When Breath Becomes Air: Pulitzer Prize Finalist

This brief memoir is interposed between a foreword by Abraham Verghese, the brilliant author of “Cutting for Stone” and an epilogue by author’s wife, Lucy Kalanithi. It is a beautifully, heartrending, deeply philosophical piece by an accomplished young man who dedicated heart and mind to his work and study in neurosurgery. He discovers that he has terminal lung cancer at the age of 36, just before completing his grueling neurosurgical residency and embarking on the career he has worked so hard to attain. The book is very thoughtful and reflective in nature, especially upon the meaning of life. It made me wonder if the author was truly always so interested in finding the meaning of life, or if only when told of this terminal diagnosis, that reflection back on his life made this search so apparent. As one nears death, what is most important, becomes glaringly more obvious, and Paul Kalanithi describes this so well. Abraham Verghese speaks in the foreword of how he had met Paul in person several times before his death, but it was not until he read his book that he felt he really knew him. I too, felt like I got to know Paul through this book. He is very open and honest about himself, his sickness, his relationships, and struggles and triumphs throughout the process of dealing with cancer. I find it interesting that Paul did not always think he wanted to be a physician, but rather thought he might be a writer. He may not have realized his full potential as neurosurgeon and professor, but he surely achieved his goal to be a writer. He has left behind a beautiful book that will be read for many years to come. It will be of great interest to those with life-threatening disease, their family members, and really everyone, because we will all be in those shoes at some point. He has also left behind a wonderful gift of himself to his daughter. She will not remember her time with him, but she will be able to know him through this book and well as through the memories that I’m sure his close relations will share with her. Aside from writing and even delving back into neurosurgery residency at one point, he spent the last years of his life following his diagnosis, building closer bonds with his family, and the love there was overflowing. Aside from being an important read for anyone facing a life-threatening illness themselves or loving someone who is, I think it is a very important read for all medical professionals. It puts a face behind a patient, who is clearly able to articulate the thoughts and feelings of being a patient in our medical system. It emphasizes and highlights the importance of the physician-patient relationship. I gave this book 5 stars for it’s thought provoking, beautiful prose, as well as for writing it’s way through a death with utmost dignity. He strengthens his belief systems, forges stronger relationships with family and loved ones, and finds greater meaning in life once he is given this terminal diagnosis. For discussion questions, please visit book-chatter.com

This book is a must-read. Wonderfully written, the story unfolds when a renowned surgeon receives a diagnosis of cancer. It is a book so honest, the grief will take your breath away. It is also so honest that your heart will soar at the beauty of life. Paul Kalanithi had much he wanted to accomplish in his work life, but even more with his wife and new baby. Dr. Kalanithi's wife, Lucy, who completed Paul's work, is my hero. She wears her grief well and has survived. A blessing. Read this book. It teaches us how to live.

I re-read this book after having read it some years ago. It was a good book then, but it meant so much more this time. A little over two years ago I was diagnosed with cancer. Although I have no evidence of disease now, Paul’s story takes on a deeper meaning than it did the first time I read it. I recognize the feelings and thoughts from being diagnosed to going through treatments. It was also helpful to read what his wife experienced, because although my husband spoke to me of his feelings, there are some thoughts he never voiced.

