When Breath becomes AIR by Paul Kalanithi – Extraordinary Memoir, Review

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 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 evaporated. When Breath Becomes Air, which features a Foreword by Dr. Abraham Verghese and an Epilogue by Kalanithi’s wife, Lucy, 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 young neurosurgeon at Stanford, guiding patients toward a deeper understanding of death and illness, and finally into a patient and a new father to a baby girl, 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 mortality and on the relationship between doctor and patient, from a gifted writer who became both.

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Author Paul Kalanithi was a neurosurgeon and writer. He grew up in Kingman, Arizona, and graduated from Stanford University with a BA and MA in English literature and a BA in human biology. He earned an MPhil in history and philosophy of science and medicine from the University of Cambridge and graduated cum laude from the Yale School of Medicine, where he was inducted into the Alpha Omega Alpha national medical honor society. He returned to Stanford to complete his residency training in neurological surgery and a postdoctoral fellowship in neuroscience, during which he received the American Academy of Neurological Surgery’s highest award for research. He died in March 2015. He is survived by his large, loving family, including his wife, Lucy, and their daughter, Elizabeth Acadia.

My Review –

When Breath Becomes Air is an extraordinary book. The foreboding title alone leaves you breathless. If you want to read about an amazing person who led a meaningful life and left a legacy behind, read this book.

When Breath Becomes Air is a book to be savored. Each page is meaningful and as the story unfolds, you come to know a rare human being.

A mother came to me, newly diagnosed with brain cancer. She was confused, scared, overcome by uncertainty. I was exhausted, disconnected. I rushed through her questions, assured her that surgery would be a success, and assured myself that there wasn’t enough time to answer her questions fairly. But why didn’t I make the time? A truculent vet refused the advice and coaxing of doctors, nurses, and physical therapists for weeks; as a result, his back wound broke down, just as we had warned him it would. Called out the OR, I stitched the dehiscent wound as he yelped in pain, telling myself he’d had it coming.

Nobody has it coming.

I took meager solace in knowing that William Carlos Williams and Richard Selzer had confessed to doing worse, and I swore to do better. Amid the tragedies and failures, I fear I was losing sight of the singular importance of human relationships, not between patients and their families b ut between doctor and patient. Technical excellence was not enough. 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. When a patient comes in with a fatal head bleed, that first conversation with a neurosurgeon may forever color how the family remembers the death, from a peaceful letting go (‘Maybe it was his time’) to an open sore of regret (‘Those doctors didn’t listen! They didn’t even try to save him!’). When there’s no place for the scalpel, words are the surgeon’s only tool.

The memoir, tells a young man’s, a neurosurgeon, story of coming of age as he makes the transition from being a medical doctor, a robot if you will, to being a doctor of people; one that had the wisdom to learn to connect with the person and not just the patient.

…After surgery, we talked again…By this point, I had learned a couple of basic rules, First, detailed statistics are for research halls, not hospital rooms. The standard statistic, the Kaplan-Meier curve, measure the number of patients surviving over time. It is the metric by which we gauge progress, by which we understand the ferocity of a disease. For glioblastoma, the curve drops sharply until only about 5 percent of patients are alive at two years. Second, it is important to be accurate but always leave some room for hope. Rather than saying, ‘Median survival is eleven months’ or ‘You have a ninety-five percent chance of being dead in two years,’ I’d say, ‘Most patients live many months to a couple of years.’ This was, to me, a more honest description. The problem is that you can’t tell an individual patient where she sits on the curve: will she die in six months or sixty? I came to believe that it is irresponsible to be more precise than you can be 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?

The more I read, (and the more I come in contact with doctors) the more I realized that most doctors I’ve come across appear to be a doctor for the job. How many I wondered, are actually doctors because it is a vocation? I’ve heard diagnosis with time frames and personally, due to a deep faith, have always countered with ‘Everything in God’s time’. As I continued to read, I discovered that this young doctor was a doctor with a heart and in his short life, he made an immeasurable difference in this world.

…Suddenly tears were streaming down my face. Being with 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 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 burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.

With each surgery, with each patient, this young surgeon grew more and more into a human being who realized the importance of the human sitting before him, the human being lying on the gurney, waiting for him to save his life.

…He paused. ‘Paul,’ he said, ‘do you think my life has meaning? Did I make the right choices?’

It was stunning: even someone I considered a moral exemplar had these questions in the face of mortality.

V’s surgery, chemotherapy, and radiation treatments were trying, but a success. He was back at work a year later, just as I was returning to my clinical duties in the hospital. His hair had thinned and whitened, and the spark in his eyes had dulled. During our final weekly chat, he turned to me and said, ‘You know, today is the first day it all seems worth it. I mean, obviously, I would’ve gone through anything for my kids, but today is the first day that all the suffering seems worth it.’

How little do doctors understand the hells through which we put patients.

Through his own words, the author tells us his story of how he not only became a doctor who would see his patients as people but of his own journey as a patient, through the cancer diagnosis and treatments that would ultimately end his life.

This book would make a wonderful Christmas present for anyone on your list who loves to read. When Breath Becomes Air restores your faith in humanity. I am rating the book five stars, although it deserves so much more.

(in surgery) I could see that there were two strategies to cutting the time short, perhaps best exemplified by the tortoise and the hare. The hare moves as fast as possible, hands a blur, instruments clattering, falling to the floor; the skin slips open like a curtain, the skull flap is on the tray before the bone dust settles. As a result, the opening might need to be expanded a centimeter here or there because it’s not optimally placed. The tortoise, on the other hand, proceeds deliberately, with no wasted movements, measuring twice, cutting once. No step of the operation needs revisiting; everything moves in a precise, orderly fashion. If the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins.

I realize that I inserted many more quotes than I normally do. This was a book with many poignant moments. My thoughts were what better way to let the world know just how extraordinary a young man, a surgeon, and a writer, Paul Kalanithi was.

From a technical side, the writing was outstanding, the story flowed and kept me turning page after page. I noticed no grammatical errors.

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Maybe pre-ordered for January 12, 2016 release


My Life. One Story at a Time. is an Amazon advertising affiliate; a small fee may be earned when purchases are made at Amazon through the link above. A free book may have been provided by the source in exchange for an honest review. Views expressed by authors are their own and do not necessarily reflect the views of My Life. One Story at a Time. My opinions are my own. This provided in accordance with the FTC 16 CFR, Part 55. 



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