When Breath Becomes Air

When Breath Becomes Air is a memoir by Paul Kalanithi. It was published in 2016. Kalanithi tells the story of his battle with cancer while being a practicing neurosurgeon. The book is organized chronologically, following the trajectory of his life from childhood to death, and is laced with deep philosophical thought and literary prose. His meditations combine the expertise of a professional with the experience of a patient, resulting in a book that communicates extremely profound meaning about life and death.

Kalanithi grew up in Arizona, closely acquainted with nature and moments of solitude. He’d always loved reading and, upon entering college, studies biology and literature. It is during these years that he realizes the need to not only study but to live, to immerse himself in his surroundings. His master’s program in English literature proves unfulfilling, and he decides to pursue medical school.

Some of his clearest memories of medical school involve the study of cadavers. It is at this point that Paul first experiences the duality of practicing medicine. As he continues to learn and grow through his studies, he realizes the ways in which he becomes calloused to moments that might otherwise be traumatizing. The body exists as both miraculous and quotidian. He chooses neurosurgery as his concentration.

He marries his girlfriend, Lucy, after medical school and they move to California for their respective residencies. At Stanford, Paul often works a hundred hours per week, and, although the majority of his first year is spent pushing paperwork, he quickly gains responsibility for patients. Having experienced the spectrum of tasks at the hospital, he realizes the potential for good he has during every interaction with his patients. The proper tone during a brief counseling session can influence the patient’s entire outlook on his or her illness and recovery. As the years of his residency accumulate, Paul quickly rises to the top of his field, gaining a physical and emotional capacity in his work that qualify him for his dream jobs.

Paul, however, soon begins suffering symptoms that send him to the doctor. He’s unsure how to navigate his concern, which only pushes Lucy away from him. They are on the brink of separation when Paul is diagnosed with cancer.

In the years that follow, Paul works to finish his residency while coping with his illness. He pushes himself to continue working in the OR until he has to begin cancer treatment. He chooses a treatment plan–a pill–that is most likely to allow him to continue in his profession. It is during this time that he begins reconstructing what the rest of his life will look like. What if he cannot continue neurosurgery? What if he has one year to live, rather than twenty? He sees the fates of his patients reflected in his own decisions and is forced to ask himself what it is that makes life meaningful.

Paul does not want the rest of his life to be spent avoiding his sadness; he wants to work within his limitations, while finding what provides his life with the most meaning. Thus, he and Lucy decide to have a child.

A brief period of wellness sends him back to working in the OR, but it is not long before he receives a CT scan portraying the growth of the cancer. He begins chemotherapy–the second treatment plan–the following week. This is when his treatment’s severe side effects begin. He is no longer able to see recovery on the horizon and continues recalibrating how he envisions the rest of his life.

Because of this, his relationship with literature deepens, and he decides to prioritize his writing over his need to remain a neurosurgeon. Had he forty years left, he’d have split the time equally between medicine and writing.

Paul is rushed to the ER at almost the exact time of his daughter Cady’s birth. He makes it to Lucy’s side in time, however, lying in a cot next to her in her hospital room. The following eight months are filled with the excitement of the new baby, and Paul experiences his profoundest moments of joy. If there is one thing that he wants his daughter to know, it is that she has made him happier than he’s ever been in his life.

His health, however, is completely deteriorating, and eight months after Cady is born, Paul passes away. Lucy writes the Epilogue of the book, reflecting on the family’s final months with Paul. At the book’s close, she recounts how his family and friends decided to celebrate his life, how Paul worked relentlessly on the book through the most grueling stages of cancer, and how he hoped this book would reach and help others.