When Breath Becomes Air - Paul Kalanithi

Reviewer’s note –

‘When Breath Becomes Air’ ignites an overwhelming response in you. Life isn’t about avoiding agony. The defining characteristic of an organism is striving. ‘When Breath Becomes Air’ recounts the life of Dr. Paul Kalanithi, a neurosurgeon diagnosed with lung cancer during his last year of residency. With elegant and beautiful prose befitting a novelist more than a doctor, Paul guides readers through his journey before and after his diagnosis, a life marked by a search for understanding death and the will to survive. There is so much here that lingers, and not just about the matters of life and death.

Throughout the book, Paul takes us on his journey through medical school and into his practical training as a neurosurgical resident. He walks us through his work with patients, learning that there was more to be a doctor than merely diagnosing and treating. He became a beacon for his patients, providing a safe harbor for them to traverse the transition from the routine they followed to whatever lay on the other side after a traumatic brain injury.

Part of this book’s tremendous impact comes from the obvious fact that its author was such a brilliant polymath. And part comes from the way he conveys what happened to him — passionately working and striving, deferring gratification, waiting to live, and learning to die. None of it is maudlin. Nothing is exaggerated. As he wrote to a friend: “It’s just tragic enough and just imaginable enough.” And just important enough to be unmissable.

Book Review/Summary -

In the first part of the memoir, Paul realizes that there is also a price to the empathy he offers, because it makes him open and vulnerable, and in the field, he has chosen, many patients die regardless of his efforts. Still, he never questions whether his work is worthwhile. In the middle of residency, doctors train in additional fields, and Paul opts to study neuroscience. While Paul works at the lab, his mentor is diagnosed with pancreatic cancer, but after treatment, is able to return to work. Paul completes his work with the lab and enters his sixth year of residency.

Paul describes his sixth year as a black hole because he spent so many hours in the operating room. He never felt like time was passing when he operated because he was so intensely focused on the task at hand. Being technically precise, he stressed, was crucial because a mistake with a scalpel in brain surgery could be catastrophic. Some areas of the brain—primarily the ones that control language—are off-limits to surgery, because the risk of harming them is too severe.

As Paul nears the end of his residency, he once more becomes acutely aware of the weight of responsibility that doctors bear, when he learns that his friend from medical school, Jeff, had a patient die from a difficult complication. That evening, Jeff committed suicide. Paul wishes he could have shared with Jeff what he had learned thus far in his career: that death will always win, but it is still valuable to strive for one’s patients.

In the second part of the memoir, Paul returns to the day he is diagnosed with cancer. The tumor has invaded multiple organ systems, and he believes that his death is imminent. He meets with his oncologist, who steps him through his treatment plan but refuses to tell him the statistical probability of his death in order to allow him to remain optimistic.

Paul had grown weak leading up to his diagnosis, making basic functions difficult. His family works to help Paul adjust to a new life and cope with the turmoil. When tests conclude that Paul’s cancer is treatable because of a mutation, he grows more eager for a healthy future.

He wrote his book with great determination but also great difficulty, to the point of wearing silver-lined gloves to use the trackpad when his fingertips began to crack during chemotherapy. But the difficulty isn’t visible: Dr. Kalanithi knows how to make a paragraph fly. And the book opens with a beauty, quoted here to show its swift economy and precision:

“I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I’d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.”

We build scientific theories to organize and manipulate the world, to reduce phenomena into manageable units. Science is based on manufactured objectivity and reproducibility. This book highlights that, as strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature of human life, which is unique, subjective, and unfathomable. Science may provide the most useful way to organize empirical, data, but, its power to do so, is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering and above all virtue.

Happy Reading.