles not only with the concept of time, death, and meaning, but also with expectations, goals, and living. Markedly, Kalanithi ponders what makes life meaningful in the face of death and decay.

The book opens with Kalanithi flipping through CT scans of an obvious diagnosis of lung cancer. This was nothing new to him; as a neurosurgical resident entering his final year of training, he’d examined scores of such scans – the only difference with this one: it was his own. At the age of 36, after 10 years of relentless training and within months of completing his neurosurgical fellowship, Kalanithi was diagnosed with stage IV lung cancer. That morning, he was a doctor treating the dying and fielding job offers from major universities, and by lunch, he was a patient struggling to live. Now, Kalanithi sits as a terminal patient in the same hospital where he’d explained complex operations and terminal diagnoses to patients, where he’d pronounced patients dead, and where he’d congratulated patients on being cured of a disease. His life had been building potential; potential that would now go unrealized. With those scans, the future he’d imagined vanished, and just like that, he faced the same existential plights his patients faced. Death, so familiar to him in his work, was now paying him a personal visit.

When Breath Becomes Air chronicles Kalanithi’s transformation from an ingenuous medical student “possessed”, as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a neurosurgeon at Stanford University School of Medicine, and ultimately into a patient and father confronting his own mortality. He begins by taking us through his childhood, when he knew he would never be a doctor. Medicine, to him, meant absence. Specifically, the absence of a father growing up, who went to work before dawn and returned in the dark. Instead, Kalanithi had a love of books – endless books. It was his mother who sparked his intense passion for books. In a quest to see her children educated, she drove them great distances to PSAT, SAT, and ACT prep classes; compiled a mandatory reading list that included literary classics such as 1984 and The Count of Monte Cristo; and demanded advanced placement classes be added to their school’s curriculum – she single-handedly transformed the school system. It was from his mother, Kalanithi posited, that books became his closest confidants and drug of choice.

His love for books and language only grew as he completed his BA and MA at Stanford and MPhil at the University of Cambridge. Yet, after all of his tutelage, Kalanithi was unsatisfied with the answers he’d amassed regarding life and death. He believed the answer rested at the intersection of morality, literature, philosophy, and biology. Notably, he argued that direct experience of life-and-death questions was essential to generating substantial moral opinions about them; he wanted that direct experience. Thus, it was only by practicing medicine that he could pursue a serious biological philosophy. And so, Kalanithi went on to graduate from Yale School of Medicine and then completed his residency and postdoctoral fellowship in neuroscience at Stanford. He had started in this career, in part, to pursue death: to embrace it, demystify it, and see it eye-to-eye. Sadly, it was towards the end of his medical training that Kalanithi received the devastating news of his diagnosis. This direct experience had led him away from literature and academic work...