When Breath Becomes Air by Paul Kalanithi

Jul 7, 2016

Chances are, this is not the first you've seen or heard of this book. Although it's still fairly new (published at the beginning of this year), it has been getting a lot of attention, all well-deserved, in my opinion.

Paul Kalanathi, a neurosurgeon/neuroscientist, was in his last year of residency when he was diagnosed with stage IV lung cancer. He was in his mid-30's, married, and had never smoked. With decades of school behind him, he was right on the cusp of all he had planned and worked and hoped for. But suddenly he found himself in the unfamiliar position of patient, redefining his life as he faced his own death.

He wrote, "The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I'd spend time with family. Tell me one year, I'd write a book. Give me ten years, I'd get back to treating diseases. The truth that you live one day at a time didn't help: What was I supposed to do with that day?"

Not knowing how much time he had left, Paul chose to write (among other things), and this book is the result. I suppose it's classified as a memoir, but that doesn't seem like quite the right genre for it. It's about Paul's life, yes--his upbringing in a little Arizona town with a cardiologist father, his decision not to go into medicine followed by the reversal of that decision several years later, meeting his wife, etc.--but rather than being the point of the book (as is the case in most memoirs), these life facts are merely the framework upon which Paul hangs his musings and insights and discoveries. Truthfully, Paul's story felt much more profound than any other memoir I've ever read.

I'm not sure if that's because the book itself is cut short by Paul's own death, and death tends to lend a certain gravity and depth to any story, or if it was because Paul had an insider's perspective unlike anyone else and knew how to distill those insights into words, or if it was the way parts of his story resonated and felt so familiar because of my sister-in-law, Alisa's death last year. I guess it was probably a combination of all of those things.

Cancer is heartbreaking no matter who it inflicts, but Paul's story feels particularly tragic, or even, more selfishly, unfair, because of the huge amount of good he would have done in the world. There were times in the book where Paul came across as maybe a little too self-assured, but never egotistical. He decided to go into neurosurgery because that was the very top of the medical totem pole. He did it for the right reasons ("The call to protect life--and not merely life but another's identity; it is perhaps not too much to say another's soul--was obvious in its sacredness."), but he was well aware of the sacrifices he was making for others and said, "Putting lifestyle first is how you find a job--not a calling."

And as if that wasn't elite enough, he also decided to delve into neurological research and become a scientist. Most people are not up to the rigors of such a combination (and, in fact, when Paul was diagnosed, his own marriage was in a rough patch, so he was not immune to the emotional and physical toll either), and that is why it was so devastating to see that life come to a much-too-early end. Paul was one of the few who was up to the task.

Paul said,  "My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced.  The lung cancer diagnosis was confirmed. My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit."

So . . . heartrending? Yes. But also so much hope and joy. After his diagnosis, Paul and his wife, Lucy, think long and hard about whether or not they want to have a child. They've always wanted a family, but the uncertainty of Paul's prognosis makes it difficult to plan. Lucy knows that at some point she will most likely be a single parent, but she also wonders about how a child will affect their marriage and whether it will make Paul's final days even harder. She asked him, "Don't you think saying goodbye to your child will make your death more painful?" Paul's answer struck me to the core, "Wouldn't it be great if it did?" I think in my own life, I'm always worried about being hurt. I've never really thought about the fact that being able to be hurt is actually a blessing because it means my life has been filled with opportunities to love and be loved.

I also loved the religious undertone of the book because it was never overbearing. Paul alludes to his own religious journey only briefly. His parents were devout Christians, but once he went to school, atheism made more sense to him. However, after a point, the pendulum swung back the other way as he considered life and meaning and realized how God could (and needed to) fit into the big picture. This definitely was not the point of Paul's story, but it was there, providing some foundation, and it made an impact on me.

I finished the book on the morning after the 4th of July. I was experiencing some post-reunion/holiday laziness and didn't want to get out of bed. So instead, I cried my way through the last twenty pages of this book. The epilogue is written by Paul's wife, and it made me weep far more than the rest of the book put together. Lucy has her own gift with words, and reading about Paul's final days and the way they loved and supported each other and also how she coped with her grief after he died touched my heart. This was one of my favorite moments: "At home in bed a few weeks before he died, I asked him, 'Can you breathe okay with my head on your chest like this?" His answer was 'It's the only way I know how to breathe.'"

After Paul was initially diagnosed and went through the first line of treatment (a pill called Tarceva), he wondered what he should do with his life. He was extremely weak and tired from everything he'd been through, but he decided to do whatever it took to return to being a neurosurgeon. "Why?" he asked, "Because I could. Because that's who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I'm dying, until I actually die, I am still living."

He did exactly that, returning to surgery, graduating, being offered his dream job, having a child, and writing a book, all in the space of 22 months from the time he was diagnosed until he passed away. He made me realize that death is not something to be feared as long as you live the life you have in the best way you possibly can.

Have you read this book? What are the things you'll remember from it? What sort of an impact, if any, did it make on you? 

P.S. Episode 7 of The Book Blab will air tomorrow, July 8th, at 1:00pm MST. You might want to tune into this one because Suzanne is here in Utah, so we'll be recording it in person! We're going to try out Facebook Live to film it, so click here to watch it. 


  1. Great review. I want to read this one, but there are long waiting lists at both the BYU and Provo libraries.

    If you liked this book, you've GOT to read All the Little Live Things. From what you wrote here, it sounds like there are lots of parallels.

    1. I know, I had to wait FOREVER for it too, and then when I finally got it, I put everything else aside to read it because there was no way I was getting back on that hold list!

      Okay, I will definitely put that on my list! Have you read Being Mortal by Atul Gawande? I thought When Breath Becomes Air went along really well with that one, too.


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