[Paul Kalanithi] When Breath Becomes Air - Hardcover

This is a hard but necessary book I believe, written for all of us. It is such a profound and beautiful testimony to living well and dying in a way that absolutely changed my perceptions of so much! One of the best books I’ve read. Paul and his wife are pilgrims and prophets. I will keep their story in my heart!

<WHEN BREATH BECOMES AIR>_PAUL KALANITHI Name : Paul Kalanithi Gender : male Age : 35 Occupation : neurosurgeon and neuroscientist Additional notes : great lover of literature, deep thinker, good person Symptoms : unexplained weight loss and new-onset back pain He was diagnosed with lung cancer and died of it. His devotion didn't falter, hitting arduous and wrenching bumps on the road. ==================== This book, a culmination of his love for literature, shows the inextricability of life and death. It is a cogent and powerful tale of living with death. It epitomizes the life of a man who faced death with integrity and genuinely struggled for existential answers to the question "what makes human life meaningful and worth living". It is of great strength. I read it twice. Such a rare thing for me, part of whom always yields to the rest craving for exploring a next book. So sorry for thinking of him leaving behind great contributions he, as a neurosurgeon and neuroscientist, would have made if he had lived, I could hardly let go of him and this book, proceeding to a new one the next. Even though I was extremely impressed on first reading and I thought I grasped what he meant to say through his book, I just wanted to spend more time with it. I chose to hear his voice again, like voiceover to be heard in a tv documentary, stifling the itch to write my review about it. I opened the first page for second reading. Knowing the whole story, my throat was choked up from the first sentence. With my heart breaking, I read it through. Sometimes I stopped at unlikely points which I went past on first reading, my eyes blurring with tears, aware of how Paul and Lucy felt and the way they coped when they've been through what came up to them. ==================== Saying "I'm sorry" is not an option for some professionals like neurosurgeons. TECHNICAL EXCELLENCE IS A MORAL REQUIREMENT. GOOD INTENTIONS ARE NOT ENOUGH(Paul Kalanithi). As if one letter makes difference in court, one or two millimeters would make the difference between tragedy and triumph in the OR. Paul was perfect for that part. Even though his fully-guaranteed future spreading down the road gave way to the death, the years of ministering to terminally ill patients and their families would bear fruit. Lucy, Paul's wife, in the picture, gives a bright and unwavering smile, holding their baby girl unsuspectingly grinning, snuggling up to him who has only several weeks left until his deathbed. She deserves to be loved by such a good man like Paul. In it, she doesn't give off any fear of his imminent death and impending burdens to be shouldered. ==================== I know them only in my capacity as a reader. But it never keeps me from missing and loving them. Like Atul Gawande's endorsement saying(BEING MORTAL is his book and I read it), the dying are the ones who have the most to teach us about life. Paul's love for what he'd been pursuing during his short-lived life, remains exquisitely beautiful here in this book and touching the hearts of readers.

As an attending surgeon myself who specializes in treatment of tumors and those with cancer I remember reading Paul's initial opinion piece in The New York Times at the time of his diagnosis. I found it very insightful and thought provoking. As a result I was saddened to hear of his death last spring and was eager to read this book. Once finished with the book, I thought there were two separate components of it, one which was remarkable and one which I found disappointing. Paul's descriptions of being a young person diagnosed with cancer and the associated turmoil were very candid, deep, and lasting. I think there is much to learn here for any person, especially those with terminal illnesses. The struggle of how to live for today, when there may not be a tomorrow is something many of my patients struggle with. Paul's ability to write about and come to terms with that concept is enlightening. However, I found Paul's description of his life as a surgeon to be misleading and immature. Paul unfortunately only made it through residency, he was never able to practice. Therefore, much of his writing takes on the false bravado and confidence that most residents are prone to. In one story he talks about how he tried to save the attending from making a mistake but had to watch him mess up Paul's beautifully performed procedure. And other tales of how fast and slick he was at operating made me cringe. In this aspect, Paul's credentials for writing about life as a surgeon are as limited as mine about living with terminal illness. The reality is that being a resident is like sitting on your father's lap as a child when he was driving the car and being convinced you are the one driving. Only when one becomes an attending surgeon do they learn the stress that comes with being the person making the actual life and death decisions and accepting the guilt and responsibility when those decisions go wrong. While Paul may have one day become the great neurosurgeon he thought he was, I would like to think if he would have written this book 10 years into practice it would have been much better and deeper. Unfortunately for us all, we will never know.

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.

