When Breath Becomes Air Hardcover – Deckle Edge, January 12, 2016

I read this book in one sitting, long after the lights should have been turned off. I felt like not doing so would have been a disservice to Paul Kalanithi. After reading the book I felt stunned and hopeful in equal parts. Stunned because of the realization that someone as prodigiously talented and eloquent as Dr. Kalanithi was taken from the world at such an early age. Hopeful because even in his brief life of thirty-seven years he showcased what we as human beings are capable of in our best incarnations. His family can rest assured that he will live on through his book.

When Breath Becomes Air details Dr. Kalanithi's life as a neurosurgeon and his fight against advanced lung cancer. Even in his short life he achieved noteworthy recognition as a scholar, a surgeon, a scientist and now - posthumously - as a writer. The book is a tale of tribulations and frank reflections. Ultimately there's not much triumph in it in the traditional sense but there is a dogged, quiet resilience and a frank earthiness that endures long after the last word appears. The tribulations occur in both Dr. Kalanithi's stellar career and his refusal to give in to the illness which ultimately consumed him.

The first part of the book could almost stand separately as an outstanding account of the coming of age of a neurosurgeon and writer. Dr. Kalanithi talks about his upbringing as the child of hardworking Indian immigrant parents and his tenacious and passionate espousal of medicine and literature. He speaks lovingly of his relationship with his remarkable wife - also a doctor - who he met in medical school and who played an outsized role in supporting him through everything he went through. He had a stunning and multifaceted career, studying biology and literature at Stanford, then history and philosophy of medicine at Cambridge, and finally neurosurgery at Yale.

Along the way he became not just a neurosurgeon who worked grueling hours and tried to glimpse the very soul of his discipline, but also an eloquent writer. The mark of a man of letters is evident everywhere in the book, and quotes from Eliot, Beckett, Pope and Shakespeare make frequent appearances. Accounts of how Dr. Kalanithi wrested with walking the line between objective medicine and compassionate humanity when it came to treating his patients give us an inside view of medicine as practiced at its most intimate level. Metaphors abound and the prose often soars: When describing how important it is to develop good surgical technique, he tells us that "Technical excellence was a moral requirement"; meanwhile, the overwhelming stress of late night shifts, hundred hour weeks and patients with acute trauma made him occasionally feel like he was "trapped in an endless jungle summer, wet with sweat, the rain of tears of the dying pouring down". This is writing that comes not from the brain or from the heart, but from the gut. When we lost Dr. Kalanithi we lost not only a great doctor but a great writer spun from the same cloth as Oliver Sacks and Atul Gawande.

It is in the second part of the book that the devastating tide of disease and death creeps in, even as Dr. Kalanithi is suddenly transformed from a doctor into a patient. It must be slightly bizarre to be on the other side of the mirror and intimately know everything that is happening to your body and Dr. Kalanithi is brutally frank in communicating his disbelief, his tears, his hope and his understanding of his fatal disease. It's worth noting that this candid recognition permeates the entire account. Science mingles with emotion as compassionate doctors, family and a battery of medications and tests become a mainstay of life. The painful uncertainty which he documents - in particular the tyranny of statistics which makes it impossible to predict how a specific individual will react to cancer therapy - must sadly be familiar to anyone who has had experience with the disease. As he says, "One has a very different relationship with statistics when one becomes one". There are heartbreaking descriptions of how at one point the cancer seemed to have almost disappeared and how, after Dr. Kalanithi had again cautiously made plans for a hopeful future with his wife, it returned with a vengeance and he had to finally stop working. There is no bravado in the story; as he says, the tumor was what it was and you simply experienced the feelings it brought to your mind and heart.