4.5 stars At age 36, in the last year of his neurosurgery residency, Paul Kalanithi discovered he had stage IV lung cancer. For the next 22 months, he and his wife Lucy, an internal medicine physician, awoke each day focused on living, not “living until...” When Breath Becomes Air was written largely because Dr. Kalanithi had the soul of a poet and turning to words to express any experience in life was as instinctive to him as breathing itself. His intent was that his story could aid in the healing of others and that one day his own daughter would read it and get a sense of the father she would never remember. The book’s format, like the author’s writing style, is simple, straightforward, eloquent, and unflinchingly honest – Prologue, Part I and Part II. In the prologue, Paul describes the first step in his diagnosis, getting x-rays for his recurring severe chest pain. It was 15 months prior to the end of his residency. He could see the light at the end of the long 10-year tunnel of preparation for his work in neurosurgery. There would be wonderful opportunities to practice as well as conduct research, offer of a professorship, a huge increase in income, a new home and starting a family with Lucy. The x-rays were fine, he was told. But he had lost weight and the pain was not letting up in severity. He began researching incidence of cancer in his age group. Things with Lucy were strained at that time, partly because he was not sharing his concerns about his condition. She decided against going with him on a vacation with old friends in order to sort out her own feelings about their relationship. He came home in severe pain after just a couple of days. She picked him up from the airport. After he told her about his symptoms and his self-diagnosis, she took him to the hospital that night where a neurosurgeon friend admitted him. Most of Part 1, In Perfect Health I Begin, describes life prior to the diagnosis, obviously back to his childhood. Both of his parents were immigrants from India, his father a Christian and his mother Hindu. Both families disowned them for many years. They moved their own family of three sons from Bronxville, New York to Kingman so Paul’s father could establish a cardiology practice, which he did very successfully. Paul’s mother had been trained as a physiologist in India before eloping with Paul’s father when she was 23. Her own father had defied the traditions of 1960s rural India and insisted that his daughter be educated and trained for a profession. She was horrified to discover that Kingman’s school district was among the lowest performing in the entire country. Her eldest son had been educated in Westchester County, New York schools, where graduates were assured of admission to the nation’s most prestigious universities. He had been accepted at Stanford before the move to Kingman. What would happen to 10-year-old Paul and his 6-year-old brother Jeevan? Instead of wringing her hands, Mrs. Kalanithi threw herself into supplementing her sons’ educations and improving that of all the children in the area. She gave Paul a reading list intended for college prep students and at age ten he read 1984, followed by many other modern and traditional classics. He discovered a love for words as an expression of the human spirit. His mom got elected to the school board and worked with teachers and others to transform the school district. After a few years their 30+% dropout rate was greatly reduced and graduates were getting accepted at universities of their choice. No doubt Paul was born with that poetic soul, but it was his mother’s guidance that led him to read the literary giants who nourished that soul. It was his parents’ examples of excellence in their own lives, their faith, and service to their community, in this strange land that they made their own, that formed Paul’s desire and need to serve. In When Breath Becomes Air, he writes of vocation, a term you rarely hear people use these days. A thousand years ago when I was growing up, vocation was ubiquitous. We were told time and again that discerning our vocation was one of our prime responsibilities as human beings. It was our reason for being here, what we were called to do in service to humankind. Teaching, medicine, religious ministry, musicianship, military, etc. By knowing our natural talents we could know our vocation. Paul had many talents and interests, complicating his vocation decision. He studied both English literature and human biology in college. “I still felt literature provided the best account of the life of the mind, while neuroscience laid down the most elegant rules of the brain.” Also a man of deep spirituality, Paul reflected, “Literature not only illuminated another’s experience, it provided, I believed, the richest material for moral reflection. My brief forays into the formal ethics of analytic philosophy felt dry as a bone, missing the messiness and weight of real human life.” The intersection of science and morality was of prime interest to Paul. The rest of Part I describes how Paul came to see medicine and then neurosurgery as his vocation. He forthrightly deals with the idealism of medical students and residents and how that idealism is dimmed or completely snuffed out by the realities of giving medical care to other human beings. His explanation of cadaver dissection and why physicians and their families do not donate their own bodies to medical science is eye opening. “Cadaver dissection epitomizes, for many, the transformation of the somber, respectful student into the callous, arrogant doctor.” This is the kind of honesty displayed throughout the entire book. He writes of his own loss of idealism and how the recognition of that affected his own self-image as well as his job performance. “I wondered if, in my brief time as a physician, I had made more moral slides than strides.” That earlier mentioned phrase, “the messiness and weight of real human life” describes this book. The author has given the world not a mere recollection of events or achievements, but has laid bare his soul, exposing the very marrow of his being. This book should be read by every premed student in the world before they commit to a decade or more of study and relentless hard work. In Part II , Cease Not till Death, the author details the diagnosis, the immediate aftermath, the determination to emphasize living not dying, the quest to conceive a child, and the agony involved in treatment. I think Part II should be experienced by each reader. Most readers will find it extremely compelling and very personal. It is the nitty gritty of this man’s inner being. Lucy, his wife, wrote an eloquent epilogue further detailing Paul’s experience while writing this book, the support they received from colleagues, friends, family, and others after his death on March 9, 2015. I found this book soul wrenching, but also witty, uplifting and hopeful. Without preaching, he reveals some deep flaws in the way we do health care and the price that not just patients but the care providers sometimes pay. In our war with cancer, it won a battle here by taking this remarkable man so early. He would have touched hundreds of students and thousands of patients with the professorship that would have been his. But When Breath Becomes Air is sure to touch millions of us. Cady Kalanithi will one day be able to read for herself just who her father really was. Rating: 4.50/5.0.

