Book review of When Breath becomes Air by Paul Kalanithi

When Breath Becomes Air

Paul Kalanithi contemplated on the question of life and death of  two thirds of his life.  He was prompted to think about the self when he read a book at the age of fifteen, which claimed that mind is created totally by the physical brain. This led him to become a neurosurgeon, dissecting and understanding each part of the brain.  He died in his mid thirties, struggling with cancer which made him die, and deeply wrestling with meaning of life, that made him “live.”  

Paul started to explore this question of life, death and self-identity through literature.  T.S.Eliots Waste Land, Nuland’s How We Die, Montaigne’s That to Study Philosophy is to Learn to Die, Nabokov’s and Conrad’s writings informed his view of human connection, suffering and morals.  However, he was not just content to understand these concepts, he wanted to live them. “If the unexamined life was not worth living, was the unlived life worth examining?”

He then became a doctor and specialized in neurosurgery.  While treating every patient he struggled to “..understand his mind: his identity, his values, and what makes his life worth living, and what devastation makes it reasonable to let that life end.”  His interactions with terminally ill patients brought him face to face with their own questions about meaning of their lives.  For most of us, this question usually emerges only as we are nearing the end, but given his job, he faced it everyday.

Above all, he really understood what it meant to live, only when he was faced with his own imminent death.  When you have only a few months or maybe a couple of years to live how do you find the strength and purpose to continue a grueling medical residency.  Working ceaselessly knowing that you may not even graduate and become an attending physician.  “Does the confirmation of [advanced cancer] absolve me from my duty to my patients……Yes, I thought….like a runner crossing the finish line only to collapse, without the that duty to care for the ill to push me forward, I became an invalid.”

Paul found the strength to continue his residency through his deep understanding of what Nietzsche and Darwin wrote about–that striving is a basic human characteristic.  He often remembered Samuel Beckett’s line: I can’t go on. I’ll go on.

There is a moving description of how Paul and his wife, Lucy, decide to have a baby at an advanced stage of his cancer.  Putting all the practical caution aside of bringing in another life and caring for it, they made the life affirming decision to have a baby.

Towards the very end, Paul rediscovers his faith as well.  All this life he was a stout atheist believing “Occam’s razor cut the faithful free from blind faith.  There is no proof of God; therefore, it is unreasonable to believe in God.” He eventually reached the empty hole of realization that science provides no meaning, only a description of life. He finds solace in Christian values of sacrifice, redemption and forgiveness. He believes that “mercy trumps justice every time.”

He continued to strive to the very end, as a doctor, as a writer, as a father, and then breathed his last. He never took the artificial respirator, when his lungs gave in, his breath became air.

Besides the deep philosophical and life affirming thoughts, the book is written beautifully.  It has several rich sentences. For example, while describing how he communicated critical diagnosis to terminally ill patients he says,”A tureen of tragedy is best allotted by the spoonful.”   To describe his medical training, he says, “You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”  Describing how medical prognosis which puts a statistic on survival rates, he says, “The angst of facing mortality has no remedy in probability.”

It is a beautifully crafted book with a meaningful message that was lived through an authentic life.