What makes the book so valuable is this ready admission of what terminal disease feels like, especially an admission that is nonetheless infused with wise acceptance, hope and a tenacious desire to live, work and love normally. In spite of the diagnosis Dr. Kalanithi tries very hard - and succeeds admirably - to live a normal life. He returns to his surgery, he spends time with his family and most importantly, he decides to have a child with his wife. In his everyday struggles is seen a chronicle of the struggles that we will all face in some regard, and which thousands of people face on a daily basis. His constant partner in this struggle is his exemplary wife Lucy, whose epilogue is almost as eloquent as his own writing; I really hope that she picks up the baton where he left off.

As Lucy tells us in the epilogue, this is not some simple tale of a man who somehow "beats" a disease by refusing to give up. It's certainly that, but it's much more because it's a very human tale of failure and fear, of uncertainty and despair, of cynicism and anger. And yes, it is also a tale of scientific understanding, of battling a disease even in the face of uncertainty, of poetry and philosophy, of love and family, and of bequeathing a legacy to a two year old daughter who will soon understand the kind of man her father was and the heritage he left behind. It's as good a testament to Dr. Kalanithi's favorite Beckett quote as anything I can think of: "I can't go on. I will go on".

Read this book; it's devastating and heartbreaking, inspiring and edifying. Most importantly, it's real.

Sometimes you don’t go out and find a book; the book finds you. Facing an impending loss without a foundation of faith to fall back on, I find myself asking, “What is the meaning of life if we’re all just going to die?”

Paul Kalanithi answers that question in the most meaningful way possible in his outstanding book. A 36-year- old neurosurgeon, Paul wrestled between medicine and literature as an eventual career. Medicine won out and he was just on the cusp of a stellar trajectory when he was diagnosed with metastatic lung cancer.

Paul nurtured a passionate belief in the moral dimensions of his job. He also strongly believed that the relational aspect between people undergirded meaning and that life’s meaning has everything to do with the depth of the relationships we form in our journey. He says this, “The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win …You can’t ever reach perfection, but you can believe in an asymptote toward which are ceaselessly striving.

Just as his surgeon’s scalpel eased disease of the brain and saved lives, his words give reasons for living. The grace with which he navigates his journey – from a top-rated surgical resident to writer to his most important role of all, husband and father of a young daughter – his book is ample testimony to how one life well-lived can continue to create such a great impact.
In the foreword by fellow doctor and writer Abraham Verghese, that doctor writes, “He (Paul) wasn’t writing about anything—he was writing about time and what it meant to him now, in the context of his illness.” And in the afterword by his wife Lucy, the meaning of that time becomes even clearer. I felt the sense of having lost a personal friend.

Let me make this clear if I haven’t already: this is NOT a self-pitying, manipulative memoir and it is not the reason I’m 5-starring it. It’s a beautifully written, insightful, page-turning book on how we connect as humans and why life – no matter how truncated – is worth living. I will be recommending this strongly to just about everyone in my life.

At the age of thirty-six, Paul Kalanithi is diagnosed with stage IV lung cancer. “When Breath Becomes Air” is his unfinished memoir. From an early age, Paul became interested and searched for what makes life meaningful. This book walks us through some of the profound moments of Paul’s life, what he saw and how he felt, and how these events impacted and shaped his life.

It was Paul’s love of literature, and his interest in biological philosophy that would one day lead him to become a neurosurgeon. Books and words connect people and it’s this connection – relationships – that make life meaningful. The process of experiencing life occurs in the brain, but sometimes the brain is broken or isn’t working properly. Paul wanted to help people, and to understand for himself, just what makes life worth living.

The beautifully written epilogue, which was written by his wife Lucy, will break your heart, and give you hope at the same time. Here are a couple of quotes from this section.

"… [W]e knew that one trick to managing a terminal illness is to be deeply in love-to be vulnerable, kind, generous, grateful."

"I expected to feel only empty and heartbroken after Paul died. It never occurred to me that you could love someone the same way after he was gone, that I would continue to feel such love and gratitude alongside the terrible sorrow, the grief so heavy that at times I shiver and moan under the weight of it."

This was a beautiful story that made me cry, it made me think, it made me appreciate life, and I will never be the same because I read it.