A really good read.

5\5 Not a fraction less. As I finished this book tears rolled down both my cheeks. Breathing was hard for the last 40 pages, as I struggle to choke back the conflicting emotions I felt in reading Paul's last words and those his wife Lucy would conclude with. On the one hand I felt heartbroken with sorrow for the fate of this man who would strive so hard to help others live or to ease the agony of those who would die. Yet this book was as heart wrenching as it was beautiful. It was as uplifting as it was sad. This book deeply touched me on an emotional and what some would call a spiritual level. While I am not spiritual, I cannot deny the spirit of this man, who lived, loved, triumphed and accepted his fate with courage and strength, even as cancer weakened him physiologically. Paul died very near my own age. I struggle to find meaning in life, especially as I see others die around me every year. I also grapple with my own impending end which could come any moment, future or present. I began to question everything as I've aged. I fear perhaps I have made the wrong choices in life. I question what it is all for. Being an atheist is a blessing and a curse, for it gives life at times a hollow definition. We live to die. Most of us spend the majority of our lives dying, or declining until our last day. This does not have to be a sad thing though. This book has revealed to me that there is another way in which to die. That is, to live... until death. From the bottom of my heart I am thankful to Paul, for this book, and to Lucy for her epilogue, for her kind words which will touch my own spirit, my core being, until the end. It will forever remind me that our fate may not always be what we want it to be but our lives are what we will make of them. We will all die, some sooner, some later. This is a fact. While we live to die this does not mean we cannot also live to live, to live life appreciatively. While I do not share the expansive and loving family Paul did and while I feel at times vastly alone in this world, I have learned the deep lessons of this book. I have no one to truly comfort me in my sorrows as I grind through life. This book, these words, are my comfort. Alone we embrace, this philosophy and I. I am not dying such as Paul was. I am merely dying as life would naturally have it, as we all are, until something decides to speed this natural process up, like a cancer or some other malignance. I merely suffer the physiological strife that comes with working on a farm in rural Nova Scotia. I toil so others may not. Someone must till the soil, grow the food, harvest from life to give life. Though I often feel I should be doing more. My English degree hangs on a wall, a banner of achievement, yet a reminder of failure. I relate to Paul in that, like him, I want to help others. After all, there is no better feeling than having consoled or counselled another. I have often had the dream of using words to ease the pain of suffering. Paul has awakened me to the fallacy of how I see that piece of paper in the negative. Perhaps I will do no more than I have. Some do nothing. Some live and die, forgotten to the winds of time. The important thing is to understand that life is a treasure. It is a thing to be cherished, this consciousness, this awareness, our ability to think and see and question and comprehend. To compel or be compelled is to live. Whether alone or in the company of loved ones, we should hold dear this thing we call life. Find your happiness where you can. Be it within the pages of a book such as this or in the company of others, seek it and embrace it, for a life lived happily is to truly live. Whether short or long, alone or otherwise, we need not despair the eventuality of our end. Smile, my fellows, for were we not alive, we would not know what it is to live. Thank you Paul. Thank you Lucy. You have both, in death, and life, warmed my heart beyond what other words have elsewhere been able.

If one could caress or lovingly stroke the surface of another's heart then this is the writing in this book. Pain and pleasure live side by side with honor and simplicity. A moving account of a great soul which can in its truth pull the air from your lungs.

Not the easiest read but very well worth it. Makes you think about the meaning of life

Libro bien escrito, del principio hasta el final. Sorprendente la última parte ya que toca la fibra y es muy emotivo.