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"For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living? At the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both. Advance praise for When Breath Becomes Air "Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi's memoir is proof that the dying are the ones who have the most to teach us about life."--Atul Gawande "Thanks to When Breath Becomes Air, those of us who never met Paul Kalanithi will both mourn his death and benefit from his life. This is one of a handful of books I consider to be a universal donor--I would recommend it to anyone, everyone."--Ann Patchett"--
"At the age of 36, on the verge of a completing a decade's worth of training as a neurosurgeon, Paul Kalanithi's health began to falter. He started losing weight and was wracked by waves of excruciating back pain. A CT scan confirmed what Paul, deep down, had suspected: he had stage four lung cancer, widely disseminated. One day, he was a doctor making a living treating the dying, and the next, he was a patient struggling to live. Just like that, the future he and his wife had imagined, the culmination of decades of striving, evaporated. With incredible literary quality, philosophical acuity, and medical authority, When Breath Becomes Air approaches the questions raised by facing mortality from the dual perspective of the neurosurgeon who spent a decade meeting patients in the twilight between life and death, and the terminally ill patient who suddenly found himself living in that liminality. At the base of Paul's inquiry are essential questions, such as: What makes life worth living in the face of death? What happens when the future, instead of being a ladder toward the goals of life, flattens out into a perpetual present? When faced with a terminal diagnosis, what does it mean to have a child, to nuture a new life as another one fades away? As Paul wrote, "Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnosis, I knew that someday I would die, but I didn't know when. But now I knew it acutely. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live." Paul Kalanithi passed away in March 2015, while working on this book"--
On the verge of completing a decade's worth of training as a neurosurgeon, Kalanithi was diagnosed with stage IV lung cancer. Just like that, the future he and his wife had imagined evaporated. Kalanithi chronicles his transformation from a naïve medical student into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.… (more)
This was a very moving account of Paul's life in the face of his death from cancer.
As I'm staring the field of medicine in the face as a hopeful future medical student, I found Paul's reflections on his medical career to be insightful. I was not encouraged by his accounts of life as a resident in neurosurgery, but medicine was to him a calling, not a job. I think that it's significant how important he saw the practice to be as a means of gaining insight into what it means to be alive.
I enjoy thinking of this book, and its being incomplete, as an artifact of Paul's life. Ultimately, there is more to be said about his experience and what he has learned from his unique lens as a neurosurgeon and a student of literature, but the essence of his experience is captured here nonetheless. I was so moved by the importance of the decision to have a daughter and how much she meant to Paul. To me, this shed light on the value of children and the connection we share with them, which is sometimes taken for granted.
The final theme of the book, that Paul found satisfaction despite being removed from the career that he had spent his whole life building towards, resonated with me. What mattered was the life that Paul had been able to live, and how he shared that with others. ( )
Gripping: excellent shifting between past and present, balancing the pain and challenge of imminent early death with a passion for life, love, and a vocation dedicated to healing. ( )
This was a sad read. Recollections and thoughts of an ailing man as he faces death. Paul Kalanithi was a brilliant doctor and scholar and in these pages he writes about his childhood, his search for answers, understanding and Truth, his family and friends, his practice and patients and his cancer diagnosis.
For a book written in such a terrible crisis there is a surprising calmness to it. There is a sense of urgency that can be felt, especially towards the end, which one can understand but still very moving and quietly told. ( )
“When Breath Becomes Air” is gripping from the start. But it becomes even more so as Dr. Kalanithi tries to reinvent himself in various ways with no idea what will happen.
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, learning to die — so well. 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.
You that seek what life is in death, Now find it air that once was breath. New names unknown, old names gone: Till time end bodies, but souls none. Reader! then make time, while you be, But steps to your eternity.
— Baron Brooke Fulke Greville, “Caelica 83”
Dedication
For Cady
First words
I knew with certainty that I would never be a doctor. — Part One
I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumours, the spine deformed, a full lobe of the liver obliterated. — Prologue
Quotations
I knew with certainty that I would never be a doctor. I stretched out in the sun, relaxing on a desert plateau just above our house. My uncle, a doctor, like so many of my relatives, had asked me earlier that day what I planned on doing for a career, now that I was heading off to college, and the question barely registered. If you had forced me to answer, I suppose I would have said a writer, but frankly, thoughts of any career at this point seemed absurd. I was leaving this small Arizona town in a few weeks, and I felt less like someone preparing to climb a career ladder than a buzzing electron about to achieve escape velocity, flinging out into a strange and sparkling universe.