We live in a society that esteems the young, beautiful and vibrant above all things. We live in a society that thinks it is invincible and that we will live forever. Doctors are Gods who bring us miracles every day and the advances that they lead are truly astounding. We turn away from death embarrassed, scared, and nervous. When the doctors fail us we sue them. We want them to do everything they can to save us without any examination of what that means. This book is so beautiful and profound because Paul Kalanithi and his wife Lucy stand tall in the face of illness and death and just talk about it. This book is refreshing for its honesty and especially for Paul's refusal to give in to platitudes like, "We are going to beat it!" "We will win!" I understand why people choose that approach, but I think Paul's book and the way he lived his life after his diagnosis shows what a disservice that can be to living the life you have been handed. This is best exemplified in the exchange between Lucy and Paul about whether or not to have a child: ""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." That's not to say that Paul did not fight his cancer. He did. He desperately wanted to live. But as he said "...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 dying, until I actually die, I am still living." I also liked this book for the lessons that physicians can learn from how they talk about treatment and death. I have been blessed to have dealt with some fantastic health care providers in recent years. The doctors and nurses who cared for my father when he was dying last year were fantastic, especially his oncologist. But there were some doctors and nurses who still seemed to side-step the conversation. I know they do not want to be wrong and that there is always hope, but there were so many euphemisms. Instead of telling us that he was in fact dying, there was a lot of talk about labs, and phrases like, "He is a very sick man." When I pressed they agreed wholeheartedly that my brother should come now. But no one said "death." No one said "dying." Paul's desire to understand human relationality and death lead him to medicine. He is honest that he was seeking a kind of transcendence there. But he comes to learn that, "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." And that, "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." I could share quote after quote here, but that understanding and transcendence is the meat of this book. Go read it! This book was sad because Paul was so talented and he left behind so much. He was a brilliant and thoughtful doctor. He was also an incredible writer. As I read his book, I was fascinated by his time as a neurosurgeon, but I was equally sad that he would not be writing any more. I wished he had chosen a writing career so that we would have more of his words to read. A writer that can use the word "pluperfect" so well to make his point and to capture his struggle with tense is wonderful. This is another example of his talent: "At moments, the weight of it became palpable. It was in the air, the stress and misery. Normally, you breathed it in, without noticing it. But some days, like a humid muggy day, it had a suffocating weight of its own. Some days, this is how it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down." The book was also sad because it was so clearly not finished. It felt like the solid beginning of a book and as I neared the end I was a little let down. But Lucy Kalanithi's Epilogue saved it for me. Lucy is a talented writer in her own right. Lucy's Epilogue gave the book the balance and the ending that it needed. Lucy writes, "Although these last few years have been wrenching and difficult - sometimes almost impossible - they have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love." Lucy signs off her epilogue, "I was his wife and a witness." I loved this book for allowing me to witness Paul's journey. I was honoured to witness his death from afar. I hope this book reminds us all what an honour it is to witness life, and death in particular, and to embrace that more.

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

An absolutely amazing book to read. I initially didn't want to read this book because I knew it would be sad. But then my dad was diagnosed with cancer and he would pass ten days later. The suddenness of it along with the hard reality of everything made me decide it was time to finally read this book, and I'm glad I did. The author's perspective on life and death is very refreshing and amazing to read. Dr Kalanithi was truly an inspiration that can revive some hope in humanity. I thought I would be sad for him, but I was more sad for everyone who lost him. He never talks about himself as being this or that, but just reading his words tell you so much about him and how he looked at life and death. The writing is very poetic, and visual. I would recommend this book to anyone and everyone and I'm thankful the Paul Kalanithi shared his story with us.

I was speaking with someone who had also read Theo of Golden and he said, "if you like that book, you'll love When breath becomes air". He was right! Both books zoom in on something that is becoming more and more scarce even since this book was published and that is what it means to be seen by others. The author is such a good writer and he is able to provide a description of the struggles that he endured as a surgeon as well as the struggles that he had to encounter in his patients. His eloquence and honesty really depicted a sense that I have never experienced before and it's quite remarkable when a book can resonate on that sort of level. It has certainly changed how I view all aspects of treatment and being treated and this book is a great legacy for the author and his family. It is sad that it is too short, but it's great to see that it has helped to touch the lives of many including myself. A great read for everyone!

A really good read.

Um livro que traz lágrimas nos olhos… sensível e verdadeiro. Impossível não se emocionar e nos fazer pensar na finitude da vida.

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.

When Breath Becomes Air is not just a memoir—it's a mirror to how high-achieving, ambitious professionals cope with mortality. Paul Kalanithi was brilliant and successful, but also deeply driven—maybe even obsessed—with work and productivity. Even after being diagnosed with terminal cancer, he found solace not in rest or reflection, but in returning to the operating room and chasing routine. That was his coping mechanism—his form of dopamine. What stood out to me was how little focus was given to health basics—no deep mention of sleep, food, or exercise, except a brief line about enjoying running. Instead, Paul seemed to rely on sheer willpower and purpose to keep going. It makes you think: was the chronic stress and 100-hour workweeks a contributor to his illness? It’s a tough but relevant question for our times. His wife’s chapter confirms how relentlessly he kept working till the very end. He wasn’t money-minded per se, but he needed to keep moving, keep achieving—it was his identity. That kind of internal pressure is admirable, yet concerning. Many educated professionals today, like Paul, plan their lives—right down to the timing of having children—but faith or surrender rarely feature. Between the lines, the book teaches powerful "dos and don’ts" of life, stress, and balance. It’s an emotional read, full of honesty, but also a reminder of the cost of relentless ambition. Highly recommended—but it’s not just a book to read. It’s one to reflect on.