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When Breath Becomes Air By Paul Kalanithi Book Review

“The fact of death is unsettling. Yet there is no other way to live.”

-Paul Kalanithi

When Breath Becomes Air is an autobiography written by Paul Kalanithi. He tells the story of how he was diagnosed with and then faced terminal cancer. This book is moving and powerful. In it, Kalanithi explores the themes of friendship, family, loss and the meaning of life. It is more than a tear-jerker in that it is truly heart-wrenching from the forward to the ending, which was written by his wife after his passing. The author was a good and decent man, a medical doctor training as a neurosurgeon when he received the diagnosis of Stage IV lung cancer. He’d received his education at Stanford, Cambridge, and Yale. Through the memoir, he shared the tumultuous journey through his disease and impending death with this painful, honest, passionate, and inspiring story.

Paul Kalanithi was just 36 years old and a young healthy man in the prime of his life, married and in his sixth year of training as a neurosurgeon, when he is diagnosed with Stage IV lung cancer. He’d never smoked. He was a smart and healthy man, yet he was suddenly struck with agonizing back pain and profound weight loss. He and his physician wife suspect cancer when they visited a doctor and a full-body CT scan confirmed this death sentence. At that moment when their darkest fears are confirmed, he writes, “The future I had imagined, the one just about to be realized, the culmination of decades of striving, evaporated.” When he described this, he made it clear that cancer had not only stolen his future but also his identity. After he was diagnosed, Paul started to write about his experiences. He tackled and grappled with what it is to meet death head-on, to cope with the loss of any future while still treasuring and honoring the life that remains. He found comfort in writing to process this experience and in reading poetry such as this:

“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.”-Caelica 83.

In the first half of the book, Dr. Kalanithi provided anecdotes about how he went from medical resident to doctor to neurosurgeon by describing a series of firsts: the first cadaver in medical school, first births, and first deaths he witnesses, some on the same day. From the start, even though he was a workaholic, he understood the needs of his patients better than most young doctors do.

Paul loved to write, and prior to medical school and in his earlier life, he pictured himself becoming a writer. So writing came easily to him and was how he coped with and came to terms with the enormity of his situation. Words brought him comfort, and he hoped that after his death, it might bring comfort to others facing their own mortality. In interviews and in the book itself, he mused about the appropriate conjugation of to be. He struggled with trying to find the right verb tense to describe his situation. “He had been a doctor, he is a doctor, he was going to be a neurosurgeon, and if he survived, he would be again, a practicing surgeon.” He anguished over the correct verbiage to describe his situation. He also pondered time, the passage of time being different for him as a dying man than it is for his infant daughter and for others around him not facing certain death. He thinks about these things, and talks about them, but remains uncertain. He had worked incredibly hard to pursue his dreams and as soon as it was about to happen, he had it ripped from his fingertips. However, being diagnosed led him back to his original dream to be a writer. In the process of coming full-circle, his book became a dying wish to leave behind a remembrance for his baby daughter and has become an invaluable aid to the dying and those that love them, and an enduring testament to bravery, courage, tenacity, and love.

Part of this book’s tremendous impact comes from the obvious fact that its author was such a brilliant person. And part comes from the way he conveys what happened to him. He passionately wrote, surrounded by his family, while waiting to die and learning to live at the same time. None of it is maudlin. Nothing is exaggerated or overdone. It is simply perfect in every way. I feel privileged to have read it.


“Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still, it is never complete.” -Paul Kalanithi


© 2021 Paola Iannetta

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