Though we had free will, we were also biological organisms -- the brain was an organ, subject to all the laws of physics, too! Literature provided a rich account of human meaning; the brain, the, was the machinery that somehow enabled it. It seemed like magic.
Literature provided, I believed, the richest material for moral reflection.
Moral speculation was puny compared moral action.
I had come to see language as an almost supernatural force, existing between people, bringing our brains, shielded in centimeter-thick skulls, into communion.
In anatomy lab, we objectified the dead, literally reducing them to organs, tissues, nerves, muscles. On that first day, you simply could not deny the humanity of the corpse. But by the time you'd skinned the limbs, sliced through inconvenient muscles, pulled out the lung, cut open the heart, and removed a lobe of the liver, it was hard to recognize this pile of tissue as human. Anatomy lab, in the end, becomes less a violation of the sacred and more something that interferes with happy hour, and that realization discomfits. In our rare reflective moments, we were all silently apologizing to our cadavers, not because we sensed the transgression but because we did not.
It was not a simple evil, however. All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escoret them into the world, and then back out. Seeing the body as matter and mechanism is th eflip side to easing the most profound human suffering. By the same token, the most profound human suffering becomes a mere pedagogical tool.
Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: neurosurgery, ICU medicine, neurology, radiology. Not only would I have to train my mind and hands, I realized; I'd have to train my eyes, and perhaps other organs as well. The idea was overwhelming and intoxicating; perhaps I, too, could join the ranks of these polymaths who strode into the densest thicket of emotional, scientific, and spiritual problems and found, or carved, ways out.
I wondered if, in my brief time as a physician, I had made more moral slides than strides.
I feared I was on the way to becoming Tolstoy's stereotype of a doctor, preoccupied with empty formalism, focused on rote treatment of disease -- and utterly missing the larger human significance.
As a resident, my highest ideal was not saving lives -- everyone dies eventually -- but guiding a patient or family to an understanding of death or illness.
Any major illness transforms a patient's -- really, an entire family's -- life.
The root of disaster means a star coming apart, and no image expresses better the look in a patient's eyes when hearing a neurosurgeon's diagnosis.
A tureen of tragedy was best alloted by the spoonful.
Second, it is important to be accurate, but you must always leave some room for hope . . . I came to believe that it is irresponsible to be more precise than accurate. Those apocryphal doctors who gave specific numbers ("The doctor told me I had six months to live"): Who were they, I wondered, and who taught them statistics.
Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.
Being with these patients in these moments certainly had its emotional cost, but it also had its rewards. I don't think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life -- and not merely life but an another's identity; it is perhaps not too much to say another's soul -- was obvious in its sacredness.
Before operating on a patient's brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burderns are what make medicine holy and wholly impossible: in taking up another's cross, one must sometimes get crushed by the weight.
Perhaps unique in medicine, the ethos of neurosurgery -- of excellence in all things -- maintains that excellence in neurosurgery alone is not enough. In order to carry the field, neurosurgeons must venture forth and excel in other fields as well.
Certain brain areas are considered near--inviolable, like the primary motor cortex, damage to which results in paralysis of affected body parts. But the most sacrosanct regions of the cortex are those that control language . . . What kind of life exists withouth language?
I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnosis, I knew that someday I would die, but I didn't know when. But now I knew it acutely. The problem wasn't a scientific one. The fact of death is unsettling. Yet there is no other way to live.
It occurred to me that my relationship with statistics changed as soon as I became one.
What patients seek is not scientific knowledge that doctors hide but existential authenticity each person must find on her own. Getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing morality has no remedy in probability.
I had passed from the subject to the direct object of every sentence of my life.
"Will having a newborn distract from the time we have together?" she asked. "Don't you think saying goodbye to your child will make your death more painful?" "Wouldn't it be great if it did?" I said. Lucy and I both felt that life wasn't about avoiding suffering. Years ago, it had occurred to me that Darwin and Nietzshe agreed on one thing: the defining characteristic of the organism is striving. Describing life otherwise was like painting a tiger without stripes. After so many years of living with death, I'd come to understand that the easiest death wasn't necessarily the best. We talked it over. Our families gave their blessing. We decided to have a child. We would carry on living, instead of dying.
