When Breath Becomes Air

As a young neurosurgeon, Paul Kalanithi had the difficult task of preparing patients and their families for death. As a brain surgeon his patients included everyone from young children with epilepsy, to teens shot in the head during gang violence, to people of all ages suffering from brain tumors.

Then there was the man who spoke only in numbers. He enunciated well, and spoke with a conversational lilt to his words yet no one understood him. The numbers signified nothing, and left him feeling more alone.

Unlike many doctors, Dr. Kalanithi enjoyed the challenge of discussing death with his terminally-ill patients. His undergraduate and graduate studies of philosophy and literature helped him make these talks both meaningful and helpful while always being cognizant of where the patient and family were coming from in their understanding of the patient’s condition.

But then in his last year as a resident when he was the chief neurosurgery resident at Stanford, he woke one day with intense back pain. He had a checkup but nothing serious showed, so he flew to upstate New York for a reunion with dear friends that he had long been anticipating.


His pain became so intense that he returned home early minus his luggage. His friends offered to send it realizing that Paul did not have the strength to carry it.  A visit to his GP and a few new tests showed that he was suffering from advanced lung cancer.

This book describes his odyssey from a curious boy in the Arizona desert to a man making difficult choices dying.  The high school boy who preferred romantic poetry to rock and roll to the man who worked eighteen hours a day wielding a scalpel and carving tumors from people’s brains.

It’s also about the difficult choices that dying in one’s prime brings. Should he gave up the neurosurgery he had trained so long and hard for? Or the experimental neuroscience that broadened his world? Should he and his wife have the child they’d long planned with the almost certain knowledge that Paul would only be there for the beginning of the baby’s life?

What this book vividly provides is a vivid look at what disease and mortality look like from both sides of the patient/doctor desk.  Paul felt strongly that a diagnosis of terminal cancer strongly affects a person’s very sense of self. It divides your life into two sections: the before knowing and the after knowing that one is dying.

He also had to learn to stop doctoring himself. To trust his oncologist, and also to surrender at times to the demands of the body.  This was one of the hardest lessons he learned.

This book is intimate, philosophical, and full of interesting information, everything from how brain surgery is actually done, to the original meaning of the word “patient.” It also describes the caring and deep love that he and his wife--another doctor--shared.

Kalanithi’s belief in the healing properties of literature threads through this moving book.  Paul always wanted to be a writer, so he pushed to create this book while his health deteriorated. Despite the somberness of the topic, this memoir’s deep search into how to life a good live even while dying is truly inspiring.