Review: “When Breath Becomes Air” by Paul Kalanithi

I never cry when I’m reading. In fact, reading is not an outwardly emotional activity for me. Even when reading some of the most tragic and the most beautiful literature produced by English, I do not cry. This book changed that. This book broke that because it broke me in a multitude of ways. I was not prepared for the emotional roller coaster that was reading When Breath Becomes Air and I was not prepared for the beauty of it.  Nor was I prepared for the pain and loss that came at the end. When Breath Becomes Air is a book that will stick with me, a book that I will think about often, and a book that made me cry.

“Amid the tragedies and failures, I feared I was losing sight of the singular importance of human relationships, not between patients and their families but between doctor and patient. Technological excellence was not enough. As a resident, my highest ideal was not saving lives-everyone dies eventually- but guiding a a patient or family to an understanding of death or illness. When a patient comes in with a fatal head bleed, that first conversation with a neurosurgeon may forever color how the family remembers the death, from a peaceful letting go (‘Maybe it was his time’) to an open sore of regret (‘Those doctors didn’t listen! They didn’t even try to save him!’) . When there’s no place for the scalpel, words are the surgeons only tool.”

Paul Kalanithi was a neurosurgical resident with the world before him. The holder of degrees from Stanford, The University of Cambridge, and Yale  and countless awards, Kalanithi was in the position every resident hopes to be when he was diagnosed with lung cancer. At the age of 37, Kalanithi succumbed to his diagnosis leaving behind a wife, an eighth-month old daughter, and an unfinished manuscript.

Kalanithi opens the book reflecting on the first days after his diagnosis. He does not set out to take any cheap emotional shots, as he can’t afford that. The diagnosis is his, not imaginary, and he has no interest in entertaining. The opening is merely to get the cold facts of Kalanithi’s life out of the way so that he is free to reflect on his life both before and after his diagnosis.

That is the beauty of When Breath Becomes Air: the reflecting. Brilliantly and with painful honesty Kalanithi reflects not only his diagnosis but on life, both his personal life and the concept; being a physician; and the nature of humanity. He is probing and knowledgeable in his observations without being heady or pretentious. Kalanithi’s observations are more musings, thoughts of a person trying to get everything out on the page. Because of that, When Breath Becomes Air is incredibly relatable and unimaginable all at the same time.

“How little do doctors understand the hells through which which we put patients”

It is unimaginable that a man in his prime would suddenly succumb to cancer, that his life would be cut short without an obvious reason. Of course, when we hear these types of things we want to believe that the individual died with dignity and quiet grace. Maybe that was true for Kalanithi, I will never know, but I do know that he makes no pretenses as he reflects on his diagnosis. It is clear that he does not wish to die. He wants to live, to see his daughter grow up, to see the fulfillment of everything he’s worked for but that is not what he gets. Amazingly, he is not bitter as he confronts all of this. He isn’t passively accepting either. He fights and thrashes against it, but it does not seem to take the essence of him.

And this, I believe, is why he writes. He writes because of the diagnosis and the loss of his dreams. He writes to accept his reality, and he writes to preserve himself in the minds of not only those who knew him best but also those who never knew him. Because of When Breath Becomes Air, thousands of people will know Paul Kalanithi. They will know his story and that he died seemingly in the middle of it. They will know and see and hear. They will cry and mourn and laugh. And that is exactly why books exist and are worth reading.

When Breath Becomes Air is exquisitely beautiful in its humanity. It is honest and open in a memoirs rarely are, and it will remind you of all the good things that humanity has to offer. It is a must read that is well-worth the emotional roller coaster on which it will take you.


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