I was searching for a vocabulary with which to make sense of death, to find a way to begin defining myself and inching forward again. The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language. Hemingway described his process in similar terms: acquiring rich experiences, then retreating to cogitate and write about them. I needed words to go forward. And so it was literature that brought me back to life during this time.
Even working on the dead, with their faces covered, their names a mystery, you fund that their humanity pops up at you—in opening my cadaver’s stomach, I found two indigested morphine pills, meaning that he had died in pain, perhaps alone and fumbling with the cap of a pill bottle.
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 dyung, until I actually die, I am still living.
I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.
Last words
There is perhaps only one thing to say to this infant, who is all future, overlapping briefly with me, whose life, barring the improbable, is all but past. That message is simple: When you come to one of the many moments in life where you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man's days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more but rests, satisfied. In this time, right now, that is an enormous thing.
"For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living? At the age of thirty-six, on the verge of completing a decade's worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi's transformation from a naïve medical student "possessed," as he wrote, "by the question of what, given that all organisms die, makes a virtuous and meaningful life" into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything," he wrote. "Seven words from Samuel Beckett began to repeat in my head: 'I can't go on. I'll go on.'" When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both. Advance praise for When Breath Becomes Air "Rattling, heartbreaking, and ultimately beautiful, the too-young Dr. Kalanithi's memoir is proof that the dying are the ones who have the most to teach us about life."--Atul Gawande "Thanks to When Breath Becomes Air, those of us who never met Paul Kalanithi will both mourn his death and benefit from his life. This is one of a handful of books I consider to be a universal donor--I would recommend it to anyone, everyone."--Ann Patchett"--
"At the age of 36, on the verge of a completing a decade's worth of training as a neurosurgeon, Paul Kalanithi's health began to falter. He started losing weight and was wracked by waves of excruciating back pain. A CT scan confirmed what Paul, deep down, had suspected: he had stage four lung cancer, widely disseminated. One day, he was a doctor making a living treating the dying, and the next, he was a patient struggling to live. Just like that, the future he and his wife had imagined, the culmination of decades of striving, evaporated. With incredible literary quality, philosophical acuity, and medical authority, When Breath Becomes Air approaches the questions raised by facing mortality from the dual perspective of the neurosurgeon who spent a decade meeting patients in the twilight between life and death, and the terminally ill patient who suddenly found himself living in that liminality. At the base of Paul's inquiry are essential questions, such as: What makes life worth living in the face of death? What happens when the future, instead of being a ladder toward the goals of life, flattens out into a perpetual present? When faced with a terminal diagnosis, what does it mean to have a child, to nuture a new life as another one fades away? As Paul wrote, "Before my cancer was diagnosed, I knew that someday I would die, but I didn't know when. After the diagnosis, I knew that someday I would die, but I didn't know when. But now I knew it acutely. The problem wasn't really a scientific one. The fact of death is unsettling. Yet there is no other way to live." Paul Kalanithi passed away in March 2015, while working on this book"--
On the verge of completing a decade's worth of training as a neurosurgeon, Kalanithi was diagnosed with stage IV lung cancer. Just like that, the future he and his wife had imagined evaporated. Kalanithi chronicles his transformation from a naïve medical student into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.
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5
As I'm staring the field of medicine in the face as a hopeful future medical student, I found Paul's reflections on his medical career to be insightful. I was not encouraged by his accounts of life as a resident in neurosurgery, but medicine was to him a calling, not a job. I think that it's significant how important he saw the practice to be as a means of gaining insight into what it means to be alive.
I enjoy thinking of this book, and its being incomplete, as an artifact of Paul's life. Ultimately, there is more to be said about his experience and what he has learned from his unique lens as a neurosurgeon and a student of literature, but the essence of his experience is captured here nonetheless. I was so moved by the importance of the decision to have a daughter and how much she meant to Paul. To me, this shed light on the value of children and the connection we share with them, which is sometimes taken for granted.
The final theme of the book, that Paul found satisfaction despite being removed from the career that he had spent his whole life building towards, resonated with me. What mattered was the life that Paul had been able to live, and how he shared that with others. (