Paul Kalanithi’s When Breath Becomes Air

I wanted to include When Breath Becomes Air in my medical nonfiction roundup, but this memoir takes a different path and deserves its own standalone post. (After this I’ll return to non-medical topics next week, I promise!)

I came across a coffee-stained copy (I hope it’s coffee) in my neighborhood’s Little Free Library while I was dropping off a cookbook and decided to give it a chance, especially since I could drop it back there if I didn’t like it.

Instead, I spent two evenings reading and crying over this book and everything it made me feel and consider and I can’t recommend enough that you do that too, even if that sounds unappealing and although I suspect I’m the last person to discover it.

Of course I was familiar with the hype around it since its publication in 2016, after author Paul Kalanithi had already passed away. But it’s not my typical fare — nothing among the ostensible ideas covered here of death, grief, or reckoning with medical horrors appeal to me. It’s also not easy to come to terms with whether one has lived a life of meaning, especially when dealing with the exhaustion of cancer and chemotherapy and the limited time to do anything at all, and reading about that can be uncomfortable as well.

And I’m not a “misery memoir” reader — although I love reading stories of people overcoming difficult situations or life events, or doing extraordinary things in tough times. And I don’t like tearjerking-anything. I say all this to convince you that it’s worth reading even if you shy from all this too.

Considering our own mortality is always going to be a fraught subject, as is the topic of medical anomalies with the worst outcome. Which is what confronted Stanford resident and Yale-educated neurosurgeon Kalanithi, who at 36 years old, nearly finished with a decade of medical education and residency was diagnosed with stage IV metastatic lung cancer. He would have about two years to live.

In that time he had big, unimaginable decisions to make while faced with nothing but uncertainty. This was mortality making itself known, and as he points out we all know death is coming, but rarely do we face the possibility that it may be tangibly soon, when we’re so young with so many plans that suddenly have to be scrapped for entirely new ones that you never imagined having to make.

For Paul and his wife Lucy, this included deciding whether to have a child while knowing that his cancer, after another tumor appeared despite initially successful treatments, would almost certainly be fatal within a handful of years.

They moved forward with that plan anyway, and he got to meet his daughter and know that something of him will continue existing even after he’s gone. It’s a devastating moment and the words he writes to his daughter at the end of the book make me ugly cry even remembering them.

What I loved most was his honesty. With diagnoses or revelations like this, the unimportant just falls away so quickly and clearly. But to see that he still included mention of their marital difficulties before his diagnosis impressed me greatly — just that unusual level of transparency. There was no glossing over the truth; this is what it was, so he told their story truthfully.

It’s moving to see him change from doctor to patient — to having helped usher so many patients and their families through their worst nightmares of diagnoses, illness, death, as well as the triumphs of surgical successes — to becoming a patient himself.

And what makes it so incredible to read is not only his impressive intelligence and passion as he discusses his path to neurosurgery, but his joint background in medicine and English literature (he had an MA in English Lit from Stanford). He loved TS Eliot and quotes him liberally, and ties in ideas around word origin as they take on new meaning from his changed perspective. My favorite was “The root of disaster means a star coming apart, and no image expresses better the look in a patient’s eyes when hearing a neurosurgeon’s diagnosis.” I mean, my god.

There were a few elements I didn’t enjoy; for one, I had trouble following some complex reasoning around religion, but what’s even the point of discussing these things when the whole thing is so extraordinary? Just the fact of its existence humbles me. He didn’t get to finish writing it but his wife wrote a touching conclusion, as well as fulfilling her promise to get it published. It breaks my heart and is the most beautiful testament to a deep love that I can imagine.

May we all be capable of summoning the kind of grace and strength he showed in his life when we need it.

When Breath Becomes Air, by Paul Kalanithi (Bookshop.org)
published 2016 by Random House